Introduction: While hip osteoarthritis is a disease of the whole synovial joint, cartilage defects are considered a hallmark feature. A high proportion of young adult football players have hip cartilage defects. However, the role that other intra-articular features play in the pathogenesis of cartilage defects in football players remains unknown. This study had two aims: 1) examine the relationship between imaging-defined intra-articular features (labral tears, bone marrow edema pattern, subchondral cysts, effusion-synovitis and ligamentum teres tears) and cartilage defects (presence and severity) in football players; 2) investigate if the relationship between imaging-defined intra-articular features and cartilage defects is stronger in football players with hip/groin pain
Methods: 182 semi-elite football (soccer/Australian football) players (288 hips; 50% soccer; age:26yrs; height:1.79m; weight:78kg; 20% women) with hip/groin pain (>6 months of pain and +ve flexion-adduction-internal-rotation test) and 55 semi-elite control football players (110 control hips; 55% soccer; age:26yrs; height:1.79m; weight:79kg; 25% women) without hip/groin pain underwent 3-tesla MRI. Cartilage defects, labral tears, bone marrow edema pattern (BMEP), subchondral cysts, effusion-synovitis and ligamentum teres tears were scored semi-quantitatively. Logistic and negative binomial regression with generalised estimating equations were used to determine whether intra-articular features were associated with presence and severity of cartilage defects.
Results: Hips with minor (OR 1.8, 95%CI 1.2,2.9) and severe (OR 5.1, 95%CI 2.5,10.3) labral tears had a higher prevalence of cartilage defects than hips without. Only hips with severe labral tears (IRR 2.1, 95%CI 1.4,3.2) had higher (greater severity) cartilage defects scores than hips without. Hips with BMEP or subchondral cysts had a higher prevalence (OR 7.7, 95%CI 3.1,20.0) and more severe (IRR 1.8 95%CI 1.4,2.3) cartilage defects than hips without. Effusion synovitis was not associated with a higher prevalence or greater severity of cartilage defects. For ligamentum teres tears only, a significant feature by symptoms interaction was present. Symptomatic football players without a ligamentum teres tear had a greater severity of cartilage defects when compared to those with symptoms and ligamentum teres tears.
Discussion: Labral tears, BMEP and subchondral cysts were associated with the presence and severity of cartilage defects in active adult football players. Effusion-synovitis was not associated with cartilage defects. With the exception of ligament teres tears, the relationship between imaging-defined intra-articular features and cartilage defects was no stronger in football players with hip/groin pain when compared to those without.
Conflict of interest statement: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.