Twelve Percent of Hips With a Primary Cam Deformity Exhibit a Slip-like Morphology Resembling Sequelae of Slipped Capital Femoral Epiphysis

Albers, Christoph E.; Steppacher, Simon D.; Haefeli, Pascal C; Werlen, Stefan; Hanke, Markus S.; Siebenrock, Klaus A.; Tannast, Moritz

doi:10.1007/s11999-014-4068-x

Cited by 53 publications

(40 citation statements)

References 28 publications

(66 reference statements)

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“…Exclusion criteria were: A history of hip pathology or symptoms; genetic, neuromuscular or developmental condition; and low‐quality CT images precluding 3D reformatting. A total of 80 subjects (age: 8–15 years; 10 per age group; 50% females) with normal hips were selected, Hip normality was verified radiographically by measuring alpha angle, epiphyseal tilt angle, and the acetabular index angle . Details of patients selection process and their baseline characteristics are previously reported in a study focused on age‐ and sex‐related changes in development of capital femoral epiphysis morphology .…”

Section: Methodsmentioning

confidence: 99%

Relative contribution of epiphyseal tubercle and peripheral cupping to capital femoral epiphysis stability during daily activities

Kiapour

Maranho

et al. 2019

Journal Orthopaedic Research

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Epiphyseal tubercle and peripheral cupping can influence the development of slipped capital femoral epiphysis (SCFE) and Cam morphology. During normal skeletal growth, epiphyseal tubercle shrinks while the peripheral cupping grows. We hypothesized that epiphyseal tubercle act as the primary stabilizer of the head-neck junction at early stages and this role is gradually transferred to epiphyseal cupping as the tubercle shrinks and cupping grows. From a cohort of 80 boys and girls (8-15 years old) with normal hips, CT scans of 5 subjects corresponding to minimum, 25th percentile, median, 75th percentile and maximum relative tubercle and cupping height were used to develop 3D finite element models. In vivo measured hip loads were used to study load sharing between the tubercle and peripheral cupping under combined and uniaxial loads exerted on femoral head during a range of daily activities. Lower epiphyseal tubercle height, larger epiphyseal cupping height and bigger differences in tubercle and cupping heights were strongly associated with increased epiphyseal cupping to epiphyseal tubercle stress ratios (R 2 > 0.7). We found lower peripheral cupping stresses relative to the tubercle (cupping to tubercle stress ratio <1) in hips with larger tubercle and smaller cupping. The relative decreases in tubercle size along with increased in peripheral cupping in our models gradually shifted the load distribution to higher stresses in the periphery compared to the epiphyseal tubercle area (cupping to tubercle stress ratio >1). Both tubercle and

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Section: Methodsmentioning

confidence: 99%

Relative contribution of epiphyseal tubercle and peripheral cupping to capital femoral epiphysis stability during daily activities

Kiapour

Maranho

et al. 2019

Journal Orthopaedic Research

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“…Subclinical slipped capital femoral epiphysis (SCFE) has been proposed as the possible pathomechanism of cam‐type FAI. In a cohort of 200 patients with cam impingement, Albers et al have shown that a post‐slip morphology was present in only 12%. The highest prevalence (72%) in the cohort contained hips with idiopathic cam‐type morphology with a normal epiphyseal angle but increased epiphyseal extension.…”

Section: Development Of Cam‐type Faimentioning

confidence: 99%

Influence of evolution on cam deformity and its impact on biomechanics of the human hip joint

Anwander

Beck

Büchler

2018

Journal Orthopaedic Research

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Anatomy and biomechanics of the human hip joint are a consequence of the evolution of permanent bipedal gait. Habitat and behaviour have an impact on hip morphology and significant differences are present even within the same biological family. The forces acting upon the hip joint are mainly a function of gravitation and strength of the muscles. Acetabular and femoral anatomy ensure an inherently stable hip with a wide range of motion. The femoral head in first human ancestors with upright gait was spherical (coxa rotunda). Coxa rotunda is also seen in close human relatives (great apes) and remains the predominant anatomy of present-day humans. High impact sport during adolescence with open physis however can activate an underlying genetic predisposition for reinforcement of the femoral neck, causing an epiphyseal extension and the formation of an osseous asphericity at the antero-superior femoral neck (cam deformity). The morphology of cam deformity is similar to the aspherical hips of quadrupeds (coxa recta), with the difference that in quadrupeds the asphericity is posterior. It has been postulated that this is due to the fact that humans bear weight on the extended leg, while quadrupeds bear weight at 90-100° flexion. The asphericity alters the biomechanical properties of the joint and as it is forced into the acetabulum leading to secondary cartilage damage. It is considered a risk factor for later development of osteoarthritis of the hip. Clinically this presents as reduced range of motion, which can be an indicator for the structural deformity of the hip. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 9999:XX-XX, 2018.

