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Femoroacetabular impingement syndrome (FAIS) leads to hip pain and reduced hip function in young athletes. Recent studies have reported high-impact sporting activities during adolescent growth as an important cause of cam morphology. However, not all athletes with cam morphology develop symptoms and dysfunction related to FAIS, nor do they require surgical treatment. The question of why some athletes with cam morphology function well at a high level of sports for years, while others do not, and possible differences between genders and different sports, remains to be answered. The aim of this thesis is to investigate the correlation between cam morphology, hip joint range of motion (ROM) and hip pain in young elite athletes and patient-reported outcome measures (PROMs) and the rate of athletes still active at elite level after arthroscopic treatment for FAIS, and to make comparisons between genders, sports types and evaluations over time. Study I is a cross-sectional study comprising young athletes (60 male football players, 40 male and 35 female skiers). The prevalence of cam morphology, hip ROM, hip pain and FAIS is studied. Football players had reduced hip rotation compared with skiers, independent of cam morphology and hip pain. Male and female skiers had a higher proportion fulfilling the diagnostic criteria for FAIS compared with football players. Study II is a cohort study comparing hip ROM over 2 years in young skiers (n=30) with and without cam morphology. All the skiers reduced their hip rotation, independent of cam morphology. A statistical, not clinically relevant, larger reduction was shown in internal rotation in skiers with cam morphology. Study III is a cohort study investigating the correlation between cam morphology, activity level and hip pain over 5 years in young skiers (n=60). Activity level and cam morphology had no, or only a low, correlation with hip pain. Study IV is a cross-sectional study comprising 919 athletes undergoing arthroscopic treatment for FAIS. Preoperative PROMs and types of sport participation between genders is studied. Females had a longer duration and a higher degree of symptoms. Horseback riding and football were equally common in females, while football was dominant in males. Study V is a cohort study comprising 551 athletes undergoing arthroscopic treatment for FAIS. The rate of continued sporting activity is evaluated and compared between sports, genders and PROMs. Only 25% were still active at pre-injury level after 2 years, with no gender difference, but with a greater improvement in PROMs.

Additional file 1.

Majoriteten av idrottsskador inklusive skada på främre korsbandet (Anterior Cruciate Ligament, ACL) uppstår i slutet av träning/tävling när personen tenderar att vara trött. Nuvarande funktionstest inför återgång till idrott efter skada utvärderar ofta individens hoppförmåga i ett icke-uttröttat tillstånd. Syfte: Syftet med följande studie var att se huruvida prestationen i två olika enbenshopp kunde skilja sig mellan före och efter 25 minuters löpning, varav 15 minuter på hög-intensiv nivå och om hopprestationen skiljer sig mellan oskadade och ACL-opererade kvinnor. Metod: Totalt deltog 8 friska kvinnor, utan pågående besvär från nedre extremitet samt 6 färdigrehabiliterade ACL-opererade kvinnor som återgått till sin tidigare aktivitetsnivå. Deltagarna genomförde tester vid två olika tillfällen. Ett Pre-test-tillfälle då inträning av distans- och cross-overhopp samt ett max-pulstest (HRmax) på löpband utfördes. Ett Test-tillfälle där respektive hopp utfördes före och efter cirka 25 minuters löpning varav 15 minuter var på hög-intensiv nivå (>RPE 15 eller >85 % av HRmax). Total distans mättes, registrerades och analyserades för två godkända hopp per ben, tillstånd och hopptyp. Antal hopp-försök per ben och hopp registrerades. Ett symmetri index (LSI) beräknades för att bedöma om det förelåg en normal eller onormal sidoskillnad. Resultat: Cross-overhoppet var signifikant kortare efter löpning jämfört med före. Samma resultat syntes inte för distanshoppet. Ingen skillnad fanns mellan grupperna i hopplängd eller LSI-värden, före eller efter löpning. Ingen onormal sidoskillnad syntes före eller efter löpning i något utav hoppen. ACL-skadade behövde signifikant fler hoppförsök på det opererade benet i uttröttat tillstånd jämfört med det icke-opererade och jämfört med oskadade för att uppnå två godkända hopp. Slutsats: Cross-overhoppet försämrades av löpningen och kan därför sägas vara känsligt nog att kunna skilja uttröttat från icke-uttröttat tillstånd hos båda grupperna. Samma resultat syntes inte för distanshoppet. Det uttröttningsprotokoll och de hopptester som utfördes kunde inte frambringa några större förändringar eller olika sidoskillnader mellan färdigrehabiliterade ACL-opererade kvinnor som återgått till sin tidigare aktivitetsnivå och oskadade, generellt fysisk aktiva kvinnor. Viss osäkerhet kan ha funnits kvar hos det tidigare skadade benet eftersom fler hoppförsök krävdes i uttröttat tillstånd på det opererade benet jämfört med det icke-opererade benet eller jämfört med oskadade deltagare för båda hopptyperna. Most sport injuries including anterior cruciate ligament-injury (ACL) occur at the end of sport events when the person tends to be fatigued. Despite this, the tests commonly used today to assess whether the individual should return to sports are performed in a non-fatigued state. Aim: The aim of this study was to compare effects of 25 minutes treadmill running, including 15 minutes at a level of high-intenisty on the performance of two different single-leg hop tests between un-injured women and women who underwent an ACL-reconstruction. Method: Eight un-injured women without any ongoing symptoms from either leg, and 6 women who had undergone an ACL-reconstruction, finished the rehabilitation program and returned to their pre-injury level of activity performed tests at two different occasions. The first occasion included technique training for each single-leg hop and a maximal heart rate test (HRmax) on a treadmill. On the second occasion subjects performed the single-leg hop for distance and the cross-over hop before and directly after 25 minutes running, including 15 minutes on a high-intensity level (>RPE 15 and/or >85 % HRmax). Total jump-distance was measured, registered and analysed for 2 approved trials per leg, condition and hop. A leg symmetry index (LSI) was calculated to assess side-to-side-differences. Results: The cross-over hop was significantly shorter after running in both groups, whereas no such effect was seen for the single-leg hop for distance. No difference was shown between groups in performed distance, side-to-side difference or LSI-values, before or after running any of the single-leg hops. Subjects in the ACL-group needed significantly more hop-trials on the operated leg compared to the non-operated leg and compared to un-injured subjects to achieve two qualified hops. Conclusions: Subjects jumped shorter in the cross-over hop after running. This hop can therefore be regarded as sensitive enough to tell fatigued state from a non-fatigued state in both groups. The fatigue protocol did not induce any side-to-side differences in subjects who had undergone ACL-reconstruction, finished their rehabilitation and returned to their pre-injury activity level. Some insecurity may still have been present in the previously injured leg since ACL-operated subjects needed more hop-trials for the operated leg compared to the non-operated leg or compared to un-injured subjects when fatigue.