Male Soccer Players Have More Severe Symptoms With FAI

Biological sex and competition level often play a role in how severe femoroacetabular impingement (FAI) is in soccer players, according to new research.

Male soccer players often have more severe clinical and radiographic findings than female soccer players. And highly competitive players are more likely to have an acute injury as the cause of their hip symptoms, the data showed.

For the study, “Characteristics of Soccer Players Undergoing Primary Hip Arthroscopy for Femoroacetabular Impingement: A Sex- and Competitive Level-Specific Analysis,” published in The American Journal of Sports Medicine on September 23, 2020, the researchers used an institutional hip preservation registry to analyze sex- and-competition level-specific differences in injury characteristics and clinical and radiographic findings of soccer players. The registry included 3,318 consecutive primary hip arthroscopies for FAI performed between March 2010 and January 2016.

There were 336 soccer players (421 hips) in the registry—257 were men and 164 women. Overall 105 of the athletes were highly competitive.

Most of the patients reported chronic hip pain for more than 6 months without an acute injury. Alpha angle, coronal center-edge angle, and femoral version on CT scan measured 64.5˚±12˚, 32.3˚±9˚, and 13.7˚±10˚ (mean ±SD), respectively.

Female athletes had more hip internal rotation in physical examination (14.9˚vs. 8˚, p < .001), lower alpha angles (57.5˚vs. 68.5˚, p < .001), and lower-grade AIIS morphology (p = .003).

The researchers also found that acute injury as the reason for hip symptoms was most likely in the highly competitive group (p < .001).

They wrote, “Female soccer players were more likely to have less severe clinical and radiographic findings than were male soccer players. Acute injury as the cause of hip symptoms was more common in highly competitive players.”

“Focusing on soccer players with an established FAI diagnosis, the findings of this study suggest that there are sex- and competition level–based differences in the presentation, physical examination, and imaging characteristics among the players. These findings can better guide clinicians in the diagnostic evaluation of symptomatic soccer players with FAI and in tailoring treatment recommendations to specific cohorts,” they added.