Hip and Pelvis Movement Patterns in Patients With Femoroacetabular Impingement Syndrome Differ From Controls and Change After Hip Arthroscopy During a Step-Down Pivot-Turn Task.

Background: Alterations in hip kinematics during functional tasks occur in positions that cause anterior impingement in patients with femoroacetabular impingement (FAI) syndrome. However, tasks that do not promote motions of symptomatic hip impingement remain understudied. Purpose: To compare movement patterns of the hip and pelvis during a step-down pivot-turn task between patients with FAI and controls as well as in patients with FAI before and after hip arthroscopy. Study Design: Controlled laboratory study. Methods: Three-dimensional motion capture was acquired in 32 patients with FAI and 27 controls during a step-down pivot-turn task. An FAI subsample (n = 14) completed testing 9.2 ± 2.0 months (mean ± SD; range, 5.8-13.1 months) after hip arthroscopy. Statistical parametric mapping analysis was used to analyze hip and pelvis time series waveforms (1) between the FAI and control groups, (2) in the FAI group before versus after hip arthroscopy, and (3) in the FAI group after hip arthroscopy versus the control group. Continuous parametric variables were analyzed by paired t test and nonparametric variables by chi-square test. Results: There were no significant differences in demographics between the FAI and control groups. Before hip arthroscopy, patients with FAI demonstrated reduced hip flexion (P = .041) and external rotation (P = .027), as well as decreased anterior pelvic tilt (P = .049) and forward rotation (P = .043), when compared with controls. After hip arthroscopy, patients demonstrated greater hip flexion (P < .001) and external rotation of the operative hip (P < .001), in addition to increased anterior pelvic tilt (P≤ .036) and pelvic rise (P≤ .049), as compared with preoperative values. Postoperatively, the FAI group demonstrated greater hip flexion (P≤ .047) and lower forward pelvic rotation (P = .003) as compared with the control group. Conclusion: Movement pattern differences between the FAI and control groups during the nonimpingement-related step-down pivot-turn task were characterized by differences in the sagittal and transverse planes of the hip and pelvis. After hip arthroscopy, patients exhibited greater hip flexion and external rotation and increased pelvic anterior tilt and pelvic rise as compared with presurgery. When compared with controls, patients with FAI demonstrated greater hip flexion and lower pelvic forward rotation postoperatively. Clinical Relevance: These findings indicate that hip and pelvis biomechanics are altered even during tasks that do not reproduce the anterior impingement position.

Association of Changes in Hip and Knee Kinematics During a Single-Leg Squat With Changes in Patient-Reported Outcomes at 6 Months and 1 Year After Hip Arthroscopy.

BACKGROUND: Previous studies have demonstrated alterations in squat kinematics in patients with femoroacetabular impingement syndrome (FAIS). Little is known about the effects of arthroscopic hip surgery on biomechanics during a single-leg squat (SLS) in these patients. PURPOSE/HYPOTHESIS: The purpose of this study was to determine if (1) lower extremity dynamic range of motion (ROM) during an SLS task improves after hip arthroscopy for FAIS and (2) correlations exist between changes in patient-reported outcomes (PROs) and changes in lower extremity dynamic ROM during an SLS after hip arthroscopy for FAIS. It was hypothesized that dynamic hip ROM would improve after hip arthroscopy and that hip dynamic ROM would be associated with changes in PRO scores at both 6 months and 1 year. STUDY DESIGN: Descriptive laboratory study. METHODS: Patients with FAIS performed 3 SLSs that were analyzed using a 20-camera motion capture system. Dynamic ROMs were calculated in 3 planes for the hip, knee, ankle, and pelvic segments. Squat depth was calculated as the change in vertical center of mass during the squat cycle. PROs including the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports (HOS-Sports), International Hip Outcome Tool-12, and visual analog scale for pain scores were collected preoperatively and at the time of postoperative testing. Paired-samples t tests were used to compare kinematic variables pre- and postoperatively. Correlations were used to compare changes in PROs with changes in kinematics. All statistical analysis was performed using SPSS Version 26. RESULTS: Fifteen patients were tested preoperatively and at a mean of 9 months postoperatively. All PRO measures improved postoperatively at 6 months and 1 year. Squat depth and sagittal plane hip and knee dynamic ROMs were significantly improved postoperatively. Positive correlations existed between changes in (1) hip ROM with the 6-month HOS-ADL score (r = 0.665) and (2) knee ROM with the 6 month (r = 0.590) and 1-year (r = 0.565) HOS-Sports scores. CONCLUSION: Dynamic sagittal plane hip and knee ROMs improve after hip arthroscopy for FAIS. These improvements demonstrate strong correlations with improvements in some but not all postoperative PROs. CLINICAL RELEVANCE: The current study sought to better understand the role of dynamic movement in the diagnosis and treatment of FAIS. These findings indicate that dynamic ROM and squat depth can, similarly to PROs, serve as biomarkers for patient function both before and after hip arthroscopic surgery.

