Cam Deformities and Limited Hip Range of Motion Are Associated With Early Osteoarthritic Changes in Adolescent Athletes: A Prospective Matched Cohort Study

Wyles, Cody C.; Norambuena, Germán A.; Howe, Benjamin M.; Larson, Dirk R.; Levy, Bruce A.; Yuan, Brandon J.; Trousdale, Robert T.; Sierra, Rafael J.

doi:10.1177/0363546517719460

Cited by 89 publications

(64 citation statements)

References 57 publications

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“…Experimentally inducing a cam lesion in sheep has demonstrated significant damage and degenerative changes of the cartilage and labrum at the corresponding location within the acetabulum in vivo. The relationship between cam location and the location of chondrolabral damage was also reported in humans, and is thought to be causal in the development of osteoarthritis . This reproducible model therefore provides an experimental platform, which has the potential to answer clinically relevant questions in the context of FAI.…”

Section: Discussionmentioning

confidence: 62%

Vascular supply of the femoral head in sheep—Implications for the ovine femoroacetabular impingement model

Tannast

Wolfer

Ryan

et al. 2018

Journal Orthopaedic Research

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Sheep hips have a natural non-spherical head similar to a cam-type deformity in human beings. By performing an intertrochanteric varus osteotomy, cam-type femoroacetabular impingement can be induced experimentally. In sheep, the aspherical portion is located superiorly-exactly matching the region where the superior retinacular vessels enter the femoral head-neck junction in human beings. In order to fully exploit the potential of this experimental FAI model, a safe osteochondroplasty of the superior asphericity would need to be done without the risk of avascular necrosis. The aim of this study was to describe the vascular anatomy of the femoral head in sheep from the aorta to the retinacular vessels in order to perform safe femoral osteochondroplasty of the superior femoral asphericity in sheep. Sixty-two ovine hips were analyzed using CT angiography (30 hips), post mortem intravascular latex injection (6 hips), vascular corrosion casting (6 hips), and analysis of the distribution of vascular foramina around the femoral head-neck junction in macerated ovine femora (20 hips). The ovine femoral head receives its blood supply from anterior retinacular arteries from the lateral femoral circumflex artery, and from posterior retinacular arteries from the medial femoral circumflex artery. The superior aspherical portion is free of vessels. Detailed knowledge about vascular anatomy of sheep hips is of clinical significance since it allows to perform osteochondroplasty of the superior aspherical portion in the experimental ovine FAI model safely without the risk of osteonecrosis. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2340-2348, 2018.

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Section: Discussionmentioning

confidence: 62%

Vascular supply of the femoral head in sheep—Implications for the ovine femoroacetabular impingement model

Tannast

Wolfer

Ryan

et al. 2018

Journal Orthopaedic Research

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“…The combination of severe cam‐type deformity and decreased internal rotation (less than 20°) at baseline resulted in an even more pronounced adjusted OR of 25.2, and in a positive predictive value of 52.6% for developing end‐stage OA. The work of Reichenbach et al, Wyles et al, and Peters et al, have also showed the higher prevalence of cam morphology among males with the associated limited internal rotation.…”

Section: Discussionmentioning

confidence: 90%

“…Studying a large cohort of individuals (700) who underwent primary total hip arthroplasty before the age of fifty, Clohisy et al found that over 60% of the hips had radiographic evidence of cam‐type femoroacetabular impingement ( strength ). The 20‐year risk of developing OA or needing THA in a hip of Tönnis 0 with cam morphology after a contralateral THA was 22%; compared to a 14% in hips with normal morphology . In a more recent large longitudinal multi‐centre cohort of over thousand individuals (the CHECK cohort), it was found that a moderate (α angle >60°) and severe (α angle >83°) cam‐type deformity resulted in adjusted odds ratio (OR) of 3.67 (95%CI 1.68–8.01) and 9.66 (95%CI 4.72–19.78), respectively, for developing end‐stage OA .…”

