Oxford consensus on primary cam morphology and femoroacetabular impingement syndrome: part 2-research priorities on conditions affecting the young person's hip

H Paul Dijkstra; Sean Mc Auliffe; Clare L Ardern; Joanne L Kemp; Andrea Britt Mosler; Amy Price; Paul Blazey; Dawn Richards; Abdulaziz Farooq; Andreas Serner; Eugene McNally; Vasco Mascarenhas; Richard W Willy; Jason L Oke; Karim M Khan; Sion Glyn-Jones; Mike Clarke; Trisha Greenhalgh; Young Athlete’s Hip Research (YAHiR) Collaborative

doi:10.1136/bjsports-2022-106092

Oxford consensus on primary cam morphology and femoroacetabular impingement syndrome: part 2-research priorities on conditions affecting the young person's hip

Br J Sports Med. 2022 Dec 6;57(6):342-358. doi: 10.1136/bjsports-2022-106092. Online ahead of print.

Authors

H Paul Dijkstra^{1

2}, Sean Mc Auliffe^{3

4}, Clare L Ardern^{5

6}, Joanne L Kemp⁶, Andrea Britt Mosler⁶, Amy Price⁷, Paul Blazey⁸, Dawn Richards⁹, Abdulaziz Farooq¹⁰, Andreas Serner¹¹, Eugene McNally¹², Vasco Mascarenhas¹³, Richard W Willy¹⁴, Jason L Oke¹⁵, Karim M Khan¹⁶, Sion Glyn-Jones¹⁷, Mike Clarke¹⁸, Trisha Greenhalgh¹⁵; Young Athlete’s Hip Research (YAHiR) Collaborative

Collaborators

Young Athlete’s Hip Research (YAHiR) Collaborative:
Rintje Agricola, Thor Einar Andersen, Olufemi Ayeni, Ian Beasley, Mario Bizzini, Marco Cardinale, Tafadzwa Chiokwindo, Richard de Villiers, Lars Engebretsen, Tom Entwisle, Emin Ergen, Scott Fernquest, Celeste Geertsema, Mo Gimpel, Fares Haddad, David Hanff, Joshua Heerey, Julie Sandell Jacobsen, Christa Janse van Rensburg, Ara Kassarjian, Vikas Khanduja, Stephanie Kliethermes, Cara Lewis, Travis Maak, Susan Mayes, Inger Mechlenburg, Nonhlanhla Mkumbuzi, Sofie Nelis, Antony Palmer, Theodora Papadopoulou, Marc Philippon, Lauren Pierpoint, Lindsey Plass, Noel Pollock, Michael Reiman, Nia Roberts, Nikki Rommers, Nisrine Sawaya, Toni-Jane Snoxell, Jomar Souza, Louise Strickland, Tina Taseska, Kristian Thorborg, Jane Thornton, Johannes Tol, Larissa Trease, Pim van Klij, Pieter Volcke, Adam Weir, Fiona Wilson, Mara Yamauchi, Franco Milko Impellizzeri, Per Holmich

Affiliations

¹ Department of Medical Education, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Paul.Dijkstra@aspetar.com.
² Department for Continuing Education, University of Oxford, Oxford, UK.
³ Department of Physical Therapy and Rehabilitation Science, Qatar University, Doha, Qatar.
⁴ Department of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland.
⁵ Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada.
⁶ La Trobe Sport and Exercise Medicine Research Centre; Australian IOC Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.
⁷ Department of Anesthesia, Informatics and Media Lab, Stanford University School of Medicine, Stanford, California, USA.
⁸ Center for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada.
⁹ Five02 Labs Inc, Toronto, Ontario, Canada.
¹⁰ FIFA Medical Centre of Excellence, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
¹¹ FIFA Medical, Federation Internationale de Football Association, Zurich, Switzerland.
¹² Oxford Musculoskeletal Radiology, Oxford, UK.
¹³ Advanced Imaging Research Consortium UIME, Hospital da Luz, Lisboa, Portugal.
¹⁴ School of Physical Therapy, University of Montana, Missoula, Montana, USA.
¹⁵ Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
¹⁶ Family Practice & Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada.
¹⁷ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
¹⁸ Northern Ireland Methodology Hub, Queen's University Belfast, Belfast, UK.

Abstract

Introduction: Primary cam morphology is highly prevalent in many athlete populations, causing debilitating hip osteoarthritis in some. Existing research is mired in confusion partly because stakeholders have not agreed on key primary cam morphology elements or a prioritised research agenda. We aimed to inform a more rigorous, inclusive and evidence-based approach to research on primary cam morphology and its natural history by working towards agreement on a set of research priorities for conditions affecting the young person's hip.

Methods: An international expert panel-the Young Athlete's Hip Research (YAHiR) Collaborative-rated research priority statements through an online two-round Delphi exercise and met online to explore areas of tension and dissent. Panellists ranked the prioritised research statements according to the Essential National Health Research (ENHR) ranking strategy. Reporting of results followed REPRISE (REporting guideline for PRIority SEtting of health).

Results: A diverse Delphi panel (n=65, Delphi rounds 1 and 2; three ENHR strategy surveys: n=49; n=44; n=42) from 18 countries representing six stakeholder groups, prioritised and ranked 18 of 38 research priority statements. The prioritised statements outlined seven research domains: (1) best practice physiotherapy, (2) rehabilitation progression and return to sport, (3) exercise intervention and load management, (4) primary cam morphology prognosis and aetiology, (5) femoroacetabular impingement syndrome prognosis and aetiology, (6) diagnostic criteria, and (7) screening. The panel recommended areas of tension and dissent for the research community to focus on immediately.

Conclusion: While informing more rigorous, inclusive and evidence-based research, this consensus is a roadmap for researchers, policy-makers and funders to implement research dedicated to reducing the cost and burden of hip disease related to primary cam morphology.

Keywords: consensus; groin; hip; osteoarthritis; research.