Spinopelvic Parameters Do Not Influence Outcomes Following Primary Hip Arthroscopy for the Treatment of Femoroacetabular Impingement Syndrome.

Purpose: To evaluate the influence of spinopelvic parameters on short-term postoperative patient-reported outcomes (PROs) following primary hip arthroscopy for the treatment of femoroacetabular impingement syndrome (FAIS). Methods: Patients undergoing primary hip arthroscopy between January 2012 and December 2015 were retrospectively reviewed. Hip Outcome Score - Activities of Daily Living, Hip Outcome Score - Sports-Specific Subscale, modified Harris Hip Score, International Hip Outcome Tool-12, and visual analog scale pain were recorded preoperatively and at final follow-up. Lumbar lordosis (LL), pelvic tilt (PT), sacral slope, and pelvic incidence (PI) were measured on lateral radiographs in standing position. Patients were split into subgroups for individual analyses based on previous literature cutoffs: |PI-LL|> or <10°, PT> or <20°, and PI <40°, 40° < PI < 65°, and PI >65°. PROs and rate of achievement of patient acceptable symptom state (PASS) were compared between subgroups at final follow-up. Results: Sixty-one patients who underwent unilateral hip arthroscopy were included in the analysis, and 66% of patients were female. Mean patient age was 37.6 ± 11.3 years, whereas mean body mass index was 25.0 ± 5.7. Mean follow-up time was 27.6 ± 9.0 months. No significant difference in preoperative nor postoperative PROs were appreciated in patients with spinopelvic mismatch (|PI-LL| >10°) versus those without, whereas patients with mismatch achieved PASS according to the modified Harris Hip Score (P = .037) and International Hip Outcome Tool-12 (P = .030) at greater rates. When we compared patients with a PT ≥20° versus PT <20°, no significant differences in postoperative PROs were present. When we compared patients in the following pelvic incidence groups: PI <40°, 40° < PI <65°, and PI >65°, no significant differences in 2-year PROs or rates of PASS achievement for any PRO were appreciated (P > .05 for all). Conclusions: In this study, spinopelvic parameters and traditional measures of sagittal imbalance did not influence PROs in patients undergoing primary hip arthroscopy for FAIS. Patients with sagittal imbalance (|PI-LL|> 10° or PT >20°) achieved a greater rate of PASS. Level of Evidence: IV; Prognostic case series.

Patients With a High Femoroepiphyseal Roof With Concomitant Borderline Hip Dysplasia and Femoroacetabular Impingement Syndrome Do Not Demonstrate Inferior Outcomes Following Arthroscopic Hip Surgery.

