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Lewis CL, Shefelbine SJ. Lost in research translation: Female athletes are not male athletes, especially at the hip. J Orthop Res 2024; 42:2054-2060. [PMID: 38644357 DOI: 10.1002/jor.25860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/22/2024] [Accepted: 04/03/2024] [Indexed: 04/23/2024]
Abstract
Altered shape of the proximal femur (cam morphology) or acetabulum (pincer morphology) is indicative of femoroacetabular impingement, which can result in hip pain and osteoarthritis of the hip. As mechanical load during growth affects the resulting bone shape, there is strong evidence in males that cam morphology develops during skeletal growth while physes are open, rather than as an adaptation after growth plates are closed (skeletal maturity). This adaptation is particularly evident in athletes who participate at elite levels prior to skeletal maturity. The research providing this evidence, however, has primarily focused on male athletes. Despite the lack of inclusion in the research, females consistently comprise two thirds of the clinical and surgical populations with structural hip pain or pathology. Knowledge gained from male-dominated cohorts may not appropriately transfer to female athletes, especially at the hip. This perspectives article briefly reviews differences between females and males in femoral and acetabular structure, hormones, timing of puberty/maturation, hypermobility, activity level and movement control-factors which affect hip structure development and loading. Without female-focused research, the application of research findings from male athletes to female athletes may lead to ineffective or even inappropriate recommendations and treatments. Thus, there is a critical need for investment in research to promote life-long hip health for females.
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Affiliation(s)
- Cara L Lewis
- Department of Physical Therapy, Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, Massachusetts, USA
| | - Sandra J Shefelbine
- Department of Mechanical and Industrial Engineering and Department of Bioengineering, Northeastern University, Boston, Massachusetts, USA
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Regenbogen S, Shafizadeh S, Märdian S, Blum P, Osten P, Fuchs T, Jaecker V. Femoroacetabular Variations Are Predisposing Factors for Traumatic Posterior Hip Dislocation. J Bone Joint Surg Am 2024; 106:1000-1007. [PMID: 38557970 DOI: 10.2106/jbjs.23.00905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Although high-energy trauma mechanisms are generally considered to cause traumatic posterior hip dislocations, femoroacetabular variations are assumed to contribute to low-impact hip dislocations. Thus, the present study aimed to identify morphologic femoral and acetabular risk factors that may also contribute to posterior hip dislocations in high-energy trauma mechanisms. METHODS The acetabular and femoral morphology of 83 hips with a traumatic posterior dislocation following a high-energy trauma mechanism were analyzed and matched to a control group of 83 patients who sustained high-energy trauma without a hip injury. The lateral center-edge angle, acetabular index, acetabular depth/width ratio, cranial and central acetabular version angles, and the anterior and posterior acetabular sector angles were measured on computed tomography to quantify femoroacetabular impingement (FAI) morphology, acetabular version, and coverage. The caput-collum-diaphyseal angle and the alpha angles in the coronal and axial planes were measured to detect cam-type FAI deformity. A receiver operating characteristic curve was utilized to determine threshold values for an increased risk of hip dislocation. RESULTS Acetabular retroversion and posterior acetabular undercoverage were significantly increased in patients with hip dislocations compared with controls (p < 0.001). The central acetabular version angle and posterior acetabular sector angle that indicated an increased risk of hip dislocation were ≤9° and ≤90°, respectively. Cam-type FAI deformity and coxa valga were significantly increased in the dislocation group (p < 0.001). The anterolateral alpha angle that indicated an increased dislocation risk was ≥47°. CONCLUSIONS Acetabular retroversion, posterior acetabular undercoverage, and cam-type FAI morphology may be risk factors contributing to traumatic posterior hip dislocation in high-energy trauma mechanisms. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Stephan Regenbogen
- Department of Traumatology and General Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau am Staffelsee, Germany
- Department of Traumatology, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Sven Shafizadeh
- Department of Orthopedic Surgery and Sports Traumatology, Sana Medical Centre, Witten/Herdecke University, Cologne, Germany
| | - Sven Märdian
- Center for Musculoskeletal Surgery, Charitè-University Medicine Berlin, Berlin, Germany
| | - Philipp Blum
- Department of Traumatology and General Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau am Staffelsee, Germany
| | - Philipp Osten
- Department of Trauma and Orthopedic Surgery, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
| | - Thomas Fuchs
- Center for Musculoskeletal Surgery, Vivantes Klinikum, Berlin-Friedrichshain, Germany
| | - Vera Jaecker
- Center for Musculoskeletal Surgery, Charitè-University Medicine Berlin, Berlin, Germany
- Department of Trauma and Orthopedic Surgery, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany
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Palmer J, Getgood A, Lobenhoffer P, Nakamura R, Monk P. Medial opening wedge high tibial osteotomy for the treatment of medial unicompartmental knee osteoarthritis: A state-of-the-art review. J ISAKOS 2024; 9:39-52. [PMID: 37839705 DOI: 10.1016/j.jisako.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/13/2023] [Accepted: 10/08/2023] [Indexed: 10/17/2023]
Abstract
Medial unicompartmental knee osteoarthritis is a common condition that is frequently associated with significant pain and dysfunction. Medial opening wedge high tibial osteotomy (MOWHTO) offers a unique opportunity to preserve the knee joint and potentially alter the course of the degenerative process. Recent advances in this field of surgery have enabled surgeons to perform a MOWHTO in a safe, reliable and reproducible manner. This state-of-the-art review highlights the most important advances in the field of MOWHTO. Key concepts related to patient selection, pre-operative planning, surgical accuracy and patient outcome are considered. The importance of an individualized approach is emphasized and its influence on the future direction of the procedure is discussed.
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Affiliation(s)
| | - Alan Getgood
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada, N6A 3K7
| | | | - Ryuichi Nakamura
- Joint Preservation and Sports Orthopaedic Center, Harue Hospital, Sakai, 919-0476, Japan
| | - Paul Monk
- Unisports Orthopaedics, Auckland, 1072, New Zealand; Department of Trauma and Orthopaedics, Auckland City Hospital, Auckland, 1023, New Zealand.
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Morris WZ, Loewen A, Ulman S, Johnson B, Sucato DJ, Podeszwa DA, Ellis HB. Comparison of Gait and Functional Outcomes Between Open and Arthroscopic Treatment of Adolescent and Young Adult Femoroacetabular Impingement. J Pediatr Orthop 2024; 44:22-27. [PMID: 37791636 DOI: 10.1097/bpo.0000000000002532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
BACKGROUND Management of femoroacetabular impingement (FAI) through an arthroscopic or surgical hip dislocation (SHD) approach has been shown to have similar clinical success and patient-reported outcomes. However, there are limited data comparing functional outcomes. The purpose of this study was to compare gait and functional outcomes of adolescent/young adult patients with FAI treated by either an arthroscopic or open SHD approach. METHODS We identified prospectively enrolled adolescent/young adult patients (≤20 years old) who underwent surgical treatment for FAI through an SHD or arthroscopic approach. Participants were evaluated in a movement science lab preoperatively and postoperatively (minimum 8 months postoperatively) with barefoot walking and a 30-second single-limb balance trial on the affected side. Participants also completed the Harris Hip Score at the same timepoints. Differences from preoperative to postoperative were determined using a paired-samples t test for each surgical technique, and differences between the SHD and arthroscopic groups were determined using an independent samples t test (α=0.05). RESULTS Fifty-five participants (42F, 16.2±1.4 y) were tested and grouped by surgical intervention. The SHD and arthroscopy groups consisted of 28 and 27 participants, respectively, with no significant difference between the SHD and arthroscopic cohorts in age (16.4±1.2 vs. 15.9±1.5 y, respectively, P =0.218) or sex distribution (78.6% vs. 74.1% females, respectively, P =0.75). Each group demonstrated significant postoperative improvement in Harris Hip Score (SHD: 64.8±16.4 to 81.8±17.8; arthroscopy: 57.0±16.7 to 84.7±19.7; preoperatively to postoperatively, respectively, both P <0.001). During gait, increased maximum hip flexion was observed following surgical intervention for the SHD group (32.3±5.7 vs. 36.1±5.2, P =0.003). No other clinically significant changes were detected in the SHD or arthroscopic groups preoperatively to postoperatively in trunk, pelvis, or hip kinematics in the coronal plane. During the balance task, neither cohort demonstrated markers of clinically significant abductor dysfunction. However, post operatively, the arthroscopy group was able to balance longer than the SHD group (18.8±7.8 vs. 14.2±2.7 s, respectively, P =0.008), although no differences were detected in trunk or pelvis position in the coronal plane during balance. CONCLUSIONS Both open SHD and arthroscopic treatment of FAI resulted in improved clinical outcomes with no clinically significant abductor dysfunction 1 year post operatively. However, further study is needed to determine whether more dynamic tasks can potentially elicit subtle differences between the groups. LEVELS OF EVIDENCE Level II-prospective study.
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Affiliation(s)
- William Z Morris
- Department of Orthopedics, Scottish Rite for Children, Dallas, TX
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Sinkler MA, Morris WZ, Yuh RT, Fowers CA, Xie K, Cooperman DR, Liu RW. Association of Idiopathic Cam Morphology With Femoral and Acetabular Version: Analysis of 986 Cadaveric Hips. Orthop J Sports Med 2024; 12:23259671231223185. [PMID: 38213506 PMCID: PMC10782882 DOI: 10.1177/23259671231223185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/14/2023] [Indexed: 01/13/2024] Open
Abstract
Background Studies have correlated symptomatic femoroacetabular impingement (FAI) with femoral retroversion and cam lesions. Purpose To investigate any association between femoral and acetabular versions with cam deformity in a largely asymptomatic population. Study Design Descriptive laboratory study. Methods A total of 986 cadaveric hips were selected from a historical osteologic collection. Each hip was assessed to determine the femoral and acetabular versions, anterior offset, and alpha angle. Cam morphology was defined as an alpha angle >60°. Multiple regression analysis was performed to determine the relationship between age, femoral version, acetabular version, and either alpha angle or anterior femoral offset. Results The mean alpha angle and anterior offset for the sample population were 48.1°± 10.4° and 0.77 ± 0.17 cm, respectively, with cam morphology in 149 of the 986 (15.1%) specimens. No significant difference was observed between hips with and without cam morphology with respect to the femoral (10.8°± 10° vs 10.3°± 9.6°; P = .58) or acetabular versions (17.4°± 6° vs 18.2°± 6.3°; P = .14). Multiple regression analysis did not demonstrate an association between the femoral or acetabular versions and the alpha angle, and it showed a small association between the increasing femoral and acetabular versions and a decreased anterior femoral offset (both P < .01). Conclusion In a large random sample of cadaveric hips, cam morphology was not associated with femoral or acetabular retroversion. Combined with the existing literature, these findings suggest that retroversion is not associated with cam development. Clinical Relevance This study provides insight into the development of cam morphology, which may eventually aid in the evaluation and treatment of FAI.
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Affiliation(s)
| | | | - Roger T. Yuh
- Case Western Reserve University, University Hospitals, Cleveland, Ohio, USA
| | - Cody A. Fowers
- Case Western Reserve University, University Hospitals, Cleveland, Ohio, USA
| | - Katherine Xie
- Case Western Reserve University, University Hospitals, Cleveland, Ohio, USA
| | | | - Raymond W. Liu
- Case Western Reserve University, University Hospitals, Cleveland, Ohio, USA
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Ren N, Zhang Z, Li Y, Zheng P, Cheng H, Luo D, Zhang J, Zhang H. Effect of hip dysplasia on the development of the femoral head growth plate. Front Pediatr 2023; 11:1247455. [PMID: 37908967 PMCID: PMC10613681 DOI: 10.3389/fped.2023.1247455] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/28/2023] [Indexed: 11/02/2023] Open
Abstract
Purpose The purpose of this study was to observe whether developmental dysplasia of the hip (DDH) affects the development of the femoral head growth plate and to analyze the risk factors. Methods We selected female patients aged between 11 and 20 years with unilateral DDH and unclosed femoral head growth plate (s). The selected patients underwent anteroposterior radiography of the hip joint to compare the degree of development of the femoral head growth plate on both sides and to identify risk factors that affect the development of the growth plate in the femoral head. Results We included 48 female patients with unilateral DDH, with an average age of 14 years (range: 11.1-18.5 years) and an average BMI of 20.4 kg/m² (range: 15.5 kg/m²-27.9 kg/m²). Among them, 23 patients had earlier development of the femoral head growth plate on the affected side than on the healthy side, while the degree of development of the femoral head growth plate in 25 patients was the same as that on the contralateral side. When the Tönnis angle was greater than 29.5°C and/or the Reimers migration index was greater than 48.5%, there was a statistically significant difference in the acceleration of femoral head growth plate development. Conclusion An abnormal relative position of the acetabulum-femoral head caused by DDH can accelerate closure of the femoral head growth plate in immature female patients. The risk factors are a Tönnis angle greater than 29.5°C and/or Reimers migration index greater than 48.5%.
