Comparison of MRI, CT, Dunn 45° and Dunn 90° alpha angle measurements in femoroacetabular impingement

2017 ◽  
Vol 28 (4) ◽  
pp. 450-455 ◽  
Author(s):  
Kevin M. Smith ◽  
Brayden J. Gerrie ◽  
Patrick C. McCulloch ◽  
David M. Lintner ◽  
Joshua D. Harris
Keyword(s):  
Femoroacetabular Impingement ◽  
Imaging Techniques ◽  
Alpha Angle ◽  
Sample Size Calculation ◽  
Test Sample ◽  
Angle Measurement ◽  
Angle Measurements ◽  
Labral Tears ◽  
Significant Difference ◽  
Cam Morphology

Purpose: To determine if a significant difference existed among alpha angle measurements between 4 imaging techniques, axial oblique CT and MRI, Dunn 45° and Dunn 90° plain radiographs, in patients with symptomatic cam femoroacetabular impingement (FAI) and labral tear. Methods: A single-surgeon prospective radiographic analysis of consecutive non-arthritic and non-dysplastic -patients with symptomatic FAI and labral tears who underwent surgery was performed. Alpha angle was measured using standard techniques as described by Nötzli. Cam morphology was defined via alpha angle measurement of >50.5 degrees. Group comparisons were made using ANOVA and chi-squared test. Sample size calculation was performed prior to study enrollment. Results: 31 subjects (16 female; 33.5 ± 10.5 years mean age) were included. There was a significant difference in alpha angle measurements between all 4 imaging techniques (F [3,120] = 8.144; p<0.001), with the Dunn 45° view (66.3 ± 11.4°) significantly greater than all 3 other techniques (Dunn 90° [57.5 ± 10.7°; p = 0.015], MRI [53.3 ± 11.5°; p<0.001], and CT (54.9 ± 11.6°; p = 0.001). There was no significant difference in alpha angle between Dunn 90°, MRI, and CT. There was a significant difference in the observed number of hips with cam morphology between imaging techniques (χ2 9.4; p = 0.025). Conclusions: The Dunn 45° radiograph yielded a significantly higher alpha angle than Dunn 90°, axial oblique MRI, and CT imaging modalities. Use of the Dunn 90° or axial oblique MRI or CT as the threshold for cam osteoplasty may result in untreated symptomatic cam FAI. The authors recommend the Dunn 45° radiograph as the most sensitive evaluation of cam morphology.

scholarly journals Morphological Changes of the Hip Commonly Associated With Femoroacetabular Impingement Are Not Correlated With Rotational Range of Hip Motion in Elite Soccer Athletes

2021 ◽  
pp. 194173812097366
Author(s):  
André Orlandi Bento ◽  
Guilherme Falótico ◽  
Keelan Enseki ◽  
Ronaldo Alves Cunha ◽  
Benno Ejnisman ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Lower Limb ◽  
Clinical Relevance ◽  
Morphological Changes ◽  
Alpha Angle ◽  
Soccer Players ◽  
Level Of Evidence ◽  
Rotational Movement ◽  
Professional Soccer ◽  
Significant Difference

Background: Morphological changes characteristic of femoroacetabular impingement (FAI) are common in soccer players. However, the clinical relevance of such anatomical variations is still not well-defined. Hypothesis: We hypothesized that high alpha angle values and/or acetabular retroversion index (ARI) are correlated with rotational range of motion (ROM) of the hip and that there are clinical-radiological diferences between the dominant lower limb (DLL) and nondominant lower limb (NDLL) in professional soccer players. Study Design: Cross-sectional. Level of Evidence: Level 3. Methods: A total of 59 male professional soccer players (average age 25.5 years, range 18-38 years) were evaluated in the preseason. As main outcome measures, we evaluated the alpha angle and the ARI and hip IR and ER ROM with radiographic analysis. Results: The measurements taken on DLL and NDLL were compared and a significant difference was found between the sides in the ER ( P = 0.027), where the DLL measures were 1.54° (95% CI, 0.18-2.89) greater than the NDLL. There were no significant differences between the sides in the measures of IR ( P > 0.99), total ROM ( P = 0.07), alpha angle ( P = 0.250), and ARI ( P = 0.079). The correlations between the rotation measurements and the alpha angle in each limb were evaluated and the coefficient values showed no correlation; so also between the ARI and rotation measures. Conclusion: Morphological changes of the femur or acetabulum are not correlated with hip IR and ER ROM in male professional soccer players. ER on the dominant side was greater than on the nondominant side. There was no significant difference in the other measurements between sides. Clinical Relevance: In clinical practice, it is common to attribute loss of hip rotational movement to the presence of FAI. This study shows that anatomical FAI may not have a very strong influence on available hip rotational movement in professional soccer athletes.

