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The influence of athletic activities during growth on hip development
Rintje AGRICOLA
Friday, Sept. 22, 2017 · 8:35 a.m. · 19m 29s
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like a pretty to uh to get his presentation on the development of uh of the hip
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uh and i would also like to complement the organisation or it's very well organised
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a conference and i'm looking forward to the rest of the program today
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i've no conflicts of interest and i'm going to mainly
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talk about it development and it it it shouldn't
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um i'll start with a short clip on keeping busy and it's a bit of a
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c. k. should of what it is but if it
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gets a good representation of what we're talking about
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um this is simply do show a clip you can find it yourself as well
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and the thing we're talking about this uh mainly can methodology
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can mythology is a extra bone formation at t. and so let's roll at neck junction
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and that makes the timer had more a spherical instead
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of us were comparable had in a normal situation
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uh this can morphology can be forced into d. s. have them
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uh mainly during the motions of flexion and internal patiently hid it
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and it is a impeachment occurs read that actually uh
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that can be labelled damage and controlled image
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of the us travelling and it might finally a result in austria trials of the hip
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so there have been a lot of publications uh from about two thousand
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and three on handguns first proposed is a mechanism and probably stayed
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i have recently we had this consensus meeting uh about what
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how we should define every i and we came up with two m. f. e. i. syndrome
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because there was a lot of confusion about morphology
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about function about paying symptomatic or a symptomatic
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and we came up with the definition of that's the i syndrome
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which we defined as some motion related clinical disorder of hip
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and it's important that we can only speak of sci syndrome
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when there's a person's of the trials of sentence
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so that is paid so you should have paid nor be symptomatic to fulfil the criteria of f. e. i. syndrome
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it should be clinical signs mostly decreased internal rotation apostate impeachment uh tests
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and imaging findings corresponding with f. e. i. uh so for
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example camera for what you been some of college
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um and today i'm going to talk primarily about the morphology so
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not three yeah the i syndrome but more of fortune
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so this is how it looks light on regular are on the
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left side and uh during an operation during open procedure
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not very often done uh but it gives you good a representation of how can morphology looks like
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and this doesn't matter can well we know that it's it's associated
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with decreased function of the primarily with decreased internal rotation
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um it has been associated with a decrease muscle strain
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with a a pane of the woods is a little bit of a um
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some study showed association there some don't so there's
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a little bit of distortion whether morphology alone
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associated with the development but this one perspective study available
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and that's shows an association with pain in time
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and there's an association with the development of a strip try to stop it
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when i go one would uh presenting some results all first
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interviews how we often quantify can mythology on radio perhaps
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we use the l. single for that and the alpha angle is measured by first
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drawing a best fit that circle around to several happens you can see here
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then we drove first line from the centre of the had to descent of the neck
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and then the second line from the centre of the had to that part of where the phone service departs from the circle
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so in this case on the left hand uh there's this work of them have resulting in a low l. thing now
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and on the right side yes a a a regular off related
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with can a mythology which results in a higher l. thing
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and we did studies on cut off values and um and there's a debate on what colour so you should
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use what we often use a cutoff value of sixty degrees all thing go to define camping forty
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and to show the relationship between cam apology and development of foster tribes of the hip
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we did a a nationwide study in the netherlands we included a thousand people
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that's the that's the standard to the general practitioner with the first onset
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of hip or knee pain but they didn't have also tried it yet um
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they were all between forty five to sixty five years old and
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every green dot u. c. initially you represents one hit
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so that two thousand dots left and right here in this figure
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and on the x. axis the elf angle so we can
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morphology and on the y. axis the amount of internal rotation
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of the hip and these are all hips at baseline
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then these red dots on the hips that developed after try this within five years for what
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so they had a camera score three or four or total hip replacement within five years follow
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if you don't look at the people that have had morphology a baseline
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a defined by now send a highway sixty degrees they have four
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times almost four times increased risk of developing austria trials
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the big um the higher the race so the people that had alzheimer's about eighty three degrees at the
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risk of a a a a a an odds ratio of almost ten uh for development office supplies
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and if they had a combination of decrease internal rotation together with them morphology at baseline