PURPOSE: The purpose of this study was to compare outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) in patients with borderline hip dysplasia and hip instability defined radiographically using the femoroepiphyseal acetabular roof (FEAR) index and in patients without radiographic evidence of hip instability. METHODS: Data from consecutive patients with borderline hip dysplasia (lateral center edge angle between 18˚-25˚) who underwent primary hip arthroscopy between April 2012 and June 2017 for the treatment of FAIS were analyzed. Baseline demographic data, radiographic parameters, preoperative, and 2-year postoperative patient-reported outcome measures were collected. The FEAR index was measured by 3 different observers. Patients with an average FEAR index ≥2˚ were categorized as having radiographic evidence of instability as previously published. The analysis was powered to detect a minimal clinically important difference (MCID) for each outcome score. Statistical analysis was performed as appropriate to compare patients with FEAR index ≥2 and <2°. RESULTS: A total of 140 patients met the inclusion criteria. The average age and body mass index of included patients was 31.7 ± 13.2 (P < .325) years and 25.1 ± 5.6 kg/m2 (P < .862). There were no statistically significant demographic differences between the groups. Nineteen (13.0%) patients were found to have a FEAR index of over 2˚. The FEAR index <2° and FEAR index ≥2° groups had a mean preoperative FEAR index (standard deviation, range) of -7.0 (5.2, -26.8 to 1.9) and 4.8 (2.5, 2.0-11.8), respectively. The interrater intraclass correlation coefficient was 0.96. Postoperative patient-reported outcomes and rates of MCID and patient-acceptable symptomatic state achievement were not statistically different between the radiographically stable and unstable groups. (p>0.05 for all). CONCLUSION: Patients with borderline hip dysplasia and radiographic evidence of hip instability, as measured by the FEAR index (≥2°), achieve similar improvement in 2-year outcomes compared to those with radiographically stable hips after arthroscopic treatment of FAIS. CLINICAL RELEVANCE: Retrospective Level III cohort study.

Iliopsoas Bursitis Managed with Endoscopic Bursectomy and Lesser Trochanter Decompression: A Case Report.

CASE: A 32-year-old woman presented with worsening right anterior hip pain, reduced hip flexion strength, and passive range of motion during hip flexion. Magnetic resonance imaging of the hip demonstrated a prominent lesser trochanter and localized fluid signal intensity at the iliopsoas bursa. The patient underwent endoscopic iliopsoas bursectomy and lesser trochanterplasty, reporting improvement in all clinical outcome scores at 1-year follow-up. CONCLUSION: Lesser trochanter morphology should be evaluated in patients presenting with iliopsoas bursitis. In patients failing to respond to conservative management, endoscopic iliopsoas bursectomy and lesser trochanterplasty may address pain and functional limitations.

Impaired Lower Extremity Biomechanics, Hip External Rotation Muscle Weakness, and Proximal Femoral Morphology Predict Impaired Single-Leg Squat Performance in People With FAI Syndrome.

BACKGROUND: Impairments in squat depth have been reported in patients with femoroacetabular impingement syndrome (FAIS). However, little is known about single-leg squat (SLS) performance in these patients, despite this task being commonly used in the rehabilitation and training settings. PURPOSE/HYPOTHESIS: The aims of this study were (1) to investigate whether patients with FAIS demonstrate differences in SLS performance compared with healthy controls and (2) to determine whether dynamic range of motion (ROM), muscle strength, hip morphologic measures, hip pain, and hip-specific function predict SLS performance in patients with FAIS. We hypothesized that patients with FAIS would demonstrate impaired SLS performance and that impaired hip biomechanics, muscle strength, and hip-specific function would predict squat performance in patients with FAIS. STUDY DESIGN: Controlled laboratory study. METHODS: Three-dimensional (3D) kinematic data were collected at 100 Hz using a 20-camera 3D motion capture system during 3 SLS trials in 34 patients with FAIS and 26 healthy controls. Isometric muscle strength was tested with a stationary handheld dynamometer in all participants. Squat performance was quantified by squat depth (in meters), and the biomechanical variables of dynamic ROM of the pelvis, the hip, the knee, and the ankle in all planes were calculated. In patients with FAIS, femoral and acetabular morphology were measured using radiographic alpha angles and lateral center-edge angles. Hip pain and hip-specific function were measured using the visual analog scale for pain and the Hip Outcome Score Activities of Daily Living subscale, respectively. Two-tailed independent-samples t tests were used to determine between-group differences for squat depth, dynamic ROM variables, and muscle strength. A hierarchical multiple linear regression (MLR) model was used to determine whether biomechanical variables, muscle strength, hip morphology measures, hip pain, and hip-specific function were predictors of squat depth. All statistical analyses were performed using SPSS Version 26. RESULTS: There were no between-group differences in age (FAIS, 30.0 ± 7.0 years vs controls, 27.3 ± 7.0 years; P = .18) or body mass index (FAIS, 23.1 ± 2.8 vs controls, 22.6 ± 3.2; P = .51). Squat depth was less in patients with FAIS compared with healthy controls (FAIS, 0.24 ± 0.4 m vs controls, 0.29 ± 0.05 m; P < .001). In the sagittal plane, patients with FAIS demonstrated less dynamic ROM of the hip (FAIS, 67.8°± 12.4° vs controls, 79.2°± 12.5°; P = .001) and the knee (FAIS, 71.9°± 9.4° vs controls, 78.9°± 13.2°; P = .02) compared with controls. Patients with FAIS also demonstrated a less dynamic coronal plane pelvis ROM (FAIS, 11.3°± 5.0° vs controls, 14.4°± 6.7°; P = .044). Patients with FAIS had reduced hip muscle strength of the hip external rotator (FAIS, 1 ± 0.3 N/kg vs controls, 1.2 ± 0.3 N/kg; P = .034), hip internal rotator (FAIS, 0.8 ± 0.3 N/kg vs controls 1 ± 0.3 N/kg; P = .03), and hip flexor (FAIS, 4 ± 1.1 N/kg vs controls, 4.8 ± 1.2 N/kg; P = .013) muscle groups. The hierarchical MLR revealed that the dynamic ROM of the hip, the knee, and the pelvis, the hip external rotation muscle strength, and the femoral alpha angles were all significant predictors of squat performance, and the final MLR model explained 92.4% of the total variance in squat depth in patients with FAIS. CONCLUSION: Patients with FAIS demonstrate impaired SLS squat performance compared with healthy controls. This impaired squat performance is predominantly predicted by sagittal plane knee and hip biomechanics and hip external rotator strength, and less by frontal plane pelvic ROM and hip morphology in patients with FAIS. CLINICAL RELEVANCE: Clinicians should focus treatment on improving dynamic ROM and hip external rotator muscle strength to improve squat performance; however, femoral morphology should also be considered in the treatment paradigm.

