Imaging of Impingement Syndromes around the Hip Joint

Vassalou, Evangelia E.; Zibis, Aristeidis; Klontzas, Michail E.; Karantanas, Apostolos H.

doi:10.5301/hipint.5000526

Cited by 7 publications

(7 citation statements)

References 112 publications

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“…Although narrowing of the IF and QF spaces accompanied with QF edema is sensitive radiographic markers for the IFI syndrome [ 10 ], its exact pathophysiology remains disputed [ 14 ]. Papavasiliou et al [ 15 ] reported reduced IF and QF spaces in non-symptomatic young athletes and Stenhouse et al [ 7 ] found bilateral QF edema in young patients with unilateral symptomatology, as we did in our case ( Fig.…”

Section: Discussionmentioning

confidence: 99%

Quadratus Femoris Partial Tear Secondary to Occult Ischiofemoral Impingement

Papavasiliou¹,

Stamiris²,

Stamiris³

et al. 2021

JOCR

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Introduction: Hip pain in children and adolescents may become a diagnostic challenge. A wide range of causes must be considered in the deferential diagnosis. Ischiofemoral impingement (IFI) is a pathological condition defined by hip pain associated with narrowing of the ischiofemoral (IF) space. We report the case of an adolescent patient with non-traumatic quadratus femoris (QF) tear secondary to an occult IFI syndrome. To the best of our knowledge, this is the first such case reported in the literature. Case Report: A 15-year-old girl reported persisting hip pain for a month following increased physical activity. The symptoms had started a couple of days following a weekend of increased activity due to her participating in a dancing contest. Physical examination and imaging studies (standard anterior pelvis radiograph and MRI-scan) failed to reveal any pathology apart from an area of diffused edema in the IF space. Standard hematology and biochemistry laboratory tests were all within normal range. Conservative treatment for 6 months with rest and modification of physical activities failed. A new MRI scan showed partial edema resolution and marked reduction in the IF and QF spaces (12 mm and 8 mm, respectively), thus suggesting IFI, which, in turn, led to a partial rupture of the QF. The patient underwent a local infiltration of the QF with betamethasone sodium phosphate and betamethasone acetate (6+6 mg/2 ml) under CT guidance, which led to the complete resolution of all her symptoms. She remains symptoms free for 24 months. Conclusion: IFI is a rather uncommon condition in the developing skeleton. As in adults, in adolescents as well, MRI is the study of choice in cases of IFI, since it shows QF pathology and allows measurement of the IF and QF spaces, assisting physicians in establishing the right diagnosis. However, the coexistence of a QF hematoma and/or edema, may temper with the initial MRI measurements and render the diagnosis of the primary condition rat

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Section: Discussionmentioning

confidence: 99%

Quadratus Femoris Partial Tear Secondary to Occult Ischiofemoral Impingement

Papavasiliou¹,

Stamiris²,

Stamiris³

et al. 2021

JOCR

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“…Images of 3-dimensional computed tomography (3D-CT) are widely used for cam evaluation because they provide better evaluation of bony structures than magnetic resonance imaging (MRI). 16,28 Yet, it is still largely left to the surgeon’s experience to define the cam borders on 3D-CT. 31,32…”

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confidence: 99%

“…It has been reported that the alpha angle can be measured effectively on MRI oblique axial, oblique coronal, and radial views, 13 but it can not be accurately evaluated on the standard axial and coronal CT views because the scanning directions are not parallel to the long axis of the femoral neck. 23,24 Recently, CT multiplanar reconstruction has been introduced for cam evaluation, 28 in which the CT images are reformatted based on the same scanning direction as hip MRI. Therefore, the markers of the cam border can be defined on the reformatted 2D-CT images using the AAM method, and then 3D-CT can display the area of cam deformity after the markers are imported.…”

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confidence: 99%

“…16 Images of 3-dimensional computed tomography (3D-CT) are widely used for cam evaluation because they provide better evaluation of bony structures than magnetic resonance imaging (MRI). 16,28 Yet, it is still largely left to the surgeon's experience to define the cam borders on 3D-CT. 31,32 The clinical imaging parameters for cam evaluation include the alpha angle, femoral head-neck offset ratio (hnoR), omega zone, and omega angle, among which the alpha angle is the most commonly used. 15,24 In the alpha angle measurement on 2-dimensional (2D) images, the superior border of the cam deformity is marked by the anterosuperior point where the distance from the bone to the center of the head first exceeds the radius of the femoral head.…”