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Affiliation(s)
- Ningtao Ren
- Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Zhendong Zhang
- Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Yong Li
- Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Ping Zheng
- Department of Orthopedics, Fuzhou No.2 General Hospital (Fuzhou No.2 Hospital), Fuzhou, China
| | - Hui Cheng
- Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Dianzhong Luo
- Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Jianli Zhang
- Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Hong Zhang
- Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, China
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Mitchell C, Emami K, Emami A, Hosseinzadeh S, Shore B, Novais EN, Kiapour AM. Effects of joint loading on the development of capital femoral epiphysis morphology. Arch Orthop Trauma Surg 2023; 143:5457-5466. [PMID: 36856839 DOI: 10.1007/s00402-023-04795-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/22/2023] [Indexed: 03/02/2023]
Abstract
INTRODUCTION The deleterious influence of increased mechanical forces on capital femoral epiphysis development is well established; however, the growth of the physis in the absence of such forces remains unclear. The hips of non-ambulatory cerebral palsy (CP) patients provide a weight-restricted (partial weightbearing) model which can elucidate the influence of decreased mechanical forces on the development of physis morphology, including features related to development of slipped capital femoral epiphysis (SCFE). Here we used 3D image analysis to compare the physis morphology of children with non-ambulatory CP, as a model for abnormal hip loading, with age-matched native hips. MATERIALS AND METHODS CT images of 98 non-ambulatory CP hips (8-15 years) and 80 age-matched native control hips were used to measure height, width, and length of the tubercle, depth, width, and length of the metaphyseal fossa, and cupping height across different epiphyseal regions. The impact of age on morphology was assessed using Pearson correlations. Mixed linear model was used to compare the quantified morphological features between partial weightbearing hips and full weightbearing controls. RESULTS In partial weightbearing hips, tubercle height and length along with fossa depth and length significantly decreased with age, while peripheral cupping height increased with age (r > 0.2, P < 0.04). Compared to normally loaded (full weightbearing) hips and across all age groups, partially weightbearing hips' epiphyseal tubercle height and length were smaller (P < .05), metaphyseal fossa depth was larger (P < .01), and posterior, inferior, and anterior peripheral cupping heights were smaller (P < .01). CONCLUSIONS Smaller epiphyseal tubercle and peripheral cupping with greater metaphyseal fossa size in partial weightbearing hips suggests that the growing capital femoral epiphysis requires mechanical stimulus to adequately develop epiphyseal stabilizers. Deposit low prevalence and relevance of SCFE in CP, these findings highlight both the role of normal joint loading in proper physis development and how chronic abnormal loading may contribute to various pathomorphological changes of the proximal femur (i.e., capital femoral epiphysis).
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Affiliation(s)
- Charles Mitchell
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Koroush Emami
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Alex Emami
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Shayan Hosseinzadeh
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Benjamin Shore
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Eduardo N Novais
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Ata M Kiapour
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
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Sadeghian SM, Lewis CL, Shefelbine SJ. Can pelvic tilt cause cam morphology? A computational model of proximal femur development mechanobiology. J Biomech 2023; 157:111707. [PMID: 37441913 DOI: 10.1016/j.jbiomech.2023.111707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 06/23/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023]
Abstract
Cam deformity of the proximal femur is a risk factor for early osteoarthritis. While cam morphology is related to mechanical force at a formative time in skeletal growth, the specific problematic forces contributing to the development of cam morphology remain unknown. Individuals with femoroacetabular impingement syndrome exhibit an increased anterior pelvic tilt during walking, which alters their hip joint forces. This study aims to investigate the influence of altered joint force caused by anterior pelvic tilt on proximal femur epiphyseal growth and the potential association between increased anterior pelvic tilt and the development of cam morphology. A computational model is utilized to simulate the endochondral ossification in the proximal femur and predict cam formation. Cartilage growth and ossification patterns for a gait cycle with and without anterior pelvic tilt were modeled. The simulated growth results indicated an increased alpha angle (53° for typically developing to 68° for anterior pelvic tilt) and aspherical femoral head in the model with anterior pelvic tilt. We conclude that anterior pelvic tilt may be sufficient to cause the formation of the cam morphology. Identifying the critical mechanical conditions that increase the risk of cam deformity could help prevent this condition by adjusting the physical activities before skeletal maturity.
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Affiliation(s)
- S Mahsa Sadeghian
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Cara L Lewis
- Department of Physical Therapy, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Sandra J Shefelbine
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA; Department of Bioengineering, Northeastern University, Boston, MA, USA.
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Ayeni OR. Prospective evaluation of sport activity and the development of femoroacetabular impingement in the adolescent hip (PREVIEW): results of the pilot study. Pilot Feasibility Stud 2022; 8:201. [PMID: 36076280 PMCID: PMC9452871 DOI: 10.1186/s40814-022-01164-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/25/2022] [Indexed: 11/28/2022] Open
Abstract
Background The purpose of this pilot study was to validate the feasibility of a definitive study aimed at determining if high-intensity physical activity during adolescence impacts the development of femoroacetabular impingement (FAI). Methods This prospective cohort pilot study had a sample size target of 50 volunteers between 12 and 14 years old at sites in Canada, South Korea, and the Netherlands. Participants were evaluated clinically and radiographically at baseline and at 2 years. The participants’ sport and physical activity were evaluated using the Habitual Activity Estimation Scale (HAES) and the American Orthopaedic Society for Sports Medicine (AOSSM) criteria for sport specialization. The primary outcome was feasibility and secondary outcomes included the incidence of radiographic FAI and hip range of motion, function (Hip Outcome Score, HOS), and quality of life (Pediatric Quality of Life questionnaire, PedsQL) at 24 months. Study groups were defined at the completion of follow-up, given the changes in participant activity levels over time. Results Of the 54 participants enrolled, there were 36 (33% female) included in the final analysis. At baseline, those classified as highly active and played at least one organized sport had a higher incidence of asymptomatic radiographic FAI markers (from 6/32, 18.8% at baseline to 19/32, 59.4% at 24 months) compared to those classified as low activity (1/4, 25% maintained at baseline and 24 months). The incidence of radiographic FAI markers was higher among sport specialists (12/19, 63.2%) compared to non-sport specialists (8/17, 47.1%) at 24 months. The HOS and PedsQL scores were slightly higher (better) among those that were highly active and played a sport compared to those who did not at 2 years (mean difference (95% confidence interval): HOS-ADL subscale 4.56 (− 7.57, 16.70); HOS-Sport subscale 5.97 (− 6.91, 18.84); PedsQL Physical Function 7.42 (− 0.79, 15.64); PedsQL Psychosocial Health Summary 6.51 (− 5.75, 18.77)). Conclusion Our pilot study demonstrated some feasibility for a larger scale, definitive cohort study. The preliminary descriptive data suggest that adolescents engaged in higher levels of activity in sports may have a higher risk of developing asymptomatic hip deformities related to FAI but also better quality of life over the 2-year study period. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01164-3.
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Affiliation(s)
- Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. .,McMaster University Medical Centre, 1200 Main St West, 4E15, Hamilton, Ontario, L8N 3Z5, Canada.
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Yang F, Huang HJ, He ZY, Xu Y, Zhang X, Wang JQ. Extent of Cam Resection Relative to Epiphyseal Line and Its Association With Clinical Outcomes After Arthroscopic Treatment for Femoroacetabular Syndrome. Orthop J Sports Med 2022; 10:23259671221125509. [PMID: 36199833 PMCID: PMC9528010 DOI: 10.1177/23259671221125509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Inadequate resection of cam lesions can cause inferior outcomes after hip arthroscopy and result in revision surgery for femoroacetabular impingement syndrome (FAIS). Purpose: To evaluate the association between postoperative cam lesions measured using the proximal boundaries of resection area (PBRE) relative to the epiphyseal line and 2-year outcomes after hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: Included were patients with FAIS who had undergone primary hip arthroscopy between 2016 and 2018. The PBRE was calculated by measuring the linear distance from the PBRE to the epiphyseal line, dividing it by the diameter of the femoral head, and multiplying by 100; PBRE measurements were made at the 12-, 1-, and 2-o’clock positions on postoperative hip computed tomography. Within each clockface position, patients were divided into subgroups depending on whether their postoperative PBRE was greater than a half standard deviation above the mean (adequate resection) or less than or equal to a half standard deviation above the mean (inadequate resection). Patient-reported outcomes (PROs; Hip Outcome Score–Activities of Daily Living [HOS-ADL], International Hip Outcome Tool–Short Form [iHOT-12], modified Harris Hip Score [mHHS], and pain visual analog scale [VAS]) and rates of achieving the minimal clinically important difference (MCID) and patient-acceptable symptomatic state (PASS) were compared among the subgroups. Results: Included were 80 pairs of hips at 12 o’clock, 81 pairs of hips at 1 o’clock, and 80 pairs of hips at 2 o’clock. All subgroups demonstrated significant improvements in PRO scores at a minimum 2-year follow-up compared with preoperatively. At the 12-o’clock position, the subgroup with adequate resection had significantly superior HOS-ADL ( P = .004), iHOT-12 ( P < .001), and mHHS ( P < .001) scores and were more likely to achieve the MCID for the iHOT-12 score ( P = .035) and the PASS for the HOS-ADL ( P = .003), iHOT-12 ( P = .007), and mHHS ( P < .001) scores compared with the matched subgroup. There were no significant differences in PRO scores or rates of MCID and PASS for the 1- or 2-o’clock groups. Conclusion: The epiphyseal line may be a useful and reproducible landmark measurement for cam-type deformity. Patients considered to have inadequate resection at 12 o’clock had lower outcome scores at a minimum 2-year follow-up.
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Affiliation(s)
- Fan Yang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Hong-Jie Huang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Zi-Yi He
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Yan Xu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Xin Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Jian-Quan Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
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Honda H, Kobayashi N, Kamono E, Yukizawa Y, Higashihira S, Takagawa S, Choe H, Ike H, Tezuka T, Inaba Y. Effect of 3-Dimensional Versus Single-Plane Changes in Pelvic Dynamics on Range of Motion in Hips With Femoroacetabular Impingement: A Computer Simulation Analysis. Orthop J Sports Med 2022; 10:23259671221123604. [PMID: 36186710 PMCID: PMC9523872 DOI: 10.1177/23259671221123604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background Femoroacetabular impingement (FAI) is primarily caused by bony impingement between the acetabulum and femoral neck during hip motion. Increasing posterior pelvic tilt improves hip range of motion in patients with FAI. Purpose To use computer simulation analysis to compare the effects of 3-dimensional (3D) changes in pelvic tilt (sagittal tilt [St], axial rotation, and coronal tilt) with changes in a single plane (St), with the aim of improving range of motion in patients with FAI. Study Design Controlled laboratory study. Methods We evaluated 43 patients with FAI treated by arthroscopic cam resection. A 3D simulation was used to construct the following pelvic models: a 5° and 10° increase posteriorly in St (St5° and St10°) and a combined 5° change in St, axial rotation, and coronal tilt (Complex5°) from the baseline of the anterior pelvic plane. Improvements in maximum internal rotation (MIR) at 45°, 70°, and 90° of hip flexion and improvements in maximum flexion with no internal rotation were compared among the St5°, St10°, and Complex5° models. The pelvic models of each single-plane change of 5° and 10° were evaluated in the same simulation. Results At 90° and 70°, there was a significant difference between the Complex5° and St10° models with respect to improvement in MIR (P = .004 at 90° of flexion; P = .017 at 70° of flexion). There was no significant difference in MIR at 45° of flexion (P = .71) or in maximum flexion (P = .42). Conclusion At 70° and 90° of hip flexion, a combined change in 3D pelvic alignment of 5° (ie, St, axial rotation, and coronal tilt) was more effective in improving hip MIR than a 10° change in St only. Clinical Relevance Effective physical therapy for FAI should address pelvic motion in all 3 planes rather than in a single plane.
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Affiliation(s)
- Hideki Honda
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Naomi Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Emi Kamono
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Yohei Yukizawa
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Shota Higashihira
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Shu Takagawa
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Hyonmin Choe
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Hiroyuki Ike
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Taro Tezuka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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12
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Uquillas CA, Sun Y, Van Sice W, ElAttrache NS, Banffy MB. Prevalence of femoroacetabular impingement in elite baseball players. J Hip Preserv Surg 2022; 9:145-150. [PMID: 35992028 PMCID: PMC9389915 DOI: 10.1093/jhps/hnac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 06/06/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
ABSTRACT
CAM-type femoroacetabular impingement continues to be an underrecognized cause of hip pain in elite athletes. Properties inherent to baseball such as throwing mechanics and hitting may enhance the risk of developing a cam deformity. Our goal is to gain an appreciation of the radiographic prevalence of cam deformities in elite baseball players. Prospective evaluation and radiographs of 80 elite baseball players were obtained during the 2016 preseason entrance examination. A sports medicine fellowship-trained orthopedic surgeon with experience treating hip disorders used standard radiographic measurements to assess for the radiographic presence of cam impingement. Radiographs with an alpha angle >55° on modified Dunn views were defined as cam positive. Of the 122 elite baseball players included in our analysis, 80 completed radiographic evaluation. Only 7.3% (9/122) of players reported hip pain and 1.6% (4/244) had a positive anterior impingement test. The prevalence of cam deformities in right and left hips were 54/80 (67.5%) and 40/80 (50.0%), respectively. The mean alpha angle for cam-positive right and left hips were 64.7 ± 6.9° and 64.9 ± 5.8°, respectively. Outfielders had the highest risk of right-sided cam morphology (Relative Risk (RR) = 1.6). Right hip cam deformities were significantly higher in right-handed pitchers compared with left-handed pitchers (P = 0.02); however, there was no significant difference in left hip cam deformities between left- and right-handed pitchers (P = 0.307). Our data suggest that elite baseball players have a significantly higher prevalence of radiographic cam impingement than the general population.