Arthroscopic Anchor-Based Hip Capsular Reconstruction Without Graft Augmentation.

The hip capsule is one of the most important static stabilizers of the hip joint. Routine capsulotomy without closure during hip arthroscopy increases instability of the hip joint, leading to pain and dysfunction. Capsular repair is now part of routine practice for most hip arthroscopists with restoration of normal hip biomechanics. In patients requiring revision surgery due to ongoing pain and instability as a result of deficient capsule, capsular reconstruction often is necessary to restore hip stability. Although there are many techniques available both with and without the use of allograft tissue, the purpose of this report is to describe a novel technique for capsular reconstruction without the use of graft augmentation using suture anchors at the acetabular rim.

High rate of return to tennis after hip arthroscopy for patients with femoroacetabular impingement syndrome.

OBJECTIVE: The purpose of this study was to evaluate return to sport (RTS) outcomes in tennis athletes following hip arthroscopy for femoroacetabular impingement syndrome (FAIS). It was hypothesized that there would be a high rate of return to tennis after hip arthroscopy. STUDY DESIGN: Level IV, Retrospective Analysis. SETTING: Outpatient sports medicine clinic at a single institution. PARTICIPANTS: A total of 28 patients (60.8% female; mean age, 36.2 ± 9.2 years; mean BMI, 22.8 ± 2.1 kg/m2) with self reported tennis activity prior to hip arthroscopy. MAIN OUTCOME MEASURES: A postoperative return to sport and minimum two-year patient reported outcomes. RESULTS: There was a high rate of return to tennis, with 78% of patients eventually returning to tennis. An additional 9% of patients had the necessary hip function to return, but did not return due to lack of interest or resources. The patients returned to tennis at an average of 8.0 ± 3.3 months after surgery. The majority of athletes (66.7%) were able to continue competing at the same or higher levels following surgery. CONCLUSIONS: Patients return to tennis 78% of the time at a mean of 8.0 ± 3.3 months following hip arthroscopy for FAIS.

Intraoperative Computer Vision Integrated Interactive Fluoroscopy Correlates With Successful Femoroplasty on Clinic-Based Radiographs.

