Association between leg length discrepancy and femoroacetabular impingement syndrome in tennis players
A case-control study
Abstract
Objective: To evaluate the association between leg length discrepancy (LLD) and femoroacetabular impingement (FAI) syndrome in tennis players.
Materials and method: 14 tennis players diagnosed with FAI (cases) according to Warwick’s criteria were consecutively selected and matched, based on age and sex, with 14 tennis players without FAI (controls). As a measure of association, the odds ratio (OR), with a 95% confidence interval (95% CI), was calculated. A p value < 0.05 was considered significant.
Results: A total of 28 subjects (14 cases and 14 controls) were included in the study. LLD was present in 64.3% (9 subjects) of the case group and in 57.1% (8 subjects) of the control group. LLD was not a risk factor for the development of FAI [OR 2 (95% CI 0.1 – 117.1; p=0.99)]. LLD variable ≥1.2 cm was not associated with FAI either. [OR 1 (95% CI 0.01 – 78.5; p=0.9)].
Conclusion: No association between LLD and FAI was found. LLD may not be considered a risk factor for the development of FAI in tennis players.
References
Smith-Petersen M. Treatment of malum coxae senilis, old slipped upper femoral epiphysis, intrapelvic protrusion of the acetabulum, and coxa plana by means of acetabuloplasty. J Bone Joint Surg Am. 1936;18:869-80.
Montgomery SR, Ngo SS, Hobson T, Nguyen S, Alluri R, Wang JC, Hame SL. Trends and demographics in hip arthroscopy in the United States. Arthroscopy. 2013;29:661-5.
Abrams GD, Renstrom PA, Safran MR. Epidemiology of musculoskeletal injury in the tennis player. Br J Sports Med. 2012;46(7),492–498.
Safran M. Evaluation of the painful hip in tennis players. Aspetar Sports Medicine Journal. 2014;vol 3,516-25.
O’Toole GC, Makwana NK, Lunn J, Harty J, Stephens MM. The effect of leg length discrepancy on foot loading patterns and contact times. Foot Ankle Int. 2003;24:256-259.
Rothbart BA. Relationship of functional leg-length discrepancy to abnormal pronation. J Am Podiatr Med Assoc. 2006;96:499-504.
Soukka A, Alaranta H, Tallroth K, Heliovaara M. Leg-length inequality in people of working age. The association between mild inequality and low-back pain is questionable. Spine. 1991;16:429-431.
Vitale MA, Choe JC, Sesko AM. The effect of limb length discrepancy on health-related quality of life: is the “2 cm rule” appropriate? J Pediatr Orthop B. 2006;15:1-5.
Burke W. Leg length inequality in humans: a new neurophysiological approach. Neurosci Lett. 2004;361:29-31.
Gofton JP. Studies in osteoarthritis of the hip. IV. Biomechanics and clinical considerations. Can Med Assoc J. 1971;104:1007-1011.
Griffin DR, Dickenson EJ, O’Donnell J, Agricola R, Awan T, Beck M. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med. 2016;50(19):1169-76.
Brady RJ, Dean JB, Skinner TM, Gross MT. Limb length inequality: clinical implications for assessment and intervention. J Orthop Sports Phys Ther. 2003;33(5):221-34.
Gogia PP, Braatz JH. Validity and reliability of leg length measurements. J Orthop Sports Phys Ther. 1986;8(10):185-8.
Hoyle DA, Latour M, Bohannon RW. Intraexaminer, interexaminer, and interdevice comparability of leg length measurements obtained with measuring tape and metrecom. J Orthop Sports Phys Ther. 1991;14(6):263–8
Gofton JP, Trueman GE. Studies in osteoarthritis of the hip, II: osteoarthritis of the hip and leg-length disparity. Can Med Assoc J. 1971;104(9):791-799.
Giles LG, Taylor JR. Lumbar spine structural changes associated with leg length inequality. Spine. 1982;7(2):159-62
Sharpe CR. Leg length inequality. Can Fam Physician. 1983;29:332-336
Knutson GA. Anatomic and functional leg-length inequality: a review and recommendation for clinical decision-making: part II, the functional or unloaded leg-length asymmetry. Chiropr Osteopat. 2005;13:12.
Cleveland RH, Kushner DC, Ogden MC, Herman TE, Kermond W, Correia JA. Determination of leg length discrepancy: a comparison of weight-bearing and supine imaging. Invest Radiol. 1988;23(4):301-304.
Kuchera ML. Postural considerations in osteopathic diagnosis and treatment. In: Chila AG, editor. Foundations of Osteopathic Medicine. 3rd ed. Baltimore: Lippincott Williams & Wilkins. 2011;437-483.
Cummings G, Scholz JP, Barnes K. The effect of imposed leg length difference on pelvic bone symmetry. Spine. 1993;18(3):368-373.
Woerman AL, Binder-Macleod SA. Leg length discrepancy assessment: accuracy and precision in five clinical methods of evaluation. J Orthop Sports Phys Ther. 1984;5(5):230-9.










