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Do high-impact sports in children promote abnormal physeal growth and cam-type deformity of the femoral head during the adolescent growth spurt? - A longitudinal study -

English title Do high-impact sports in children promote abnormal physeal growth and cam-type deformity of the femoral head during the adolescent growth spurt? - A longitudinal study -
Applicant Siebenrock Klaus
Number 153469
Funding scheme Project funding (Div. I-III)
Research institution Klinik für Orthopädische Chirurgie Inselspital Universität Bern
Institution of higher education University of Berne - BE
Main discipline Surgery
Start/End 01.03.2015 - 28.02.2019
Approved amount 213'228.00
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Keywords (5)

osteoarthritis; magnetic resonance imaging; cam type deformity; hip; prospective comparative study

Lay Summary (German)

Lead
Verschiedene Untersuchungen der letzten Jahre haben gezeigt, dass diskrete Formvarianten der Hüfte für die überwiegende Zahl der Hüftgelenksveränderungen (insbesondere bei jungen Patienten) ursächlich sind. Diese Formvarianten können zu einem sogenannten „Femoroazetabulären Impingement (FAI)“ führen. Dabei kann es zu einem Anstehen des Oberschenkelknochens an der Hüftpfanne bei endgradigen Hüftbewegungen kommen. Dies führt zu einer übermässigen Belastung des Gelenksknorpels, aber auch der umgebenden Gelenkslippe.Verschiedene Untersuchungen zeigten, dass Formvarianten des Oberschenkelknochens, gehäuft bei Männern, insbesondere in Zusammenhang mit intensiver sportlicher Aktivität und körperlicher Arbeit auftreten. Um die Entwicklung des Oberschenkelknochens besser zu verstehen, möchten wir deshalb an einer grösseren Anzahl von Heranwachsenden die Ausreifung des Knochens beurteilen.
Lay summary

 Inhalt und Ziele des Forschungsprojekts

Das Ziel dieser Studie ist es, mittels wiederholten Magnetresonanzuntersuchungen (keine Strahlenbelastung!) über eine Zeitspanne von drei Jahren mittels drei Untersuchungen die Formentwicklung des Oberschenkelknochens bei sportlichen (Eishockeyjunioren) mit wenig aktiven Jugendlichen zu vergleichen. Damit soll herausgefunden werden, ob unterschiedliche Formvarianten zu erkennen sind.

 

Wissenschaftlicher und gesellschaftlicher Kontext des Forschungspro-jekts

Dieses Projekt soll dazu beitragen die Entwicklung von Formvarianten des Hüftgelenkes besser zu verstehen. Damit könnte herausgefunden werden, ob bei einzelnen Heranwachsenden ungünstige Formvarianten auftreten und allenfalls vorbeugend behandelt werden könnten.

Direct link to Lay Summary Last update: 02.03.2015

Responsible applicant and co-applicants

Employees

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
DKOU - Deutscher Kongress für Orthopädie und Unfallchirurgie Poster "Do high impact sports promote proximal femoral pathomorphology before the growth spurt - preliminary results of a longitudinal, prospective, controlled study" 23.10.2018 Berlin, Germany Siebenrock Klaus; Schmaranzer Florian; Werlen Stefan; Hanke Markus Simon;
77th annual meeting swiss orthopaedics 2017, St. Gallen, Switzerland Individual talk Do high impact sport promote proximal femoral pathomorphology before the growth spurt – preliminary results of a longitudinal, prospective, controlled study 28.06.2017 St.Gallen, Switzerland Werlen Stefan; Hanke Markus Simon; Siebenrock Klaus; Schmaranzer Florian;


Communication with the public

Communication Title Media Place Year
Talks/events/exhibitions Studienvorstellung/Informationsabend German-speaking Switzerland 2016
Print (books, brochures, leaflets) Studienvorstellung-/information German-speaking Switzerland 2015

Associated projects

Number Title Start Funding scheme
160153 Femoro-acetabular impingement and its role in the development of osteoarthritis of the hip: A 10-year follow-up study of the Sumiswald cohort 01.04.2016 Project funding (special)
135627 Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) to assess outcome of treatment for femoro-acetabular impingement (FAI) 01.07.2012 Project funding (Div. I-III)
100814 Induction of peripheral hip joint lesions in a sheep model by femoro-acetabular impingement: a new pathomechanism for early osteoarthritis 01.04.2004 Project funding (Div. I-III)
104778 Femoro-Acetabluar Impingement: Role in Osteoarthritis of the Hip 01.04.2005 NRP 53 Musculoskeletal Health - Chronic Pain

Abstract

Background Osteoarthritis (OA) of the hip is one of the major causes of pain and disability in the developed world. Femoroacetabular impingement (FAI) is described as a risk factor for early OA in the non-dysplastic hip due to morphologic deviations. The cam-type impingement is caused by an abnormal shape of the proximal femur (“cam-type deformity”) with a typically decreased anterior head-neck offset. It is more frequent in male individuals and has been related to sports activities or heavy physical work. It can be quantified by measuring alpha angles. Recent studies have shown that elevated alpha angles already can be seen in adolescents before or around closure of the femoral growth plate in cohorts of basketball and ice hockey players. Preliminary data showed that an abnormal extension of the capital physeal growth plate in children performing high-impact sports can be detected during maturation and the adolescent growth spurt. It is plausible that high-impact sports are detrimental to the development of the capital growth plate during childhood. However, there is lack of knowledge about the physeal growth pattern, the time point of growth aberration and to which degree an abnormal growth pattern of the physis can be associated with elevated alpha angles and a later non-spherical deformity of the proximal femur. Objectives First, to compare growth pattern of the femoral capital physis (relative physeal extension) in a longitudinal study over 3 years in physically active and less active children during the adolescent growth spurt; second, to evaluate whether a different physeal growth pattern in children performing high impact sports is associated with a cam-type deformity; third, to determine at which age during the adolescent growth spurt the first signs of an aberrant epiphyseal growth can be seen. Methods Longitudinal study of boys and adolescent male individuals starting at the age of 12 years until the age of 15 years performing physical sports activities at different levels. Study participants with high-impact sports activity will be recruited from the local ice hockey club in Bern (Schlittschuh-Club Bern, SCB), while less physically active persons will be chosen from age-matched controls attending the same school as the high-activity participants. All individuals will undergo physical examination of their hip joints and repetitive non-invasive magnetic resonance imaging (MRI) of the hip at the ages of 12, 13.5 and 15 years, respectively. Primary outcome will be the differences in capital physeal extension and alpha angle (parameter for cam-type deformity), measured on MRI, between highly active individuals and physically less active controls We anticipate including 30 participants (30 hips) from the SCB and 30 age-matched controls (30 hips) resulting in a total sample size of 60 participants. The association between physeal extension, alpha angle and level of sports activity will be assessed using linear regression models. Significance of the project This project will contribute to our understanding of the development of cam-type deformities, a potential risk factor for early hip OA. It might reveal a so far unknown detrimental effect of high-impact sports on the growth plate of the proximal femur. Early diagnostic findings on MRI may initiate modification of sports activities during childhood. Systematic screening for boys at risk might be an interesting tool to prevent such growth abnormality. In the longer term the rate of joint-preserving surgeries or total hip replacements might be reduced.
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