Radiographic findings of femoroacetabular impingement in capoeira players

Purpose

Capoeira is a Brazilian martial art that requires extreme movements of the hip to perform jumps and kicks. This study evaluated a group of capoeira players to assess the prevalence of femoroacetabular impingement (FAI) in athletes practicing this martial art.

Methods

Twenty-four experienced capoeira players (14 men, 10 women) underwent a diagnostic assessment, including clinical examination and standard radiographs of the pelvis and hips. The α-angle, head–neck offset, crossover sign, acetabular index, lateral centre-edge angle, and the Tönnis grade were assessed using the radiographs. Clinical relationships for any radiographic abnormalities indicating FAI were also evaluated.

Results

Four subjects (17 %) reported pain in their hips. Forty-four hips (91.7 %) had at least one radiographic sign of CAM impingement, and 22 (45.8 %) had an α-angle of more than 60°. Eighteen hips (37.5 %) had at least one sign of pincer impingement and 16 (33.3 %) a positive crossover sign. Sixteen hips (33.3 %) had mixed impingement. There was a significant positive association between having an α-angle of more than 60° and the presence of groin pain (P = 0.002). A reduced femoral head–neck offset (P < 0.001) and an increased α-angle on the anteroposterior radiograph (P = 0.008) were independently associated with a higher Tönnis grade.

Conclusion

High prevalence of radiographic CAM-type FAI among these skilled capoeira players was found. In these subjects, a negative clinical correlation for an increased α-angle was also detected. Additional caution should be exercised whenever subjects with past or present hip pain engage in capoeira.

Level of evidence

Diagnostic, Level III.     

Fibrocystic changes at anterosuperior femoral neck: prevalence in hips with femoroacetabular impingement

PURPOSE: To retrospectively evaluate if there is an association between juxta-articular fibrocystic changes at the anterosuperior femoral neck and femoroacetabular impingement (FAI). MATERIALS AND METHODS: The institutional review board approved this study and did not require informed patient consent. An orthopedic surgeon and a radiologist in consensus retrospectively reviewed the anteroposterior (AP) pelvic radiographs of 117 hips with FAI and compared these images with the AP radiographs of a control group of 132 hips with developmental dysplasia (DD) to determine the prevalence of juxta-articular fibrocystic changes at the anterosuperior femoral neck. Criteria for juxta-articular fibrocystic changes at the anterosuperior femoral neck were location close to the physis and a diameter (of the fibrocystic change) of greater than 3 mm. The sensitivity and specificity of AP pelvic radiography in the detection of these fibrocystic changes were calculated by using an additional 61 hips with FAI and on the basis of findings at magnetic resonance (MR) arthrography, which was routinely performed for assessment of FAI. In 24 patients who underwent joint-preserving surgery for FAI, the fibrocystic changes were localized intraoperatively and the spatial relation of the region of these changes to the area of FAI was identified. Joint-preserving surgery consisted of anterior surgical dislocation of the hip with osteochondroplasty of the proximal femur and/or the acetabular rim to improve the impingement-free range of hip motion. For statistical comparisons, nonparametric tests were performed. RESULTS: Fibrocystic changes were identified on the AP radiographs of 39 (33%) of the 117 FAI-affected hips and on none of the radiographs of the 132 DD-affected hips. According to MR arthrogram findings, the sensitivity, specificity, and positive and negative predictive values of AP pelvic radiography were 64%, 93%, 91%, and 71%, respectively. The mean diameter of the juxta-articular fibrocystic changes was 5 mm (range, 3-15 mm); smaller lesions were more prevalent. Dynamic MR imaging with the hip flexed and intraoperative observations revealed a close spatial relationship between the region of the fibrocystic changes at the anterosuperior femoral neck and the acetabular rim. CONCLUSION: The high prevalence of juxta-articular fibrocystic changes at the anterosuperior femoral neck and their spatial relation to the impingement site suggest an association and possible causal relationship between these alterations and FAI.     

Radiographic prevalence of CAM-type femoroacetabular impingement after open reduction and internal fixation of femoral neck fractures

Purpose

The purpose of this study was to estimate the radiographic prevalence of CAM-type femoroacetabular impingement (FAI) in elderly patients (≥50 years) who have undergone internal fixation for femoral neck fracture.

Methods

A total of 187 frog-leg lateral radiographs of elderly patients who underwent internal fixation for a femoral neck fracture were reviewed by two independent reviewers. The alpha angle, beta angle, and femoral head–neck offset ratio were calculated. The presence of two abnormal radiographic parameters was deemed to be diagnostic of radiographic CAM-type impingement.

Results

Radiographic CAM-type FAI was identified in 157 out of 187 (84 %) patients who underwent internal fixation for fractures of the femoral neck. Moderate-to-good inter-observer reliability was achieved in the measurement of radiographic parameters. With reference to fracture subtypes and prevalence of radiographic features of CAM-type morphology, 97 (72 %) out of 134 patients were positive for CAM in Garden subtypes I and II, whereas 49 (85.9 %) out of 57 patients had radiographic CAM in Garden III and IV subtypes.