scholarly journals Influence of Femoral Version on the Outcomes of Hip Arthroscopic Surgery for Femoroacetabular Impingement or Labral Tears: A Systematic Review and Meta-analysis

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110091
Author(s):  
Chenghui Wang ◽  
Yaying Sun ◽  
Zheci Ding ◽  
Jinrong Lin ◽  
Zhiwen Luo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Satisfaction ◽  
Femoroacetabular Impingement ◽  
Arthroscopic Surgery ◽  
Harris Hip Score ◽  
Cochrane Library ◽  
Femoral Version ◽  
Labral Tears ◽  
Significant Difference ◽  
Secondary Outcomes

Background: It remains controversial whether abnormal femoral version (FV) affects the outcomes of hip arthroscopic surgery for femoroacetabular impingement (FAI) or labral tears. Purpose: To review the outcomes of hip arthroscopic surgery for FAI or labral tears in patients with normal versus abnormal FV. Study Design: Systematic review; Level of evidence, 4. Methods: Embase, PubMed, and the Cochrane Library were searched in July 2020 for studies reporting the outcomes after primary hip arthroscopic surgery for FAI or labral tears in patients with femoral retroversion (<5°), femoral anteversion (>20°), or normal FV (5°-20°). The primary outcome was the modified Harris Hip Score (mHHS), and secondary outcomes were the visual analog scale (VAS) for pain, Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), Non-Arthritic Hip Score (NAHS), failure rate, and patient satisfaction. The difference in preoperative and postoperative scores (Δ) was also calculated when applicable. Results: Included in this review were 5 studies with 822 patients who underwent hip arthroscopic surgery for FAI or labral tears; there were 166 patients with retroversion, 512 patients with normal version, and 144 patients with anteversion. Patients with retroversion and normal version had similar postoperative mHHS scores (mean difference [MD], 2.42 [95% confidence interval (CI), –3.42 to 8.26]; P = .42) and ΔmHHS scores (MD, –0.70 [96% CI, –8.56 to 7.15]; P = .86). Likewise, the patients with anteversion and normal version had similar postoperative mHHS scores (MD, –3.09 [95% CI, –7.66 to 1.48]; P = .18) and ΔmHHS scores (MD, –1.92 [95% CI, –6.18 to 2.34]; P = .38). Regarding secondary outcomes, patients with retroversion and anteversion had similar ΔNAHS scores, ΔHOS-SSS scores, ΔVAS scores, patient satisfaction, and failure rates to those with normal version, although a significant difference was found between the patients with retroversion and normal version regarding postoperative NAHS scores (MD, 5.96 [95% CI, 1.66-10.26]; P = .007) and postoperative HOS-SSS scores (MD, 7.32 [95% CI, 0.19-14.44]; P = .04). Conclusion: The results of this review indicated that abnormal FV did not significantly influence outcomes after hip arthroscopic surgery for FAI or labral tears.

scholarly journals Comparison of MRI Alpha Angle Measurement Planes in Femoroacetabular Impingement

2008 ◽  
Vol 467 (3) ◽  
pp. 660-665 ◽  
Author(s):  
Kawan S. Rakhra ◽  
Adnan M. Sheikh ◽  
David Allen ◽  
Paul E. Beaulé
Keyword(s):  
Femoroacetabular Impingement ◽  
Alpha Angle ◽  
Angle Measurement

scholarly journals Are Chondrocytes Overlying Cam Morphology Suitable for Therapeutic Use?

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0042
Author(s):  
Mitchell Coleman ◽  
Robert Westermann
Keyword(s):  
Articular Chondrocytes ◽  
Periacetabular Osteotomy ◽  
Alpha Angle ◽  
Therapeutic Use ◽  
Testing Procedures ◽  
Significant Difference ◽  
Carbonyl Cyanide ◽  
Cam Morphology ◽  
Head Neck

Objectives: Cam-type femoroacetabular impingement (FAI) results in extra bone and cartilage on the anterolateral femoral head-neck junction, causing abnormal contact between the femur and the acetabulum. We investigated whether chondrocytes isolated from cam lesions in FAI patients are metabolically similar to normal chondrocytes and therefore a potential option for therapeutic use via autologous implantation. Methods: Cam cartilage was obtained intraoperatively from 7 human patients with cam lesions (Alpha angle > 60 degrees) (4 arthroscopy, 2 arthroplasty, and 1 periacetabular osteotomy). Healthy femoral and acetabular articular cartilage was obtained from 8 Yucatan minipig hips for comparison. Chondrocytes were extracted from the cartilage then cultured at a high density for up to 1 week. Mitochondrial stress testing procedures (with 2 mM oligomycin, 2.5 mM carbonyl cyanide p-trifluoromethoxy-phenylhydrazone (FCCP), 2 mM rotenone, 5 mM antimycin A) for determination of the chondrocytes basal and maximal respiration were performed. Results: No significant differences in basal (p = 0.73) or maximum (p = 0.40) respiration were found when comparing chondrocytes from cam lesions to normal porcine articular chondrocytes. There was a significant difference in maximum respiration when comparing chondrocytes from cam lesions in patients who underwent a total hip arthroplasty to chondrocytes from other cam lesions (p = 0.007). Conclusion: Basal and maximum respiration in chondrocytes from cartilage overlying cam lesions suggests a similar level of respiration to healthy articular chondrocytes. Given the importance of mitochondria to cartilage homeostasis, this study supports that chondrocytes overlying non-arthritic femoral cam lesions may be a novel source of healthy chondrocytes.

