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Noebauer-Huhmann IM, Koenig FRM, Chiari C, Schmaranzer F. [Femoroacetabular impingement in adolescents]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:749-757. [PMID: 37698653 PMCID: PMC10522737 DOI: 10.1007/s00117-023-01197-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 09/13/2023]
Abstract
Femoroacetabular impingement syndrome (FAIS) is caused by a repetitive mechanical conflict between the acetabulum and the proximal femur, occurring in flexion and internal rotation. In cam impingement, bony prominences of the femoral head-neck junction induce chondrolabral damage. The acetabular type of FAIS, termed pincer FAIS, may be either due to focal or global retroversion and/or acetabular overcoverage. Combinations of cam and pincer morphology are common. Pathological femoral torsion may aggravate or decrease the mechanical conflict in FAI but can also occur in isolation. Of note, a high percentage of adolescents with FAI-like shape changes remain asymptomatic. The diagnosis of FAIS is therefore made clinically, whereas imaging reveals the underlying morphology. X‑rays in two planes remain the primary imaging modality, the exact evaluation of the osseous deformities of the femur and chondrolabral damage is assessed by magnetic resonance imaging (MRI). Acetabular coverage and version are primarily assessed on radiographs. Evaluation of the entire circumference of the proximal femur warrants MRI which is further used in the assessment of chondrolabral lesions, and also bone marrow and adjacent soft tissue abnormalities. The MRI protocol should routinely include measurements of femoral torsion. Fluid-sensitive sequences should be acquired to rule out degenerative or inflammatory extra-articular changes.
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Affiliation(s)
- Iris-M Noebauer-Huhmann
- Universitätsklinik für Radiologie und Nuklearmedizin, Abteilung für Neuroradiologie und Muskuloskelettale Radiologie, Medizinische Universität Wien, Wien, Österreich.
| | - Felix R M Koenig
- Universitätsklinik für Radiologie und Nuklearmedizin, Abteilung für Neuroradiologie und Muskuloskelettale Radiologie, Medizinische Universität Wien, Wien, Österreich
| | - Catharina Chiari
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Wien, Österreich
- Abteilung für Kinderorthopädie und Fußchirurgie, Orthopädisches Spital Speising, Wien, Österreich
| | - Florian Schmaranzer
- Universitätsklinik für Diagnostische‑, Interventionelle- und Pädiatrische Radiologie, Inselspital Bern, Universität Bern, Bern, Schweiz
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Zimmerer A, Gebhardt S, Kinkel S, Sobau C. [Minced cartilage procedure for the treatment of acetabular cartilage lesions of the hip joint]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2023; 35:100-109. [PMID: 36692521 DOI: 10.1007/s00064-022-00796-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/11/2022] [Accepted: 08/21/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Treatment of acetabular cartilage defects using autologous cartilage fragments. INDICATIONS Acetabular cartilage damage (1-6 cm2) associated with femoroacetabular impingement syndrome (FAIS). CONTRAINDICATIONS Advanced osteoarthritis (≥ 2 according to Tönnis) and extensive acetabular cartilage damage > 6 cm2. Lack of labral containment due to irreparable labral damage. SURGICAL TECHNIQUE Arthroscopic preparation of the acetabular cartilage damage and removal of unstable cartilage fragments using a 4.0 mm shaver, which minces the cartilage fragments. If necessary, additional cartilage harvesting over the CAM morphology requiring resection. Collection of the cartilage fragments using GraftnetTM and augmentation with autologous conditioned plasma (ACP). Treatment of associated pathologies such as CAM morphology, pincer morphology, and labral refixation or reconstruction. Implantation of cartilage mass and remodeling into the defect zone. Final sealing with autologous fibrin. POSTOPERATIVE MANAGEMENT Postoperatively, weight bearing is restricted to 20 kg and range of motion to 90° of flexion for 6 weeks. This is supplemented by passive movement using a continuous passive motion (CPM) device. RESULTS Since 2021, 13 patients treated with the described method were followed up for at least 6 months. A significant increase in the International Hip Outcome Tool (iHot)-12 and a significant reduction of pain were observed. No severe complications occurred.
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Affiliation(s)
- Alexander Zimmerer
- ARCUS Kliniken, Rastatterstr. 17-19, 75179, Pforzheim, Deutschland.
