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AuthorDijkstra, H. Paul
AuthorArdern, Clare L.
AuthorSerner, Andreas
AuthorMosler, Andrea Britt
AuthorWeir, Adam
AuthorRoberts, Nia Wyn
AuthorMc Auliffe, Sean
AuthorOke, Jason L.
AuthorKhan, Karim M.
AuthorClarke, Mike
AuthorGlyn-Jones, Siôn
Available date2023-09-06T05:27:57Z
Publication Date2021
Publication NameBritish Journal of Sports Medicine
ResourceScopus
ISSN3063674
URIhttp://dx.doi.org/10.1136/bjsports-2020-103308
URIhttp://hdl.handle.net/10576/47256
AbstractBackground Cam morphology, a distinct bony morphology of the hip, is prevalent in many athletes, and a risk factor for hip-related pain and osteoarthritis. Secondary cam morphology, due to existing or previous hip disease (eg, Legg-Calve-Perthes disease), is well-described. Cam morphology not clearly associated with a disease is a challenging concept for clinicians, scientists and patients. We propose this morphology, which likely develops during skeletal maturation as a physiological response to load, should be referred to as primary cam morphology. The aim of this study was to introduce and clarify the concept of primary cam morphology. Design We conducted a concept analysis of primary cam morphology using articles that reported risk factors associated with primary cam morphology; we excluded articles on secondary cam morphology. The concept analysis method is a rigorous eight-step process designed to clarify complex ' concepts'; the end product is a precise definition that supports the theoretical basis of the chosen concept. Results We propose five defining attributes of primary cam morphology-tissue type, size, site, shape and ownership-in a new conceptual and operational definition. Primary cam morphology is a cartilage or bony prominence (bump) of varying size at the femoral head-neck junction, which changes the shape of the femoral head from spherical to aspherical. It often occurs in asymptomatic male athletes in both hips. The cartilage or bone alpha angle (calculated from radiographs, CT or MRI) is the most common method to measure cam morphology. We found inconsistent reporting of primary cam morphology taxonomy, terminology, and how the morphology is operationalised. Conclusion We introduce and clarify primary cam morphology, and propose a new conceptual and operational definition. Several elements of the concept of primary cam morphology remain unclear and contested. Experts need to agree on the new taxonomy, terminology and definition that better reflect the primary cam morphology landscape- A bog-standard bump in most athletic hips, and a possible hip disease burden in a selected few.
SponsorFunding CLA's research is funded by the Australian National Health and Medical Research Council, the Swedish Research Council and the Swedish Research Council for Sport Science. JLO is funded by the NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust. KMK's research is funded via a Canadian Institutes of Health (CIHR) Scientific Director Grant SOP 394810.
Languageen
PublisherBMJ Publishing Group
Subjectadolescent
athletes
hip
sporting injuries
training load
TitlePrimary cam morphology; Bump, burden or bog-standard? A concept analysis
TypeArticle
Pagination1212-1221
Issue Number21
Volume Number55
dc.accessType Open Access


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