Ultrasound Screening for Cam Morphology in Male University Soccer Players: Prevalence and Association With Groin Symptoms and Functional Impairments

Background: Ultrasound (US) screening for cam morphology in athletes is rarely performed. Conventional US imaging in the neutral hip position may overlook cam lesions in the anterolateral position, which is the most common location that exhibits cam morphology. Purpose: To investigate US-detected cam-related morphology and prominence in male collegiate soccer players using US with an additional 15° hip extension view and to examine their associations with groin symptoms and functional impairments. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This voluntary screening study included 55 male collegiate soccer players (110 hips; mean age, 19.5 ± 1.1 years) from a single varsity team, all of whom were active and without hip or groin pain severe enough to limit soccer participation. US imaging of the femoral head-neck junction was performed in the neutral position and at 15° of hip extension using a linear probe. The femoral morphology on US was classified as normal, flattened, or prominent; and flattened or prominent findings were grouped as cam-positive for analysis. Groin pain and pinching sensations were assessed using questionnaires and flexion adduction internal rotation tests. Four functional parameters were evaluated, and logistic regression analyses were performed to identify factors associated with the current symptoms. Results: US-based cam-positive morphology was identified in 97 hips (88%) and prominence in 53 hips (48%). The detection rate of US-based cam-positive morphology increased from 79% at 0° to 88% at 15° of hip extension ( P = .02), and that of prominence increased from 21% to 48% ( P < .0001). Groin pain was present in 25 hips (19%), and pinching sensation was reported with 49 hips (45%). In cam-positive hips, having ≥3 functional deficits (odds ratio [OR], 5.0) and greater side-to-side internal rotation difference (OR, 1.2) predicted groin pain; the same variables (OR, 10.2 and 1.1, respectively) predicted pinching sensation. In prominence-positive hips, ≥3 functional deficits predicted groin pain (OR, 6.5) and pinching sensation (OR, 6.9). Conclusion: US screening with 15° hip extension improved the detection of anterolateral cam-related morphology in male collegiate soccer players. Current symptoms were more strongly associated with multiple functional impairments than with morphology alone.