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Affiliation(s)
- Carlos A Uquillas
- Kerlan Jobe Orthopedic Clinic , 6801 Park Terrace, Suite 500, Los Angeles, CA 90045, USA
| | - Yuhang Sun
- Kerlan Jobe Orthopedic Clinic , 6801 Park Terrace, Suite 500, Los Angeles, CA 90045, USA
| | - Wade Van Sice
- Kerlan Jobe Orthopedic Clinic, 2055 Military Trail #204 , Jupiter, FL 33458, USA
| | - Neal S ElAttrache
- Kerlan Jobe Orthopedic Clinic , 6801 Park Terrace, Suite 500, Los Angeles, CA 90045, USA
| | - Michael B Banffy
- Kerlan Jobe Orthopedic Clinic , 6801 Park Terrace, Suite 500, Los Angeles, CA 90045, USA
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13
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Cai B, Duan S, Yi J, Huang W, Bay BH, Li C, Chen C. Training surgical skills on hip arthroscopy by simulation: a survey on surgeon's perspectives. Int J Comput Assist Radiol Surg 2022; 17:1813-1821. [PMID: 35831550 PMCID: PMC9468038 DOI: 10.1007/s11548-022-02708-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 06/21/2022] [Indexed: 11/15/2022]
Abstract
Purpose The purpose of this study is to investigate the importance of general and specific surgical skills for hip arthroscopy from the perspective of surgeons in China. Concurrently, we intend to identify the preferred type of simulation that would facilitate competency of surgical trainees in performing arthroscopy and reinforce their preparation for carrying out the actual surgical procedure. Methods An online survey comprising 42 questions was developed by experts in hip arthroscopy and sent to 3 online communities whose members are arthroscopic surgeons in China. The responses collected were based on a 5-point Likert scale, with an open-ended comment section. Data were analyzed using one-way AVOVA and post hoc Tukey’s test. Results A total of 159 valid responses from 66 junior specialist surgeons, 68 consultant surgeons, and 25 senior consultant surgeons (from 130 institutions in 27 out of 34 provincial administrative districts in China) were collected. Cognitive ability was identified as the overall most important attribute for hip arthroscopic trainees to possess, while skills relevant to the treatment of femoroacetabular impingement (FAI) were considered as the most important specific skills by the surgeons surveyed. In addition, simulation using cadaveric specimens was considered the most favorable method for surgeons to practice their surgical skills. Conclusion In designing a training program for hip arthroscopy, it is essential to incorporate features that evaluate cognitive skills. It would be helpful for trainees to specifically practice skills that are often used in the treatment of some very common diseases of the hip joint, such as FAI. Using high-fidelity physical models for simulation to train skills of hip arthroscopy could be an ideal alternative and effective way to overcome problems arising from the lack of accessibility to cadaveric specimens. Supplementary Information The online version contains supplementary material available at 10.1007/s11548-022-02708-x.
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Affiliation(s)
- Bohong Cai
- Department of Industrial and Product Design, School of Design, Sichuan Fine Arts Institute, Chongqing, China
| | - Shengfeng Duan
- Department of Industrial and Product Design, School of Design, Sichuan Fine Arts Institute, Chongqing, China
| | - Jiahui Yi
- Department of Industrial and Product Design, School of Design, Sichuan Fine Arts Institute, Chongqing, China
| | - Wei Huang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Boon Huat Bay
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chunbao Li
- Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China.
| | - Cheng Chen
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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14
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Vuillemin N, Steppacher SD, Meier MK, Büchler L. [Treatment strategies for the combination of hip dysplasia, femoroacetabular impingement and malrotation of the proximal femur : How much should be corrected?]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:438-449. [PMID: 35925372 DOI: 10.1007/s00132-022-04252-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Hip dysplasia, FAI and femoral malrotation often occur together, resulting in mixed symptoms and severe biomechanical limitations of the hip. OBJECTIVES To report on the current recommendations for the best possible diagnosis and treatment strategies of combination pathologies in hip-preserving surgery. METHODS Review and discussion of the relevant literature with consideration of own experience in the treatment of complex combined pathomorphologies of the hip. RESULTS Patient history and a thorough clinical examination are key for determining the predominant pathomorphologies causing the symptoms. Standardized conventional ap pelvic and axial images of the hip are the basis for the radiological assessment of the hip, supplemented with MRI, CT and animations of the hip, depending on the case. As the pathologies influence each other functionally, a stepwise approach to treatment is recommended. The functionally most relevant pathology is treated first, followed by further corrections as needed. The primary goal is to achieve a stable hip with normal acetabular coverage, followed by an impingement-free range of motion and normalized musculoskeletal function. Care must be taken in the choice of surgical method to ensure that all pathologies can be adequately treated. CONCLUSION Complex, combined pathologies of the hip can be treated sufficiently with hip-preserving surgery. A thorough diagnosis is important in order to recognize the functional interaction of the different pathologies. The goal of the surgical therapy is a correctly covered, stable hip with a normal range of motion.
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Affiliation(s)
- Nicolas Vuillemin
- Department für Orthopädie und Traumatologie, Inselspital, Universitätsklinik Bern, Bern, Schweiz
| | - Simon D Steppacher
- Department für Orthopädie und Traumatologie, Inselspital, Universitätsklinik Bern, Bern, Schweiz
| | - Malin K Meier
- Department für Orthopädie und Traumatologie, Inselspital, Universitätsklinik Bern, Bern, Schweiz
| | - Lorenz Büchler
- Department für Orthopädie und Traumatologie, Inselspital, Universitätsklinik Bern, Bern, Schweiz.
- Klinik für Orthopädie und Traumatologie, Kantonsspital Aarau, Tellstrasse 25, 5001, Aarau, Schweiz.
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15
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Fukase N, Murata Y, Pierpoint LA, Soares RW, Arner JW, Ruzbarsky JJ, Quinn PM, Philippon MJ. Outcomes and Survivorship at a Median of 8.9 Years Following Hip Arthroscopy in Adolescents with Femoroacetabular Impingement: A Matched Comparative Study with Adults. J Bone Joint Surg Am 2022; 104:902-909. [PMID: 35255011 DOI: 10.2106/jbjs.21.00852] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Because of the unique theoretical surgical risks, including osteonecrosis, acute iatrogenic slipped capital femoral epiphysis, and epiphyseal injury, the optimal treatment strategy for femoroacetabular impingement (FAI) in growing adolescents has yet to be established. The aim of this study was to compare the clinical outcomes of primary arthroscopic treatment of FAI in growing adolescents with a matched adult group. METHODS Patients with FAI who underwent arthroscopic treatment with a minimum follow-up of 2 years were included. Patients with previous ipsilateral hip surgery, an Outerbridge grade of ≥3, a preoperative Tönnis grade of ≥2, or evidence of dysplasia (lateral center-edge angle of <25°) were excluded. Eligible patients who were ≤19 years old and whose proximal femoral physis had not yet closed were matched to adult (20 to 40-year-old) counterparts in a 1:1 ratio by sex, body mass index, and time of surgery. For the adolescents, cam resection was performed with a physeal-sparing approach. Outcome scores, including the modified Harris hip score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and HOS-Sports-Specific Subscale (HOS-SSS), were prospectively collected. RESULTS Of the 196 eligible adolescents, 157 (80%) were pair-matched to adult controls, with a median postoperative follow-up of 8.9 and 6.6 years, respectively. Fourteen (9%) of the adolescents required revision hip arthroscopy compared with 18 adults (11%) (p = 0.46). No patient in the adolescent group had conversion to a total hip arthroplasty (THA), while 3 in the adult group had a THA (p = 0.25). For adolescents without subsequent hip surgery, the median mHHS improved from 59 preoperatively to 96 postoperatively; the HOS-ADL, from 71 to 98; and the HOS-SSS, from 44 to 94 (p < 0.001), which were significantly higher postoperative scores than those of the matched adults (p < 0.05) despite similar or inferior baseline scores. No complications were found during the office visit or at the final follow-up. CONCLUSIONS Hip arthroscopy performed with a physeal-sparing approach for FAI in growing adolescents is safe and effective and yields superior clinical outcomes compared with those in a matched adult group. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Naomasa Fukase
- Steadman Philippon Research Institute, Vail, Colorado.,Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoichi Murata
- Department of Orthopaedic Surgery, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | - Rui W Soares
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Justin W Arner
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | - Marc J Philippon
- Steadman Philippon Research Institute, Vail, Colorado.,The Steadman Clinic, Vail, Colorado
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16
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Doran C, Pettit M, Singh Y, Sunil Kumar KH, Khanduja V. Does the Type of Sport Influence Morphology of the Hip? A Systematic Review. Am J Sports Med 2022; 50:1727-1741. [PMID: 34428084 PMCID: PMC9069562 DOI: 10.1177/03635465211023500] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) has been extensively investigated and is strongly associated with athletic participation. PURPOSE To assess (1) the prevalence of cam-type FAI across various sports; (2) whether kinematic variation among sports influences hip morphology; and (3) whether performance level, duration, and frequency of participation or other factors influence hip morphology in a sporting population. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic search of Embase, PubMed, and the Cochrane Library was undertaken following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Prospective and retrospective case series, case reports, and review articles published after 1999 were screened, and those that met the inclusion criteria decided a priori were included for analysis. RESULTS The literature search identified 58 relevant articles involving 5683 participants. A total of 49 articles described a higher prevalence of FAI across various "hip-heavy" sports, including soccer, basketball, baseball, ice hockey, skiing, golf, and ballet. In studies including nonathlete controls, a greater prevalence of FAI was reported in 66.7% of studies (n = 8/12). The highest alpha angle was identified at the 1-o'clock position (n = 9/9) in football, skiing, golf, ice hockey, and basketball. The maximum alpha angle was located in a more lateral position in goalkeepers versus positional players in ice hockey (1 vs 1:45 o'clock). A positive correlation was also identified between the alpha angle and both age and activity level (n = 5/8 and n = 2/3, respectively) and between prevalence of FAI and both age and activity level (n = 2/2 and n = 4/5). CONCLUSION Hip-heavy sports show an increased prevalence of FAI, with specific sporting activities influencing hip morphology. There is some evidence to suggest that a longer duration and higher level of training also result in an increased prevalence of FAI. REGISTRATION CRD4202018001 (PROSPERO).
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Affiliation(s)
| | | | | | | | - Vikas Khanduja
- Addenbrooke’s – Cambridge University Hospital NHS Foundation Trust, Cambridge, UK,Vikas Khanduja, MA (Cantab), MSc, PhD, FRCS(Orth), Young Adult Hip Service, Addenbrooke’s – Cambridge University Hospital, Box 37, Hills Road, Cambridge, CB2 0QQ UK () (Twitter: @CambridgeHipDoc)
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17
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Horenstein RE, Meslier Q, Spada JA, Halverstadt A, Lewis CL, Gimpel M, Birchall R, Wedatilake T, Fernquest S, Palmer A, Glyn-Jones S, Shefelbine SJ. Measuring 3D growth plate shape: Methodology and application to cam morphology. J Orthop Res 2021; 39:2398-2408. [PMID: 33368641 PMCID: PMC8222423 DOI: 10.1002/jor.24972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 12/10/2020] [Accepted: 12/16/2020] [Indexed: 02/04/2023]
Abstract
Physeal changes corresponding to cam morphology are currently measured using two-dimensional (2D) methods. These methods are limited by definitions of the femoral neck axis and head center that are dependent on the radiographic plane of view. To address these limitations, we developed three-dimensional (3D) methods for analyzing continuous growth plate shape using magnetic resonance imaging scans. These new methods rely on a single definition of the femoral neck axis and head center that are both nondependent on the radiographic plane of view and allow for analysis of growth plate shape across the growth plate surface (performed using statistical parametric mapping). Using our 3D method, we analyzed the position of the growth plate in the femoral head (relative to a plane tangent to the femoral head) and the curvature of the growth plate (relative to a plane through the center of the growth plate) in 9-16-year-old males at risk for cam morphology and their recreationally active peers (n = 17/cohort). These two measurements provide an avenue to separately analyze the effects of these variables in the overall growth plate shape. We detected differences in growth plate shape with age in recreationally active adolescents but did not detect differences between at risk and recreationally adolescents.
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Affiliation(s)
- Rachel E. Horenstein
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA 02115, USA
| | - Quentin Meslier
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA 02115, USA
| | - Julia A. Spada
- Department of Bioengineering, Northeastern University, Boston, MA 02115, USA
| | - Anne Halverstadt
- Department of Physical Therapy & Athletic Training, Boston University, Boston,MA 02215, USA
| | - Cara L. Lewis
- Department of Physical Therapy & Athletic Training, Boston University, Boston,MA 02215, USA
| | - Mo Gimpel
- Southampton Football Club, Southampton, UK
| | | | | | - Scott Fernquest
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Antony Palmer
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Siôn Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sandra J. Shefelbine
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA 02115, USA,Department of Bioengineering, Northeastern University, Boston, MA 02115, USA
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18
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Carsen S, Grammatopoulos G, Zaltz I, Ward L, Smit K, Beaulé PE. The Effects of Physical Activity on Physeal and Skeletal Development. JBJS Rev 2021; 9:01874474-202110000-00002. [PMID: 34637401 DOI: 10.2106/jbjs.rvw.21.00060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» There is increasing evidence in the literature regarding the important health impact of and risk factors for injury in youth sport. » Increasing pediatric and adolescent activity intensity, such as is seen in earlier single-sport focus and specialization, may be associated with morphological changes in the growing skeleton. » Chronic subacute injury to the developing physes in the active child can lead to stress on the growth plate and surrounding tissues that induces developmental morphological changes in the joint. » There is evidence to suggest that frequent participation in sports that place particular stress across the physes of the proximal humerus, the proximal femur, and the distal radius can be associated with an increased risk of inducing developmental and morphological changes that could lead to future joint dysfunction and premature degeneration. » Additional research is necessary to better define the pathoetiology of activity-mediated morphological changes, as well as to create and validate parameters for safe involvement in competitive physical activities.
