Femoroacetabular impingement: correlation between imaging parameters, sport activity, and chondral damage

Alpha angle values predict the severity of hip chondral damage in patients with cam-type femoroacetabular impingement syndrome: a systematic review and meta-analysis

PURPOSE

To assess the role of alpha angle (AA) in predicting the severity of hip chondral damage in patients with cam-type femoroacetabular impingement (FAI) syndrome.

METHODS

Following PRISMA guidelines, a systematic review was performed to summarize and critically appraise studies analyzing the prognostic capability of AA values in predicting the severity of intraoperatively evaluated hip chondral damage in patients with cam-type FAI syndrome. The risk of bias was assessed through the QUIPS tool. Meta-analyses based on groups and individual data from studies with a low risk of bias were conducted. We employed a Cumulative Link Mixed Model (CLMM) to analyze the relationship between AA and the ordinal outcome (chondral damage). The model was adjusted for sex, age, and the lateral center-edge angle (LCEA). Interactions between sex and AA were also investigated, and probabilities were calculated.

RESULTS

Twelve studies with 4,564 patients were included in a qualitative review (aged 30 to 39 years, 1,822 women [40%]). Studies with a low risk of bias (n = 4; 2945 patients) indicated that AA values are significantly smaller (MD [95% CI] of 10.5° [6.5° to 15°]) in the low-grade chondral damage group (grades 0/I/II) compared to the high-grade chondral damage group (III/IV). The CLMM with individual patient data from studies with low risk of bias (n = 3; 1460 patients) indicated that for each 1° increase in AA, the odds of being in a higher category of chondral damage increase by a factor of 1.04 (OR = 1.04, p < 0.0001). Men were at significantly higher risk (OR = 2.11, p < 0.0001) than women, but no significant interaction between sex and AA was observed (p=0.054). We estimate the average probability of having high-grade chondral damage to be greater than 33% when AA values surpass 71° for men and 90° for women, and greater than 50% when 89° for men and 108° for women. However, the heterogeneity observed across studies should be considered.

CONCLUSION

The alpha angle is a significant predictor of hip chondral damage severity in patients with cam-type FAI syndrome, regardless of sex, and independently of age and LCEA. Additionally, men are at a higher risk of chondral damage than women, and this risk increases with aging but decreases with the magnitude of the LCEA.

LEVEL OF EVIDENCE

Level III, systematic review of Level II and III studies.

Anatomical Features in Inguinal-Pubic-Adductor Area That May Contribute to Gender Difference in Susceptibility to Groin Pain Syndrome

Groin pain syndrome (GPS) is often a diagnostic challenge for sport physicians. Despite this diagnostic difficulty, the incidence of GPS in athletes is relatively high, afflicting 10-20% of the total sports population. In the literature, a certain number of studies demonstrate an important gender-based difference in the incidence of GPS in both sexes, with a ratio of female:male athletes clearly in favor of the female gender being relatively less prone to GPS. Indeed, some anatomical differences between the two sexes seem to represent a protective factor against the onset of GPS in women, although the current literature still needs to clarify the validity of these findings. It is the aim of this systematic review to examine all the anatomical differences between men and women that may be responsible for the difference in the onset of GPS in the two sexes.

Long-standing groin pain syndrome in athletic women: a multidisciplinary assessment in keeping with the italian consensus agreement

BACKGROUND

Long-standing groin pain syndrome (LSGPS) is a form of groin pain syndrome in which the cohort of symptoms reported by patients is experienced for a long period, typically for over 12 weeks, and is recalcitrant to any conservative therapy. The aim of this prospective epidemiological study was to describe the clinical causes of LSGPS in 37 female athletic subjects in Italy through the Groin Pain Syndrome Italian Consensus Conference on terminology, clinical evaluation and imaging assessment in groin pain in athletes classification and guidelines.

METHODS

Thirty-seven female athletes affected by LSGPS were evaluated following the guidelines issued by the Groin Pain Syndrome Italian Consensus Conference on terminology, clinical evaluation and imaging assessment of groin pain in athletes.

RESULTS

In the considered population, each patient presented only one pathological cause for LSGPS. The most frequent aetiologies were inguinal pathologies (54.05% of the cases), acetabular labrum tear (18.92%) and pelvic floor disorders (8.11%). Adductor tendinopathy represented only 2.70% of cases.

CONCLUSIONS

Female athletic patients affected by LSGPS show a similar incidence of inguinal and hip pathologies as in male populations. However, these clinical situations do not seem to be associated in women unlike in the male population. This difference is probably due to particular anatomical differences related to gender. For this reason, women affected by LSGPS represent an important subset of patients. Moreover, adductor tendinopathy is probably overrated as an etiopathogenetic source of LSGPS in women.