Abstract
BackgroundFemoroacetabular impingement (FAI) is an important cause of hip pain in young and active individuals and occurs as a result of size and shape mismatch between the femoral head and acetabulum. Open physes in children can make hips more susceptible to injury, and high impact forces have been suggested to affect the developing femur. The diagnosis of FAI has recently risen, especially within adolescent populations, and there is an increasing trend towards year-round participation in sports with early specialization. The PREVIEW study is an international longitudinal study designed to determine the association between sport specialization in adolescence and the development of hip impingement.MethodsThis is a multicentre prospective cohort study evaluating 200 participants between the ages of 12–14 that include sport specialists at the moderate to vigorous physical activity (MVPA) level and non-sport specialists at any activity level. We will monitor physical activity levels of all participants using an activity log and a wrist-mounted activity tracker, with synced data collected every 3 months during the study period. In addition, participants will be evaluated clinically at 6, 12, and 18 months and radiographically at the time of enrolment and 24 months. The primary outcome is the incidence of FAI between groups at 2 years, determined via MRI. Secondary outcomes include hip function and health-related quality of life between subjects diagnosed with FAI versus no FAI at 2 years, as determined by the Hip Outcome Score (HOS) and Pediatric Quality of Life (PedsQL) questionnaires.DiscussionIt is important to mitigate the risk of developing hip deformities at a young age. Our proposed prospective evaluation of the impact of sport activity and hip development is relevant in this era of early sport specialization in youth. Improving the understanding between sport specialization and the development of pre-arthritic hip disease such as FAI can lead to the development of training protocols that protect the millions of adolescents involved in sports annually.Trial registrationPREVIEW is registered with clinicaltrials.gov (NCT03891563).
Highlights
Femoroacetabular impingement (FAI) is an important cause of hip pain in young and active individuals and occurs as a result of size and shape mismatch between the femoral head and acetabulum
Because we have looked at early data from the pilot study to inform our calculation, we have adjusted our type I error rate
The PREVIEW study is one of the largest prospective cohort studies using Magnetic Resonance Imaging (MRI) to determine the relationship between FAI development during skeletal maturation and physical activity
Summary
Study design This is a longitudinal cohort study of 200 participants between the ages of 12 and 14 (i.e. critical age of development of the femoral head and neck). Outcome measures Participants will complete the study questionnaires and undergo a physical examination (at baseline and 6, 12, 18, and 24 months) and MRI (at baseline and 24 months) of their dominant hip Participants will sync their activity tracker data and send their activity log (at baseline and every 3 months until final follow-up at 2 years) (Table 3). Sample size calculation We have based our sample size calculation on our pilot study data (N = 53), where the primary outcome event rate (incidence of FAI) is 40% for the sport specialists at the MVPA level (group 1) and 15% for the non-sport specialists at all physical activity levels (group 2) These proportions very closely match prior cross-sectional research that evaluated the incidence of FAI among athletes [10]. All local databases used for storage of study data will be password protected
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