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Affiliation(s)
- Sasha Carsen
- Division of Orthopaedic Surgery, CHEO (the Children's Hospital of Eastern Ontario), Ottawa, Ontario, Canada
| | | | - Ira Zaltz
- Department of Orthopedic Surgery, Beaumont Health, Royal Oak, Michigan
| | - Leanne Ward
- Division of Endocrinology, CHEO (the Children's Hospital of Eastern Ontario), Ottawa, Ontario, Canada
| | - Kevin Smit
- Division of Orthopaedic Surgery, CHEO (the Children's Hospital of Eastern Ontario), Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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19
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A longitudinal cohort study of adolescent elite footballers and controls investigating the development of cam morphology. Sci Rep 2021; 11:18567. [PMID: 34535729 PMCID: PMC8448877 DOI: 10.1038/s41598-021-97957-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/27/2021] [Indexed: 12/02/2022] Open
Abstract
Cam morphology describes an asphericity of the femoral head that develops during adolescence, is highly prevalent in athletes, and predisposes individuals to future osteoarthritis. However, it’s aetiology remains poorly understood. The aim of this study was to perform 3-year longitudinal follow-up of a control population and football club academy cohort to compare the change in hip and growth plate anatomy between athletes and controls. MRI and questionnaires were used to characterise change in hip and growth plate anatomy and quantify activity levels. 121 male academy footballers and 107 male and female controls participated at baseline. Footballers experienced significantly greater increases in femoral head asphericity (4.83 degrees (95% CI: 2.84 to 6.82), p < 0.001) than controls. A positive correlation existed between activity levels and change in femoral head morphology (coefficient 0.79, p ≤ 0.001). Greatest morphological change occurred in individuals aged 11–12 years at baseline, with no significant change in individuals aged 14 years and older at baseline. Cam morphology development was secondary to soft tissue hypertrophy and lateral growth plate extension. In conclusion, excessive loading of the hip joint through exercise prior to 14 years of age may result in growth plate adaptations causing cam morphology. Potential interventions may include training type and load modification in young adolescent football players.
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20
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How does the cam morphology develop in athletes? A systematic review and meta-analysis. Osteoarthritis Cartilage 2021; 29:1117-1129. [PMID: 33989785 DOI: 10.1016/j.joca.2021.02.572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 02/19/2021] [Accepted: 02/28/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE A higher prevalence of cam morphology has been reported in the athletic population but the development of the cam morphology is not fully understood. The purpose of this systematic review is to establish the timing of development of the cam morphology in athletes, the proximal femoral morphologies associated with its development, and other associated factors. DESIGN Embase, MEDLINE and the Cochrane Library were searched for articles related to development of the cam morphology, and PRISMA guidelines were followed. Data was pooled using random effects meta-analysis. Study quality was assessed using the Downs and Black criteria and evidence quality using the GRADE framework. RESULTS This search identified 16 articles involving 2,028 participants. In males, alpha angle was higher in athletes with closed physes than open physes (SMD 0.71; 95% CI 0.23, 1.19). Prevalence of cam morphology was associated with age during adolescence when measured per hip (β 0.055; 95% CI 0.020, 0.091) and per individual (β 0.049; 95% CI 0.034, 0.064). Lateral extension of the epiphysis was associated with an increased alpha angle (r 0.68; 95% CI 0.63, 0.73). A dose-response relationship was frequently reported between sporting frequency and cam morphology. There was a paucity of data regarding the development of cam morphology in females. CONCLUSIONS Very low and low quality evidence suggests that in the majority of adolescent male athletes, osseous cam morphology developed during skeletal immaturity, and that prevalence increases with age. Very low quality evidence suggests that osseous cam morphology development was related to lateral extension of the proximal femoral epiphysis.
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21
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Winge S, Winge S, Kraemer O, Dippmann C, Hölmich P. Arthroscopic treatment for femoroacetabular impingement syndrome (FAIS) in adolescents—5-year follow-up. J Hip Preserv Surg 2021; 8:249-254. [PMID: 35414955 PMCID: PMC8994113 DOI: 10.1093/jhps/hnab051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/26/2021] [Accepted: 05/25/2021] [Indexed: 11/23/2022] Open
Abstract
To report the minimum 5-year outcome after hip arthroscopy with labral repair in adolescents. From 2011 to 2014, 29 consecutive patients with a mean age 16.3 years (range 12.7–19.8 years) underwent hip arthroscopy treatment for femoroacetabular impingement syndrome. Patient-related outcome measures (PROMs) including modified Harris Hip Score (mHHS), Visual Analog Scale (VAS) for pain and Copenhagen Hip and Groin Outcome Score (HAGOS) were used preoperatively and at follow-up (FU). Percentage of patients achieving minimum clinically important difference (MCID) and substantial clinical benefit (SCB) for mHHS and HAGOS were determined. Mean FU was 6.7 years (range 5–9.6 years), and a 100% FU was accomplished. Significant improvements were seen for all PROMs at FU in patients not having a periacetabular osteotomy (PAO) with VAS pain score improving from mean 62 to 9, mHHS from 58 to 94 and HAGOS improved in all subgroups. For mHHS, SCB changes were achieved by 76% and MCID by 76% of the patients. Percentage of patients achieving MCID for HAGOS subgroups were 81% for pain, 67% for symptoms, 76% for physical function in daily living, 76% for physical function in sport and recreation, 81% for participation in physical activities and 81% for hip-related quality of life. Two patients had revision hip arthroscopy. PAO was later performed in three patients. The risk of further surgery with center edge (CE) bony edge (CEB) <30° was 42% and 0% with CEB ≥30°. Adolescents having hip arthroscopy with labral repair and resection of cam and pincer morphology achieve significant improvements at mean 6.7 years of FU. CEB < 30° increases the risk of further surgery.
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Affiliation(s)
- Søren Winge
- CPH Private Hospital, Rådhustorvet 4, Farum 3520, Denmark
| | - Sophie Winge
- Department of Vascular Surgery, Rigshospitalet, Blegdamsvej 9, Copenhagen Ø 2100, Denmark
| | - Otto Kraemer
- Section of Sport Traumatology, Bispebjerg Hospital, Copenhagen University Hospital, Bispebjerg Bakke, Copenhagen 2400, Denmark
| | - Christian Dippmann
- Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Kettegaard alle 30, Hvidovre 2650, Denmark
| | - Per Hölmich
- Section of Sport Traumatology, Bispebjerg Hospital, Copenhagen University Hospital, Bispebjerg Bakke, Copenhagen 2400, Denmark
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Outcomes and rate of return to play in elite athletes following arthroscopic surgery of the hip. INTERNATIONAL ORTHOPAEDICS 2021; 45:2507-2517. [PMID: 34148120 PMCID: PMC8514359 DOI: 10.1007/s00264-021-05077-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/10/2021] [Indexed: 11/18/2022]
Abstract
Background The tremendous physical demands of elite performance increase the risk of elite athletes sustaining various orthopaedic injuries. Hip pain is common in high-level athletes representing up to 6% of all athletic injuries. Expedient diagnosis and effective treatment are paramount for their future sporting careers and to prevent subsequent joint degeneration. Purpose This systematic review aimed to evaluate the outcome and the rate of return to play (RTP) following arthroscopic procedures in the hip (osteoplasty, chondroplasty, labral repair and/or debridement, capsulotomy, capsulorrhaphy or any soft tissue procedure) in elite athletes. Elite athletes were defined as those who represented their country in international contests or were competing professionally for the purpose of this study. Methods A computer-based systematic search, following the PRISMA Guidelines, was performed on CENTRAL, PUBMED, EMBASE, SCOPUS, EBSCO, Google Scholar and Web of Science from inception until January 1, 2020, identifying studies that looked at return to sports post-hip arthroscopy in elite athletes. Weighted means were calculated for the RTP rate and duration and for patient-reported outcome measures (PROMs). Results After eligibility screening, 22 articles were included with a total of 999 male and seven female patients, 1146 hips and a mean age of 28.4 ± 3.2 years. The mean follow-up period was 35.8 ± 13.4 months and 15.9 ± 9.6% of athletes had undergone bilateral procedures. Overall, 93.9% (95% CI: 90.5, 96.6, P < 0.0001) of patients demonstrated RTP after 6.8 ± 2.1 months post-surgery and all PROMs improved post-operatively. During follow-up, 9.6% (95% CI: 5.2, 15.2, P = 0.025) patients needed further intervention. Conclusion A high percentage of elite athletes return to the same level of competition after hip arthroscopy, with a low rate of further interventions. Hip arthroscopy appears to be an efficacious treatment for hip and/or groin pain, caused by pathologies such as FAI or labral tears, in elite athletes in the shorter term. Long term outcomes need further evaluation.
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Nonsurgical Versus Surgical Management of Femoroacetabular Impingement: What Does the Current Best Evidence Tell Us. J Am Acad Orthop Surg 2021; 29:e471-e478. [PMID: 33351525 DOI: 10.5435/jaaos-d-20-00571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/15/2020] [Indexed: 02/01/2023] Open
Abstract
Controversy exists as to the management of femoroacetabular impingement (FAI). When nonsurgical management of symptomatic FAI fails, surgical management is generally indicated. However, many groups with a stake in patient care (particularly payors) have insisted on higher levels of evidence. Recently, there have been several Level I studies published, comparing physical therapy (PT) with hip arthroscopy in the management of symptomatic FAI. All of these studies have used outcomes tools developed and validated for patients with nonarthritic hip pain (the International Hip Outcome Tool). Most highest level evidence confirms that although patients with FAI do benefit from PT, patients who undergo surgical management for FAI with hip arthroscopy benefit more than those who undergo PT (mean difference in the International Hip Outcome Tool 6.8 [minimal clinically important difference 6.1], P = 0.0093). Future large prospective studies are needed to evaluate the effect on the outcomes when there is a delay in surgical management in symptomatic individuals, assess whether FAI surgery prevents or delays osteoarthritis, and determine the role of other advanced surgical techniques.
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Hanke MS, Schmaranzer F, Steppacher SD, Reichenbach S, Werlen SF, Siebenrock KA. A Cam Morphology Develops in the Early Phase of the Final Growth Spurt in Adolescent Ice Hockey Players: Results of a Prospective MRI-based Study. Clin Orthop Relat Res 2021; 479:906-918. [PMID: 33417423 PMCID: PMC8052031 DOI: 10.1097/corr.0000000000001603] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/18/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cam morphologies seem to develop with an increased prevalence in adolescent boys performing high-impact sports. The crucial question is at what age the cam morphology actually develops and whether there is an association with an aberration of the shape of the growth plate at the cam morphology site. QUESTIONS/PURPOSES (1) What is the frequency of cam morphologies in adolescent ice hockey players, and when do they appear? (2) Is there an association between an extension of the physeal growth plate and the development of a cam morphology? (3) How often do these players demonstrate clinical findings like pain and lack of internal rotation? METHODS A prospective, longitudinal MRI study was done to monitor the proximal femoral development and to define the appearance of cam morphologies in adolescent ice hockey players during the final growth spurt. Young ice hockey players from the local boys' league up to the age of 13 years (mean age 12 ± 0.5 years) were invited to participate. From 35 players performing on the highest national level, 25 boys and their parents consented to participate. None of these 25 players had to be excluded for known disease or previous surgery or hip trauma. At baseline examination as well as 1.5 and 3 years later, we performed a prospective noncontrast MRI scan and a clinical examination. The three-dimensional morphology of the proximal femur was assessed by one of the authors using radial images of the hip in a clockwise manner. The two validated parameters were: (1) the alpha angle for head asphericity (abnormal > 60°) and (2) the epiphyseal extension for detecting an abnormality in the shape of the capital physis and a potential correlation at the site of the cam morphology. The clinical examination was performed by one of the authors evaluating (1) internal rotation in 90° of hip and knee flexion and (2) hip pain during the anterior impingement test. RESULTS Cam morphologies were most apparent at the 1.5-year follow-up interval (10 of 25; baseline versus 1.5-year follow-up: p = 0.007) and a few more occurred between 1.5 and 3 years (12 of 23; 1.5-year versus 3-year follow-up: p = 0.14). At 3-year follow-up, there was a positive correlation between increased epiphyseal extension and a high alpha angle at the anterosuperior quadrant (1 o'clock to 3 o'clock) (Spearman correlation coefficient = 0.341; p < 0.003). The prevalence of pain on the impingement test and/or restricted internal rotation less than 20° increased most between 1.5-year (1 of 25) and the 3-year follow-up (6 of 22; 1.5-year versus 3-year follow-up: p = 0.02). CONCLUSION Our data suggest that a cam morphology develops early during the final growth spurt of the femoral head in adolescent ice hockey players predominantly between 13 to 16 years of age. A correlation between an increased extension of the growth plate and an increased alpha angle at the site of the cam morphology suggests a potential underlying growth disturbance. This should be further followed by high-resolution or biochemical MRI methods. Considering the high number of cam morphologies that correlated with abnormal clinical findings, we propose that adolescents performing high-impact sports should be screened for signs of cam impingement, such as by asking about hip pain and/or examining the patient for limited internal hip rotation. LEVEL OF EVIDENCE Level I, prognostic study.
