Differences in the Association of Hip Cartilage Lesions and Cam‐Type Femoroacetabular Impingement With Movement Patterns: A Preliminary Study

Abstract

Objective Preliminary study to investigate the differences in hip movement patterns during different daily and athletic activities in individuals with cam-type femoroacetabular impingement (FAI) with and without cartilage lesions compared with controls. Design Controlled laboratory study using a Cross-sectional design. Setting Research Institution with Tertiary Care Medical Center. Participants Fifteen subjects [M:F – 13:2, Age- 31.6±9.7 years (22-52), BMI- 24.9±4.6 (18.8-38.4), FAI: Control = 7:8]. Methods All subjects had 3-Tesla MR imaging of the hip and also underwent 3-D motion capture during walking, deep-squat and drop landing tasks. Experienced radiologists graded cartilage lesions on clinical MR images. Outcomes Peak kinematic and kinetic variables were compared between those with and without FAI, and those with FAI and cartilage lesions compared to subjects without cartilage lesions. Results Subjects with FAI demonstrated no significant differences for walking or drop-landing compared to controls. However, during deep-squat, subjects with FAI adducted more and had greater internal rotation moment. Subjects with cartilage lesions in the presence of a cam-lesion demonstrated - no difference for walking; greater adduction, greater internal rotation moment and lower transverse plane range of motion during deep-squat; and greater adduction and lower internal rotation during drop-landing, compared to those without cartilage lesions. Conclusions We observed differences in movement patterns between subjects with FAI compared to controls. However, the differences were more pronounced between subjects with FAI who had cartilage lesions compared to subjects who did not have cartilage lesions. These findings highlight the importance of understanding the complex interplay between bony morphology, cartilage lesions, and movement patterns in individuals with cam-type FAI.

Hip joint biomechanics during gait in people with and without symptomatic femoroacetabular impingement

“…We did not find this difference in our data, but total ROM and maximum amplitude in the same plane are clearly not independent and the Page 12 of 23 A c c e p t e d M a n u s c r i p t 13 difference in outcome between studies may depend on features such as the definition of reference position. Sagittal plane ROM alterations in FAI were not reported in the two remaining studies [17,20] that specifically investigated participants with cam-type FAI.…”

“…We found no evidence for reduced ROM in the transverse plane during gait. Although two studies have reported reduced peak hip internal rotation in Page 13 of 23 A c c e p t e d M a n u s c r i p t 14 symptomatic FAI compared to controls with uncertain hip morphology [18,19], differences were not found in other studies [13,17,20]. It is widely accepted that measurement of transverse plane kinematics is less reliable (curve r² between 0.28 and 0.47 [26]) at the hip than the knee and ankle.…”

“…Reduced hip ROM in participants with symptomatic FAI may be explained in part by bony deformity, though it is unclear whether the maximal hip angles measured in our cohort reached a range where mechanical restriction may occur. It is likely that cartilage lesions, which in combination with cam lesions have been previously associated with biomechanical movement abnormalities [20], damage to the surrounding soft tissue, abnormal joint contact forces, and altered neuromuscular function all contribute to a complex multifaceted mechanism for disruption to hip joint homeostasis in those with symptomatic FAI. Similar to a study by Kumar et al [20], our findings demonstrate no significant differences in frontal plane ROM during gait in people with symptomatic FAI.…”

“…It is likely that cartilage lesions, which in combination with cam lesions have been previously associated with biomechanical movement abnormalities [20], damage to the surrounding soft tissue, abnormal joint contact forces, and altered neuromuscular function all contribute to a complex multifaceted mechanism for disruption to hip joint homeostasis in those with symptomatic FAI. Similar to a study by Kumar et al [20], our findings demonstrate no significant differences in frontal plane ROM during gait in people with symptomatic FAI. Although other studies have reported reduced ROM in this plane [13,[17][18][19], patient groups were older (4-10 years) than our cohort, and included individuals diagnosed with pincer FAI [18,19] or were comprised of cam-type only patients [13,17].…”

“…Gait is the most common repetitive voluntary movement of the lower limbs and an essential activity of daily living. There is limited and conflicting evidence regarding alterations to hip ROM during gait in individuals with symptomatic FAI [13,[17][18][19][20]. Interpretation of current evidence is limited by the use of narrow patient samples that render it difficult to generalize results to the broader FAI population, and the failure to use diagnostic imaging to ensure healthy controls in the comparison groups have no evidence of asymptomatic morphological FAI.…”