Hip capsular thickness correlates with range of motion limitations in femoroacetabular impingement

Zhang, Kailai; de, Darren; Yu, Hang; Choudur, Hema; Simunovic, Nicole; Ayeni, Olufemi R.

doi:10.1007/s00167-018-4915-5

Cited by 15 publications

(25 citation statements)

References 37 publications

(64 reference statements)

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“…We also found no correlation between age, gender, or BMI and hip capsule characteristics. Our results are consistent with another study showing no correlation between age and hip capsular thickness 15 . Other reports have shown that in FAI patients, men have thicker capsules than women, particularly anterosuperiorly 15,21 .…”

Section: Discussionsupporting

confidence: 93%

“…Previous studies have shown that, at the femoral head‐neck junction, capsular thickness is greatest anterosuperiorly in FAI hips, 21 whereas normal hips are thickest posterosuperiorly 23 . Further, studies have reported that increased thickness of the anterior hip capsule is associated with decreased range of motion in FAI patients 15 and may play a role in the development of cam deformities 14 …”

Section: Discussionmentioning

confidence: 99%

“…In FAI, there is an increasing recognition of the hip capsule and the role it may play in disease development and progression 14,15,21 . However, there is a paucity of research investigating its connection with patient symptoms in this population.…”

Section: Discussionmentioning

confidence: 99%

“…One study suggests the thickness and tension of the iliofemoral ligament may contribute to the development of cam deformities in FAI. 14 Another study demonstrates that increased anterior hip capsule thickness is correlated with decreased range of motion in FAI patients, 15 while a systematic review shows a thinner anterior capsule is associated with clinical hip laxity. 16 The purpose of this study is to correlate hip capsule morphological characteristics, including volume and thickness, with patientreported symptoms in a population of FAI patients.…”

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confidence: 99%

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Correlation of hip capsule morphology with patient symptoms from femoroacetabular impingement

Shaw

Warwick

Nguyen

et al. 2020

Journal Orthopaedic Research

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The relationship between morphological characteristics of the hip capsule and patient symptoms in the setting of femoroacetabular impingement (FAI) is undefined. In this study, patients with symptomatic FAI prospectively underwent 3T magnetic resonance (MR) imaging of the affected hip and completed the hip disability and osteoarthritis outcome score (HOOS) to determine the correlation between hip capsule anatomy and patient symptoms. Anterior hip capsule volume, posterior capsule volume, anterior‐posterior capsule volume ratio, and proximal‐distal volume ratio in the anterior capsule were quantified and measured using axial‐oblique intermediate‐weighted 3D fast spin echo MR images. A total of 35 patients (35 hips) were included for analysis (mean age: 30.6 years; mean body mass index [BMI]: 24.9 kg/m2; 57% male). The mean alpha angle was 62.2° ± 4.7°, the mean anterior hip capsule volume was 1705.1 ± 450.3 mm3, the mean posterior hip capsule volume was 1284.8 ± 268.5 mm3, the mean anterior to posterior capsule volume ratio was 1.1 ± 0.39, and the mean proximal to distal volume ratio of the anterior capsule was 0.65 ± 0.28. There was no correlation between age, gender, or BMI, and any hip capsule characteristics. Worse scores on the HOOS pain scale were correlated with increased anterior to posterior volume ratio (r = −.38; 95% confidence interval: −0.06 to −0.63). In conclusion, hip capsule morphology correlates with patient symptoms in the setting of FAI as increased anterior capsular volume, relative to posterior capsular volume, is associated with greater patient pain.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Correlation of hip capsule morphology with patient symptoms from femoroacetabular impingement

Shaw

Warwick

Nguyen

et al. 2020

Journal Orthopaedic Research

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“…There may be low sensitivity because it is difficult to detect small restrictions in ROM or because a decreased ROM is not always present in patients with FAI syndrome [ 24 ]. Additionally, restrictions in the ROM during internal rotation in a neutral hip position and external rotation with 90° of hip flexion might not be caused by bony interactions but rather due to soft tissue restrictions, such as increased capsular thickness [ 55 ] and/or involuntary muscle contractions [ 12 ]. Restricted hip ROM in all three planes is associated with more severe cases in patients with hip OA [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Combining results from hip impingement and range of motion tests can increase diagnostic accuracy in patients with FAI syndrome