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Affiliation(s)
- Markus S. Hanke
- M. S. Hanke, S. D. Steppacher, K. A. Siebenrock, Department of Orthopedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- S. F. Werlen, Department of Radiology, Sonnenhof Clinic, Lindenhof Group, Bern, Switzerland
| | - Florian Schmaranzer
- M. S. Hanke, S. D. Steppacher, K. A. Siebenrock, Department of Orthopedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- S. F. Werlen, Department of Radiology, Sonnenhof Clinic, Lindenhof Group, Bern, Switzerland
| | - Simon D. Steppacher
- M. S. Hanke, S. D. Steppacher, K. A. Siebenrock, Department of Orthopedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- S. F. Werlen, Department of Radiology, Sonnenhof Clinic, Lindenhof Group, Bern, Switzerland
| | - Stephan Reichenbach
- M. S. Hanke, S. D. Steppacher, K. A. Siebenrock, Department of Orthopedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- S. F. Werlen, Department of Radiology, Sonnenhof Clinic, Lindenhof Group, Bern, Switzerland
| | - Stefan F. Werlen
- M. S. Hanke, S. D. Steppacher, K. A. Siebenrock, Department of Orthopedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- S. F. Werlen, Department of Radiology, Sonnenhof Clinic, Lindenhof Group, Bern, Switzerland
| | - Klaus A. Siebenrock
- M. S. Hanke, S. D. Steppacher, K. A. Siebenrock, Department of Orthopedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- S. F. Werlen, Department of Radiology, Sonnenhof Clinic, Lindenhof Group, Bern, Switzerland
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Hosseinzadeh S, Novais EN, Emami A, Portilla G, Maranho DA, Kim YJ, Kiapour AM. Does the Capital Femoral Physis Bony MorphologyDiffer in Children with Symptomatic Cam-type Femoroacetabular Impingement. Clin Orthop Relat Res 2021; 479:922-931. [PMID: 33337602 PMCID: PMC8052091 DOI: 10.1097/corr.0000000000001602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 11/11/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND The epiphyseal tubercle, the corresponding metaphyseal fossa, and peripheral cupping are key stabilizers of the femoral head-neck junction. Abnormal development of these features in the setting of supraphysiologic physeal stress under high forces (for example, forces that occur during sports activity) may result in a cam morphology. Although most previous studies on cam-type femoroacetabular impingement (FAI) have mainly focused on overgrowth of the peripheral cupping, little is known about detailed morphologic changes of the epiphyseal and metaphyseal bony surfaces in patients with cam morphology. QUESTIONS/PURPOSES (1) Does the CT-based bony morphology of the peripheral epiphyseal cupping differ between patients with a cam-type morphology and asymptomatic controls (individuals who did not have hip pain)? (2) Does the CT-based bony morphology of the epiphyseal tubercle differ between patients with a cam-type morphology and asymptomatic controls? (3) Does the CT-based bony morphology of the metaphyseal fossa differ between patients with a cam-type morphology and asymptomatic controls? METHODS After obtaining institutional review board approval for this study, we retrospectively searched our institutional database for patients aged 8 to 15 years with a diagnosis of an idiopathic cam morphology who underwent a preoperative CT evaluation of the affected hip between 2005 and 2018 (n = 152). We excluded 96 patients with unavailable CT scans and 40 patients with prior joint diseases other than cam-type FAI. Our search resulted in 16 patients, including nine males. Six of 16 patients had a diagnosis of bilateral FAI, for whom we randomly selected one side for the analysis. Three-dimensional (3-D) models of the proximal femur were generated to quantify the size of the peripheral cupping (peripheral growth of the epiphysis around the metaphysis), epiphyseal tubercle (a beak-like prominence in the posterosuperior aspect of the epiphysis), and metaphyseal fossa (a groove on the metaphyseal surface corresponding to the epiphyseal tubercle). A general linear model was used to compare the quantified anatomic features between the FAI cohort and 80 asymptomatic hips (aged 8 to 15 years; 50% male) after adjusting for age and sex. A secondary analysis using the Wilcoxon matched-pairs signed rank test was performed to assess side-to-side differences in quantified morphological features in 10 patients with unilateral FAI. RESULTS After adjusting for age and sex, we found that patients with FAI had larger peripheral cupping in the anterior, posterior, superior, and inferior regions than control patients who did not have hip symptoms or radiographic signs of FAI (by 1.3- to 1.7-fold; p < 0.01 for all comparisons). The epiphyseal tubercle height and length were smaller in patients with FAI than in controls (by 0.3- to 0.6-fold; p < 0.02 for all comparisons). There was no difference in tubercle width between the groups. Metaphyseal fossa depth, width, and length were larger in patients with FAI than in controls (by 1.8- to 2.3-fold; p < 0.001 for all comparisons). For patients with unilateral FAI, we saw similar peripheral cupping but smaller epiphyseal tubercle (height and length) along with larger metaphyseal fossa (depth) in the FAI side compared with the uninvolved contralateral side. CONCLUSION Consistent with prior studies, we observed more peripheral cupping in patients with cam-type FAI than control patients without hip symptoms or radiographic signs of FAI. Interestingly, the epiphyseal tubercle height and length were smaller and the metaphyseal fossa was larger in hips with cam-type FAI, suggesting varying inner bone surface morphology of the growth plate. The docking mechanism between the epiphyseal tubercle and the metaphyseal fossa is important for epiphyseal stability, particularly at early ages when the peripheral cupping is not fully developed. An underdeveloped tubercle and a large fossa could be associated with a reduction in stability, while excessive peripheral cupping growth would be a factor related to improved physeal stability. This is further supported by observed side-to-side differences in tubercle and fossa morphology in patients with unilateral FAI. Further longitudinal studies would be worthwhile to study the causality and compensatory mechanisms related to epiphyseal and metaphyseal bony morphology in pathogenesis cam-type FAI. Such information will lay the foundation for developing imaging biomarkers to predict the risk of FAI or to monitor its progress, which are critical in clinical care planning. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Shayan Hosseinzadeh
- S. Hosseinzadeh, E. N. Novais, A. Emami, G. Portilla, D. A. Maranho, Y.-J. Kim, A. M. Kiapour, Department of Orthopaedic Surgery, Child and Young Adult Hip Preservation Program at Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Carter CW, Campbell A, Whitney D, Feder O, Kingery M, Baron S, Youm T, Gonzalez-Lomas G. Characterizing cam-type hip impingement in professional women's ice hockey players. PHYSICIAN SPORTSMED 2021; 49:203-206. [PMID: 32799611 DOI: 10.1080/00913847.2020.1808434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE There is a high prevalence of femoroacetabular impingement (FAI) amongst elite men's ice hockey players, yet little is known about the hips of players in the National Women's Hockey League (NWHL). The primary purpose of this study was to determine the prevalence of radiographic cam-type FAI in women's professional ice hockey players. The secondary purpose was to analyze the relationship between the cam deformity and both menarchal age and hip range-of-motion (ROM). METHODS Data were collected for NWHL players during pre-participation physicals. Alpha angles were measured on 45° Dunn radiographs, with alpha angles >55° defined as cam-positive. Pearson correlation coefficients (ρ) were performed to analyze the relationship between alpha angle and both ROM measurements and menarchal age, with statistical significance set at p < 0.05. RESULTS Twenty-six athletes were included. Twenty-four (92%) had alpha angles >55°; 20 players (77%) had bilateral cam deformity. Average menarchal age was 13.8 ± 1.7 years. There was a significant association between age of menarche and alpha angle (ρ = 0.36, p < 0.02). There was no significant association between alpha angle and hip ROM (p > 0.05). CONCLUSION Elite women's ice hockey players have a higher prevalence of cam-type morphology than the general population. The positive association between alpha angle and menarchal age lends additional support to the etiological hypothesis of the cam lesion resulting from activity-related stress at the proximal femoral physis during skeletal development. Professional women's ice hockey players have a high risk of developing cam-type morphology, although each player's menarchal age may mediate her individual risk for cam development.
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Affiliation(s)
- Cordelia W Carter
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Abigail Campbell
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Darryl Whitney
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Oren Feder
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Matthew Kingery
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Samuel Baron
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Thomas Youm
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
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Clinical and radiological hip parameters do not precede, but develop simultaneously with cam morphology: a 5-year follow-up study. Knee Surg Sports Traumatol Arthrosc 2021; 29:1401-1410. [PMID: 33001216 PMCID: PMC8038954 DOI: 10.1007/s00167-020-06282-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/14/2020] [Indexed: 12/02/2022]
Abstract
PURPOSE The aim of this study was to (1) investigate whether radiographic and clinical parameters, which influence how stresses during sporting activities act on the proximal femur, are associated with cam morphology or (2) precede cam morphology development. METHODS Young male football players participated at baseline (n = 89, 12-19 years of age), 2.5-year (n = 63) and 5-year follow-up (n = 49). Standardized anteroposterior pelvic and frog-leg lateral radiographs were obtained at each time-point. Cam morphology was quantified by an alpha angle ≥ 60°, and large cam morphology ≥ 78°. The neck-shaft angle (NSA), epiphyseal extension (EE), lateral center-edge angle (LCEA) and hip internal rotation (IR) were also measured. Cross-sectional associations between NSA, EE, LCEA and IR and (large) cam morphology were studied at all time-points. To study whether these variables preceded cam morphology development, hips without cam morphology at baseline were studied prospectively. RESULTS A lower NSA, a higher EE and limited IR were consistently associated with cam morphology at all three time-points. These differences were more pronounced in hips with large cam morphology. No association between cam morphology and the LCEA was found. None of the parameters studied preceded cam morphology development. CONCLUSION Cam morphology developed simultaneously with a varus orientation, growth plate extension towards the femoral neck and limited hip internal rotation. These parameters did not precede cam morphology development. The hip parameters studied cannot be used to identify individuals at risk of developing cam morphology. LEVEL OF EVIDENCE Level II.
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Balci S, Karanfil Y, Oguz B, Aydingoz U. Validity of US measurements of cam-type femoroacetabular impingement parameters: a preliminary study in an asymptomatic adult population. Jpn J Radiol 2020; 38:1082-1089. [DOI: 10.1007/s11604-020-01005-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 06/10/2020] [Indexed: 10/24/2022]
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Yacovelli S, Parvizi J. Return to Sports After Joint Preservation Hip Surgery. Orthop Clin North Am 2020; 51:427-439. [PMID: 32950212 DOI: 10.1016/j.ocl.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Femoroacetabular impingement results from a mismatch of congruency between the femoral head and the acetabulum. This condition is most common among young, active patients and may lead to pain, decreased quality of life, and inability to participate in athletics. Hip preservation surgery is widely performed is used as a definitive treatment option in athletes at all levels of competition. Athletes have reported high rates of return to play and satisfaction and expect rehabilitation to require approximately 4 to 6 months. This article provides an overview of femoroacetabular impingement, including diagnosis and treatment, with focus on athletes and return to play.
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Affiliation(s)
- Steven Yacovelli
- The Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107, USA
| | - Javad Parvizi
- The Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107, USA.
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Abrahamson J, Jónasson P, Sansone M, Aminoff AS, Todd C, Karlsson J, Baranto A. Hip pain and its correlation with cam morphology in young skiers-a minimum of 5 years follow-up. J Orthop Surg Res 2020; 15:444. [PMID: 32993723 PMCID: PMC7523319 DOI: 10.1186/s13018-020-01952-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is conflicting evidence regarding the association between cam morphological changes and hip pain, and it remains unclear who with cam morphology will develop hip pain and who will not. This study aimed to investigate the correlation between cam morphology, hip pain, and activity level at a 5-year follow-up in young Alpine and Mogul skiers. METHOD All students (n = 76) at Åre Ski National Sports High School were invited and accepted participation in this prospective study at baseline. Magnetic resonance imaging (MRI) of both hips was conducted to evaluate the presence of cam morphology (α-angle ≥ 55°) and its size alongside the reporting of hip pain, type, and frequency of training by the Back and hip questionnaire, at baseline. After 5 years, the skiers were invited to complete a shortened version of the same questionnaire. RESULTS A total of 60 skiers (80%) completed the follow-up questionnaire, of which 53 had concomitant MRI data. Cam morphology was present in 25 skiers (47.2%, 39 hips). Hip pain at baseline and at follow-up was reported in 17 (28.3%) and 22 (36.7%) skiers, respectively. No correlations were found between the activity level, the frequency, and the size of cam morphology and hip pain, except for the right hip α-angle at 1 o'clock and hip pain in skiers with cam morphology at baseline (rs = 0.49; P = 0.03) and at follow-up (rs = 0.47; P = 0.04). A total of 73.3% skiers had retired, of which 48% reported this was due to injuries. CONCLUSION Hip pain was not shown to be correlated, or had a low correlation, with activity level and the presence and size of cam morphology in young skiers on a 5-year follow-up. Based on these results, cam morphology or activity level did not affect hip pain to develop during 5 years of follow-up in young skiers. Furthermore, this study highlights that almost 75% of young elite skiers had retired from their elite career with almost 50% reporting that this was due to injuries sustained from skiing.
