1. Cam-Type FAI By Position
Prevalence of Cam-Type Morphology in Elite Ice Hockey Players
Frantz Lerebours,MD William Robertson,MD Brian Neri,MD Brian Schulz,MD Thomas Youm,MD Orr Limpisvasti,MD
Objective
To define the prevalence of cam-type femoroacetabular Impingement in elite ice hockey players.
Background
14% prevalence of Cam-Type FAI Morphology in asymptomatic adults.
25% in men (5% in women)
3.5% Bilaterally Hack et al. JBSJ 2010
75% of youth ice hockey players vs. 42% of age matched youth skiers had an Alpha Angle ≥ 55°
Philippon et al. AJSM 2013
Methods
130 Elite ice hockey players during preseason entrance examinations from 3 NHL Hockey Clubs
Exclusion Criteria: History of previous hip surgery
All players underwent physical exam including:
Bilateral Hip Range of Motion Assessment
Provocative Hip Testing
Anterior Impingement Test (FADIR)
Posterior Impingement Test (Extension ER)
Methods Cont…
Bilateral Frog Leg View
Alpha Angle ≥ 55° considered abnormal
AP Pelvis View
Crossover Sign
Center Edge Angle
Radiographic evaluation was performed by the same fellowship trained sports medicine physician with experience evaluating and treating FAI
Results
Cam-Type FAI By Position
Position
% with α ≥ 55° by postition
Mean α angle (°)
Right
Left
Center (33)
54.6%
66.7%
58.9
60.1
Defenseman (43)
69.8%
65.1%
61.9
61.8
Goalie
(16)
93.8%
81.3%
66.4
65.8
Left Wing (23)
65.2%
78.3%
62.4
67.7
Right Wing (15)
73.3%
65.1
63.5
24.6% reported a history of hip pain.
Percentage of Hips with Alpha Angle ≥ 55°
Right Hip = 68.5% (89/130)
Left Hip = 70.0% (91/130)
Bilateral Hips = 60.8% (79/130)
16.2% had a Hx of prior hip pain and an
elevated alpha angle
5.4% had a + Hx of hip pain, + anterior impingement
test, and an elevated alpha angle
Goalies had the lowest Center Edge Angles:
Right Hips = 27.6° ± 6.95
Left Hips = 26.4° ± 7.07
Food for Thought
Goalies have a high prevalence of Cam-Type FAI
but tended to have the least acetabular coverage.
Is this protective?
Are goalies without slight acetabular under-coverage selected out and less likely to make it to the elite level?
Figure 1: The alpha angle is obtained by first drawing a best-fit circle surrounding the femoral head. Lines are drawn from the vertex down the center of the femoral neck and to the point where the best fit circle deviates from the anterior femoral neck.
Figure 2: The center edge angle is the angle formed by a vertical line drawn through the center of the femoral head and a line drawn from the center of the femoral head to the outer edge of the acetabular roof.