Department of Paediatric Orthopaedics and Traumatology, Poznan University of Medical Sciences, Poznan, Poland.
Insitute of Zoology, Poznań University of Life Sciences, Poznań, Poland, PaleoFED team, UMR 7194, CNRS, Département Homme et Environnement, Muséum national d'Histoire naturelle, Musée de l'Homme, Paris, France.
Clin Orthop Relat Res. 2021 Aug 1;479(8):1830-1838. doi: 10.1097/CORR.0000000000001771.
Cam morphology is thought to originate near puberty and reflects a response of the peripheral aspect of the proximal femoral physis to increased local load. Participation in particular sports activities has been associated with cam morphology in contemporary patient populations; however, it is unclear whether cam is a recent phenomenon. There are limited data regarding the frequency of its occurrence and the general deviations in femoral anatomy in different historical populations. Such information may help to understand the possible influence of lifestyle and diet on cam morphology.
QUESTIONS/PURPOSES: The purpose of this study was to evaluate femoral morphology in three historical populations. We asked: (1) Was cam morphology present in the three study populations, did those populations differ, and were there differences between sexes? (2) Were there differences in neck-shaft angle, version, or inclination between and among the examined populations?
We examined 204 adult femurs from the Neolithic population from Iran (n = 37, 3000 BC to 1631 BC), medieval population from Poland (n = 135, 10th to 13th centuries), and contemporary Australian aborigines (n = 32, early 20th century), provided by the Open Research Scan Archive, Museum of the First Piasts at Lednica and the University of Wrocław, respectively. All three human populations represent different chronologic periods and lifestyles. All bones were scanned using CT and then measured on their three-dimensional (3-D) reconstructions in selected planes. Cam impingement was defined as an alpha angle > 55° measured on the inclination view. To evaluate the differences in anatomy between populations, we measured the true neck-shaft angle on the true AP view, apparent neck-shaft angle on the apparent AP view, the version angle on the version view, and the inclination angle on the inclination view. The prevalence of cam morphology and other anatomic parameters were compared among groups using chi-square test, one-way ANOVA with post hoc Tukey test, and paired t-test.
Cam morphology was present in 5% of the Neolithic population from Iran, in 7% of the medieval population from Poland, and 3% of the contemporary Australian aborigine femurs (OR Neolithic population from Iran/the medieval population from Poland 0.7 [95% CI 0.2 to 3.4]; p = 0.67; OR Neolithic population from Iran/contemporary Australian aborigines 1.8 [95% CI 0.2 to 20.5]; p = 0.65; OR the medieval population from Poland/contemporary Australian aborigines 2.5 [95% CI 0.3 to 20.1]; p = 0.40). There were differences in the presence of cam morphology between the sexes in the medieval population from Poland with both femurs (females: 1% [1 of 76]; males: 15% [9 of 59]; p = 0.002). There was a difference in true neck-shaft angle between the Neolithic population from Iran (121° ± 6°) and contemporary Australian aborigines (131° ± 5°; mean difference 10° [95% CI 7° to 13°]; p < 0.001) and between the medieval population from Poland (124° ± 5°) and the contemporary Australian aborigines (mean difference 7° [95% CI 5° to 9°]; p < 0.001). Apparent neck-shaft angle differed between the Neolithic population from Iran (126° ± 6°) and the contemporary Australian aborigines (134° ± 5°; mean difference 8° [95% CI 6° to 11°]; p < 0.001), and between the medieval population from Poland (126° ± 6°) and the contemporary Australian aborigines (mean difference 9° [95% CI 7° to 11°]; p < 0.001). Moreover, we observed a difference in the version angle between the Neolithic population from Iran (19° ± 7°) and the medieval population from Poland (12° ± 9°; mean difference 7° [95% CI 4° to 10°]; p < 0.001] and in the inclination angle between aforementioned groups (18° ± 7° versus 11° ± 8°; mean difference 7° [95% CI 5° to 10°]; p < 0.001).
This study found that cam morphology existed in historical populations at rates comparable with a contemporary population.