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Affiliation(s)
- Josefin Abrahamson
- Department of Orthopaedics, Institue of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
- Orthopaedic Research Unit, Sahlgrenska University Hospital, R-house, Level 7, 431 80, Mölndal, Sweden.
| | - Pall Jónasson
- Department of Orthopaedics, Institue of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mikael Sansone
- Department of Orthopaedics, Institue of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Swärd Aminoff
- Department of Orthopaedics, Institue of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Carl Todd
- Department of Orthopaedics, Institue of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jón Karlsson
- Department of Orthopaedics, Institue of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Adad Baranto
- Department of Orthopaedics, Institue of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
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Normative Values for Capital Femoral Epiphyseal Extension of the Developing Hip Based on Age, Sex, and Oxford Bone Age. J Pediatr Orthop 2020; 40:e335-e340. [PMID: 31821249 DOI: 10.1097/bpo.0000000000001476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent evidence suggests that increasing capital femoral epiphyseal extension may be an adaptive response that underlies the development of most cam morphology, whereas slipped capital femoral epiphysis is associated with its deficiency. However, there is an absence of rigorous data on the normal development of epiphyseal extension in the hip joint in modern adolescents. The aim of this study was to establish normative values for anterior and superior epiphyseal extension in a normal adolescent control population. METHODS A total of 210 pediatric subjects (420 hips) between the ages of 8 and 17 years old at the time of presentation who received pelvic radiographs were retrospectively reviewed. Basic demographic data were collected. All subjects with underlying hip pathology were excluded. Epiphyseal extension ratio (EER) was measured, defined as the ratio of extension of the capital femoral epiphysis down the femoral neck relative to the diameter of the femoral head. Superior EER was measured on the anterioposterior view and anterior EER on the frog-leg lateral view bilaterally. Skeletal maturity was graded based on Oxford bone age (OBA) at the proximal femur. RESULTS The superior EER increased from 0.63±0.05 at age 8 to 0.80±0.05 at age 17. The anterior EER similarly increased from 0.56±0.06 at age 8 to 0.74±0.05 at age 17. The superior and anterior EERs increased with age in a linear fashion for males (r=0.80 and 0.75, respectively) and females (r=0.67 and 0.65) through physeal closure. When subjects were standardized by the OBA stage of the femoral head, females and males showed no statistical difference at OBA stages 6, 7 or 8. CONCLUSIONS Superior and anterior EER increased throughout adolescent development until physeal closure. When controlling for skeletal maturity, there were no significant differences between sexes. This normative data may help guide future management and research of slipped capital femoral epiphysis and cam morphology. LEVEL OF EVIDENCE Level II, Diagnostic.
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Horenstein RE, Goudeau YR, Lewis CL, Shefelbine SJ. Using Magneto-Inertial Measurement Units to Pervasively Measure Hip Joint Motion during Sports. SENSORS 2020; 20:s20174970. [PMID: 32887517 PMCID: PMC7506643 DOI: 10.3390/s20174970] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/26/2020] [Accepted: 08/31/2020] [Indexed: 01/08/2023]
Abstract
The use of wireless sensors to measure motion in non-laboratory settings continues to grow in popularity. Thus far, most validated systems have been applied to measurements in controlled settings and/or for prescribed motions. The aim of this study was to characterize adolescent hip joint motion of elite-level athletes (soccer players) during practice and recreationally active peers (controls) in after-school activities using a magneto-inertial measurement unit (MIMU) system. Opal wireless sensors (APDM Inc., Portland OR, USA) were placed at the sacrum and laterally on each thigh (three sensors total). Hip joint motion was characterized by hip acceleration and hip orientation for one hour of activity on a sports field. Our methods and analysis techniques can be applied to other joints and activities. We also provide recommendations in order to guide future work using MIMUs to pervasively assess joint motions of clinical relevance.
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Affiliation(s)
- Rachel E. Horenstein
- Department of Mechanical & Industrial Engineering, Northeastern University, Boston, MA 02115, USA; (R.E.H.); (Y.R.G.)
| | - Yohann R. Goudeau
- Department of Mechanical & Industrial Engineering, Northeastern University, Boston, MA 02115, USA; (R.E.H.); (Y.R.G.)
| | - Cara L. Lewis
- Department of Physical Therapy & Athletic Training, Boston University, Boston, MA 02215, USA;
| | - Sandra J. Shefelbine
- Department of Mechanical & Industrial Engineering, Northeastern University, Boston, MA 02115, USA; (R.E.H.); (Y.R.G.)
- Department of Bioengineering, Northeastern University, Boston, MA 02115, USA
- Correspondence:
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Capital Femoral Epiphyseal Cupping and Extension May Be Protective in Slipped Capital Femoral Epiphysis: A Dual-center Matching Cohort Study. J Pediatr Orthop 2020; 40:334-339. [PMID: 32040063 DOI: 10.1097/bpo.0000000000001528] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Peripheral cupping of the capital femoral epiphysis over the metaphysis has been reported as a precursor of cam morphology, but may also confer stability of the epiphysis protecting it from slipped capital femoral epiphysis (SCFE). The purpose of this study was to investigate the relationship between a novel morphologic parameter of inherent physeal stability, epiphyseal cupping, and the development of SCFE in a dual-center matched-control cohort study. METHODS We performed a dual-center age-matched and sex-matched cohort study comparing 279 subjects with unilateral SCFE and 279 radiographically normal controls from 2 tertiary children's hospitals. All SCFE patients had at least 18 months of radiographic follow-up for contralateral slip surveillance. Anteroposterior and frog lateral pelvis radiographs were utilized to measure the epiphyseal cupping ratio and the current standard measure of inherent physeal stability, the epiphyseal extension ratio. RESULTS Control hips were found to have greater epiphyseal cupping than the contralateral uninvolved hip of SCFE subjects both superiorly (0.28±0.08 vs. 0.24±0.06; P<0.001) and anteriorly (0.22±0.07 vs. 0.19±0.06; P<0.001). The 58/279 (21%) subjects who went on to develop contralateral slip had decreased epiphyseal cupping superiorly (0.25±0.07 vs. 0.23±0.05; P=0.03) and anteriorly (0.20±0.06 vs. 0.17±0.04; P<0.001). When we compared controls with hips that did not progress to contralateral slip and hips that further developed a contralateral SCFE, 1-way ANOVA demonstrated a stepwise decrease in epiphyseal cupping and epiphyseal extension ratio in the anterior and superior planes from control hips to contralateral hips without subsequent slip to contralateral hips that developed a SCFE (P<0.01 for each). CONCLUSIONS This study provides further evidence that epiphyseal cupping around the metaphysis is associated with decreased likelihood of SCFE and may reflect increased inherent physeal stability. Epiphyseal cupping may represent an adaptive mechanism to stabilize the epiphysis during adolescence at the long-term cost of the eventual development of associated cam-femoroacetabular impingement deformity. LEVELS OF EVIDENCE Level III-prognostic Study.
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Öhlin A, Simunovic N, Duong A, Ayeni OR. Protocol for a multicenter prospective cohort study evaluating sport activity and development of femoroacetabular impingement in the adolescent hip. BMC Musculoskelet Disord 2020; 21:221. [PMID: 32278355 PMCID: PMC7149893 DOI: 10.1186/s12891-020-03220-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 03/17/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is an important cause of hip pain in young and active individuals and occurs as a result of size and shape mismatch between the femoral head and acetabulum. Open physes in children can make hips more susceptible to injury, and high impact forces have been suggested to affect the developing femur. The diagnosis of FAI has recently risen, especially within adolescent populations, and there is an increasing trend towards year-round participation in sports with early specialization. The PREVIEW study is an international longitudinal study designed to determine the association between sport specialization in adolescence and the development of hip impingement. METHODS This is a multicentre prospective cohort study evaluating 200 participants between the ages of 12-14 that include sport specialists at the moderate to vigorous physical activity (MVPA) level and non-sport specialists at any activity level. We will monitor physical activity levels of all participants using an activity log and a wrist-mounted activity tracker, with synced data collected every 3 months during the study period. In addition, participants will be evaluated clinically at 6, 12, and 18 months and radiographically at the time of enrolment and 24 months. The primary outcome is the incidence of FAI between groups at 2 years, determined via MRI. Secondary outcomes include hip function and health-related quality of life between subjects diagnosed with FAI versus no FAI at 2 years, as determined by the Hip Outcome Score (HOS) and Pediatric Quality of Life (PedsQL) questionnaires. DISCUSSION It is important to mitigate the risk of developing hip deformities at a young age. Our proposed prospective evaluation of the impact of sport activity and hip development is relevant in this era of early sport specialization in youth. Improving the understanding between sport specialization and the development of pre-arthritic hip disease such as FAI can lead to the development of training protocols that protect the millions of adolescents involved in sports annually. TRIAL REGISTRATION PREVIEW is registered with clinicaltrials.gov (NCT03891563).
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Affiliation(s)
- Axel Öhlin
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Nicole Simunovic
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Andrew Duong
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Olufemi R Ayeni
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada.
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Riff AJ, Weber AE, Keating TC, Nwachukwu BU, Beck EC, Inoue N, Krivicich LM, Nho SJ. Mirror Image Modeling of Acetabular Rim Thickness Differences in Patients With Unilateral Femoroacetabular Impingement Syndrome. Arthrosc Sports Med Rehabil 2020; 1:e1-e6. [PMID: 32266335 PMCID: PMC7120855 DOI: 10.1016/j.asmr.2019.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 06/17/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose To use mirror imaging to identify the location and magnitude of difference in acetabular rim morphology between the symptomatic and unaffected acetabula in patients with symptomatic unilateral pincer-type or mixed femoroacetabular impingement syndrome (FAIS) using 1-dimensional models created with computed tomography (CT). Methods CT scans of bilateral hips in 33 patients diagnosed with unilateral pincer-type or mixed FAIS were obtained. Three-dimensional bilateral hip models were constructed, and the unaffected hemipelvis was superimposed onto the symptomatic side to compare acetabular thickness. Protrusion of the symptomatic side was recorded, and rim morphology was divided into clock face quadrants to analyze the location of greatest magnitude of difference between affected and unaffected acetabula. Analysis of the quadrants was performed using analysis of variance with post hoc Bonferroni correction. Results The study group consisted of more females (51.6%) than males, with an average age of 35.72 ± 7.8 years and an average body mass index of 24.3 ± 4.1 kg/m2. Of the 33 hips included, 14 were isolated pincer-type FAIS and 19 were mixed. The average preoperative symptomatic side lateral center edge angle was 37.5° ± 7.2° compared with 29° ± 5.1° on the asymptomatic side (P = .001). The symptomatic acetabular rim was on average 0.43 ± 0.18 mm thicker than the corresponding location on the unaffected rim. When the acetabulum was divided into clock face quadrants, the 12 to 3 o'clock position showed the greatest difference between symptomatic and unaffected sides (0.55 ± 0.18 mm) compared with the 3 to 6 o'clock position (0.4 ± 0.28 mm; P = .006), 6 to 9 o'clock (0.34 ± 0.07 mm; P < .001), and 9 to 12 o'clock (0.38 ± 0.03; P = .001). Conclusions Patients with unilateral, symptomatic pincer-type or mixed FAIS show statistical differences in rim thickness between the affected and unaffected acetabula. Small changes in acetabular rim morphology on the order of ≤0.5 mm may be the difference between symptomatic FAIS and the unaffected hip. Level of Evidence IV, case series.
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Affiliation(s)
- Andrew J Riff
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Alexander E Weber
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Timothy C Keating
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Benedict U Nwachukwu
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Edward C Beck
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nozomu Inoue
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Laura M Krivicich
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Shane J Nho
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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Salas AP, Brizuela-Ventura M, Velasco-Vazquez H, Mazek J. The Outside-In Technique for Slipped Capital Femoral Epiphysis: A Safe and Reproducible Approach in Hip Arthroscopy. Arthrosc Tech 2020; 9:e493-e497. [PMID: 32368469 PMCID: PMC7189202 DOI: 10.1016/j.eats.2019.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 12/03/2019] [Indexed: 02/03/2023] Open
Abstract
Femoroacetabular impingement syndrome caused by slipped capital femoral epiphysis (SCFE) can be successfully treated arthroscopically and with the minimally invasive, outside-in surgical technique. The advantages of the technique are that the residual cam-type deformity caused by the slippage can be corrected and reconstructed reliably and reproducibly before distracting the hip joint; and radiation with fluoroscopy is used for only definitive reduction and reconstruction, which is obtained with cannulated screws. In addition, this safe technique allows distraction of the hip after screw placement, without affecting the reconstruction, to address labral tears and chondrolabral delaminations caused by the impingement.
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Affiliation(s)
- Antonio Porthos Salas
- Hip Arthroscopy and Preservation Mexico, San Pedro Garza Garcia, Mexico
- Address correspondence to Antonio Porthos Salas, M.D., Hip Arthroscopy and Preservation Mexico, Hospital Angeles Valle Oriente, Montes Rocallosos 209, 66290 San Pedro Garza Garcia, Mexico.
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Jack RA, Sochacki KR, Hirase T, Vickery J, McCulloch PC, Lintner DM, Harris JD. Performance and Return to Sport After Hip Arthroscopy in the National Basketball Association. Arthroscopy 2020; 36:473-478. [PMID: 31866277 DOI: 10.1016/j.arthro.2019.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/05/2019] [Accepted: 09/10/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine: (1) return to sport (RTS) rate in National Basketball Association (NBA) players following hip arthroscopy, (2) postoperative career length and games per season, (3) pre- and postoperative performance, and (4) postoperative performance compared with control players. METHODS NBA athletes who underwent hip arthroscopy and matched controls were identified. RTS was defined as playing in at least 1 game after surgery. Player efficiency ratings were used for performance evaluation. Continuous variables of each group were compared using a 2-tailed paired samples Student t test for normally distributed data. χ2 was used to analyze categorical data. RTS was used as the primary outcome with statistical significance defined by a P value < .05. A Bonferroni correction was used to control for the remaining multiple comparisons with statistical significance defined by a P value ≤.008. RESULTS Twenty-three players (24 hips) were analyzed (mean age 27.5 ± 3.1 years; mean experience in the NBA 5.8 ± 2.8 years at time of surgery). Small forwards (n = 8, 33.3%) represented the largest proportion of players that underwent hip arthroscopy. Twenty players (21 surgeries, 87.5%) were able to RTS in NBA at an average of 5.7 ± 2.6 months. The overall 1-year NBA career survival rate of players undergoing hip arthroscopy was 79.2%. Players in the control group (5.2 ± 3.5 years) had a similar career length as (P = .068) players who underwent surgery (4.4 ± 3.0 years). There was no significant (P = .045) decrease in games per season following surgery. There was no significant difference in performance postoperatively compared with preoperatively (P = .017) and compared with matched controls following surgery (P = .570). CONCLUSIONS The RTS rate for NBA athletes after hip arthroscopy is high. There was no decrease in games played, career lengths, or performance following hip arthroscopy in NBA players versus preoperatively and matched controls. LEVEL OF EVIDENCE Level III case-control study.
