MRI for the preoperative evaluation of femoroacetabular impingement

Abstract

Femoroacetabular impingement (FAI) refers to a condition characterized by impingement of the femoral head–neck junction against the acetabular rim, often due to underlying osseous and/or soft tissue morphological abnormalities. It is a common cause of hip pain and limited range of motion in young and middle-aged adults. Hip preservation surgery aims to correct the morphological variants seen in FAI, thereby relieving pain and improving function, and potentially preventing early osteoarthritis. The purpose of this article is to review the mechanisms of chondral and labral injury in FAI to facilitate an understanding of patterns of chondrolabral injury seen on MRI. Preoperative MRI evaluation of FAI should include assessment of osseous morphologic abnormalities, labral tears, cartilage status, and other associated compensatory injuries of the pelvis. As advanced chondral wear is the major relative contraindication for hip preservation surgery, MRI is useful in the selection of patients likely to benefit from surgery.Teaching points • The most common anatomical osseous abnormalities predisposing to FAI include cam and pincer lesions.• Morphological abnormalities, labral lesions, and cartilage status should be assessed.• In cam impingement, chondral wear most commonly occurs anterosuperiorly.• Pre-existing advanced osteoarthritis is the strongest predictor of poor outcomes after FAI surgery.• Injury to muscles and tendons or other pelvic structures can coexist with FAI.

Results of arthroscopic treatment of chondral delamination in femoroacetabular impingement with bone marrow stimulation and BST-CarGel®

“…The imaging techniques have been advanced to help surgeons for a more accurate assessment. The quantitative magnetic resonance imaging (MRI) of the cartilage, as delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) and T2 mapping, can map the concentration of glycosaminoglycans (GAGs) in the cartilage, so it provides high sensitivity and accuracy for detecting early damage and for follow-up of patients after conservative hip surgeries [ 3 , 4 ].…”

Joint Loading in the Sagittal Plane During Gait Is Associated With Hip Joint Abnormalities in Patients With Femoroacetabular Impingement

“…1,9,14,36 Another approach to studying the effects of FAI on hip joint health and function is through the use of magnetic resonance imaging (MRI) to assess articular cartilage degeneration in the FAI population. 11,19–21 Studies using MRI have demonstrated that there is a high incidence of hip joint cartilage abnormalities and labral lesions in the FAI population. 11,21 Gait assessments of patients with FAI during ADL may provide researchers and clinicians with the knowledge needed to detect this condition at an early stage and possibly reduce the need for surgical intervention.…”

Consecutive Bilateral Hip Arthroscopy for Symptomatic Bilateral Femoroacetabular Impingement in an Elite Rugby player: A Case Report

“…Furthermore, prolonged traction time may introduce a higher risk of nerve palsy and/or perioperative hypothermia on hip arthroscopic surgery, even though the traction time for one site was almost the same as that in single hip arthroscopy 18,19 . Therefore, we should carefully consider performing bilateral hip arthroscopic surgery si- rho, and T2 mapping, should also be considered 23 .…”