Femoral cam deformity due to anterior capsular force: A theoretical model with MRI and cadaveric correlation

Lee, Cara Beth; Spencer, Hillard T.; Nygaard, Kirsten

doi:10.1016/j.jor.2016.06.012

Cited by 4 publications

(9 citation statements)

References 26 publications

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“…14,15,[26][27][28][29] Capsular forces against an immature epiphysis may also induce bone growth and cam formation; decreased acetabular depth has been reported in patients with a cam deformity, potentially exposing the epiphysis to greater capsular contact than subjects with deeper coverage. 30 Although a genetic predisposition to developing FAI has been proposed, [5][6][7][8][9] the majority of studies investigating the development of FAI in athletes report developmental factors as the main driver; the earlier age of sports commencement and increased intensity of training and playing have been implicated in development of cam deformity. 14,17,27 The type of physical activity may also be effective and a number of different impact sports have been explored for their causal relationship in the development of FAI.…”

Section: Discussionmentioning

confidence: 99%

“…14,15,26–29 Capsular forces against an immature epiphysis may also induce bone growth and cam formation; decreased acetabular depth has been reported in patients with a cam deformity, potentially exposing the epiphysis to greater capsular contact than subjects with deeper coverage. 30…”

Section: Discussionmentioning

confidence: 99%

“…The cam deformity is most likely a secondary phenomenon and not due to epiphyseal overgrowth; 18,40–42 we believe the cam deformity develops from a combination of repeated impingement from a prominent acetabular rim (pincer deformity) during flexion, adduction and internal rotation (kicking/jumping) and from pulling, rubbing and abrasion of the hip capsule, zona orbicularis and iliofemoral ligament against the femoral head and neck primarily during extension and external rotation (running/twisting). 30…”

Section: Discussionmentioning

confidence: 99%

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The clinical presentation, diagnosis and pathogenesis of symptomatic sports-related femoroacetabular impingement (SRFAI) in a consecutive series of 1021 athletic hips

Carton

Filan

2019

HIP International

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Aim: To examine the pathogenesis and clinical presentation of sports-related femoroacetabular impingement (SRFAI) in a large consecutive series of symptomatic athletes. Methods: Between January 2009 and February 2017 prospectively collected data from competitive athletes within the Gaelic Athletic Association (GAA), and who subsequently underwent arthroscopic treatment for symptomatic FAI, were analysed. Data was collected using internationally validated health questionnaires (Harris Hip Score, UCLA, SF-36, WOMAC) and recognised clinical (ROM, symptom presentation, provocation tests) and radiological (AP pelvis, Dunn, False profile) indicators/measures of FAI. Results: A total of 1021 consecutive cases (mean 26.6 ± 6.2 years) were included. In every case, conservative treatment failed to resolve symptoms with athletes attending an average of 2.4 ± 1.1 health care professionals prior to referral. Symptoms developed gradually (78%) and consisted primarily of groin pain (76.1%) and hip stiffness (76.5%) following activity. An acetabular rim deformity (pincer) was present in all cases; a cam deformity in 72.1%. The prevalence and degree of cam deformity increased with progressing age groups ( p < 0.001); mean lateral centre-edge angle remained static ( p = 0.456). Increasing CEA, alpha angle and presence of rim fracture was associated with a reduction in all ranges of hip movement ( p < 0.001). Conclusion: Symptomatic SRFAI presented in this large series of GAA athletes failed to resolve with non-operative treatment. Increasing hip deformity resulted in poorer ROM. Abnormal acetabular morphology remains static with increasing athletic age while cam deformity is progressive and most likely a secondary pathology.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The clinical presentation, diagnosis and pathogenesis of symptomatic sports-related femoroacetabular impingement (SRFAI) in a consecutive series of 1021 athletic hips

Carton

Filan

2019

HIP International

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“…Cam morphology, for example, is characterized by abnormal convexity at the anterosuperior portion of the femoral head-neck junction. It is highly prevalent (>50%) in athletes who participated in elite-level soccer [ 32 , 33 , 34 , 35 , 36 , 37 , 38 ], basketball [ 39 , 40 ] and ice hockey [ 41 , 42 , 43 , 44 , 45 ] during adolescence and is thought to be the result of a mechanoadaptive response to altered hip joint mechanics associated with these at-risk sports [ 32 , 33 , 34 , 36 , 39 , 40 , 41 , 42 , 43 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ]. However, the altered stresses suspected to contribute to cam morphology have not yet been quantified.…”