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Affiliation(s)
- Robert A Jack
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas
| | - Kyle R Sochacki
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas
| | - Takashi Hirase
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas
| | - Justin Vickery
- Vanderbilt University Medical Center Orthopaedic Surgery and Rehabilitation, Nashville, Tennessee, U.S.A
| | | | - David M Lintner
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas
| | - Joshua D Harris
- Houston Methodist Orthopedic and Sports Medicine, Houston, Texas.
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Aminoff AS, Agnvall C, Todd C, Jónasson P, Thoreson O, Sansone M, Swärd L, Karlsson J, Baranto A. Young elite Alpine and Mogul skiers have a higher prevalence of cam morphology than non-athletes. Knee Surg Sports Traumatol Arthrosc 2020; 28:1262-1269. [PMID: 30367199 PMCID: PMC7148273 DOI: 10.1007/s00167-018-5236-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 10/17/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the prevalence of cam morphology in (1) a group of young elite Mogul and Alpine skiers compared with non-athletes and (2) between the sexes. METHOD The hip joints of 87 subjects [n = 61 young elite skiers (29 females and 32 males) and n = 26 non-athletes (17 females and 9 males)] were examined using MRI, for measurements of the presence of cam morphology (α-angle ≥ 55). RESULTS The skiers had a significantly higher prevalence of cam morphology compared with the non-athletes (49% vs 19%, p = 0.009). A significant difference (p < 0.001) was also found between females and males, where 22% of the females and 61% of the males had cam morphology. Among the skiers, there was also a significant difference (p < 0.001) between the sexes, where 28% of the females and 68% of the males had cam morphology. This difference between the sexes was not found in the non-athletic group. No significant differences were found between Mogul and Alpine skiers. CONCLUSION Young male elite skiers have a higher prevalence of cam morphology of the hips compared with non-athletes. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Anna Swärd Aminoff
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden. .,Åre Hälsocentral, Box 25, 830 14, Åre, Sweden.
| | | | - Carl Todd
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Olof Thoreson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mikael Sansone
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Leif Swärd
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Adad Baranto
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden
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Lorenzon P, Scalvi A, Scalco E. The Painful Hip in Young Adults Between Impingement and Mild Dysplasia: Clinical and Instrumental Diagnostical Criteria. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:11-20. [PMID: 32555072 PMCID: PMC7944806 DOI: 10.23750/abm.v91i4-s.9666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/14/2020] [Indexed: 11/25/2022]
Abstract
Femoroacetabular impingement and developmental dysplasia of the hip are among the main causes of hip arthritis. In absence of degenerative alterations of the hip, there is the chance of a surgical conservative treatment. This study aims to show the clinical and imaging criteria to a correct and prompt diagnosis.
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Affiliation(s)
- Paolo Lorenzon
- Ospedale Civile di Cittadella, U. O. di Ortopedia e Traumatologia, Centro Regionale Specializzato per la Prevenzione, lo Studio ed il Trattamento dell'Artrosi deformante dell'Anca, Cittadella (Padova), Italy.
| | - Andrea Scalvi
- Ospedale Civile di Cittadella, U. O. di Ortopedia e Traumatologia, Centro Regionale Specializzato per la Prevenzione, lo Studio ed il Trattamento dell'Artrosi deformante dell'Anca, Cittadella (Padova), Italy.
| | - Enrico Scalco
- Ospedale Civile di Cittadella, U. O. di Ortopedia e Traumatologia, Centro Regionale Specializzato per la Prevenzione, lo Studio ed il Trattamento dell'Artrosi deformante dell'Anca, Cittadella (Padova), Italy.
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Craig Garrison J, Hannon J, Conway J. NO DIFFERENCES IN HIP RANGE OF MOTION EXISTS BETWEEN BASEBALL PLAYERS WITH AN ULNAR COLLATERAL LIGAMENT TEAR AND HEALTHY BASEBALL PLAYERS. Int J Sports Phys Ther 2019; 14:920-926. [PMID: 31803524 PMCID: PMC6878864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND AND PURPOSE Restrictions in hip rotational motion of the baseball athlete can alter throwing mechanics in a manner that is inefficient and increases risk of injury. The purpose of this study was to assess for differences in hip external rotation (ER) and internal rotation (IR) range of motion (ROM) between baseball players with an ulnar collateral ligament (UCL) tear and healthy baseball players. DESIGN Case-control. METHODS Eighty-seven baseball players with a UCL tear (UCL) were compared with 87 age, experience, and position-matched healthy baseball players (CONT). UCL were enrolled at the initial visit to the outpatient sports medicine facility while CONT were measured before their baseball season. Passive hip ROM (ER and IR) of the stance and lead limbs was measured in the prone position using a bubble goniometer. Hip total range of motion (TRM) was calculated by adding ER and IR of each limb. Independent t-tests were run to compare mean group differences for hip ROM (p<0.05). RESULTS No differences between groups were discovered for hip ER on the stance (UCL = 33.9 °±9.9 °, CONT = 34.3 °±10.6 °, p = 0.8) or lead (UCL = 32.9 °±9.9 °, CONT = 34.4 °±10.0 °, p = 0.3) limbs. Similarly, there were no group differences in hip IR on the stance (UCL = 30.6 °±10.5 °, CONT = 29.6 °±9.5 °, p = 0.5) or lead (UCL = 33.5 °±17.5 °, CONT = 29.5 °±9.0 °, p = 0.1) limbs. The groups were also similar in hip TRM on the stance (UCL = 64.5 °±13.7 °, CONT = 64.0 °±17.2 °, p = 0.8) and lead (UCL = 66.4 °±17.4 °, CONT = 63.9 °±15.6 °, p = 0.3) limbs. CONCLUSIONS When measured in the prone position, hip passive ROM is not different between baseball players with a UCL tear compared to a matched healthy cohort. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
| | | | - John Conway
- Orthopedic Specialty Associates, Texas Health Sports Medicine, Fort Worth, TX, USA
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Predicting growth plate orientation with altered hip loading: potential cause of cam morphology. Biomech Model Mechanobiol 2019; 19:701-712. [DOI: 10.1007/s10237-019-01241-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 10/14/2019] [Indexed: 11/26/2022]
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Acetabular Version Increases During Adolescence Secondary to Reduced Anterior Femoral Head Coverage. Clin Orthop Relat Res 2019; 477:2470-2478. [PMID: 31389900 PMCID: PMC6903867 DOI: 10.1097/corr.0000000000000900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acetabular version influences joint mechanics and the risk of impingement. Cross-sectional studies have reported an increase in acetabular version during adolescence; however, to our knowledge no longitudinal study has assessed version or how the change in version occurs. Knowing this would be important because characterizing the normal developmental process of the acetabulum would allow for easier recognition of a morphologic abnormality. QUESTIONS/PURPOSES To determine (1) how acetabular version changes during adolescence, (2) calculate how acetabular coverage of the femoral head changed during this period, and (3) to identify whether demographic factors or hip ROM are associated with acetabular development. METHODS This retrospective analysis of data from a longitudinal study included 17 volunteers (34 hips) with a mean (± SD) age of 11 ± 2 years; seven were male and 10 were female. The participants underwent a clinical examination of BMI and ROM and MRIs of both hips at recruitment and at follow-up (6 ± 2 years). MR images were assessed to determine maturation of the triradiate cartilage complex, acetabular version, and degree of the anterior, posterior, and superior acetabular sector angles (reflecting degree of femoral head coverage provided by the acetabulum anteriorly, posteriorly and superiorly respectively). An orthopaedic fellow (GG) and a senior orthopaedic resident (PJ) performed all readings in consensus; 20 scans were re-analyzed for intraobserver reliability. Thereafter, a musculoskeletal radiologist (KR) repeated measurements in 10 scans to test interobserver reliability. The intra- and interobserver interclass correlation coefficients for absolute agreement were 0.85 (95% CI 0.76 to 0.91; p < 0.001) and 0.77 (95% CI 0.70 to 0.84), respectively. All volunteers underwent a clinical examination by a senior orthopaedic resident (PJ) to assess their range of internal rotation (in 90° of flexion) in the supine and prone positions using a goniometer. We tested investigated whether the change in anteversion and sector angles differed between genders and whether the changes were correlated with BMI or ROM using Pearson's coefficient. The triradiate cartilage complex was open (Grade I) at baseline and closed (Grade III) at follow-up in all hips. RESULTS The acetabular anteversion increased, moving caudally further away from the roof at both timepoints. The mean (range) anteversion angle increased from 7° ± 4° (0 to 18) at baseline to 12° ± 4° (5 to 22) at the follow-up examination (p < 0.001). The mean (range) anterior sector angle decreased from 72° ± 8° (57 to 87) at baseline to 65° ± 8° (50 to 81) at the final follow-up (p = 0.002). The mean (range) posterior (98° ± 5° [86 to 111] versus 97° ± 5° [89 to 109]; p = 0.8) and superior (121° ± 4° [114 to 129] to 124° ± 5° [111 to 134]; p = 0.07) sector angles remained unchanged. The change in the anterior sector angle correlated with the change in version (rho = 0.5; p = 0.02). The change in version was not associated with any of the tested patient factors (BMI, ROM). CONCLUSIONS With skeletal maturity, acetabular version increases, especially rostrally. This increase is associated with, and is likely a result of, a reduced anterior acetabular sector angle (that is, less coverage anteriorly, while the degree of coverage posteriorly remained the same). Thus, in patients were the normal developmental process is disturbed, a rim-trim might be an appropriate surgical solution, since the degree of posterior coverage is sufficient and no reorientation osteotomy would be necessary. However, further study on patients with retroversion (of various degrees) is necessary to characterize these observations further. The changes in version were not associated with any of the tested patient factors; however, further study with greater power is needed. LEVEL OF EVIDENCE Level II, prognostic study.
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Carton PF, Filan DJ. The clinical presentation, diagnosis and pathogenesis of symptomatic sports-related femoroacetabular impingement (SRFAI) in a consecutive series of 1021 athletic hips. Hip Int 2019; 29:665-673. [PMID: 30741014 PMCID: PMC6753647 DOI: 10.1177/1120700018825430] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM To examine the pathogenesis and clinical presentation of sports-related femoroacetabular impingement (SRFAI) in a large consecutive series of symptomatic athletes. METHODS Between January 2009 and February 2017 prospectively collected data from competitive athletes within the Gaelic Athletic Association (GAA), and who subsequently underwent arthroscopic treatment for symptomatic FAI, were analysed. Data was collected using internationally validated health questionnaires (Harris Hip Score, UCLA, SF-36, WOMAC) and recognised clinical (ROM, symptom presentation, provocation tests) and radiological (AP pelvis, Dunn, False profile) indicators/measures of FAI. RESULTS A total of 1021 consecutive cases (mean 26.6 ± 6.2 years) were included. In every case, conservative treatment failed to resolve symptoms with athletes attending an average of 2.4 ± 1.1 health care professionals prior to referral. Symptoms developed gradually (78%) and consisted primarily of groin pain (76.1%) and hip stiffness (76.5%) following activity. An acetabular rim deformity (pincer) was present in all cases; a cam deformity in 72.1%. The prevalence and degree of cam deformity increased with progressing age groups (p < 0.001); mean lateral centre-edge angle remained static (p = 0.456). Increasing CEA, alpha angle and presence of rim fracture was associated with a reduction in all ranges of hip movement (p < 0.001). CONCLUSION Symptomatic SRFAI presented in this large series of GAA athletes failed to resolve with non-operative treatment. Increasing hip deformity resulted in poorer ROM. Abnormal acetabular morphology remains static with increasing athletic age while cam deformity is progressive and most likely a secondary pathology.
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Affiliation(s)
- Patrick F Carton
- The Hip and Groin Clinic, UPMC
Whitfield, Waterford, Ireland,Department of Sports and Exercise
Science, Waterford Institute of Technology, Waterford, Ireland,Patrick F Carton, The Hip and Groin Clinic,
UPMC Whitfield, Butlerstown North, Cork Road, Waterford, Ireland.
| | - David J Filan
- The Hip and Groin Clinic, UPMC
Whitfield, Waterford, Ireland
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Rhyu KH, Chun YS, Jung GY, Cho YJ. Age and sex-related distribution of alpha angles and the prevalence of the cam morphology of the hip in Asians do not differ from those of other ethnicities. Knee Surg Sports Traumatol Arthrosc 2019; 27:3125-3132. [PMID: 29876864 DOI: 10.1007/s00167-018-4980-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 05/04/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE This study was performed to evaluate the effects of age on the alpha angle and the incidence of asymptomatic cam morphology. METHODS The radiographs of asymptomatic individuals between ages 8 and 22 were retrospectively collected. A total of 1417 individuals were included and grouped according to age: 8-12 (Group A), 13-18 (Group B), and 19-22 (Group C) years. Radiographic measurements of the alpha angles of the right hip were obtained from anteroposterior (AP) and frog-leg lateral (FL) radiographs. The correlations among alpha angles, the presence of cam morphology, and age were determined. RESULTS The mean alpha angles of the three groups were statistically different (p < 0.001, each). The alpha angles on both radiographs were positively correlated with age. Intra-group analysis revealed that this correlation was only evident on the FL images of males in Group B. The presence of a radiographic cam morphology also positively correlated with age (p < 0.001 in both AP and FL images). The cam morphology on AP radiographs was 0 in Group A, 17(3.0%) in Group B, and 21(4.8%) in Group C; that on FL radiographs was 2(0.3%) in Group A, 45(7.9%) in Group B, and 103(23.6%) in Group C. Intra-group analysis revealed that the correlation was only significant in males in Group B. CONCLUSIONS Higher alpha angles and the presence of cam morphology were positively correlated with age, particularly in males at or before the time of skeletal maturation. The prevalence of cam morphology did not differ from those in other ethnicities. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Kee Hyung Rhyu
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, 23 Kyungheedae-ro, Dongdaemun-ku, Seoul, 02447, Republic of Korea
| | - Young Soo Chun
- Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-ku, Seoul, 05278, Republic of Korea
| | - Gwang Young Jung
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, 23 Kyungheedae-ro, Dongdaemun-ku, Seoul, 02447, Republic of Korea
| | - Yoon Je Cho
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, 23 Kyungheedae-ro, Dongdaemun-ku, Seoul, 02447, Republic of Korea.