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they uh had a extremely increase rates to develop a states rights within those like yours
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but there's also reason why i present the data in this way because if i go back and you look at this figure
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you see a lot of green dots there as well so that means that a lot of
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hits with can mythology won't develop of still try this at least not within five years
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and and it's important to remember although there is an association which is quite strong
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or even more hips with can morphology that wants to sell also try to so that's always important to remember
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so this is what it can look like you had atrocity uh on the
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left side the as double room with the label images problem there already
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and and what we often see is this type of carpet lesion what is some control
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uh of the car clips is uh the laminated from the start control bar
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we often see this in the superior side of t. s. uh tell them exactly
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decide what we can and this was forced into the yes camp oh
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that is uh that's the place where most them so chris
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so then go back to the development of cam apology because it was quite interesting
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that uh a lot of publications have shown that the preference also
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can morphology so again only what we she on on imaging
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extremely high in the outlet population especially need adults
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uh in a variety of of of sports and the
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privilege a reported ranges between sixty and ninety percent
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oh and there's also clear differences in the few studies
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that directly compared actually it's with not that leads
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uh the reported preference of cam unfortunately it's it's
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about ten to fifteen percent of males um
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so that was quite interesting because that might also implied it
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then that that could be an opportunity for prevention
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but then you have to know when it develops what type of clothing buttons uh uh or or related with
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development of got morphology uh does intensity matter these are
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all questions that we would like to um so
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uh and and here i have a a a small clip in which i tried to show you
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that's bones can really add that to mechanical load especially when they're in their growing face
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and the next clip i will show you a needs a little introduction
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and what i'm going to show is a am a clip of uh
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uh several radio graphs that have been obtained after hip rotation lastly
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that's an a procedure which we look you don't have to do that often
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um but sometimes uh if they have for example would be chew more in the proximal femur
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um you sometimes have to remove the complete femur and put back to to be out into
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d. s. attempt to allow for benefit of approached pieces uh of the lower left
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uh so here's the clip it starts with the rate of growth uh at
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beginning situation the the proximal to be out of this already and situation
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try to start again
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doesn't start really getting what i what i would try to show is that
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if you put it to be a into d. s. example um
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uh the rim of the morphology of what you see it's really the t. v. i did this oh it it works
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luckily so it's really the tibia uh that is placed into the s.
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seven and this part it is genetically imprinted to become tibia um
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resulting from the loads that are applied to the t. v. or the shape is
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mm over the years time a much more looking like a proximal
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theme so that is what a mechanical loads during which well
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um i well we we're yes they the boss somebody is said to me well it's actually
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it's it's really nice that you were one of the first it really looked
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into d. e. geological uh into logical part of campus policy but
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we were actually be burned this has to do it at a far from that actually
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because there was a british radiologist already nineteen seventy one
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what knowledge that uh athletic activity during adolescence might be in geological
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factor of can morphology and also try to solve the hip
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um you study it's a young adults and he ripped respectively cost
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the the loading buttons during adolescence and you found out
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that uh uh let uh adolescence that were more active but
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also more can morphology you called in to tilt deformity
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but it's what we now know eskimo faulty and you also recognise already
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banned that that might be a cost for him was detritus
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so we did a study uh in these fine not academy um
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we uh included a young football players uh between
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the age of twelve and eighteen yes
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and they will playing this this team of the of the of the uh academy and we followed them up in time
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uh we did uh the baseline measurements with all of them up off the tune health yes and after five years
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and at baseline but we first no this was that can befall apology develops around th of
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twelve to thirteen yes at that age can morphology becomes visible on radio grounds
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and when we followed the mean time we we saw that it can
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morphology gradually increases in size uh during
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the period of adolescence and
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and after the growth plate has closed it doesn't seem to be any change anymore
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so this might very well be a bone adaptation in
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response to a atlantic activities during sculptor broke
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and this is how that looks like i'm already grass you can see a
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twelve year old soccer player with just the mobiles record several hats
