Clinical presentation of femoroacetabular impingement

The purpose of this study was to identify subjective complaints and objective findings in patients treated for femoroacetabular impingement (FAI). Three hundred and one arthroscopic hip surgeries were performed to treat FAI. The most frequent presenting complaint was pain, with 85% of patients reporting moderate or marked pain. The most common location of pain was the groin (81%). The average modified Harris Hip score was 58.5(range 14–100). The average sports hip outcome score was 44.0 (range 0–100). The anterior impingement test was positive in 99% of the patients. Range of motion was reduced in the injured hip. Patients who had degenerative changes in the hip had a greater reduction in range of motion. The most common symptom reported in patients with FAI was groin pain. Patient showed decreased ability to perform activities of daily living and sports. Significant decreases in hip motion were observed in operative hips compared to non-operative hips. Research performed at the Steadman Hawkins Research Foundation, Vail, CO.     

股骨髋臼撞击症的CT表现分析

目的通过观察分析确诊为股骨髋臼撞击症的髋关节的CT表现,找出其影像特点。方法对22侧(21例)髋关节的CT图像进行了分类和影像征象分析。结果 22侧股骨髋臼撞击症髋关节,杵型12侧,臼型10侧。以股骨头骨赘、髋臼缘硬化增生、关节面失光滑、关节面下密度异常四项CT征象做为杵型组和臼型组的对照指标,股骨头骨赘和关节面失光滑有明显差别。结论股骨头骨赘和关节面失光滑这些指标都反映了致病机制的差异。股骨髋臼撞击症的诊断,需要综合考虑临床病史及影像征象。     

髋关节撞击综合征的影像表现

瑞士医生Ganz于1999年首先报道髋关节撞击综合征(femoroacetabular impingement,FAI)[1],并于2003年正式提出FAI的概念[2].FAI是由于股骨近端与髋臼盂缘的相对解剖关系异常,导致髋关节活动时两者之间不正常的接触、碰撞,损伤髋臼盂唇、关节软骨,从而引起腹股沟区慢性疼痛、髋关节活动受限等一系列临床症状[2].     

Physical examination tests for the diagnosis of femoroacetabular impingement. A systematic review

Numerous clinical tests have been proposed to diagnose FAI, but little is known about their diagnostic accuracy.ObjectivesTo summarize and evaluate research on the accuracy of physical examination tests for diagnosis of FAI.MethodsA search of the PubMed, SPORTDiscus and CINAHL databases was performed. Studies were considered eligible if they compared the results of physical examination tests to those of a reference standard. Methodological quality and internal validity assessment was performed by two independent reviewers using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool.ResultsThe systematic search strategy revealed 298 potential articles, five of which articles met the inclusion criteria. After assessment using the QUADAS score, four of the five articles were of high quality. Clinical tests included were Impingement sign, IROP test (Internal Rotation Over Pressure), FABER test (Flexion–Abduction–External Rotation), Stinchfield/RSRL (Resisted Straight Leg Raise) test, Scour test, Maximal squat test, and the Anterior Impingement test. IROP test, impingement sign, and FABER test showed the most sensitive values to identify FAI.ConclusionsThe diagnostic accuracy of physical examination tests to assess FAI is limited due to its heterogenecity. There is a strong need for sound research of high methodological quality in this area.     

股骨髋臼撞击症的影像学评估

股骨髋臼撞击症（FAI）是引起青年人髋关节运动障碍及髋部疼痛的主要原因之一,与股骨、髋臼解剖形态学异常密切相关,髋关节运动时异常撞击进而导致软骨损伤。X线摄影、CT定量测量及MRI等观察软骨的影像方法可进一步明确FAI的分型,有助于临床诊断治疗。就FAI的影像学典型表现及其定量测量方法予以综述。     

髋关节撞击综合征的X线诊断

髋关节撞击综合征(femoroacetabular impingement,FAI)是指由于股骨近端和髋臼盂缘间解剖形态异常,在髋关节运动时股骨近端和髋臼盂缘之间发生异常接触或碰撞,引起髋臼盂唇和关节的软骨、骨的损伤和异常,如果不早期干预处理,最终会导致髋关节骨性关节炎[1,2].X线检查是确诊其解剖形态异常的重要而简易的手段.由于FAI是近些年才被认识的病变,骨科和影像医师对其认识不足,本文通过收集FAI患者的髋关节X线片进行分析和探讨,旨在加深对该病X线表现的认识,提高其影像诊断水平.     

Arthroscopic management of femoroacetabular impingement: osteoplasty technique and literature review

Morphological and spatial abnormalities of the proximal femur and acetabulum have been recently recognized as causes of femoroacetabular impingement. During joint motion in hips with femoroacetabular impingement, abnormal bony contact occurs, and soft tissue structures (chondral and labral) often fail. Femoroacetabular impingement has been reported to be a contributor to early-onset joint degeneration. Ganz et al have described good midterm success with an open surgical dislocation approach to reconstruct normal joint clearance. The purpose of this report is to discuss relevant literature and describe an arthroscopic approach to treat femoroacetabular impingement. This approach has particular relevance in high-demand patients, particularly in athletes seeking to return to high-level sport.     