Conclusion

There was a high prevalence of CAM-type FAI in patients that underwent surgical fixation of femoral neck fractures. This is significantly higher than the reported prevalence in non-fracture patient populations. The high prevalence of CAM morphology could be related to several factors, including age, fracture morphology, quality of reduction, type of fixation, and fracture healing.

Level of evidence

IV.     

Altered gait mechanics are associated with severity of chondropathy after hip arthroscopy for femoroacetabular impingement syndrome

BackgroundSuboptimal patient-reported function and movement impairments often persist after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Individuals with FAIS with preoperative cartilage pathology (ie. chondropathy) demonstrate distinct movement patterns and have worse post-operative outcomes. It is unknown whether the presence of chondropathy after surgery negatively affects movement and function.Research questionDo sagittal plane gait mechanics differ based on chondropathy severity following arthroscopy for FAIS?MethodsA cross-sectional walking gait analysis was performed for 25 participants post-arthroscopy (2.48 ± 1.38y) and 12 healthy controls (HCs). Peak total support moment (TSM) and relative contributions of the hip, knee, and ankle were calculated during loading response. The Hip Osteoarthritis MRI Scoring System was used to categorize the FAIS group into no-mild or moderate-severe chondropathy groups based on 3 T magnetic resonance imaging of their surgical hip. The interactions of group by limb were evaluated for kinetic variables, covaried by gait speed.ResultsGroups did not differ based on age, BMI and sex distribution (P ≥ 0.14). 13 participants with FAIS presented with moderate-severe chondropathy and 12 presented with no-mild chondropathy. Participants with moderate-severe chondropathy walked significantly slower than both other groups (P = 0.006) and demonstrated lower peak TSM than those with no-mild chondropathy (P = 0.002). Participants with no-mild chondropathy demonstrated lower hip (61.5 %) and greater ankle (17.7 %) contributions to the TSM on the involved limb compared to the moderate-severe group (hip:73.4 %, P = 0.07; ankle:10.5 %, P = 0.007).SignificanceSlower gait speed alone did not explain the lower TSM strategy in participants with moderate-severe chondropathy. Interestingly, the joint contribution strategy of this group was not different than HCs. Participants with no-mild chondropathy demonstrated a TSM strategy that shifted the demand away from their hip and toward their ankle. Given the small sample size, and large variability in joint strategies, future work needs to examine whether these alterations in gait strategy, with or without advanced chondropathy, impact patient function.     

2081例健康青年人股骨髋臼撞击综合征相关影像学表现发生率的人群队列研究

目的探讨股骨髋臼撞击综合征(FAI)的定性影像学表现以及征象之间的关系,并评估影像解读时组内与组间的变异性。材料与方法本研究为经机构审查委员会批准的     

Triad of MR arthrographic findings in patients with cam-type femoroacetabular impingement

PURPOSE: To retrospectively analyze magnetic resonance (MR) arthrographic findings in patients with clinical cam-type femoroacetabular impingement. MATERIALS AND METHODS: This study was approved by the institutional review board, and informed consent was waived. Study was compliant with the Health Insurance Portability and Accountability Act. Forty-two MR arthrograms obtained in 40 patients with clinical femoroacetabular impingement were analyzed retrospectively by two radiologists. Quantitative analysis by using alpha angle measurement was performed to assess anterosuperior femoral head-neck morphology. Presence of labral tears, articular cartilage lesions, paralabral cysts, os acetabuli, and synovial herniation pits was recorded. Presence of the typical triad of anterosuperior labral tear, anterosuperior cartilage lesion, and abnormal alpha angle was recorded. Surgical comparison was available for 11 patients. RESULTS: At imaging, in 40 patients (22 male, 18 female) with a mean age of 36.5 years, 39 of 42 hips (93%) had an abnormal alpha angle, with a mean angle of 69.7 degrees ; 40 of 42 (95%) had an anterosuperior cartilage abnormality; and 42 of 42 (100%) had an anterosuperior labral tear. Thirty-seven of 42 hips (88%) had the triad. Six had paralabral cysts, 17 had an os acetabuli, and two had synovial herniation pits. Surgical comparison for 11 hips led to confirmation of all labral and cartilage abnormalities seen at imaging. CONCLUSION: MR arthrography demonstrated a triad of abnormal head-neck morphology, anterosuperior cartilage abnormality, and anterosuperior labral abnormality in 37 of 42 patients with cam-type femoroacetabular impingement.     

Effects of a hip brace on biomechanics and pain in people with femoroacetabular impingement

Objectives

This study evaluates whether hip bracing in patients with femoroacetabular impingement (FAI) (a) immediately reduces range of hip internal rotation, flexion, adduction, and pain during functional tasks; and (b) improves patient-reported outcomes when worn daily over 4 weeks.

