Association between femoroacetabular impingement syndrome and limited lateral hip rotation in young athletes: A case–control study

Purpose:Hip pain is very common in athletes. One of the main disorders causing hip pain is femoroacetabular impingement syndrome. This study aimed to identify a new etiological risk factor for femoroacetabular impingement in the hip.Methods:This case–control study included 88 young athletes, 34 with pains in the hip (supposedly with femoroacetabular impingement) and 54 controls. Femoroacetabular impingement was diagnosed with a flexion, adduction, internal, and rotation test and a particular type of hip pain during sports activities. The medial (internal) and lateral (external) hip ranges of rotation have been measured with an inclinometer. The data were analyzed using a t-test, the Wilcoxon test, the Mann–Whitney U test, and logistic regression.Results:There is a statistically significant difference in the external hip rotation range between the athletes with hip pain and controls. Logistic regression analysis showed that external hip range of motion is significantly associated with femoroacetabular impingement.Conclusion:Limited external hip range of motion was found to be significantly associated with the diagnosis of femoroacetabular impingement in young athletes. A biomechanical explanation of the hypothesis that limited external hip rotation can predict femoroacetabular impingement is given. Based on our results, the hip’s lateral range of motion screening can be advised within the regular screening of young athletes. Kinesiotherapeutic procedures for stretching the muscles of the medial hip rotors can be advised to prevent the lateral hip rotation restriction and lower the risk of femoroacetabular impingement in case the limited rotation is due to muscular restriction.Level of evidence:level III—case–control study.     

Arthroscopically assisted anterior decompression for femoroacetabular impingement: technique and early clinical results

Introduction  In patients with symptomatic femoroacetabular impingement resection osteochondroplasty of the femoral head–neck junction may improve hip pain and range of motion. We evaluated the short-term treatment results of an arthroscopically assisted mini-open anterior approach to compare it with the results after surgical dislocation for FAI. Methods  The clinical and radiographic results of 33 patients were reviewed retrospectively 15 months after the surgery. Harris hip scores and plain radiographs were obtained preoperatively and at follow-up. Patient satisfaction with the treatment result was quantified with a Visual Analogous scale (VAS) ranging from 0 (very dissatisfied) to 10 (very satisfied). Results  The mean Harris hip score improved from 64 points preoperatively to 85 points at the time of follow-up (P < 0.001). Mean patient satisfaction on the VAS was seven points (range: 2–10 points). In two of our first patients we observed a transient femoral nerve palsy (completely resolved at follow-up) and 15 patients reported numbness in the area of the lateral cutaneous femoral nerve. Conclusions  Treatment of anterior femoroacetabular impingement through an arthroscopically assisted mini-open anterior approach can reduce pain and improve function in a short-term observation period. Femoral osteochondroplasty as well as surgical treatment of acetabular cartilage and labrum lesions are possible, but the access is limited to the anterior and anterolateral part of the hip joint.     

No Regeneration of the Human Acetabular Labrum After Excision to Bone

BackgroundTreatment options for a symptomatic, torn, irreparable, or completely ossified acetabular labrum are limited to either excision and/or reconstruction with grafts. In a previous animal model, regeneration of the acetabular labrum after excision to the bony rim has been shown. In humans, less is known about the potential of regeneration of the labrum. Recent studies seem to confirm labral regrowth, but it is still unclear if wide excision might be a surgical option in cases where repair is not possible.Questions/purposesThe purposes of this study were (1) to determine the extent of acetabular labrum regeneration after excision to the bony rim; and (2) to determine whether this procedure results in higher hip scores.MethodsWe reviewed all patients treated with surgical dislocation for symptomatic femoroacetabular impingement by a single surgeon at one institution between 2003 and 2008, of whom 14 underwent wide labral excision (of at least 60°) down to bone; we used this approach when there was an absence of reparable tissue. Of these 14, nine were available for voluntary reexamination. The mean age at surgery was 38 ± 9 SD years and the mean followup was 4 ± 1 SD years. All patients consented to a physical examination and an MRI arthrogram, which was evaluated for evidence of new tissue formation by four observers. A modified Harris hip score and the UCLA were recorded.ResultsRegrowth of a structure equivalent to normal labrum was not observed on the MRI arthrograms. Six of nine hips had segmental defects, bone formation was found in five, and the capsule was confluent with the new tissue in six. The mean Harris hip score at latest followup was 83 ± 14, and the mean UCLA score was 6 ± 2.ConclusionsResection of a nonreparable acetabular labrum down to a bleeding bony surface does not stimulate regrowth of tissue that appears to be capable of normal function by MR arthrography, and patients who underwent this procedure had lower hip scores at midterm than previously reported from the same institution for patients undergoing labral repair or sparse débridement. Based on these results, we believe that future studies should evaluate alternatives to reconstructing the labrum, perhaps using ligamentum teres, because resection seems neither to result in regrowth nor the restoration of consistently high hip scores.

Level of Evidence

Level IV, therapeutic study.     

Eighty Percent of Patients With Surgical Hip Dislocation for Femoroacetabular Impingement Have a Good Clinical Result Without Osteoarthritis Progression at 10?Years

BackgroundWe previously reported the 5-year followup of hips with femoroacetabular impingement (FAI) that underwent surgical hip dislocation with trimming of the head-neck junction and/or acetabulum including reattachment of the labrum. The goal of this study was to report a concise followup of these patients at a minimum 10 years.Questions/purposesWe asked if these patients had (1) improved hip pain and function; we then determined (2) the 10-year survival rate and (3) calculated factors predicting failure.MethodsBetween July 2001 and March 2003, we performed surgical hip dislocation and femoral neck osteoplasty and/or acetabular rim trimming with labral reattachment in 75 patients (97 hips). Of those, 72 patients (93 hips [96%]) were available for followup at a minimum of 10 years (mean, 11 years; range, 10–13 years). We used the anterior impingement test to assess pain and the Merle d’Aubigné-Postel score to assess function. Survivorship calculation was performed using the method of Kaplan and Meier and any of the following factors as a definition of failure: conversion to total hip arthroplasty (THA), radiographic evidence of worsening osteoarthritis (OA), or a Merle d’Aubigné-Postel score less than 15. Predictive factors for any of these failures were calculated using the Cox regression analysis.ResultsAt 10-year followup, the prevalence of a positive impingement test decreased from preoperative 95% to 38% (p < 0.001) and the Merle d’Aubigné-Postel score increased from preoperative 15.3 ± 1.4 (range, 9–17) to 16.9 ± 1.3 (12–18; p < 0.001). Survivorship of these procedures for any of the defined failures was 80% (95% confidence interval, 72%–88%). The strongest predictors of failure were age > 40 years (hazard ratio with 95% confidence interval, 5.9 [4.8–7.1], p = 0.002), body mass index > 30 kg/m² (5.5 [3.9–7.2], p = 0.041), a lateral center-edge angle < 22° or > 32° (5.4 [4.2–6.6], p = 0.006), and a posterior acetabular coverage < 34% (4.8 [3.7–5.6], p = 0.006).ConclusionsAt 10-year followup, 80% of patients with FAI treated with surgical hip dislocation, osteoplasty, and labral reattachment had not progressed to THA, developed worsening OA, or had a Merle d’Aubigné-Postel score of less than 15. Radiographic predictors for failure were related to over- and undertreatment of acetabular rim trimming.

Level of Evidence

Level IV, therapeutic study.