Does acetabular coverage influence the clinical outcome of arthroscopically treated cam-type femoroacetabular impingement (FAI)?

2018 ◽  
Vol 100-B (7) ◽  
pp. 831-838 ◽  
Author(s):  
M. M. Ibrahim ◽  
S. Poitras ◽  
A. C. Bunting ◽  
E. Sandoval ◽  
P. E. Beaulé
Keyword(s):  
Functional Outcome ◽  
Femoroacetabular Impingement ◽  
Alpha Angle ◽  
3D Analysis ◽  
Acetabular Coverage ◽  
Crossover Sign ◽  
Significant Difference ◽  
Patient Reported ◽  
Outcome Scores

Aims What represents clinically significant acetabular undercoverage in patients with symptomatic cam-type femoroacetabular impingement (FAI) remains controversial. The aim of this study was to examine the influence of the degree of acetabular coverage on the functional outcome of patients treated arthroscopically for cam-type FAI. Patients and Methods Between October 2005 and June 2016, 88 patients (97 hips) underwent arthroscopic cam resection and concomitant labral debridement and/or refixation. There were 57 male and 31 female patients with a mean age of 31.0 years (17.0 to 48.5) and a mean body mass index (BMI) of 25.4 kg/m2 (18.9 to 34.9). We used the Hip2Norm, an object-oriented-platform program, to perform 3D analysis of hip joint morphology using 2D anteroposterior pelvic radiographs. The lateral centre-edge angle, anterior coverage, posterior coverage, total femoral coverage, and alpha angle were measured for each hip. The presence or absence of crossover sign, posterior wall sign, and the value of acetabular retroversion index were identified automatically by Hip2Norm. Patient-reported outcome scores were collected preoperatively and at final follow-up with the Hip Disability and Osteoarthritis Outcome Score (HOOS). Results At a mean follow-up of 2.7 years (1 to 8, sd 1.6), all functional outcome scores significantly improved overall. Radiographically, only preoperative anterior coverage had a negative correlation with the improvement of the HOOS symptom subscale (r = -0.28, p = 0.005). No significant difference in relative change in HOOS subscale scores was found according to the presence or absence of radiographic signs of retroversion. Discussion Our study demonstrated the anterior coverage as an important modifier influencing the functional outcome of arthroscopically treated cam-type FAI. Cite this article: Bone Joint J 2018;100-B:831–8.

scholarly journals 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

2021 ◽  
Vol 7 (4) ◽  
pp. e001199
Author(s):  
Joshua Heerey ◽  
Joanne Kemp ◽  
Rintje Agricola ◽  
Ramya Srinivasan ◽  
Anne Smith ◽  
...  
Keyword(s):  
Young Adult ◽  
Groin Pain ◽  
Case Control Study ◽  
Alpha Angle ◽  
Case Control ◽  
Cartilage Defects ◽  
Football Players ◽  
Labral Tears ◽  
Cam Morphology ◽  
Control Study

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.

scholarly journals Association between hip joint impingement and lumbar disc disease in elite rowers

2021 ◽  
Vol 7 (4) ◽  
pp. e001063
Author(s):  
Thamindu Wedatilake ◽  
Antony Palmer ◽  
S Fernquest ◽  
Ann Redgrave ◽  
Liz Arnold ◽  
...  
Keyword(s):  
Degenerative Disc Disease ◽  
Lumbar Disc ◽  
Alpha Angle ◽  
Disc Disease ◽  
Lumbar Disc Disease ◽  
Degenerative Disc ◽  
Labral Tears ◽  
History Of ◽  
Elite Rowers ◽  
Cam Morphology

