Oxford consensus on primary cam morphology and femoroacetabular impingement syndrome: part 1—definitions, terminology, taxonomy and imaging outcomes

Abstract

IntroductionPrimary cam morphology is a mostly benign bony prominence that develops at the femoral head-neck junction of the hip, but it is highly prevalent in many athlete populations. In the small proportion of athletes for whom it is not benign, the resulting hip osteoarthritis can be debilitating. Clinicians, athletes, patients and researchers do not yet agree on important primary cam morphology elements. We aimed to ascertain and improve the level of agreement on primary cam morphology definitions, terminology, taxonomy and imaging outcome measures.MethodsTo collect and aggregate informed opinions, an expert panel—the Young Athlete’s Hip Research Collaborative—rated primary cam morphology definition, terminology, taxonomy and imaging outcome statements through an online Delphi exercise followed by an online meeting to explore areas of tension and dissent. Reporting followed Conducting and REporting DElphi Studies.ResultsA diverse and inclusive Delphi panel (n=65 for rounds 1 and 2, representing 18 countries; 6 stakeholder groups; 40% women) agreed on 35 of 47 statements in 4 domains, while surfacing areas of tension and dissent. This Delphi panel agreed on four key issues essential to moving research and clinical care forward around primary cam morphology. They agreed on: (1) definition, confirming its conceptual attributes (tissue type, size, location, shape and ownership); (2) terminology—use ‘morphology’ and not terms with a negative connotation like ‘lesion’, ‘abnormality’ or ‘deformity’; (3) taxonomy, distinguishing between primary and secondary cam morphology, and (4) imaging outcomes, a continuous bone/cartilage alpha angle on radial femoral head-neck MRI for primary cam morphology aetiology research.ConclusionThis consensus provides athletes, patients, clinicians and researchers with a strong foundation to guide more precise communication, better clinical decision-making and higher value research about primary cam morphology and its natural history.

ACcurate COnsensus Reporting Document (ACCORD) explanation and elaboration: Guidance and examples to support reporting consensus methods

“…"Panel information pack All panel members had access from the outset of the project and throughout the Delphi process, to relevant study material, including recorded presentations of the first 8 webinars of the Oxford-Aspetar-La Trobe Young Athlete's Hip Webinar Series (online supplemental file 4: webinar series agenda)." [53] M9. Describe the methods used and steps taken to gather panellist input and reach consensus (for example, Delphi, RAND-UCLA, nominal group technique).…”

Infographic. Oxford consensus on primary cam morphology and femoroacetabular impingement syndrome—natural history of primary cam morphology to inform clinical practice and research priorities on conditions affecting the young person’s hip

“…H Paul Dijkstra , 1,2 Sean Mc Auliffe , 3,4 Clare L Ardern , 5,6 Joanne L Kemp , 6 Andrea Britt Mosler , 6 Amy Price , 7 Paul Blazey , 8 Dawn Richards, 9…”

“…This infographic illustrates the natural history of primary cam morphology (PCM) to inform the Oxford Consensus Study’s seven prioritised research domains on conditions affecting the young person’s hip 1 2. We share 16 key messages for athletes, patients, clinicians and researchers:…”

Surgical decision-making in the management of knee cartilage injuries in football players: Development of patient-specific recommendations using the RAND/UCLA appropriateness method v1

“…In relation to panel selection, the surgical expert panel is created based on objective closeness, whereas the multidisciplinary discussion panel and the players are based on mandated and subjective closeness [16]. Protocol references…”