BJSM - 2026-09-21 - Journal Article
Longitudinal cohort study of the association between labral pathology and cartilage loss in high-impact athletes: the FORCe study.
Heerey J, Smith A, Agricola R, Luitjens J, Gassert F, King M, Lawrenson P, Scholes M, Mosler A, Kemp J, Link T, Souza R, Girdwood M, Mentiplay B, Semciw AI, Crossley K
Topics
Key Takeaway
Anterior labral tears in high-impact athletes are associated with accelerated cartilage loss over 2.1 years (aIRR 1.46; 95% CI 1.01–2.09), though the effect size is modest.
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Summary
The FORCe study examined whether baseline labral tears on 3T MRI predict cartilage loss in young high-impact athletes (soccer, Australian football) with and without hip/groin pain. Semi-quantitative MRI scoring at baseline and 2–3 years later showed anterior labral tears (aIRR 1.46), paralabral cysts (aIRR 1.38), and higher labral sum score (aIRR 1.05 per unit) were each independently associated with cartilage sum change score after adjusting for sex, age, BMI, alpha angle, and baseline cartilage score. Effect sizes were weak-to-moderate, indicating labral pathology is a contributing but not dominant driver of cartilage loss.
Key Limitation
Median follow-up of only 2.1 years is insufficient to determine whether the observed cartilage changes translate into clinically meaningful joint degeneration or eventual osteoarthritis in this young cohort.
Original Abstract
OBJECTIVE
Labral tears are common in young adults participating in high-impact physical activity. No longitudinal studies have investigated whether labral tears expedite cartilage loss. This longitudinal study investigated the association between labral tears and cartilage loss in young adults participating in high-impact physical activity.
METHODS
Study participants were high-impact athletes (soccer or Australian football) with and without hip and/or groin pain from the femoroacetabular impingement and hip osteoarthritis cohort study who underwent unenhanced 3T MRI at baseline and after 2-3 years. Labral tears and cartilage defects were scored semi-quantitatively. At baseline, labral tear presence (grade ≥2), subregion, number of subregions affected by labral tear, maximal labral score, labral sum score and presence of paralabral cysts were determined. A cartilage sum change score (difference between baseline and follow-up) was calculated for each hip (0-20). Negative binomial regression models were used to estimate if baseline labral tears were associated with cartilage loss, adjusting for sex, age, body mass index, alpha angle and baseline cartilage sum score.
RESULTS
173 (343 hips) participants (82% with hip and/or groin pain; 22% women) with a median age of 26 years were included. The median International Hip Outcome Tool-33 total score was 69 at baseline. Follow-up MRIs were collected at a median of 2.1 years after baseline. 150 (87%) participants were still participating in high-impact physical activity at follow-up. Weak-to-moderate strength associations were identified between cartilage sum change score and baseline anterior labral tears (adjusted incidence rate ratio (a)IRR 1.46; 95% CI 1.01 to 2.09), paralabral cysts (aIRR 1.38; 95% CI 1.02 to 1.86) and labral sum score (aIRR 1.05; 95% CI 1.00 to 1.09).
CONCLUSION
Our findings suggest that acetabular labral tears contribute to cartilage loss in young adult athletes; however, the associations observed were modest, suggesting that additional factors contribute to cartilage loss in this population. Further research is required to inform preventative strategies aimed at reducing cartilage loss in athletes with labral tears.