Section: Introductionmentioning

confidence: 99%

Using Magneto-Inertial Measurement Units to Pervasively Measure Hip Joint Motion during Sports

Horenstein

Goudeau

Lewis

et al. 2020

Sensors

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The use of wireless sensors to measure motion in non-laboratory settings continues to grow in popularity. Thus far, most validated systems have been applied to measurements in controlled settings and/or for prescribed motions. The aim of this study was to characterize adolescent hip joint motion of elite-level athletes (soccer players) during practice and recreationally active peers (controls) in after-school activities using a magneto-inertial measurement unit (MIMU) system. Opal wireless sensors (APDM Inc., Portland OR, USA) were placed at the sacrum and laterally on each thigh (three sensors total). Hip joint motion was characterized by hip acceleration and hip orientation for one hour of activity on a sports field. Our methods and analysis techniques can be applied to other joints and activities. We also provide recommendations in order to guide future work using MIMUs to pervasively assess joint motions of clinical relevance.

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“…As such, there is increasing interest in the relationship between hip capsule anatomy and the development and symptomology of FAI. One study suggests the thickness and tension of the iliofemoral ligament may contribute to the development of cam deformities in FAI 14 . Another study demonstrates that increased anterior hip capsule thickness is correlated with decreased range of motion in FAI patients, 15 while a systematic review shows a thinner anterior capsule is associated with clinical hip laxity 16 .…”

Section: Introductionmentioning

confidence: 99%

Correlation of hip capsule morphology with patient symptoms from femoroacetabular impingement

Shaw

Warwick

Nguyen

et al. 2020

Journal Orthopaedic Research

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The relationship between morphological characteristics of the hip capsule and patient symptoms in the setting of femoroacetabular impingement (FAI) is undefined. In this study, patients with symptomatic FAI prospectively underwent 3T magnetic resonance (MR) imaging of the affected hip and completed the hip disability and osteoarthritis outcome score (HOOS) to determine the correlation between hip capsule anatomy and patient symptoms. Anterior hip capsule volume, posterior capsule volume, anterior‐posterior capsule volume ratio, and proximal‐distal volume ratio in the anterior capsule were quantified and measured using axial‐oblique intermediate‐weighted 3D fast spin echo MR images. A total of 35 patients (35 hips) were included for analysis (mean age: 30.6 years; mean body mass index [BMI]: 24.9 kg/m2; 57% male). The mean alpha angle was 62.2° ± 4.7°, the mean anterior hip capsule volume was 1705.1 ± 450.3 mm3, the mean posterior hip capsule volume was 1284.8 ± 268.5 mm3, the mean anterior to posterior capsule volume ratio was 1.1 ± 0.39, and the mean proximal to distal volume ratio of the anterior capsule was 0.65 ± 0.28. There was no correlation between age, gender, or BMI, and any hip capsule characteristics. Worse scores on the HOOS pain scale were correlated with increased anterior to posterior volume ratio (r = −.38; 95% confidence interval: −0.06 to −0.63). In conclusion, hip capsule morphology correlates with patient symptoms in the setting of FAI as increased anterior capsular volume, relative to posterior capsular volume, is associated with greater patient pain.

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Femoral cam deformity due to anterior capsular force: A theoretical model with MRI and cadaveric correlation

Cited by 4 publications

References 26 publications

The clinical presentation, diagnosis and pathogenesis of symptomatic sports-related femoroacetabular impingement (SRFAI) in a consecutive series of 1021 athletic hips

The clinical presentation, diagnosis and pathogenesis of symptomatic sports-related femoroacetabular impingement (SRFAI) in a consecutive series of 1021 athletic hips

Using Magneto-Inertial Measurement Units to Pervasively Measure Hip Joint Motion during Sports

Correlation of hip capsule morphology with patient symptoms from femoroacetabular impingement

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