The arthroscopic management of femoroacetabular impingement

Femoroacetabular impingement (FAI) has recently been implicated in causing a spectrum of injury ranging from anterior hip pain, labral tears, chondral damage, and eventually perhaps to idiopathic arthritis of the hip. Three distinct types have been described: cam, pincer and mixed, with the mixed one being the commonest. Surgical treatment of femoroacetabular impingement is focused towards providing an adequate clearance to alleviate femoral abutment against the acetabular rim. This is achieved by restoring a normal femoral head–neck offset and recessing the acetabular rim if necessary. The treatment of FAI has been achieved with reasonable success by open surgical dislocation as described by the Swiss group. However, the protracted post-operative recovery coupled with the trauma sustained during the open procedure, have led to the development of an arthroscopic approach to manage this problem. The purpose of this article is to provide the reader with an up-to-date knowledge of the clinical and diagnostic aspects of FAI, to describe our arthroscopic technique in detail with its pitfalls and possible complications and to discuss the results and future of FAI.     

Imaging findings of femoroacetabular impingement syndrome

Femoroacetabular impingement syndrome (FAI) is a pathologic entity which can lead to chronic symptoms of pain, reduced range of motion in flexion and internal rotation, and has been shown to correlate with degenerative arthritis of the hip. History, physical examination, and supportive radiographic findings such as evidence of articular cartilage damage, acetabular labral tearing, and early-onset degenerative changes can help physicians diagnose this entity. Several pathologic changes of the femur and acetabulum are known to predispose patients to develop FAI and recognition of these findings can ultimately lead to therapeutic interventions. The two basic mechanisms of impingement—cam impingement and pincer impingement—are based on the type of anatomic anomaly contributing to the impingement process. These changes can be found on conventional radiography, MR imaging, and CT examinations. However, the radiographic findings of this entity are not widely discussed and recognized by physicians. In this paper, we will introduce these risk factors, the proposed supportive imaging criteria, and the ultimate interventions that can help alleviate patients symptoms.     

Rehabilitation after hip femoroacetabular impingement arthroscopy

Hip arthroscopic techniques to repair labral tears and address femoroacetabular impingement (FAI) are evolving. This article discusses the different phases of rehabilitation and the rehabilitation protocol. Although there is evidence to support arthroscopic procedures to address labral tears and FAI, there are few published evidence-based rehabilitation studies dedicated to postoperative rehabilitative care. It is thought that by following the restrictions set by the physician while performing early circumduction, using the minimal criteria to advance through each subsequent phase, and allowing patients to perform functional sport progressions throughout the rehabilitation athletes will be able to return to sport smoothly and effectively.     

充分发挥影像检查在髋关节撞击综合征诊断中的作用

近年来,髋关节撞击综合征(femoroacetabular impingement,FAI)逐渐受到临床的重视,它是由于股骨近端和髋臼盂缘间解剖的异常,或解剖正常但长期不正常轻微、反复外力作用于髋关节,导致两者长期不正常接触、碰撞,产生髋关节盂唇损伤和关节软骨退行性变化,引起髋关节慢性疼痛,屈曲和内旋受限,最终发展为髋关节骨关节炎[1].     

Hip MR arthrography and femoroacetabular impingement

Hip pain is a common complaint among athletes of all ages. Advances in imaging and treatment are changing the paradigm of evaluation and management of hip pain. The role of abnormal femoral and acetabular morphology and lesions of the acetabular labrum and cartilage is increasingly recognized as being crucial in the development of degenerative change. In addition, femoroacetabular impingement is increasingly recognized as an etiologic factor in hip pain. This article discusses techniques of hip magnetic resonance (MR) arthrography, normal anatomy seen at hip MR arthrography, common intra-articular pathologies in patients with hip pain, and imaging findings of femoroacetabular impingement.     

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.     

Imaging findings of femoroacetabular impingement syndrome: focusing on mixed-type impingement

The aim of our study was to analyze the imaging findings of femoroacetabular impingement (FAI). Eight consecutive patients [age range, 19–46 years (mean, 28.6 years); M/F ratio=7:1] who underwent operation for FAI were analyzed. We analyzed bump, acetabular retroversion and protrusion, and osteoarthritis in the radiographs. In MR arthrography, we analyzed α-angle, anterolateral labral tear, cartilage abnormality, herniation pit, paralabral cyst, subchondral cyst, and marrow edema. We correlated the imaging findings with operative findings. In the radiographs, all eight patients showed bump and osteoarthritis (Kellgren–Lawrence score II–IV), and five (62.5%) patients showed acetabular retroversion. In MR arthrography, anterolateral labral tear and mild cartilage abnormality (Outerbridge grade I and II) were seen in all eight patients; increased α-angle was seen in six cases (75%). Anterolateral labral tear, bump, and mild cartilage abnormality were seen in all eight patients during operation. According to the above findings, we divided the patients into three cam-type and five mixed-type FAI. In the five mixed-type FAI, both bump and acetabular retroversion were seen. The mixed-type FAI is the most prevalent type in our study. The main imaging findings of mixed-type FAI were acetabular retroversion, bump, and early osteoarthritis in radiographs, and anterolateral labral tear, cartilage abnormality, and increased α-angle in MR arthrography.