CT assessment of herniation pits: prevalence, characteristics, and potential association with morphological predictors of femoroacetabular impingement

The purpose of this study was to evaluate whether there is a correlation between the presence of herniation pits (HPs) and morphological indicators of cam and pincer femoroacetabular impingement (FAI) based on computed tomography (CT) examinations. CT studies of the pelvis obtained from 200 patients were retrospectively analysed for the presence of HPs and morphological abnormalities of the femoral head and acetabulum. As an indicator for cam FAI, we used the angle alpha, describing the anterior femoral head-neck junction. As an indicator for pincer FAI, we measured the acetabular coverage and the acetabular orientation. Student's t-test was used for statistical analysis. HPs were identified in 85 of the 200 patients. HPs were predominantly found in the superior portion of the proximal anterior femoral neck; some were located in the inferior portion. The angle alpha was significantly larger by 10% in the group with HPs. A correlation between the presence of HPs and morphological indicators of pincer FAI was not found. In conclusion HPs are not only located in the superior portion of the proximal anterior femoral neck, but also in the inferior portion. There is an association between the presence of HPs and a high value of angle alpha.     

股骨颈疝窝的CT评价:患病率、特征及其与股骨髋臼撞击综合征的形态学危险因素之间的可能关系

本研究的目的是评价CT上出现股骨颈疝窝(her-niation pits,HPs)与凸轮型及钳型股骨髋臼撞击综合征(femoroacetabular impingement,FAI)的形态学危险指标之间     

Herniation pits as a radiographic indicator of pincer-type femoroacetabular impingement in symptomatic patients

Purpose

The role of herniation pits as a radiographic indicator is still debated. This case–control study was to determine (1) the prevalence and sizes of herniation pits and (2) the relationship between herniation pits and femoral and acetabular bony morphology consistent with femoroacetabular impingement.

Methods

This comparative study was performed on 151 patients (151 hips; median patient age 46 years; range 16–73 years) with mechanical symptoms, who underwent multi-detector computed tomography (MDCT) arthrography (the symptomatic group), and an age-, gender-, site (left or right)-, and time (at diagnosis)-matched group of control patients that underwent multi-detector computed tomography due to an ureter stone (the asymptomatic group). Two orthopaedic surgeons reviewed images to evaluate the prevalence, sizes of herniation pits, and relationship with morphological abnormality.

Results

The prevalences of herniation pits in symptomatic and asymptomatic groups were 23.8 % (36/151) and 3.3 % (5/151), respectively (OR 9.14, 95 % CI 3.47–24.30; p < 0.001). Herniation pits were found to be significantly associated with pincer-type abnormality (p = 0.034), especially central acetabular retroversion (p < 0.001).

Conclusions

This study shows that the prevalence of herniation pits is higher in symptomatic patients with femoroacetabular impingement, and herniation pits are associated with central acetabular retroversion. Furthermore, herniation pits were also found to be a useful predictor of pincer-type femoroacetabular impingement.

Level of evidence

III.     

Comparison of pre-operative dGEMRIC imaging with intra-operative findings in femoroacetabular impingement: preliminary findings

Objectives  

To study standard MRI and dGEMRIC in patients with symptomatic FAI undergoing surgical intervention and compare them with intra-operative findings to see if they were corroborative.     

Outcome after hip arthroscopy for femoroacetabular impingement in 289 patients with minimum 2-year follow-up

Femoroacetabular impingement (FAI) is a common cause of hip pain and dysfunction. The purpose of this study was to report outcome 2 years after the arthroscopic treatment of FAI using validated outcome measurements. Two hundred and eighty-nine patients (males = 190, females = 99) with a mean age of 37 years underwent arthroscopic surgery for FAI. Patients were included consecutively in a hip arthroscopy registry. The cohort was evaluated using online web-based validated health-related patient-reported outcomes measurements, including the iHOT-12, HAGOS, EQ-5D, HSAS for physical activity level, VAS for overall hip function and overall satisfaction. The mean follow-up time was 25.4 months. Pre-operative scores compared with those obtained at follow-up revealed statistically and clinically significant improvements (P < 0.05) for all measured outcomes; iHOT-12 (43 vs 66), VAS for global hip function (50 vs 71), HSAS (2.9 vs 3.6), EQ-5D index (0.58 vs 0.75), EQ-VAS (67 vs 75) and HAGOS different subscales (56 vs 76, 51 vs 69, 60 vs 78, 40 vs 65, 29 vs 57, 33 vs 58). At the 2-year follow-up, 236 patients (82%) reported they were satisfied with the outcome of surgery. We conclude that arthroscopic treatment for FAI resulted in statistically and clinically significant improvements in outcome parameters.     

Radioguided surgery of primary hyperparathyroidism in a population with a high prevalence of thyroid pathology

Purpose  

Patients with concomitant thyroid pathology are usually excluded from minimally invasive radioguided parathyroidectomy (MIRP). We assessed the value in these patients of the gamma probe, alone or in combination with other techniques, in MIRP and unilateral or bilateral approaches. We evaluated its performance in association with intraoperative determination of intact parathyroid hormone (ioPTHi) and preoperative ^99mTc-MIBI dual phase scintigraphy.