Central Femoral Head Chondromalacia Is Associated with a Diagnosis of Hip Instability

Pullen, W. Michael; Curtis, Daniel M.; Safran, Marc R.

doi:10.1016/j.asmr.2021.10.023

Cited by 6 publications

(12 citation statements)

References 19 publications

(36 reference statements)

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“…The diagnosis of hip microinstability remains poorly defined, with many features described, but no clear gold standard [7]. In broad terms, hip microinstability has been defined as supraphysiologic motion of the hip coupled with pain or dysfunction [3, 7, 22, 23, 26, 29]. Several authors have described pathologic findings at hip arthroscopy, including straight anterior and/or lateral labral‐chondral separation, central femoral head chondromalacia, inside‐out wear pattern of the acetabular articular cartilage and ligamentum teres tearing or hypertrophy as features of microinstability [23, 25, 26, 28, 31].…”

Section: Introductionmentioning

confidence: 99%

“…In broad terms, hip microinstability has been defined as supraphysiologic motion of the hip coupled with pain or dysfunction [3, 7, 22, 23, 26, 29]. Several authors have described pathologic findings at hip arthroscopy, including straight anterior and/or lateral labral‐chondral separation, central femoral head chondromalacia, inside‐out wear pattern of the acetabular articular cartilage and ligamentum teres tearing or hypertrophy as features of microinstability [23, 25, 26, 28, 31]. Additionally, ease of hip distraction at the time of hip arthroscopy is a widely reported criterion, yet methods to objectively quantify this metric in a practical way are limited [4, 7, 9, 15, 19, 23, 26, 28].…”

Section: Introductionmentioning

confidence: 99%

“…Several authors have described pathologic findings at hip arthroscopy, including straight anterior and/or lateral labral‐chondral separation, central femoral head chondromalacia, inside‐out wear pattern of the acetabular articular cartilage and ligamentum teres tearing or hypertrophy as features of microinstability [23, 25, 26, 28, 31]. Additionally, ease of hip distraction at the time of hip arthroscopy is a widely reported criterion, yet methods to objectively quantify this metric in a practical way are limited [4, 7, 9, 15, 19, 23, 26, 28]. Prior investigations have utilized custom integration of load cells into the traction table [10, 15], providing quantitative measurements of hip stiffness (which some question the accuracy), while others have described simplified clinical maneuvers that can be applied more broadly by hip arthroscopists [9, 21].…”

Section: Introductionmentioning

confidence: 99%

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Female gender, decreased lateral center edge angle and a positive hyperextension–external rotation test are associated with ease of hip distractability at time of hip arthroscopy

Curtis

Pullen

Murray

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeTo identify factors associated with ease of hip distraction at the time of hip arthroscopy. MethodsA retrospective review of patients 17–50 years old undergoing hip arthroscopy with a single high‐volume hip arthroscopist was performed from 2014 to 2020. Demographics, clinical history, examination, and imaging findings were collected. Distractibility was quantified using turns of fine traction (1 turn = 4 mm axial distraction) with the patient paralyzed on a fracture table with a well‐padded perineal post Fine axial traction was applied after the patient’s perineum contacted the post. Demographic and clinical predictors of ease of distractibility were analyzed with simple linear regression models. Significant predictors were subsequently added to a multivariable linear regression model, estimating the effect of each variable. ResultsIn total, 453 patients were included, with an average age of 31.6 years (± 9.2) and 45.9% females. In univariate analysis, gender, race, BMI, range of motion, hyperextension–external rotation (HEER) test, the abduction–extension–external rotation test, and lateral center edge angle (LCEA) were associated with the number of fine traction turns required to distract the hip. On multivariable analysis, lower LCEA (p = 0.002), female gender (p < 0.001), and a positive HEER test (p = 0.045) were associated with decreased turns required for adequate hip distraction. ConclusionFemale gender, decreased LCEA, and a positive HEER test are associated with decreased axial traction required for adequate hip distraction at the time of hip arthroscopy. As ease of distractibility has been associated with hip microinstability, these findings may allow pre‐operative identification of hip instability patients and aid in pre‐operative counseling, risk stratification and capsular management planning. Level of evidenceIV. Clinical relevancePreoperative identification of risk factors for ease of hip distraction may raise pre‐surgical suspicion and, when coupled with other intraoperative findings, may aid in the diagnosis and management of hip microinstability.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Female gender, decreased lateral center edge angle and a positive hyperextension–external rotation test are associated with ease of hip distractability at time of hip arthroscopy

Curtis

Pullen

Murray

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…We identified 69 patients with isolated hip microinstability (without bony FAI morphology) based on previously published intraoperative criteria (ease of hip distraction, residual hip subluxation after release of traction, straight anterior or lateral chondral and labral pathology). 4,6,7,14,15,22,26 The force required for hip distraction was measured based on a consistent and standardized method, recorded as the number of turns of traction (1 turn ¼ 4 mm of axial traction) to obtain 10 mm of hip distraction, as has been previously reported. 6 The initial state was obtained by placing the patient firmly against a perineal post with body weight traction applied by the senior surgeon as previously described.…”

