Preoperative Alpha Angles Can Predict Severity of Acetabular Rim Chondral Damage in Symptomatic Cam-Type Femoroacetabular Impingement: A Prospective Observatory Study

<p class="abstract">Femoroacetabular impingement (FAI) is one of the causes of hip arthritis. If FAI diagnosed earlier and treated properly, arthritis of hip and eventual total hip replacement (THR) can be potentially avoided. We report 48 yr male who presented with left hip severe pain, limp, restricted movements and unable do daily day activities. He is diagnosed to have pincer type of lesion in the acetabular rim and we did arthroscopic excision of the protruding fragment. The patient now has a pain free joint and able to squat and sit cross leg. His pre-operative oxford hip score was 30 which improved to 54. </p>

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Acetabular Rim Disorders/Pincer-type Femoroacetabular Impingement and Hip Arthroscopy

Sports Medicine and Arthroscopy Review ◽

10.1097/jsa.0000000000000296 ◽

2020 ◽

Vol 29 (1) ◽

pp. 35-43

Author(s):

Christopher M. Larson ◽

Robert F. LaPrade ◽

Edward R. Floyd ◽

Rebecca S. McGaver ◽

Asheesh Bedi

Keyword(s):

Femoroacetabular Impingement ◽

Hip Arthroscopy ◽

Acetabular Rim

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Correlation between bone apposition of the acetabular rim and morphological indicators of femoroacetabular impingement in the japanese asymptomatic population

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2014.02.559 ◽

2014 ◽

Vol 22 ◽

pp. S300

Author(s):

T. Goto ◽

K. Mineta ◽

D. Hamada ◽

H. Egawa ◽

K. Sairyo

Keyword(s):

Femoroacetabular Impingement ◽

Bone Apposition ◽

Acetabular Rim

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Os acetabuli—a new arthroscopic treatment option for the acetabular rim fracture

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnab036 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. i46-i50

Author(s):

Bent Lund

Keyword(s):

Treatment Option ◽

Femoroacetabular Impingement ◽

Hip Dysplasia ◽

Groin Pain ◽

Arthroscopic Treatment ◽

Acetabular Coverage ◽

Suture Bridge ◽

Technical Article ◽

Suture Bridge Technique ◽

Acetabular Rim

Abstract Os acetabuli (Os) or acetabular rimfractures are often seen in femoroacetabular impingement patients and can result in groin pain. When seen in symptomatic patients, the question is whether to remove them or to fixate the loose fragment to the acetabular rim. This depends on acetabular coverage and the extent of the Os. If removal of the Os might lead to hip dysplasia and instability, fixation of the Os should be the goal. This technical article describes the author's technique in fixating the Os with a suture-bridge technique.

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The role and clinical relevance of the ligamentum teres: long-term outcomes after hip arthroscopic surgery of cam-type femoroacetabular impingement

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnab080 ◽

2021 ◽

Author(s):

Jeong-Kil Lee ◽

Deuk-Soo Hwang ◽

Sang-Bum Kim ◽

Chan Kang ◽

Jung-Mo Hwang ◽

...

Keyword(s):

Femoroacetabular Impingement ◽

Arthroscopic Surgery ◽

Hip Osteoarthritis ◽

Ligamentum Teres ◽

Thermal Shrinkage ◽

Radiologic Evaluation ◽

Chondral Damage ◽

Group A ◽

Tönnis Grade

ABSTRACT We aimed to compare clinical and radiologic outcomes in patients with cam-type femoroacetabular impingement (FAI), with and without a partial ligamentum teres (LT) tear, who underwent hip arthroscopy (HA) with ≥10 years of follow-up. Among the patients who underwent HA for a cam-type FAI diagnosis with a labral tear, 28 patients (28 hips) with a partial LT tear and 87 patients (99 hips) with an intact LT were assigned to Groups A and B, respectively. All patients underwent partial labral debridement and femoroplasty. Debridement and thermal shrinkage were performed for LT tears. The grade of chondral damage was measured intraoperatively. Clinical items were assessed preoperatively and at the last follow-up. Patients’ satisfaction with the surgery and changes in postoperative sports ability in those who had previously been active in sports were assessed at the last follow-up. The Tönnis grade was assessed preoperatively and at the last follow-up for radiologic evaluation. Chondral damage to the acetabular and femoral head detected intraoperatively was significantly different between the groups (P = 0.005 and P < 0.001). At the last follow-up, Group A patients experienced more difficulty performing sports activities than Group B patients (P = 0.056), and significantly, more Group A patients had stopped exercising despite their active participation in sports preoperatively (P = 0.002). Regarding the Tönnis grade, significant differences were found only at the final follow-up (P = 0.020). Patients with partial LT tear showed a higher grade of chondral damage, experienced decreased exercise capacity and had significantly worsened Tönnis grades, suggesting hip osteoarthritis progression compared to those with an intact LT.

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Open MRI assessment of anterior femoroacetabular clearance in active and passive impingement-provoking postures

Bone & Joint Open ◽

10.1302/2633-1462.211.bjo-2021-0143 ◽

2021 ◽

Vol 2 (11) ◽

pp. 988-996

Author(s):

Maryam Mohtajeb ◽

Jolanda Cibere ◽

Michelle Mony ◽

Honglin Zhang ◽

Emily Sullivan ◽

...

Keyword(s):

Femoral Head ◽

Internal Rotation ◽

Femoroacetabular Impingement ◽

Hip Osteoarthritis ◽

Population Based ◽

Joint Degeneration ◽

Open Mri ◽

Hip Flexion ◽

Head Neck ◽

Acetabular Rim

Aims Cam and pincer morphologies are potential precursors to hip osteoarthritis and important contributors to non-arthritic hip pain. However, only some hips with these pathomorphologies develop symptoms and joint degeneration, and it is not clear why. Anterior impingement between the femoral head-neck contour and acetabular rim in positions of hip flexion combined with rotation is a proposed pathomechanism in these hips, but this has not been studied in active postures. Our aim was to assess the anterior impingement pathomechanism in both active and passive postures with high hip flexion that are thought to provoke impingement. Methods We recruited nine participants with cam and/or pincer morphologies and with pain, 13 participants with cam and/or pincer morphologies and without pain, and 11 controls from a population-based cohort. We scanned hips in active squatting and passive sitting flexion, adduction, and internal rotation using open MRI and quantified anterior femoroacetabular clearance using the β angle. Results In squatting, we found significantly decreased anterior femoroacetabular clearance in painful hips with cam and/or pincer morphologies (mean -11.3° (SD 19.2°)) compared to pain-free hips with cam and/or pincer morphologies (mean 8.5° (SD 14.6°); p = 0.022) and controls (mean 18.6° (SD 8.5°); p < 0.001). In sitting flexion, adduction, and internal rotation, we found significantly decreased anterior clearance in both painful (mean -15.2° (SD 15.3°); p = 0.002) and painfree hips (mean -4.7° (SD 13°); p = 0.010) with cam and/pincer morphologies compared to the controls (mean 7.1° (SD 5.9°)). Conclusion Our results support the anterior femoroacetabular impingement pathomechanism in hips with cam and/or pincer morphologies and highlight the effect of posture on this pathomechanism. Cite this article: Bone Jt Open 2021;2(11):988–996.

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