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“…The presence of such deformities may predispose one to FAI. However, FAI is a dynamic process, which can only be diagnosed clinically and differs from the idiopathic cam deformity (83). Two imaging signs are helpful to detect the slip-like morphology: the fovea sign and the tilt angle (83), both seen on radial MR images at the 2 o'clock anterosuperior position.…”

Section: Extraarticular Hip Impingementmentioning

confidence: 99%

“…The fovea sign is positive if the femoral neck axis does not cross the fovea capitis femoris. The tilt angle is calculated between the femoral neck axis and the line perpendicular to the connecting line between the two ends of the femoral epiphysis and is positive if the angle is greater than 4° (83). These signs may be more useful in research than in the clinical routine, as therapy is not different between idiopathic and slip-like cam deformities.…”

Section: Extraarticular Hip Impingementmentioning

confidence: 99%

Hip Imaging in Athletes: Sports Imaging Series

et al. 2016

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Hip or groin pain in athletes is common and clinical presentation is often nonspecific. Imaging is a very important diagnostic step in the work-up of athletes with hip pain. This review article provides an overview on hip biomechanics and discusses strategies for hip imaging modalities such as radiography, ultrasonography, computed tomography, and magnetic resonance (MR) imaging (MR arthrography and traction MR arthrography). The authors explain current concepts of femoroacetabular impingement and the problem of high prevalence of cam-and pincer-type morphology in asymptomatic persons. With the main focus on MR imaging, the authors present abnormalities of the hip joint and the surrounding soft tissues that can occur in athletes: intraarticular and extraarticular hip impingement syndromes, labral and cartilage disease, microinstability of the hip, myotendinous injuries, and athletic pubalgia. Hip or groin pain in athletes is common and clinical presentation is often nonspecific. Imaging is a very important diagnostic step in the work-up of athletes with hip pain. This review article provides an overview on hip biomechanics and discusses strategies for hip imaging modalities such as radiography, ultrasonography, computed tomography, and magnetic resonance (MR) imaging (MR arthrography and traction MR arthrography). The authors explain current concepts of femoroacetabular impingement and the problem of high prevalence of cam-and pincer-type morphology in asymptomatic persons. With the main focus on MR imaging, the authors present abnormalities of the hip joint and the surrounding soft tissues that can occur in athletes: intraarticular and extraarticular hip impingement syndromes, labral and cartilage disease, microinstability of the hip, myotendinous injuries, and athletic pubalgia. After reading the article and taking the test, the reader will be able to:n Describe biomechanical implications of torsional malalignment and other atypical forms of hip impingement n Describe the most common MR imaging findings in femoroacetabular impingement and identify anatomic variants n Describe imaging characteristics of a Morel-Lavallée lesion and identify the anatomic compartment where this lesion typically occurs n Identify common stress fractures around the hip joint in athletes and discuss potential complications n Describe features of myotendinous injuries around the hip n Describe the anatomic relationship of the sacrotuberous ligament and the origin of the hamstring tendons n Describe the anatomic structures involved in an athletic pubalgia Accreditation and Designation Statement The RSNA is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The RSNA designates this journal-based SA-CME activity for a maximum of 1.0 AMA PRA Category 1 Credit ™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity. Disclosure StatementThe ACCME requires that the RSNA, as an accredited prov...

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Twelve Percent of Hips With a Primary Cam Deformity Exhibit a Slip-like Morphology Resembling Sequelae of Slipped Capital Femoral Epiphysis

Cited by 53 publications

References 28 publications

Relative contribution of epiphyseal tubercle and peripheral cupping to capital femoral epiphysis stability during daily activities

Relative contribution of epiphyseal tubercle and peripheral cupping to capital femoral epiphysis stability during daily activities

Influence of evolution on cam deformity and its impact on biomechanics of the human hip joint

Hip Imaging in Athletes: Sports Imaging Series

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