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confidence: 99%

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Evaluation of Cam Deformity on 3-Dimensional Computed Tomography With the Best-Fit Sphere Technique and the Alpha Angle Marking Method

et al. 2021

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Background: Three-dimensional computed tomography (3D-CT) is commonly used for the evaluation of cam deformity; however, it does not display the cam border directly. Purpose: To compare the efficacy of the best-fit sphere (BFS) method and the alpha angle marking (AAM) method in 3D-CT evaluation for the cam border. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: Twenty-six cases of cam deformity, confirmed during hip arthroscopy, were included in this study. All patients underwent a CT scan before surgery. Using multiplanar reconstruction, we obtained reformatted CT images of oblique axial, oblique coronal, and radial views. The alpha angle and femoral head-neck offset ratio (hnoR) were measured on the reformatted CT images. The cam area on 3D-CT was displayed in 4 different ways: by importing the markers from the reformatted CT images of the oblique axial view (cam-oa), the oblique coronal view (cam-oc), or the radial view (cam-r) using the AAM method, or by using the BFS method (cam-bfs). The sizes and locations of the displayed cams were compared. Results: All hips in this study had an alpha angle greater than 60° and an hnoR smaller than 0.17. The radial view measured a larger alpha angle and smaller hnoR than the oblique axial and coronal views ( P < .05). The areas of cam-oa, cam-oc, cam-r, and cam-bfs were 161.47 ± 27.96, 89.78 ± 19.23, 241.73 ± 34.55, and 329.75 ± 42.73 mm2, respectively, and their medial-to-lateral ranges along the acetabulum (clockface referents) were 12:30 to 03:00, 11:30 to 01:30, 11:30 to 03:00, and 11:00 to 03:30, respectively. Among the 4 displays, cam-bfs had the largest area and medial-to-lateral range ( P < .05), and cam-r had the second largest area and range ( P < .05). No significant difference in the mean distances from the acetabular rim to the superior border was detected among the 4 displays ( P > .05). Conclusion: The cam area displayed by the BFS method on 3D-CT was larger than those evaluated by the AAM method. In the reformatted CT, the sizes and locations of cam deformity differed among the oblique axial, oblique coronal, and radial views, with the radial view showing the greatest area.

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“…2 Although FAI was originally described as cam or pincer bony impingement, it is usually accompanied by soft tissue lesions (labrum, ligamentum teres hip musclestendons, hip capsule) and cartilage defects. 3,4 Femoroacetabular impingement syndrome is a multifactorial disease due to genetic predisposition, the presence of hip dysplastic changes, history of a pediatric hip disease, and excessive or abnormal joint overloading during hip mobilization. 3,5 Various sports have been reported to increase the risk of FAI development, especially when hip flexion or extension is combined with rotational movements or repetitive extreme hip range of motion is obtained during performance.…”

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confidence: 99%

Hip Pain in the Athlete Part 2: How to Work Up, Diagnosis, and Manage Femoroacetabular Impingement

2018

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Femoroacetabular impingement (FAI) is frequently recognized as a cause of hip pain in athletes. Sports predisposing to the development of FAI often include repetitive hip flexion combined with rotational movements or extreme joint range of motion. Hip symptoms often arise due to multiple structural abnormalities in and around the joint. Conservative management with physical therapy is recommended at the initial manifestation of FAI in athletes, which is followed by hip arthroscopy if no improvement is observed. Physicians must consider the socioeconomic impact of the hip injury on active individuals, especially in athletes who compete at a professional level.

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Imaging of Impingement Syndromes around the Hip Joint

Cited by 7 publications

References 112 publications

Quadratus Femoris Partial Tear Secondary to Occult Ischiofemoral Impingement

Quadratus Femoris Partial Tear Secondary to Occult Ischiofemoral Impingement

Evaluation of Cam Deformity on 3-Dimensional Computed Tomography With the Best-Fit Sphere Technique and the Alpha Angle Marking Method

Hip Pain in the Athlete Part 2: How to Work Up, Diagnosis, and Manage Femoroacetabular Impingement

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