PURPOSE: To quantitatively evaluate computer vision interface (CVI)-guided femoroplasty in the arthroscopic treatment of femoroacetabular impingement syndrome and compare those results with traditional unguided resections. METHODS: Consecutive patients undergoing hip arthroscopy for femoroacetabular impingement syndrome between July 2019 and October 2019 were evaluated. Cases with CVI were identified along with controls, consisting of patients from the same study period who underwent surgery without the CVI and were balanced for age, sex, laterality, and preoperative alpha angles. Alpha angles were measured on pre- and postoperative clinic radiographs, as well as intraoperatively for the CVI group. Cam resections were quantified by measuring pre- and postresection alpha angles and compared between groups. The correlation between CVI views and office-based radiographs was assessed, and the 3 CVI views that best correlated with each of the 3 standard clinic radiographs were evaluated for accuracy and performance in detection of cam deformity with alpha angle ≥48° with the clinic-based films as the reference. RESULTS: A total of 49 patients (51 hips) (average age, 28.7; 33 female patients) in the CVI group, and 51 patients (51 hips) (average age: 29.9; 35 female patients) in the control group. There were no significant differences between groups with respect to age, sex, laterality, or preoperative alpha angle (all P > .05). Significant alpha angle reduction occurred on all intraoperative and postoperative clinic views (all P < .01). The CVI views that best correlated with the clinic radiographs were 11:45 with the anteroposterior (ρ = 0.588, P = .0025), 12:30 with the Dunn lateral (ρ = 0.632, P = .0009), and 1:45 with the false-profile (ρ = 0.575, P = .0033). Greater reliability was observed with 12:30/Dunn (accuracy = 83.33%, P < .0001; sensitivity = 77.14%; specificity = 87.76%) and 1:45/false-profile (accuracy = 82.35%, P = .0051; sensitivity = 81.82%; specificity = 82.61%) than with 11:45/anteroposterior (accuracy = 69.15%, P = .0077; sensitivity = 56.10%; specificity = 79.25%). CONCLUSIONS: CVI-guided cam resection results in successful resection of proximal femur cam lesions and represents a femoroplasty templating method that does not require preoperative computed tomography imaging or additional invasive intraoperative referencing modules. The accuracy and adequacy of this resection was validated by comparison with routine clinic radiographs. LEVEL OF EVIDENCE: Therapeutic Level III: retrospective comparative analysis.

High Rate of Full Duty Return to Work After Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Workers Who Are Not on Workers' Compensation.

BACKGROUND: Femoroacetabular impingement syndrome (FAIS) is an increasingly common diagnosis among working-age adults. Hip arthroscopy provides reliable improvements in pain and may allow patients to return to physical activities. No study to date has evaluated return to work (RTW) among a general population of adults after arthroscopic surgery for FAIS. PURPOSE: To evaluate (1) patients' rate of RTW, (2) time required to RTW, and (3) factors correlated with time required to RTW after arthroscopic surgery for symptomatic FAIS. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Consecutive patients aged 25 to 59 years who underwent arthroscopic surgery for FAIS between June 2018 and December 2018 were reviewed. Workers' compensation cases and patients with <1-year follow-up were excluded. The following were collected at a minimum of 1 year postoperatively: demographics, employment characteristics, Hip Outcome Score (HOS; Activities of Daily Living and Sports Specific subscales), modified Harris Hip Score, 12-Item International Hip Outcome Tool (iHOT-12), visual analog scale for pain, and RTW characteristics. Work physical activity level was classified as sedentary, light, moderate, heavy, or very heavy per established criteria. RESULTS: A total of 97 patients were selected through inclusion and exclusion criteria. RTW surveys were collected for 79 (81.4%), and 61 were employed preoperatively. Time worked per week was 42.8 ± 12.5 hours (mean ± SD). Patients' work level was most commonly classified as sedentary (42.6%), followed by moderate (24.6%). All 61 (100%) patients returned to work at a mean 7.3 weeks (range, <1-88 weeks) postoperatively. Sixty patients (95.2%) returned to full duty. Time required to full duty RTW was strongly correlated with expected time off from work (r = 0.900; P < .0001) and moderately correlated with work classification (r = 0.640; P = .0001). All patients had significant pre- to postoperative improvements in the HOS-Activities of Daily Living (64.8 ± 15.3 to 87.1 ± 12.2; P < .001), HOS-Sports Specific (42.8 ± 18.8 to 76.7 ± 16.5; P < .001), iHOT-12 (31.3 ± 18.8 to 69.3 ± 21.1; P < .001), modified Harris Hip Score (61.8 ± 12.1 to 80.3 ± 14.1; P < .001), and visual analog scale for pain (5.19 ± 2.11 to 2.40 ± 1.96; P < .001). CONCLUSION: Patients undergoing arthroscopic treatment for FAIS demonstrated a high rate of RTW at a mean of <2 months postoperatively. A patient's expected time off from work and the level of physical demands required for work were highly associated with time required to RTW. These results are valuable for orthopaedic surgeons, patients, and employers when establishing a timeline for expected RTW after surgery.

