Patient-specific factors are associated with severity of chondrolabral injury in patients with femoroacetabular impingement

Dumont, Guillaume D.; Ergen, Thomas J; Pacana, Matthew J.; Money, Adam; Menge, Travis J.; Barnes, Allen J.

doi:10.1007/s00167-020-06001-9

Cited by 3 publications

(3 citation statements)

References 27 publications

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“…A dose-response association was found between cam morphology and MRI-defined intra-articular features in football players, similar to reports from people undergoing hip arthroscopy. [24][25][26] For example, a 10° increase in AP alpha angle was associated with a small Combined with others, [27][28][29][30] our findings in football players might implicate cam morphology as a risk factor for early hip OA. The progression of joint disease may involve the interplay between bony parameters, hip and/or pelvic biomechanics and muscle function, and be unrelated to symptoms.…”

Section: Cam Morphology and Mri-defined Cartilage Defects And Labral Tears In Football Playerssupporting

confidence: 61%

Cam morphology is associated with MRI-defined cartilage defects and labral tears: a case–control study of 237 young adult football players with and without hip and groin pain

Heerey

Kemp

Agricola

et al. 2021

BMJ Open Sport Exerc Med

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ObjectiveFootball players are at risk of developing hip osteoarthritis (OA). Cam morphology (present in almost two of every three football players) may explain this heightened risk, but there is limited research on its role in hip OA development in younger athletes. Knowledge of this relationship will advance our understanding of the aetiology of hip OA in football players. We aimed to study the relationship between cam morphology size and MRI-defined cartilage defects and labral tears, and if this relationship differs by symptomatic state in young adult football players.MethodsFor this case–control study, 182 (288 hips) symptomatic (hip and/or groin pain >6 months and positive flexion-adduction-internal-rotation (FADIR) test) and 55 (110 hips) pain-free football players (soccer or Australian football) underwent anteroposterior and Dunn 45° radiographs, and 3-Tesla MRI. Cam morphology size was defined using alpha angle, and cartilage defects and labral tears were scored semiquantitatively. Presence, location and score (severity) of cartilage defects and labral tears were determined. Each participant completed the International Hip Outcome Tool 33 and Copenhagen Hip and Groin Outcome Score.ResultsGreater alpha angle was associated with cartilage defects (OR 1.03, 95% CI 1.01 to 1.04) and labral tears (OR 1.02, 95% CI 1.01 to 1.04). Greater alpha angle was associated with superolateral cartilage defects (OR 1.03, 95% CI 1.02 to 1.05) and superior labral tears (OR 1.03, 95% CI 1.02 to 1.05). The association of alpha angle with MRI-defined cartilage defects and labral tears was no greater in football players with symptoms than in those without (p=0.189–0.937)ConclusionCam morphology size was associated with cartilage defects and labral tears in young adult football players with and without pain. This study provides evidence that cam morphology may contribute to the high prevalence of hip OA in football players. Prospective studies of football players are now needed to establish if cam morphology causes progression of cartilage defects and labral tears and development of hip OA.

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Section: Cam Morphology and Mri-defined Cartilage Defects And Labral Tears In Football Playerssupporting

confidence: 61%

Cam morphology is associated with MRI-defined cartilage defects and labral tears: a case–control study of 237 young adult football players with and without hip and groin pain

Heerey

Kemp

Agricola

et al. 2021

BMJ Open Sport Exerc Med

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“…Additionally, pelvic incidence greater than 55° in a standing lumbosacral lateral radiograph predicts an increase in the possibility of acetabular labral tear in patients with hip pain who do not respond to conservative treatment. Because 48–95% of acetabular labral tears are associated with substantial damage to the acetabular cartilage, higher age and degeneration based on radiographic arthritic change are considered to be risk factors for acetabular labral tears [ 2 , 9 , 12 , 27 ]. However, little is known about the effect of pelvic sagittal parameters such as PI on acetabular labral tears.…”

Section: Discussionmentioning

confidence: 99%

Acetabular labral tear is associated with high pelvic incidence with or without femoroacetabular impingement morphology