Section: Study Groupsmentioning

confidence: 99%

Can Hip Passive Range of Motion Predict Hip Microinstability? A Comparative Study

Curtis

Pullen

Hopkins

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: Hip microinstability is an increasingly recognized cause of pain and disability in young adults. It is unknown whether differences in passive hip range of motion (ROM) exist between patients with versus without hip microinstability. Hypothesis: Underlying ligamentous and capsular laxity will result in differences in clinically detectable passive ROM between patients with femoroacetabular impingement (FAI), patients with microinstability, and asymptomatic controls. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective review of all patients undergoing hip arthroscopy between 2012 and 2018 was conducted. Patients with a diagnosis of isolated microinstability based on intraoperative findings were identified and classified as having isolated FAI, instability, or FAI + instability. Patients without a history of hip injury were included as controls. Range of motion was recorded in the supine position for flexion, internal rotation, and external rotation. Univariate and multivariate analysis was performed on each measurement in isolation as well as combinations of motion to include total rotation arc, flexion + rotation arc, and flexion + 2× rotation arc Models were then created and tested to predict instability status. Results: In total, 263 hips were included: 69 with isolated instability, 50 with FAI, 50 with FAI + instability, and 94 control hips. A higher proportion of patients in the instability and FAI + instability groups were female compared with the FAI and control groups ( P < .001). On univariate analysis, differences were found in all groups in all planes of motion ( P < .001). Multivariable analysis demonstrated differences in all groups in flexion and flexion + rotation arc. In symptomatic patients, the best performing predictive model for hip microinstability was flexion + rotation arc ≥200° (Akaike information criterion, 132.3; P < .001) with a sensitivity of 68.9%, specificity of 80.0%, positive predictive value of 89.1%, and negative predictive value of 51.9%. Conclusion: Patients with hip microinstability had significantly greater ROM than symptomatic and asymptomatic cohorts without hip microinstability. Symptomatic patients with hip flexion + rotation arc ≥200° were highly likely to have positive intraoperative findings for hip microinstability, whereas instability status was difficult to predict in patients with a flexion + rotation arc of <200°.

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“…Moreover, magnetic resonance arthrography (MRA) findings associated with microinstability of the hip joint include anterior hip capsular thinning distal to the zona orbicularis (<3 mm) [16,17]. Further suspicion of the diagnosis of hip microinstability can arise intraoperatively, demonstrating the ease of distraction of the hip joint together with visualization of the specific inside-out articular chondral wear pattern, perifoveal articular cartilage damage, and damage to the articular cartilage and/or labrum straight anteriorly or straight laterally (Safran et al, in submission) [12,18].…”

Section: Introductionmentioning

confidence: 99%

Protocol for a multicenter prospective cohort study evaluating arthroscopic and non-surgical treatment for microinstability of the hip joint

Öhlin

Senorski

Sansone

et al. 2022

BMC Musculoskelet Disord

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Background Microinstability of the hip joint is a proposed cause of hip pain and reduced function in young individuals. The underlying mechanism is thought to be extraphysiological hip motion due to bony deficiency and/or soft tissue deficiency or decreased soft tissue function. Recently, the condition has gained increased attention, and despite the fact that treatment today includes both non-surgical and surgical approaches, there is limited evidence on diagnostic specificity and treatment effects. The aim of this study is to evaluate clinical outcomes of both non-surgical and surgical treatment for microinstability of the hip joint. Methods A multicenter prospective cohort study is planned to evaluating the outcome of physical therapy aimed at stabilizing the hip joint, as well as arthroscopic plication of the hip joint capsule, if the physical therapy fails. Outcomes will be evaluated using hip-specific patient-reported outcome measures: the short version of the International Hip Outcome Tool and the Copenhagen Hip and Groin Outcome Score, strength and function tests, health-related quality of life as determined using the European Quality of Life-5 Dimensions and the European Quality of Life-Visual Analog Scale, sports activity levels according to the Hip Sport Activity Scale, and reported complications. Patients will be evaluated at 6, 12 and 24 months after each treatment. Discussion It is important to evaluate the clinical outcomes of both non-surgical and surgical treatment for suspected microinstability of the hip joint, and the planned prospective evaluation will contribute to the understanding of non-surgical as well as surgical treatment outcomes, including complications. Trial registration Clinicaltrials.gov: NCT04934462. Registered June 22 2021.

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Central Femoral Head Chondromalacia Is Associated with a Diagnosis of Hip Instability

Cited by 6 publications

References 19 publications

Female gender, decreased lateral center edge angle and a positive hyperextension–external rotation test are associated with ease of hip distractability at time of hip arthroscopy

Female gender, decreased lateral center edge angle and a positive hyperextension–external rotation test are associated with ease of hip distractability at time of hip arthroscopy

Can Hip Passive Range of Motion Predict Hip Microinstability? A Comparative Study

Protocol for a multicenter prospective cohort study evaluating arthroscopic and non-surgical treatment for microinstability of the hip joint

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