- Klinik und Poliklinik für Orthopädie und Orthopädische Chirurgie, Universitätsmedizin Greifswald, Greifswald, Deutschland.
| | - Sebastian Gebhardt
- Klinik und Poliklinik für Orthopädie und Orthopädische Chirurgie, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Stefan Kinkel
- ARCUS Kliniken, Rastatterstr. 17-19, 75179, Pforzheim, Deutschland
| | - Christian Sobau
- ARCUS Kliniken, Rastatterstr. 17-19, 75179, Pforzheim, Deutschland
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Ratner D, Kolaczko JG, Jeffers K, Lambers F, Orahovats A, Wait T, Stevanovic O, Genuario J. Three-Dimensional Analysis Versus Two-Dimensional Slice-Based Analysis of CT for Measuring Femoral Torsion and Its Correlation to Passive Hip Range of Motion. Cureus 2022; 14:e29554. [PMID: 36312639 PMCID: PMC9595073 DOI: 10.7759/cureus.29554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Femoral torsion is an important anatomical consideration of the hip that has major implications on the natural motion of the hip joint. Similarly, it affects pathologic conditions of the hip, including femoroacetabular impingement, dysplasia, and/or microinstability. Femoral torsion is typically measured on two-dimensional (2D) axial CT cuts by creating the angle between the femoral neck and the posterior aspect of the ipsilateral femoral condyles. Position of the leg during imaging may affect 2D measurements. Three-dimensional (3D) analysis of a hip CT with inclusion of femoral alignment may portray the anatomy of the hip more accurately as compared to a 2D slice-based analysis of a hip CT scan. It is thought that femoral torsion measured using this system could be a more accurate and reliable means of measurement. The primary purpose of this study is to assess the differences in measuring femoral torsion with 3D modeling and analysis compared to the standard 2D slice-based approach on a CT scan. Secondarily, we attempt to determine how the passive range of motion of the hip correlates with femoral torsion measured using the 3D model versus the 2D model. Methods In a prospective cohort study of 20 patients, femoral torsion was assessed using both 2D analysis and 3D analysis. The differences between these measurements on each of the imaging modalities were compared. Additionally, each patient had the passive range of motion of their hip measured with a goniometer. The amount of internal and external rotation was measured with the hip in a neutral position and with the hip flexed to 90°. Acetabular version, combined version, and alpha angle were added to multivariate regression analysis to evaluate their effect versus femoral torsion alone. Results Femoral antetorsion measured using the standard 2D slice-based approach on CT scan was 22.1° (SD: 11.1°), which was higher (p<0.001) than that using 3D analysis (8.25°; SD: 10.5°). There was a strong correlation between femoral torsion measurements using 3D analysis and 2D analysis (R=0.91). Based on 3D analysis, there was a moderate correlation between femoral torsion and passive hip external rotation measured with the hip flexed to 90° (R=0.65, p<0.002) and with the hip in a neutral position (R=0.58, p<0.007). Conclusion There was a significant difference between femoral torsion measurements using the 3D analysis, which showed approximately 14° of less antetorsion on average. Additionally, rotation of the hip and femoral torsion was correlated to higher levels of antetorsion associated with more internal rotation of the hip.
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Heimer CYW, Wu CH, Perka C, Hardt S, Göhler F, Winkler T, Bäcker HC. The Impact of Hip Dysplasia on CAM Impingement. J Pers Med 2022; 12:jpm12071129. [PMID: 35887626 PMCID: PMC9316409 DOI: 10.3390/jpm12071129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/28/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Predisposing factors for CAM-type femoroacetabular impingement (FAI) include acetabular protrusion and retroversion; however, nothing is known regarding development in dysplastic hips. The purpose of this study was to determine the correlation between CAM-type FAI and developmental dysplastic hips diagnosed using X-ray and rotational computed tomography. In this retrospective study, 52 symptomatic hips were included, with a mean age of 28.8 ± 7.6 years. The inclusion criteria consisted of consecutive patients who suffered from symptomatic dysplastic or borderline dysplastic hips and underwent a clinical examination, conventional radiographs and rotational computed tomography. Demographics, standard measurements and the rotational alignments were recorded and analyzed between the CAM and nonCAM groups. Among the 52 patients, 19 presented with CAM impingement, whereas, in 33 patients, no signs of CAM impingement were noticed. For demographics, no significant differences between the two groups were identified. On conventional radiography, the acetabular hip index as well as the CE angle for the development of CAM impingement were significantly different compared to the nonCAM group with a CE angle of 21.0° ± 5.4° vs. 23.7° ± 5.8° (p = 0.050) and an acetabular hip index of 25.6 ± 5.7 vs. 21.9 ± 7.3 (p = 0.031), respectively. Furthermore, a crossing over sign was observed to be more common in the nonCAM group, which is contradictory to the current literature. For rotational alignment, no significant differences were observed. In dysplastic hips, the CAM-type FAI correlated to a lower CE angle and a higher acetabular hip index. In contrast to the current literature, no significant correlations to the torsional alignment or to crossing over signs were observed.