Kwon

Cho

Kim

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose The aim of this study was to investigate the association between pelvic sagittal parameters and acetabular labral tears. Methods Three-hundred and sixty-five patients (449 hips) who underwent magnetic resonance imaging (MRI) or magnetic resonance arthrogram (MRA) for hip pain were enrolled in this study. Pelvic sagittal parameters, including the pelvic incidence, pelvic tilt, and sacral slope, were measured with a standing lumbosacral lateral radiograph. All subjects were divided into two groups according to the presence or absence of radiologic acetabular labral tears and compared. Furthermore, the two groups were divided into subgroups according to whether femoroacetabular impingement (FAI) morphology was present or not and compared. Results Pelvic incidence was greater in the labral tear group than in the non-labral tear group (52.3° ± 8.2° versus 47.1° ± 6.8°, p < 0.001). After accounting for potentially confounding variables, we found that higher age (odds ratio 1.04, 95% confidence interval [CI] 1.02 to 1.06, p = 0.001), FAI (odds ratio 15.11, 95% CI 7.43 to 30.75, p < 0.001), and high pelvic incidence (odds ratio 1.13, 95% CI 1.09 to 1.17, p < 0.001) were independently associated with acetabular labral tear. When only the patients without FAI (308 hips) were divided into groups with and without acetabular labral tear, we found that higher age (odds ratio 1.03, 95% CI 1.01 to 1.06, p = 0.008) and high pelvic incidence (odds ratio 1.15, 95% CI 1.11 to 1.19, p < 0.001) were independently associated with acetabular labral tear. Conclusion Acetabular labral tear is associated with high pelvic incidence with or without FAI morphology. Level of evidence III.

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“…The hip joint is recognised as a source of groin pain, and femoroacetabular impingement syndrome (FAIS) is a common source of hip‐related pain in a younger and physically active population [17]. Cam‐type FAIS is currently understood to be the more severe of the morphological variations, with more associated labrum and cartilage damage [8, 15], as well as an increased risk of development of secondary hip osteoarthritis (OA) with greater cam deformities [21]. Cam morphology is commonly quantified by the alpha angle, defined as the angle between lines from the center of the head of the femur to the longitudinal axis and the neck of the femur and the deviation of the spherical nature of the femoral head [32].…”

Section: Introductionmentioning

confidence: 99%

Less hip range of motion is associated with a greater alpha angle in people with longstanding hip and groin pain

Estberger

Pålsson

Kostogiannis

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose A higher alpha angle has been proposed to correlate with lower hip range of motion, but the association in people with longstanding hip and groin pain is currently unclear. The aims were to: (1) assess the association between range of motion and alpha angle in patients with longstanding hip and groin pain; (2) examine if a cut-off value in range of motion variables could identify patients with an alpha angle above or below 60°. Methods Seventy-two participants were consecutively recruited from an orthopaedic department after referral for hip- and groin-related pain. Passive hip range of motion was measured in flexion, internal rotation with 90° hip flexion, internal rotation in neutral hip position, external rotation with 90° hip flexion, and abduction. The alpha angle was calculated from a frog-leg lateral radiograph. Linear regression examined the association between range of motion and alpha angle, and an ROC-curve analysis was performed to identify the sensitivity and specificity of range of motion cut-offs. Results Lower range of motion in internal rotation in flexion, external rotation, and abduction were associated with higher alpha angle. Internal rotation of 27° or less displayed good sensitivity (81%) and specificity (85%) to detect an alpha angle above 60°, while a cut-off of 41° in external rotation and 27° in abduction showed a sensitivity of 72% and specificity of 50% and 60%, respectively. Conclusion Less internal rotation in flexion, external rotation, and abduction are associated with a greater alpha angle in a cohort of people with longstanding hip and groin pain. A cut-off of 27° in internal rotation has good sensitivity and specificity to identify people with an alpha angle above or below 60° and have the potential to be used in the clinical setting to identify patients that require further imaging, or that are unlikely to have cam morphology. Level of evidence II.

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Patient-specific factors are associated with severity of chondrolabral injury in patients with femoroacetabular impingement

Cited by 3 publications

References 27 publications

Cam morphology is associated with MRI-defined cartilage defects and labral tears: a case–control study of 237 young adult football players with and without hip and groin pain

Cam morphology is associated with MRI-defined cartilage defects and labral tears: a case–control study of 237 young adult football players with and without hip and groin pain

Acetabular labral tear is associated with high pelvic incidence with or without femoroacetabular impingement morphology

Less hip range of motion is associated with a greater alpha angle in people with longstanding hip and groin pain

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