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Primary cam morphology; bump, burden or bog-standard? A concept analysis
BACKGROUND: 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 clear...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8551977/ https://www.ncbi.nlm.nih.gov/pubmed/34281962 http://dx.doi.org/10.1136/bjsports-2020-103308 |
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author | Dijkstra, H Paul Ardern, Clare L Serner, Andreas Mosler, Andrea Britt Weir, Adam Roberts, Nia Wyn Mc Auliffe, Sean Oke, Jason L Khan, Karim M Clarke, Mike Glyn-Jones, Siôn |
author_facet | Dijkstra, H Paul Ardern, Clare L Serner, Andreas Mosler, Andrea Britt Weir, Adam Roberts, Nia Wyn Mc Auliffe, Sean Oke, Jason L Khan, Karim M Clarke, Mike Glyn-Jones, Siôn |
author_sort | Dijkstra, H Paul |
collection | PubMed |
description | BACKGROUND: 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. |
format | Online Article Text |
id | pubmed-8551977 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-85519772021-11-10 Primary cam morphology; bump, burden or bog-standard? A concept analysis Dijkstra, H Paul Ardern, Clare L Serner, Andreas Mosler, Andrea Britt Weir, Adam Roberts, Nia Wyn Mc Auliffe, Sean Oke, Jason L Khan, Karim M Clarke, Mike Glyn-Jones, Siôn Br J Sports Med Original Research BACKGROUND: 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. BMJ Publishing Group 2021-11 2021-07-19 /pmc/articles/PMC8551977/ /pubmed/34281962 http://dx.doi.org/10.1136/bjsports-2020-103308 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Original Research Dijkstra, H Paul Ardern, Clare L Serner, Andreas Mosler, Andrea Britt Weir, Adam Roberts, Nia Wyn Mc Auliffe, Sean Oke, Jason L Khan, Karim M Clarke, Mike Glyn-Jones, Siôn Primary cam morphology; bump, burden or bog-standard? A concept analysis |
title | Primary cam morphology; bump, burden or bog-standard? A concept analysis |
title_full | Primary cam morphology; bump, burden or bog-standard? A concept analysis |
title_fullStr | Primary cam morphology; bump, burden or bog-standard? A concept analysis |
title_full_unstemmed | Primary cam morphology; bump, burden or bog-standard? A concept analysis |
title_short | Primary cam morphology; bump, burden or bog-standard? A concept analysis |
title_sort | primary cam morphology; bump, burden or bog-standard? a concept analysis |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8551977/ https://www.ncbi.nlm.nih.gov/pubmed/34281962 http://dx.doi.org/10.1136/bjsports-2020-103308 |
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