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and this is the same player two two and a half years later on in which
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you could see that a little bit of both nation has formed the already
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you can appreciate a little bit better on the far click use here with it
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perfectly spherical thermo hat and here the family had mentioned scene has already happened
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also the case if you look in a bit older guys we had already developed a
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flattening of the family had in here in a fourteen year old soccer player
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uh and after two and a half years you develop really of prominence of the head neck junction
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which is also visible here and on the front black few two and half years later
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we recently completed to five years for awhile and then this was to
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the typical uh a way of ah okay and uh it's not
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like starting with twelve years of age uh with a normal spherical from what had
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then they develop kind of a flattening finely some of them
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really develop a bomb on the and so let's all
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at night junction and half to grow plates close here we didn't see any difference anymore
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so talk could also into that those response relationship he asks sixty three
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adults players how much they uh practised is sports when they were younger
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and um the people that um i started to play in the
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neck admin so uh three or more times a week soccer
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uh from tells tells us all about had a preface of
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forty percent can mythology rests people or soccer players
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that played already before that twelve years of age uh
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four times a week or more uh as soccer
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they had a preference of sixty four percent camel forty so that might be also
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be a dose response relationship between intensity and development of such a can
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and then we used higher cut off values for the author angle so big it can morphology
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um we also see sought significant differences between uh these two groups
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and has been a recent publication b. g. s. m. problem a problem at all that's
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the group from oxford they started uh also
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uh uh adolescence from southampton book club
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uh and they compare them in with no no please and they
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actually confirmed our findings that as just can uh was visible
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firstly from the age of twelve to thirteen yes a fourteen yes
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but they update 'em ryan but they noticed was that they saw a a soft tissue heart but a fee
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probably some cartilage in here in he had no junction which might proceed can morphology
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and they also found that those response relationship for monday compared the uh southampton football
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players wit amateur football players and uh and uh uh no net flicks
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and this bone adaptation phenomenon due to loading is not only seen in caps
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but also it shows where baseball players have more or develop
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actually more euro read torsion and plain we'd retrofit should
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in the drawing or miss compared to the non trolling or and also in the knees because we see that
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and uh and especially soccer player but also load bearing sports in general
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uh is associated with a bow lex in uh in children
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and i'm come to the end of my presentation and i um
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and i want to show lastly the third element analysis we've
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before and so what we did we found out that
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uh athletic activities during drought um can can are associated
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with development of grammar forty so we ask ourselves
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can we really uh to figure out what kind of loading
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that and it's responsible for the development of can
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we try to do that with funded element analysis and what we found out is that we will
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be so we models proximal theme or we applied all types of loads to get female
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and uh loads of external rotation and like should resulted in
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a high bone reaction in the area webcam norman develops
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and when we look at the growth plates alone then we found out that uh if if
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if children are around clips of twelve years they mostly have for some to browse plate
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and we found out that uh it in the region that can normally developed
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yes uh stopped for bo formations so that the the the the the role played is to get a so much
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that uh there's a growth stop in there and we'd flexion we see that on the anterior start
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and that might also explain why group played extension to watch the neck is associated we
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can move on c. because once you grow play does not for example anymore but
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extended to watch the camel neck and we
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suddenly sees very very high bong trigger
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a windows uh uh loads or lighten
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this model so external rotation inflection
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mine's a uh might be associated with development of spam bought i want to warn you because this is
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offended element model in which you have to do a lot of assumptions so it's more hypothesis
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generation uh instead of that you really can prove something so that should be confident in a clinical studies
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uh that brings me to be a a to the summary of my presentation
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so can morphology is is highly preference in the uh athletic population
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some of them go get symptomatic but a lot of them
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and uh we'll remain is symptomatic due to can fourteen
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i can afford she develops a between the acts of twelve and thirteen yes
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it only developed use multiple uh a maturation and it might be a dose
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response relationship between the intensity of uh athletic activity and can mythology
00:19:10
as finely movement buttons of a selection and internal rotational to get
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