Section: Discussionmentioning

confidence: 99%

Unravelling the hip pistol grip/cam deformity: Origins to joint degeneration

Beaulé

Grammatopoulos

Speirs

et al. 2018

Journal Orthopaedic Research

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This article reviews a body of work performed by the investigators over 9 years that has addressed the significance of cam morphology in the development of hip osteoarthritis (OA). Early hip joint degeneration is a common clinical presentation and preexisting abnormal joint morphology is a risk factor for its development. Interrogating Hill's criteria, we tested whether cam-type femoroacetabular impingement leads to hip OA. Strength of association was identified between cam morphology, reduced range-of-movement, hip pain, and cartilage degeneration. By studying a pediatric population, we were able to characterize the temporality between cam morphology (occurring 1st) and joint degeneration. Using in silico (finite element) and in vivo (imaging biomarkers) studies, we demonstrated the biological plausibility of how a cam deformity can lead to joint degeneration. Furthermore, we were able to show a biological gradient between degree of cam deformity and extent of articular damage. However, not all patients develop joint degeneration and we were able to characterize which factors contribute to this (specificity). Lastly, we were able to show that by removing the cam morphology, one could positively influence the degenerative process (experiment). The findings of this body of work show consistency and coherence with the literature. Furthermore, they illustrate how cam morphology can lead to early joint degeneration analogous to SCFE, dysplasia, and joint mal-reduction post-injury. The findings of this study open new avenues on the association between cam morphology and OA including recommendations for the study, screening, follow-up, and assessment (patient-specific) of individuals with cam morphology in order to prevent early joint degeneration. Statement of significance: By satisfying Hill's criteria, one can deduct that in some individuals, cam morphology is a cause of OA. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 9999:XX-XX, 2018.

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“…Prevalence is high among athletes and intense physical activity during adolescence is believed to be a risk factor for development of hip morphologic abnormalities. A recent observational study followed adolescent athletes with limited range of motion of the hip joint, a finding commonly associated with FAI 38 . Athletes with limited hip range of motion showed increased progressive degenerative changes on MRI at 5 years.…”

Section: Prediction Prognostic and Progression Studiesmentioning

confidence: 99%

Osteoarthritis year in review 2018: imaging

Nieminen

Casula

Nevalainen

et al. 2019

Osteoarthritis and Cartilage

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Purpose: To provide a narrative review of the most relevant original research published in 2017/2018 on osteoarthritis imaging. Methods: The PubMed database was used to recover all relevant articles pertaining to osteoarthritis and medical imaging published between 1 April 2017 and 31 March 2018. Review articles, case studies and in vitro or animal studies were excluded. The original publications were subjectively sorted based on relevance, novelty and impact. Results and conclusions: The publication search yielded 1,155 references. In the assessed publications, the most common imaging modalities were radiography (N ¼ 708) and magnetic resonance imaging (MRI) (355), followed by computed tomography (CT) (220), ultrasound (85) and nuclear medicine (17). An overview of the most important publications to the osteoarthritis (OA) research community is presented in this narrative review. Imaging studies play an increasingly important role in OA research, and have helped us to understand better the pathophysiology of OA. Radiography and MRI continue to be the most applied imaging modalities, while quantitative MRI methods and texture analysis are becoming more popular. The value of ultrasound in OA research has been demonstrated. Several multi-modality predictive models have been developed. Deep learning has potential for more automatic and standardized analyses in future OA imaging research.

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Cam Deformities and Limited Hip Range of Motion Are Associated With Early Osteoarthritic Changes in Adolescent Athletes: A Prospective Matched Cohort Study

Cited by 89 publications

References 57 publications

Vascular supply of the femoral head in sheep—Implications for the ovine femoroacetabular impingement model

Vascular supply of the femoral head in sheep—Implications for the ovine femoroacetabular impingement model

Unravelling the hip pistol grip/cam deformity: Origins to joint degeneration

Osteoarthritis year in review 2018: imaging

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