What Is the Association Between Sports Participation and the Development of Proximal Femoral Cam Deformity? A Systematic Review and Meta-analysis

Am J Sports Med. 2015 Nov;43(11):2833-40. doi: 10.1177/0363546514563909. Epub 2015 Jan 13.


Background: Femoroacetabular impingement (FAI) is recognized as a common cause of hip pain and intra-articular disorders in athletes. Studies have suggested a link between participation in athletics during adolescence and the development of cam-type deformities of the proximal femoral head-neck junction.

Purpose: To investigate the association of sporting activity participation during adolescence and the development of cam deformity.

Study design: Systematic review.

Methods: The PubMed, EMBASE, and Cochrane databases were searched to identify potential studies. Abstracts and manuscripts (when applicable) were independently reviewed by 2 reviewers. Nine studies met the inclusion criteria, including 8 studies that compared the prevalence of cam deformity in athletes with that in controls and 3 studies that compared the prevalence of cam deformity before and after physeal closure (2 with both). A meta-analysis was performed with pooling of data and random-effects modeling to compare rates of cam deformity between athletes and controls.

Results: High-level male athletes are 1.9 to 8.0 times more likely to develop a cam deformity than are male controls. The pooled prevalence rate (by hip) of cam deformity in male athletes was 41%, compared with 17% for male controls. The pooled mean alpha angle among male athletes was 61°, compared with 51° for male controls.

Conclusion: Males participating in specific high-level impact sports (hockey, basketball, and possibly soccer) are at an increased risk of physeal abnormalities of the anterosuperior head-neck junction that result in a cam deformity at skeletal maturity.

Keywords: basketball; femoroacetabular impingement; hip; ice hockey.

Publication types

  • Meta-Analysis
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Athletes*
  • Femoracetabular Impingement / epidemiology*
  • Femur Head / pathology
  • Femur Neck / pathology
  • Growth Plate
  • Hip Joint / pathology*
  • Humans
  • Male
  • Pain / etiology
  • Prevalence