Association of lower extremity injuries and injury mechanism with previous concussion history in adolescent athletes.

OBJECTIVE: Determine the association between concussion and subsequent contact, non-contact, and overuse lower extremity (LE) injuries in a cohort of adolescent athletes. Secondarily, to identify this association between males and females. STUDY DESIGN: Cross-sectional. SETTING: Summer athletic events with participants ages 12-18. MAIN OUTCOME: Anonymous survey included sport-related injuries (injury month/year) and participants classified injuries as a contact, non-contact, overuse injury, or concussion. Multivariable logistic regression analyses were used to examine associations between a concussion event and a subsequent LE injury while controlling for age and any previous LE injury. RESULTS: A concussion was reported in 219 athletes (Female = 96, 44%) and were matched with 219 non-concussed athletes (438 total participants). Concussion was not association with a specific injury mechanism but was significant for any subsequent LE injury (OR = 1.58 95%CI = [1.03-2.41]; p < 0.05). Concussed females were more likely to report any subsequent LE injury compared to non-concussed female athletes (2.49[1.31, 4.74]; p < 0.01). This relationship was not observed between concussed and non-concussed males (1.11[0.62-1.99]; p > 0.5). CONCLUSION: A history of concussion was associated with any subsequent LE injury, but not associated with a specific mechanism of injury. The association with concussion and a subsequent LE injury was different between males and females.

Cartilage-Preserving Arthroscopic-Assisted Radiofrequency Ablation of Periacetabular Osteoid Osteoma in a Young Adult Hip.

Osteoid osteomas are benign bone lesions that commonly occur in the lower extremities and spine, with the radiographic evidence of a central nidus surrounded by circumferential reactive bone. Although nonsteroidal anti-inflammatory drugs can provide symptomatic relief and are used as an important diagnostic tool, surgical intervention is the definitive treatment. Arthroscopic-assisted radiofrequency ablation has been shown to be an effective technique to directly visualize and treat the lesion while minimizing damage to the articular cartilage.

Knowledge, Attitudes, and Beliefs of Youth Club Athletes Toward Sport Specialization and Sport Participation.

BACKGROUND: There are a variety of proposed motivations for sport specialization, such as improving sport skills to an elite level, making all-star or travel teams, or receiving a scholarship or professional contract. However, there has not been a quantitative examination of the attitudes and beliefs that may be contributing to the trend of sport specialization and year-round sport participation. PURPOSE: The primary aim was to describe the attitudes and beliefs of youth club sport athletes regarding sport specialization and sport participation. A secondary objective was to investigate whether an association exists between the level of sport specialization and the belief in receiving a college scholarship. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A total of 974 youth athletes (578 female; mean age, 14.2 ± 1.6 years) completed an anonymous questionnaire that focused on attitudes and beliefs toward sport specialization and sport participation. Questions were developed utilizing the feedback of a panel of content area experts and the University of Wisconsin Survey Center. Data were summarized using frequencies, proportions (%), and means ± SDs. RESULTS: Fewer than half of all athletes (45.8%) believed that specialization increased their chances of getting injured either "quite a bit" or "a great deal." However, 91% of athletes believed that specialization increased their chances of getting better at their sport either "quite a bit" or "a great deal." Similarly, the majority of athletes believed that specialization increased their chances of making their high school team (80.9%) or a college team (66.9%) either "quite a bit" or "a great deal." Overall, 15.7% of athletes believed that they were either "very" or "extremely" likely to receive a college scholarship based on athletic performance. Highly specialized athletes were nearly twice as likely to have a high belief in receiving a college scholarship compared with low-specialization athletes (20.2% vs 10.2%, respectively; χ2 = 18.8; P = .001). CONCLUSION: Most youth athletes in this study believe that specialization increases their sport performance and ability to make not only a college team but also their high school team. Highly specialized athletes were more likely to believe that they will receive a college scholarship.