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Abstract
PURPOSE OF REVIEW Femoroacetabular impingement is a common cause of hip pain in young patients and has been shown to progress to osteoarthritis. The purpose of this review is to better understand the development of femoroacetabular impingement. RECENT FINDINGS Recent literature shows little genetic transmission of FAI. However, molecular studies show strong similarities with the cartilage in osteoarthritis. The development of cam lesions has a strong association with sports participation, particularly at the time of physeal closure suggesting abnormal development. Lumbar, pelvis, and femoral biomechanics may also play an important role in dynamic impingement. In summary, femoroacetabular impingement is a dynamic process with many influences. Further research is needed to clarify the pathophysiology of FAI development in hopes of finding preventative options to reduce symptoms and progression to osteoarthritis.
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Affiliation(s)
- W Jeffrey Grantham
- The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA
| | - Marc J Philippon
- The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA.
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO, 81657, USA.
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Dukas AG, Gupta AS, Peters CL, Aoki SK. Surgical Treatment for FAI: Arthroscopic and Open Techniques for Osteoplasty. Curr Rev Musculoskelet Med 2019; 12:281-290. [PMID: 31264173 PMCID: PMC6684728 DOI: 10.1007/s12178-019-09572-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW To review the relevant literature and techniques regarding arthroscopic and open treatment of femoroacetabular impingement (FAI). To discuss both the senior authors' preferred method of arthroscopic and open treatment of FAI. RECENT FINDINGS Routine treatment of FAI has moved away from open techniques and is more focused arthroscopic methods. Arthroscopic treatment of FAI has more recently focused on differing techniques of hip access and capsular management. Open techniques still have a role in FAI, but indications for open management are focused on cases with more severe pathology. While arthroscopic techniques have shown better outcomes in the short term and higher return to play, it is not without risk and is a procedure with a steep learning curve. In cases of complex joint pathology, such as FAI coupled with dysplasia or Legg-Calve-Perthes, arthroscopy may be not indicated and an open approach preferred. We outline various techniques for both arthroscopic and open treatment of FAI and their outcomes when possible.
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Affiliation(s)
- Alex G Dukas
- Department of Orthopaedic Surgery, University of Utah Health Center, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Andrew S Gupta
- Department of Orthopaedic Surgery, University of Utah Health Center, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Christopher L Peters
- Department of Orthopaedic Surgery, University of Utah Health Center, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Stephen K Aoki
- Department of Orthopaedic Surgery, University of Utah Health Center, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
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Vap AR. Editorial Commentary: Femoroacetabular Impingement and Open Physes-To Operate or Not to Operate? Is That the Only Question? Arthroscopy 2019; 35:1826-1827. [PMID: 31159967 DOI: 10.1016/j.arthro.2019.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/02/2019] [Indexed: 02/02/2023]
Abstract
Our clinical understanding, diagnosis, and treatment of femoroacetabular impingement (FAI) have improved tremendously over the past 2 decades. However, we still have major questions to answer when it comes to the exact etiology of FAI and the role played by intense adolescent athletic activity in the development of FAI. In a society in which there is increasing sports specialization in young people and also rising rates of overuse injuries, the balance between surgical intervention and early preventive measures has yet to be clearly defined. Although we may be able to "safely" treat FAI surgically and provide clinical improvement for these patients, the question remains: Are we addressing with surgery a condition that could be prevented with earlier precautionary measures? It is our responsibility to answer that question for our patients.
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Larson CM, McGaver RS, Collette NR, Giveans MR, Ross JR, Bedi A, Nepple JJ. Arthroscopic Surgery for Femoroacetabular Impingement in Skeletally Immature Athletes: Radiographic and Clinical Analysis. Arthroscopy 2019; 35:1819-1825. [PMID: 31072717 DOI: 10.1016/j.arthro.2019.01.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 01/11/2019] [Accepted: 01/11/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate radiographic and clinical outcomes after arthroscopic femoroacetabular impingement (FAI) correction in symptomatic adolescent athletes with open physes. METHODS We retrospectively reviewed radiographic and clinical outcomes in patients treated with a non-physeal-sparing arthroscopic approach for symptomatic FAI with open physes and a minimum 1-year follow-up. Specific plain radiographic and computed tomography parameters were determined, and preoperative and postoperative outcomes were prospectively evaluated with modified Harris Hip Score (mHHS), 12-Item Veterans-Rand, and pain on a visual analog scale. RESULTS Thirty-seven hips (28 patients; 75% male) with a mean age of 15.9 years (range, 12.8-18.3 years) had imaging studies consistent with open femoral neck and iliac crest physes. The ischial tuberosity and greater trochanteric physes were open in 95% and 54% of the hips, respectively. All patients participated in organized athletics, and 50% were in multiple sports year-round. Mean follow-up was 39.8 months post-arthroscopic FAI correction. There was a mean 27.7-point improvement in the mHHS (P < .001), a 4.8-point decrease in the visual analog scale for pain (P < .001), and a 15.2-point improvement in the 12-Item Veterans-Rand physical component (P < .001). Ninety-three percent of patients returned to their preinjury level of sports participation without limitations. Thirty (81.1%) patients demonstrated improvements in mHHS greater than the minimally clinically important difference (of mHHS 8 points). Two patients could not reach minimally clinically important difference because of a preoperative mHHS of > 92. There were no postoperative physeal growth arrests, growth disturbances, physeal instability, or avascular necrosis. CONCLUSIONS A non-physeal-sparing arthroscopic approach for FAI in adolescents with open physes is safe and effective with no evidence of clinically relevant complication of growth arrest-related deformity or physeal instability in patients with a minimum of 1 year (mean, 39.8 months) of follow-up after surgery. Young, highly athletic adolescent patients with larger FAI deformities demonstrated greater outcomes improvement after arthroscopy. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
| | | | | | | | - James R Ross
- BocaCare Orthopedics, Deerfield Beach, Florida, U.S.A
| | - Asheesh Bedi
- University of Michigan MedSport, Department of Orthopedics, University of Michigan, Ann Arbor, Michigan, U.S.A
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Acetabular Retroversion and Decreased Posterior Coverage Are Associated With Sports-related Posterior Hip Dislocation in Adolescents. Clin Orthop Relat Res 2019; 477:1101-1108. [PMID: 30272610 PMCID: PMC6494309 DOI: 10.1097/corr.0000000000000514] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Leverage of the femoral head against the acetabular rim may lead to posterior hip dislocation during sports activities in hips with femoroacetabular impingement (FAI) deformity. Abnormal concavity of the femoral head and neck junction has been well described in association with posterior hip dislocation. However, acetabular morphology variations are not fully understood. QUESTIONS/PURPOSES The purpose of this study was to compare the acetabular morphology in terms of acetabular version and coverage of the femoral head in adolescents who sustained a posterior hip dislocation during sports and recreational activities with a control group of patients without a history of hip disease matched by age and sex. METHODS In this case-control study, we identified 27 adolescents with posterior hip dislocation sustained during sports or recreational activities who underwent a CT scan of the hips (study group) and matched them to patients without a history of hip disease being evaluated with CT for possible appendicitis (control group). Between 2001 and 2017, we treated 71 adolescents (aged 10-19 years old) for posterior hip dislocations. During the period in question, we obtained CT scans or MR images after closed reduction of a posterior hip dislocation. One patient was excluded because of a diagnosis of Down syndrome. Twenty-one patients who were in motor vehicle-related accidents were also excluded. Twelve patients were excluded because MRI was obtained instead of CT. Finally, three patients with no imaging after reduction and seven patients with inadequate CT reformatting were excluded. Twenty-seven patients (38%) had CT scans of suitable quality for analysis, and these 27 patients constituted the study group. We compared those hips with 27 age- and sex-matched adolescents who had CT scans for appendicitis and who had no history of hip pain or symptoms (control group). One orthopaedic surgeon and one pediatric musculoskeletal radiologist, not invoved in the care of the patients included in the study, measured the lateral center-edge angle, acetabular index, acetabular depth/width ratio, acetabular anteversion angle (10 mm from the dome and at the level of the center of the femoral heads), and the anterior and posterior sector angles in the dislocated hip; the contralateral uninvolved hip of the patients with hip dislocations; and both hips in the matched control patients. Both the study and control groups had 25 (93%) males with a mean age of 13 (± 1.7) years. Inter- and intrarater reliability of measurements was assessed with intraclass correlation coefficient (ICC). There was excellent reliability (ICC > 0.90) for the acetabular anteversion angle measured at the center of the femoral head, the acetabular version 10 mm from the dome, and the posterior acetabular sector angle. RESULTS The mean acetabular anteversion angle (± SD) was lower in the study group at 10 mm from the acetabular dome (-0.4° ± 9° versus 4° ± 4°; mean difference -5°; 95% confidence interval [CI], -9 to -0.3; p = 0.015) and at the center of the femoral heads (10° ± 5° versus 14° ± 4°; mean difference -3°; 95% CI, -6 to -0.9; p = 0.003). A higher proportion of acetabula was severely retroverted in the study group (14 of 27 [52%]; 95% CI, 33%-71% versus four of 27 [15%]; 95% CI, 1%-28%; p = 0.006). The mean posterior acetabular sector angle was lower in the study group (82° ± 8° versus 90° ± 6°; mean difference -8°; 95% CI, -11 to -4; p < 0.001), whereas no difference was found for the anterior acetabular sector angle (65° ± 6° versus 65° ± 7°; mean difference 0.3°; 95% CI, -3 to 4; p = 0.944). There was no difference for the lateral center-edge angle (27° ± 6° versus 26° ± 5°; p = 0.299), acetabular index (5° ± 3° versus 6 ± 4°; p = 0.761), or acetabular depth/width ration (305 ± 30 versus 304 ± 31; p = 0.944) between groups. Acetabular anteversion angle at the center of the femoral heads (11° ± 4° versus 14° ± 4°; p = 0.006) and the posterior acetabular sector angle (86° ± 7 ° versus 91° ± 6°; p = 0.007) were lower in the contralateral uninvolved hips compared with control hips. CONCLUSIONS Decreased acetabular anteversion angle and posterior acetabular coverage of the femoral head were associated with posterior dislocation of the hip in adolescents with sports-related injury even in the absence of a high-energy mechanism. Further studies are necessary to clarify whether a causative effect exists between acetabular and femoral morphology and the dislocation of the hip in patients with sports-related injuries. LEVEL OF EVIDENCE Level III, prognostic study.
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Polat G, Arzu U, Dinç E, Bayraktar B. Prevalence of femoroacetabular impingement and effect of training frequency on aetiology in paediatric football players. Hip Int 2019; 29:204-208. [PMID: 29932009 DOI: 10.1177/1120700018781939] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE: The aim of this study was to determine the prevalence of asymptomatic radiographic findings of femoroacetabular impingement (FAI) in paediatric football players in different age groups and to investigate aetiological factors. METHODS: Paediatric male athletes between 10 and 17 years of age from 8 soccer teams were recruited. In addition to an annual control check-up, anteroposterior pelvis and frog-leg radiographs as well as the curriculum vitae of the athletes, their injuries, and real-time complaints were recorded. The alpha angle, lateral centre-edge angle, Tönnis angle, and collodiaphyseal angle were measured and morphological abnormalities were noted. RESULTS: There were 214 male football players with a mean age of 13.4 ± 3.2 years included in the study. In the morphological analysis of hips, there was FAI in 30% of the athletes. In the analysis of FAI prevalence in 3 subgroups based on age (Group 1: 10-12 years [ n = 25], Group 2: 13-15 years [ n = 104], Group 3: 16-17 years [ n = 85]), there was 0% FAI in Group 1, 19.1% in Group 2 and 60% in Group 3. In the analysis of aetiological factors, there was no significant difference between the right and left hips of players regarding alpha angles and FAI prevalence. However, the prevalence of FAI was higher in players who had been playing football for 3 years or more and who had been training for 12.5 hours/week or more. CONCLUSION: Training for 12.5 hours or more per week in paediatric football players doubled the risk development of FAI morphology.
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Affiliation(s)
- Gökhan Polat
- 1 Istanbul University, Istanbul Medical Faculty Department of Orthopaedics and Traumatology, Istanbul,Turkey
| | - Ufuk Arzu
- 1 Istanbul University, Istanbul Medical Faculty Department of Orthopaedics and Traumatology, Istanbul,Turkey
| | - Engin Dinç
- 2 Istanbul University, Istanbul Medical Faculty Department of Sports Medicine, Istanbul,Turkey
| | - Bülent Bayraktar
- 2 Istanbul University, Istanbul Medical Faculty Department of Sports Medicine, Istanbul,Turkey
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