The prevalence of radiographic hip abnormalities in elite soccer players.

BACKGROUND: Hip injuries, both intra- and extra-articular, are becoming a more commonly recognized, diagnosed, and treated injury in athletes of all competitive levels. Our goal is to establish a previously undefined value in this athletic population--the prevalence of radiographic hip abnormalities in elite soccer athletes. PURPOSE: To provide a foundation for the future body of literature regarding hip pathologic abnormalities and "at-risk" hips in athletes of all ages and levels of participation. STUDY DESIGN: Descriptive epidemiology study. METHODS: We retrospectively reviewed the anteroposterior pelvis and frog-leg lateral radiographs of 95 elite male and female soccer players to determine the prevalence of hip abnormalities. Athletes with a history of hip or groin injuries were included. Multiple radiographic parameters were used to assess the presence of cam and pincer-type femoroacetabular impingement. Measurements were conducted by a blinded, sports medicine fellowship-trained orthopaedic surgeon with experience in treating hip disorders. RESULTS: In total, 72% (54/75) of male and 50% (10/20) of female players demonstrated some evidence of radiographic hip abnormality. Cam lesions were present in 68% (51/75) of men (76.5% [39/51] bilateral involvement) and 50% (10/20) of women (90% [9/10] bilateral involvement). Pincer lesions were present in 26.7% (20/75) of men and 10% (2/20) of women. The average male alpha angle overall was 65.6°. Cam-positive hips averaged 70.7°. The average female alpha angle overall was 52.9°, with cam-positive hips averaging 60.8°. CONCLUSION: The prevalence of radiographic hip abnormalities in elite soccer athletes is considerable, particularly in young male athletes. The establishment of the prevalence of these findings represents the first step in identifying the relationship between radiographic abnormalities and injuries of the hip and groin in athletes.

A randomized controlled trial to prevent noncontact anterior cruciate ligament injury in female collegiate soccer players.

BACKGROUND: Neuromuscular and proprioceptive training programs can decrease noncontact anterior cruciate ligament injuries; however, they may be difficult to implement within an entire team or the community at large. HYPOTHESIS: A simple on-field alternative warm-up program can reduce noncontact ACL injuries. STUDY DESIGN: Randomized controlled trial (clustered); Level of evidence, 1. METHODS: Participating National Collegiate Athletic Association Division I women's soccer teams were assigned randomly to intervention or control groups. Intervention teams were asked to perform the program 3 times per week during the fall 2002 season. All teams reported athletes' participation in games and practices and any knee injuries. Injury rates were calculated based on athlete exposures, expressed as rate per 1000 athlete exposures. A z statistic was used for rate ratio comparisons. RESULTS: Sixty-one teams with 1435 athletes completed the study (852 control athletes; 583 intervention). The overall anterior cruciate ligament injury rate among intervention athletes was 1.7 times less than in control athletes (0.199 vs 0.340; P = .198; 41% decrease). Noncontact anterior cruciate ligament injury rate among intervention athletes was 3.3 times less than in control athletes (0.057 vs 0.189; P = .066; 70% decrease). No anterior cruciate ligament injuries occurred among intervention athletes during practice versus 6 among control athletes (P = .014). Game-related noncontact anterior cruciate ligament injury rates in intervention athletes were reduced by more than half (0.233 vs 0.564; P = .218). Intervention athletes with a history of anterior cruciate ligament injury were significantly less likely to suffer another anterior cruciate ligament injury compared with control athletes with a similar history (P = .046 for noncontact injuries). CONCLUSION: This program, which focuses on neuromuscular control, appears to reduce the risk of anterior cruciate ligament injuries in collegiate female soccer players, especially those with a history of anterior cruciate ligament injury.

Avoiding allograft length mismatch during anterior cruciate ligament reconstruction: patient height as an indicator of appropriate graft length.

BACKGROUND: Given the increasing use of allografts in anterior cruciate ligament reconstruction, selection of appropriate-sized grafts may help individual surgeons as well as the efficiency of the overall system for graft distribution. HYPOTHESIS: Recipient patient height can predict the desired length for the tendinous portion of a patellar bone-tendon-bone allograft in anterior cruciate ligament reconstruction. STUDY DESIGN: Cohort study (Prognosis); Level of evidence, 2. METHODS: A series of 414 knees in 392 consecutive patients undergoing magnetic resonance imaging evaluation of knee pain were enrolled in the study. Data collected from magnetic resonance imaging included patella and patellar tendon length and intraarticular length of the anterior cruciate ligament. Patient age, height, weight, and gender were recorded. Linear regression analysis assessed the correlation between patient height and intraarticular length of the anterior cruciate ligament as well as patellar tendon length. The effect of variance in age, weight, and gender on anterior cruciate ligament intraarticular length was also measured. RESULTS: A strong positive correlation was found between intraarticular length of the anterior cruciate ligament and patient height (Pearson r = 0.73; P < .001). Anterior cruciate ligament length (y, in millimeters) as a function of height (x, in inches) can be expressed as y = 1.17x - 41.29. As a function of height (x, in centimeters), anterior cruciate ligament length (y, in millimeters) can be expressed as y = 0.4606x - 41.29. Age, gender, and weight did not significantly influence this relationship. A weak positive association was found between patient height and patellar tendon length. CONCLUSION: Patient height can predict the desired length of the tendinous portion of a patellar bone-tendon-bone allograft. An addition of 10 mm is made to the predicted anterior cruciate ligament length to allow for aperture tibial and femoral fixation. Patellar bone-tendon-bone allografts can be requested based on recipient patient height as follows: 5 ft, 0 in to 5 ft, 6 in: tendinous length/total length, 45 mm/95 mm; 5 ft, 7 in to 6 ft, 1 in: 50 mm/100 mm; > 6 ft, 1 in: 55 mm/105 mm.

Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up.

BACKGROUND: Among female athletes it has not been established whether a neuromuscular and proprioceptive sports-specific training program will consistently reduce the incidence of anterior cruciate ligament injuries. PURPOSE: To determine whether a neuromuscular and proprioceptive performance program was effective in decreasing the incidence of anterior cruciate ligament injury within a select population of competitive female youth soccer players. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: In 2000, 1041 female subjects from 52 teams received a sports-specific training intervention in a prospective non-randomized trial. The control group consisted of the remaining 1905 female soccer players from 95 teams participating in the same league who were age and skill matched. In the 2001 season, 844 female athletes from 45 teams were enrolled in the study, with 1913 female athletes (from 112 teams) serving as the age- and skill-matched controls. All subjects were female soccer players between the ages of 14 and 18 and participated in either their traditional warm-up or a sports-specific training intervention before athletic activity over a 2-year period. The intervention consisted of education, stretching, strengthening, plyometrics, and sports-specific agility drills designed to replace the traditional warm-up. RESULTS: During the 2000 season, there was an 88% decrease in anterior cruciate ligament injury in the enrolled subjects compared to the control group. In year 2, during the 2001 season, there was a 74% reduction in anterior cruciate ligament tears in the intervention group compared to the age- and skill-matched controls. CONCLUSION: Using a neuromuscular training program may have a direct benefit in decreasing the number of anterior cruciate ligament injuries in female soccer players.