The Association of α Angle on Disease Severity in Adolescent Femoroacetabular Impingement

Abstract

Background: Femoroacetabular Impingement (FAI) is a common cause of hip pain in adolescent patients. Clinical exam and radiographic markers, such as α angle and lateral center edge angle (LCEA), are commonly used to aid in the diagnosis of this condition. The purpose of this study was to correlate preoperative α angle and LCEA with preoperative symptoms, intraoperative findings, and preoperative and postoperative patient reported outcomes (PROs) in the adolescent patient. Methods: A retrospective analysis of prospectively collected data was conducted for all patients who underwent operative intervention for FAI at an academic institution over an 11-year period. Preoperative imaging was obtained and measured for LCEA and α angle. PROs (modified Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score, and UCLA score) were collected preoperatively, as well as 1, 2, and 5 years postoperatively. Operative intervention was either open surgical hip dislocation or arthroscopic, and intraoperative disease was graded using the Beck Classification system. Patients with minimum 1-year follow-up were included in statistical analysis. Results: There were 86 hips (64 female hips) included with an average age of 16.3 years (range, 10.4 to 20.5 y), with an average of 37 months of follow-up. There was no correlation between severity of preoperative symptoms or difference between pre and postoperative PROs for both α angle and LCEA. Overall, significant improvement was noted in modified Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score, and UCLA Score ( P <0.001 for each). Independent of preoperative symptoms, increased α angle correlated with more severe intraoperative labral disease ( P <0.001), and longer length of labral tear (Corr 0.295, P <0.01). Femoral head and acetabular articular cartilage damage did not correlate with α angle or LCEA, nor did overall severity of disease. Conclusions: In adolescent patients with FAI, increased α angle was found to significantly correlate with labral pathology, including increased length of tear and severity of disease, irrespective of preoperative symptoms or postoperative patient reported outcomes. Level of Evidence: Level III—retrospective.

Femoroazetabuläres Impingement beim Jugendlichen und Adoleszenten

“…Bei Adoleszenten mit FAI sind Knorpelschäden mit 88,4 % sehr häufig und korrelieren in ihrem Ausmaß mit dem Alphawinkel [ 33 ]. Dabei weisen Patienten mit Post-ECF-Slip Deformitäten im Vergleich zum primären Cam-FAI häufig einen höheren Alphawinkel und ausgedehntere Knorpelschäden auf; zudem sind die Patienten im Schnitt jünger [ 34 ].…”

Borderline Dysplastic Hips Undergoing Hip Arthroscopy Achieve Equivalent Patient Reported Outcomes When Compared With Hips With Normal Acetabular Coverage: A Systematic Review and Meta-Analysis

“…15,[18][19][20][21][22] Seven additional studies presenting associations between LCEA and PRO measures were identified but provided insufficient data to be included in a meta-analysis. [23][24][25][26][27][28][29] All associations for which there was insufficient data to perform meta-analysis are listed in Supplemental Table 4 (http://links.lww.com/JAAOS/A849). These studies were excluded as, for each PRO, there were fewer than the minimum three studies required for quantitative synthesis reporting data in the same format-such as odds ratios or mean 6 SD-thus prohibiting meta-analysis.…”

Hip Arthroscopy for Femoroacetabular Impingement-Associated Labral Tears: Current Status and Future Prospects

“…Likewise, Youngman et al found that increased alpha angle was significantly correlated with increased length of tear and severity of labral disease among adolescent patients with FAI. 35 In contrast to imaging for FAI, MRI and MRA are the preferred modalities for imaging of labral tears due to their superior visualization of soft-tissue structures and lesions compared with X-rays. While MRA has been shown to have higher sensitivity to labral tears than MRI, its invasive nature, higher learning curve, and use of radiation are major drawbacks.…”