Correlation of Patient Symptoms With Labral and Articular Cartilage Damage in Femoroacetabular Impingement

Abstract

Background:Femoroacetabular impingement (FAI) can lead to labral and articular cartilage injuries as well as early osteoarthritis of the hip. Currently, the association of patient symptoms with the progression of labral and articular cartilage injuries due to FAI is poorly understood.Purpose:To evaluate the correlation between patient-reported outcome (PRO) scores and cartilage compositional changes seen on quantitative magnetic resonance imaging (MRI) as well as cartilage and labral damage seen during arthroscopic surgery in patients with FAI.Study Design:Cohort study; Level of evidence, 3.Methods:Patients were prospectively enrolled before hip arthroscopic surgery for symptomatic FAI. Patients were included if they had cam-type FAI without radiographic arthritis. All patients completed PRO scores, including the Hip disability and Osteoarthritis Outcome Score (HOOS) and a visual analog scale for pain. MRI with mapping sequences (T1ρ and T2) on both the acetabular and femoral regions was performed before surgery to quantitatively assess the cartilage composition. During arthroscopic surgery, cartilage and labral injury grades were recorded using the Beck classification. Pearson and Spearman correlation coefficients were then obtained to evaluate the association between chondrolabral changes and PRO scores.Results:A total of 46 patients (46 hips) were included for analysis (mean age, 35.5 years; mean body mass index [BMI], 23.9 kg/m2; 59% male). Increasing BMI was correlated with a more severe acetabular cartilage grade (ρ = 0.37; 95% CI, 0.08-0.65). A greater alpha angle was correlated with an increased labral tear grade (ρ = 0.59; 95% CI, 0.37-0.82) and acetabular cartilage injuries (ρ = 0.61; 95% CI, 0.42-0.80). With respect to PRO scores, increasing femoral cartilage damage in the anterosuperior femoral head region, as measured on quantitative MRI using T1ρ and T2 mapping, correlated with lower (worse) scores on the HOOS Activities of Daily Living (r = 0.35; 95% CI, 0.06-0.64), Symptoms (r = 0.32; 95% CI, 0.06-0.57), and Pain (r = 0.31; 95% CI, 0.06-0.55) subscales. There was no correlation between PRO scores and acetabular cartilage damage or labral tearing found on quantitative MRI or during arthroscopic surgery.Conclusion:Femoral cartilage damage, as measured on T1ρ and T2 mapping, appears to have a greater correlation with clinical symptoms than acetabular cartilage damage or labral tears in patients with symptomatic FAI.

What is the Prevalence of Hip Intra-Articular Pathologies and Osteoarthritis in Active Athletes with Hip and Groin Pain Compared with Those Without? A Systematic Review and Meta-Analysis

“…In athletes without pain, we identified moderate evidence of a labral tear prevalence per hip of 33%, while in athletes with pain, there was moderate evidence of a labral tear prevalence per hip of 20%. These findings provide further evidence of the complex relationship between labral tears and experience of pain [31,71,72,27]. Furthermore, it appears that athletes do not have a higher prevalence of labral tears than non-athletic individuals, regardless of pain status [31,22,23].…”

“…Over-time, cam morphology may result in intra-articular hip conditions, including hip osteoarthritis (OA). Cam morphology is associated with intra-articular pathology including labral tears in individuals with and without pain [25][26][27], and increases the odds of developing OA by up to 10 times in older adults [28]. However, little is known about the risk of developing OA in athletic populations with cam morphology [28,16].…”

Hip joint muscle forces during gait in patients with femoroacetabular impingement syndrome are associated with patient reported outcomes and cartilage composition

“…The Iliopsoas muscle was found to be a large contributor to the anterior hip joint contact force in normal walking patterns (Correa et al, 2010) and abnormal function of the Iliopsoas may lead to altered anterior hip joint contact forces, which may be detrimental to anterior hip joint cartilage health (regions 6-7). In addition, previous work has demonstrated that FAI patients with more severe hip pain and dysfunction exhibited increased T 1ρ and T 2 values within the anterior superior femoral cartilage layer (Grace et al, 2018). The FAI patients in the current study that produced lower peak Iliopsoas force reported worse hip joint pain, function and exhibited increased T 1ρ and T 2 values within the anterior-superior femoral cartilage.…”

“…The FAI patients in the current study that produced lower peak Iliopsoas force reported worse hip joint pain, function and exhibited increased T 1ρ and T 2 values within the anterior-superior femoral cartilage. Combining the results of the current study and those of Grace et al (2018) and Correa et al (2010), may suggest that the Iliopsoas is an important muscle to consider when assessing hip joint symptoms and cartilage health in FAI patients.…”

Correlation of hip capsule morphology with patient symptoms from femoroacetabular impingement

“…A power analysis was performed a priori using data from previous studies correlating patient‐reported HOOS results with quantitative MRI findings that demonstrated a sample size of 32 for α = .05 and β = .80 20 . Correlation analyses were performed to evaluate the association between PRO scores and alpha angle, anterior hip capsule volume, posterior hip capsule volume, anterior to posterior capsular volume ratio and proximal to distal anterior capsular volume ratio.…”