Pålsson

Kostogiannis

Ageberg

2020

Knee Surg Sports Traumatol Arthrosc

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Purpose Clinical examination is an important part in the diagnosis of femoroacetabular impingement (FAI) syndrome. However, knowledge on reliability and validity of clinical diagnostic tests is scarce. The aims were to evaluate the inter-rater agreement and diagnostic accuracy of clinical tests to detect patients with FAI syndrome. Methods Eighty-one patients (49% women) were recruited. Two experienced raters performed impingement and range of motion (ROM) tests. Three criteria had to be fulfilled for the diagnosis of FAI syndrome: (1) symptoms; (2) CAM and/or Pincer morphology; and (3) being responder to intra-articular block injection. For inter-rater agreement, the Cohen's kappa statistics were used (0.41-0.60 = moderate, 0.61-0.80 = substantial agreement). For diagnostic accuracy, sensitivity, specificity, positive and negative predictive values were calculated. Results Anterior impingement test (AIMT), FADIR test and FABER test showed kappa values above 0.6. All passive hip ROM, except extension, had kappa values above 0.4. AIMT and FADIR showed the highest sensitivity, i.e., 80%, with a specificity of 26% and 25%, respectively. Passive hip ROM in internal rotation with neutral hip position had a sensitivity of 29% and a specificity of 94%. Conclusion The AIMT, FADIR and FABER tests were reliable between two experienced raters, while results from different raters for hip ROM should be interpreted with caution. The AIMT and FADIR test can only be used to rule out patients with FAI syndrome, while evaluation of ROM in internal rotation with neutral position may be more suitable to rule in patients with FAI syndrome. Level of evidence II.

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The dimensions of the hip capsule can be measured using magnetic resonance imaging and may have a role in arthroscopic planning

Kay

Memon

Rubin

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this study was to systematically evaluate the dimensions and thickness of the hip joint capsule. Secondarily, the study assessed whether there were any described correlations between capsule thickness and stability of the hip joint. Methods Four databases (PubMed, Ovid [MEDLINE], Cochrane Database, and EMBASE) were searched from database inception to May 2018, and two reviewers independently and in duplicate screened the resulting literature. Methodological quality of all included papers was assessed using the Methodological index for non‐randomized studies (MINORS) criteria. Mean differences were combined in a meta‐analysis using a random effects model when possible. Results A total of 14 studies (1 level I, 1 level II, 4 level III, 5 level IV) were identified including 796 patients (1013 hips) with a mean age of 39.5 years (range 2–95). Of the included patients, 55.2% were female and they were followed up for a mean of 7.6 months (range 1–12.5 months). The thickness of the capsule was measured in cadaveric specimens, ultrasound, and magnetic resonance imaging (MRI), with MRI measurements reported most consistently and with the least variation. Mean thickness of the anterior capsule in patients without hip disease on MRI ranged from 4.4 and 4.7 mm. Mean thickness of the anterior capsule in patients with FAI ranged between 4.9 and 5.0 mm. Males had significantly thicker capsules than females (mean difference = 1.92 mm, 0.35–3.49, P = 0.02). Clinical laxity of the hip joint, as well as female gender was correlated with thinner anterior joint capsules. Conclusion The thickness of the anterior hip capsule can be measured consistently using MRI. A thinner anterior capsule may be associated with clinical laxity of the hip joint. The relevance of capsular thickness on postoperative instability following hip arthroscopy is poorly understood and warrants further investigation. The thickness of the anterior hip capsule, as measured on MRI, has the potential to be used as part of the clinical decision‐making in capsular management strategies. Level of evidence IV.

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Hip capsular thickness correlates with range of motion limitations in femoroacetabular impingement

Abstract: 4, retrospective case series.

Cited by 15 publications

References 37 publications

Correlation of hip capsule morphology with patient symptoms from femoroacetabular impingement

Correlation of hip capsule morphology with patient symptoms from femoroacetabular impingement

Combining results from hip impingement and range of motion tests can increase diagnostic accuracy in patients with FAI syndrome

The dimensions of the hip capsule can be measured using magnetic resonance imaging and may have a role in arthroscopic planning

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