The presence of cam morphology in historical populations suggests that cam morphology can develop outside of the intense sports activity seen in modern adolescents. Further study will help elucidate the etiology of cam morphology, which may be useful in the development of preventive strategies.
凸轮形态学被认为起源于青春期前后，反映了股骨近端干骺端的外周部分对局部负荷增加的反应。在当代患者群体中，特定的运动活动与凸轮形态学有关；然而，凸轮是否是最近才出现的现象尚不清楚。关于其发生的频率以及不同历史人群中股骨解剖结构的一般偏差，数据有限。这些信息可能有助于了解生活方式和饮食对凸轮形态学的可能影响。
问题/目的：本研究旨在评估三个历史人群的股骨形态学。我们提出了以下问题：（1）在三个研究人群中是否存在凸轮形态学，这些人群之间是否存在差异，以及性别之间是否存在差异？（2）在检查的人群之间和之间，颈干角、版本或倾斜度是否存在差异？
我们检查了来自伊朗新石器时代人群（n=37，公元前 3000 年至 1631 年）、波兰中世纪人群（n=135，10 世纪至 13 世纪）和澳大利亚当代原住民（n=32，20 世纪初）的 204 个成人股骨，分别由 Open Research Scan Archive、Lednica 的第一皮阿斯博物馆和弗罗茨瓦夫大学提供。这三个人类群体代表了不同的历史时期和生活方式。所有骨骼均使用 CT 扫描，并在选定的平面上对其三维（3-D）重建进行测量。凸轮撞击定义为在倾斜视图上测量的 alpha 角>55°。为了评估人群之间解剖结构的差异，我们在真实 AP 视图上测量真实颈干角，在虚假 AP 视图上测量虚假颈干角，在版本视图上测量版本角，在倾斜视图上测量倾斜角。使用卡方检验、单因素方差分析和事后 Tukey 检验以及配对 t 检验比较组间凸轮形态学和其他解剖参数的差异。
伊朗新石器时代人群中有 5%存在凸轮形态学，波兰中世纪人群中有 7%存在凸轮形态学，澳大利亚当代原住民股骨中有 3%存在凸轮形态学（伊朗新石器时代人群/波兰中世纪人群的比值为 0.7[95%置信区间 0.2 至 3.4]；p=0.67；伊朗新石器时代人群/澳大利亚当代原住民的比值为 1.8[95%置信区间 0.2 至 20.5]；p=0.65；波兰中世纪人群/澳大利亚当代原住民的比值为 2.5[95%置信区间 0.3 至 20.1]；p=0.40）。在波兰中世纪人群中，男女两性之间存在凸轮形态学的存在差异，其中女性为 1%（76 人中 1 人），男性为 15%（59 人中 9 人）（p=0.002）。在伊朗新石器时代人群（121°±6°）和澳大利亚当代原住民（131°±5°；平均差异 10°[95%置信区间 7°至 13°]；p<0.001）和波兰中世纪人群（124°±5°）和澳大利亚当代原住民（平均差异 7°[95%置信区间 5°至 9°]；p<0.001）之间存在颈干角差异。在伊朗新石器时代人群（126°±6°）和澳大利亚当代原住民（134°±5°；平均差异 8°[95%置信区间 6°至 11°]；p<0.001）和波兰中世纪人群（126°±6°）和澳大利亚当代原住民（平均差异 9°[95%置信区间 7°至 11°]；p<0.001）之间存在虚假颈干角差异。此外，我们观察到伊朗新石器时代人群（19°±7°）和波兰中世纪人群（12°±9°；平均差异 7°[95%置信区间 4°至 10°]；p<0.001）之间的版本角差异和上述组之间的倾斜角差异（18°±7°对 11°±8°；平均差异 7°[95%置信区间 5°至 10°]；p<0.001）。
本研究发现，凸轮形态学在历史人群中的发生率与当代人群相当。
在历史人群中存在凸轮形态学表明，凸轮形态学可以在现代青少年的剧烈运动之外发展。进一步的研究将有助于阐明凸轮形态学的病因，这可能对制定预防策略有用。