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Affiliation(s)
- Carsten Y. W. Heimer
- Centrum für Muskuloskeletale Chirurgie, Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (C.Y.W.H.); (C.P.); (S.H.); (T.W.)
| | - Chia H. Wu
- Department of Orthopaedics & Sports Medicine, Baylor College of Medicine Medical Centre, Houston, TX 77030, USA;
| | - Carsten Perka
- Centrum für Muskuloskeletale Chirurgie, Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (C.Y.W.H.); (C.P.); (S.H.); (T.W.)
| | - Sebastian Hardt
- Centrum für Muskuloskeletale Chirurgie, Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (C.Y.W.H.); (C.P.); (S.H.); (T.W.)
| | - Friedemann Göhler
- Department of Radiology, Charité Berlin, University Hospital, Chariteplatz 1, 10117 Berlin, Germany;
| | - Tobias Winkler
- Centrum für Muskuloskeletale Chirurgie, Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (C.Y.W.H.); (C.P.); (S.H.); (T.W.)
- Julius Wolff Institute, Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies, Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Henrik C. Bäcker
- Centrum für Muskuloskeletale Chirurgie, Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (C.Y.W.H.); (C.P.); (S.H.); (T.W.)
- Correspondence:
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Gollwitzer H, Möckel G, Sobau C. Auswahl des Operationsverfahrens beim Femoroazetabulären Impingement-Syndrom. DER ORTHOPADE 2022; 51:219-229. [DOI: 10.1007/s00132-022-04213-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 01/11/2023]
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Prävalenz, Biomechanik und Diagnostik femoraler Achs- und Torsionsfehler. ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-021-00502-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ZusammenfassungAbweichungen der Anatomie des proximalen Femurs (Torsionspathologien, Coxa valga/vara) führen zu Veränderungen der Biomechanik des Hüftgelenks. Dies kann sich in einem femoroazetabulären Impingement (FAI), einer Mehrbelastung durch erhöhten intraartikulären Druck oder einer Fehl- oder Überbelastung der Hüftgelenkabduktoren manifestieren. Die Morphologie des Beckens, insbesondere die Version und Überdachung des Azetabulums, kann einen kompensatorischen oder verstärkenden Effekt haben und muss in die globale Beurteilung des Hüftgelenks miteinbezogen werden. Eine ausführliche klinische und radiologische Evaluation ist für eine korrekte Diagnosestellung von entscheidender Bedeutung. Die Patienten berichten meist von inguinalen, z. T. aber auch von glutealen Schmerzen. Diese sind häufig von mechanischem Charakter und können durch bestimmte Bewegungen provoziert werden. Der Bewegungsumfang der Hüfte ist beim FAI vermindert, und es zeigt sich ein positiver vorderer und/oder hinterer Impingement-Test. Torsionspathologien führen häufig zu einem veränderten Gangbild. So präsentieren sich Patienten mit erhöhter femoraler Torsion oft mit einem innenrotierten, bei verminderter Torsion mit einem außenrotierten Gangbild. Zudem zeigt sich häufig eine Abduktoreninsuffizienz. Während zur Bestimmung des Collum-Diaphysen-Winkels (CCD-Winkel) eine zentrierte Beckenübersichtsröntgenaufnahme im a.-p.-Strahlengang verwendet werden kann, sollte die Bestimmung der Torsion anhand einer Computertomographie (CT) oder Magnetresonanztomographie (MRT) von Knien und Hüftgelenk erfolgen. Von entscheidender Bedeutung ist die Angabe der verwendeten Messmethode der femoralen Torsion, da große systematische Unterschiede der Torsionswerte zwischen den verschiedenen Messmethoden bestehen.
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Abstract
Preoperative evaluation of the pathomorphology is crucial for surgical planning, including radiographs as the basic modality and magnetic resonance imaging (MRI) and case-based additional imaging (e.g. 3D-CT, abduction views). Hip arthroscopy (HAS) has undergone tremendous technical advances, an immense increase in use and the indications are getting wider. The most common indications for revision arthroscopy are labral tears and residual femoroacetabular impingement (FAI). Treatment of borderline developmental dysplastic hip is currently a subject of controversy. It is paramount to understand the underlining problem of the individual hip and distinguish instability (dysplasia) from FAI, as the appropriate treatment for unstable hips is periacetabular osteotomy (PAO) and for FAI arthroscopic impingement surgery. PAO with a concomitant cam resection is associated with a higher survival rate compared to PAO alone for the treatment of hip dysplasia. Further, the challenge for the surgeon is the balance between over- and undercorrection. Femoral torsion abnormalities should be evaluated and evaluation of femoral rotational osteotomy for these patients should be incorporated to the treatment plan.
Cite this article: EFORT Open Rev 2021;6:472-486. DOI: 10.1302/2058-5241.6.210019
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Affiliation(s)
- Markus S Hanke
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Till D Lerch
- Department of Diagnostic, Interventional and Pediatric Radiology University Hospital of Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology University Hospital of Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Malin K Meier
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
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