ObjectivesLumbar disc disease is a known cause of back pain. Increasingly it is thought that cam morphology of the hip may have a causal role in development of lumbar disc disease. The aim of this study was to describe the morphology of the hip and investigate the association of cam morphology with lumbar disc disease observed on MRI in elite rowers.MethodsCross-sectional observational study of 20 elite rowers (12 male, 8 female, mean age 24.45, SD 2.1). Assessment included clinical examination, questionnaires, 3T MRI scans of the hips and lumbar spine. Alpha angle of the hips and Pfirrmann score of lumbar discs were measured.Results85% of rowers had a cam morphology in at least one hip. Alpha angle was greatest at the 1 o’clock position ((bone 70.9 (SD 16.9), cartilage 71.4 (16.3)). 95% of the group were noted to have labral tears, but only 50% of the group had history of groin pain. 85% of rowers had at least one disc with a Pfirrmann score of 3 or more and 95% had a history of back pain. A positive correlation was observed between the alpha angle and radiological degenerative disc disease (correlation coefficient=3.13, p=0.012). A negative correlation was observed between hip joint internal rotation and radiological degenerative disc disease (correlation coefficient=−2.60, p=0.018).ConclusionsRowers have a high prevalence of labral tears, cam morphology and lumbar disc disease. There is a possible association between cam morphology and radiological lumbar degenerative disc disease, however, further investigation is required.

scholarly journals Are there Sex differences in Return to Play Rates in High Level Athletes Following Hip Arthroscopy?

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0042
Author(s):  
Matthew Dooley ◽  
Joost Burger ◽  
Bryan Kelly ◽  
Eilish O’Sullivan
Keyword(s):  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Female Athletes ◽  
Alpha Angle ◽  
Return To Sport ◽  
Collegiate Athletes ◽  
Return To Play ◽  
Center Edge ◽  
Significant Difference ◽  
High Level

Objectives: Return to sport is a common co ncern in those undergoing arthroscopic surgery for the treatment of femoroacetabular impingement. These are commonly young active individuals with high-level athletic aspirations. Setting expectations in terms of appropriate time frame and success rates are an integral piece of pre-operative education and planning. The goals of this study were to examine return to play (RTP) rates and time frames in professional and collegiate athletes following hip arthroscopy, evaluate sex differences in return to play (morphology and rates), and evaluate differences in return to play for the most common sports. Methods: A retrospective review of a continuous cohort of patients undergoing hip arthroscopy for the treatment of femoroacetabular impingement and labral injury was conducted between January 2014 and December 2018. Athletes whom were participating in collegiate or professional sports prior to surgery were included. Chart review was conducted to gather sport specific information, morphologic data, clearance dates, successful return, and subsequent surgery. Successful return to sport was determined by being able to return to participation following clearance in at least one season. Descriptive statistics were utilized to summarize the data set and chi-square and t-tests were utilized to examine differences between groups. Results: 265 patients undergoing 332 hip arthroscopies participating in collegiate or professional sports prior to surgery were identified (75.4% male and 24.6% female), with 237 collegiate athletes and 95 professional athletes. There was a significant difference in mean alpha angles between males and females, 70.2 ± 10.5 males and 60.7± 10.0 in females, (p<0.001), but no significant differences in coronal center edge angles or femoral version. 87% of the athletes participated in hockey, football, lacrosse, soccer, baseball, soccer, or basketball. Given that a significant portion of the athletes were in college, there was a portion that graduated and thus no longer participated in collegiate athletics (27 hips), and 3 athletes (all with bilateral hip arthroscopies) were unable to return to sport due to other conditions. 91.9% of athletes were able to return to sport. 19 athletes (22 hips) were unable to return to sport. The group that was unable to return was predominantly female (73%), and this difference was significant (p<0.001). There was a significant difference between the returning group and the group that failed to return to sport in alpha angle (RTP 68.6 ± 10.8 vs No RTP 60.7± 10.6), but there were no differences in coronal center edge angle or femoral version. The difference in alpha angle is due to the predominance of females (whom had significantly lower alphas) in the unable to return group. 10 athletes (11 hips, 3.3%) required subsequent surgery (revision arthroscopy, conversion to periacetabular osteotomy, or hip resurfacing). Times for return to play were available to 205 of the athletes, averaging 6.8 months± 2.8. There was no significant difference between the males and females for return to play. There was trend towards shorter length of return for hockey athletes. There was a significant difference in the return to sport rates between the sport groups, but there were some groups with smaller sample sizes that should be taken into account. The groups with more athletes unable to return were soccer and lacrosse; these sports also had a high number of female athletes. There were no hockey athletes that were unable to return, and only 1 football athlete was unable to return. Conclusions: Hip arthroscopy for the treatment of femoroacetabular impingement and labral injury allows patients to return to sport at a high level within an average of 6.8 months. However, female athletes are less likely to have a successful return and should potentially be counseled as such. This may also inform pre-operative rehabilitation programs and intra-operative planning for female athletes. Further research should examine causes for decreased rate of return for females, and potential ways to maximize recovery and return to sport following hip arthroscopy. [Table: see text]

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