1
|
Yoshitani J, Schoyer B, Shah A, Khanduja V. Current concepts in the diagnosis and management of Os Acetabuli. INTERNATIONAL ORTHOPAEDICS 2024; 48:657-666. [PMID: 38195946 PMCID: PMC10901947 DOI: 10.1007/s00264-023-06078-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/19/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE The aim of this review is to appraise the current evidence on the epidemiology, pathophysiology, diagnosis and management of os acetabuli. METHODS A scoping review was conducted according to the Joanna Briggs Institute guidelines. A systematic search was performed on Medline (PubMed), Embase and Cochrane Library. Inclusion criteria comprised observational and interventional studies and review articles published in the English language that focused on patients with os acetabuli according to the PRISMA extension of scoping reviews checklist using the terms 'Os Acetabuli' or 'os acetabula' or 'acetabular ossicles'. A narrative synthesis of results was undertaken, and the included articles were divided into (i) definition, (ii) aetiology, (iii) diagnosis and imaging and (iv) management of os acetabuli. RESULTS 107 articles were screened, with 22 meeting the eligibility criteria. A total of 8836 patients were considered, of which 604 had os acetabuli. The mean age was 32.8 years. The prevalence of os acetabuli ranged from 3.4 to 7.7%, with a higher prevalence in males compared to females. True os acetabuli was defined as an unfused secondary ossification centre along the acetabular rim. The aetiology of os acetabuli is thought to be secondary to acetabular dysplasia and/or femoroacetabular impingement. Standard of care for management of symptomatic os acetabuli is considered to be arthroscopic excision unless the excision results in acetabular undercoverage and/or instability, in which case, fixation is recommended. CONCLUSIONS Successful management of os acetabuli depends on understanding the pathology and treating the underlying cause rather than treating the os acetabuli in isolation. Future work needs to focus on establishing clear diagnostic criteria, consensus on definition and an evidence-based treatment algorithm.
Collapse
Affiliation(s)
- Junya Yoshitani
- Young Adult Hip Service, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - Benjamin Schoyer
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Anand Shah
- Young Adult Hip Service, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - Vikas Khanduja
- Young Adult Hip Service, Addenbrooke's - Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.
| |
Collapse
|
2
|
Huang Z, Liu W, Li T, Liu Z, Zhao P. Diagnostic value of magnetic resonance imaging and magnetic resonance arthrography for assessing acetabular labral tears: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e32963. [PMID: 36862877 PMCID: PMC9981430 DOI: 10.1097/md.0000000000032963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND This study aimed to systematically evaluate the value of magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) in the diagnosis of acetabular labral tears. METHODS Databases including PubMed, Embase, Cochrane Library, Web of Science, CBM, CNKI, WanFang Data, and VIP were electronically searched to collect relevant studies on magnetic resonance in the diagnosis of acetabular labral tears from inception to September 1, 2021. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias in the included studies by using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. RevMan 5.3, Meta Disc 1.4, and Stata SE 15.0 were used to investigate the diagnostic value of magnetic resonance in patients with acetabular labral tears. RESULTS A total of 29 articles were included, involving 1385 participants and 1367 hips. The results of the meta-analysis showed that the pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, pooled diagnostic odds ratio, area under the curve of the summary receiver operating characteristic, and Q* of MRI for diagnosing acetabular labral tears were 0.77 (95% confidence interval [CI], 0.75-0.80), 0.74 (95% CI, 0.68-0.80), 2.19 (95% CI, 1.76-2.73), 0.48 (95% CI, 0.36-0.65), 4.86 (95% CI, 3.44-6.86), 0.75, and 0.69, respectively. The pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, pooled diagnostic odds ratio, area under the curve of the summary receiver operating characteristic, and Q* of MRA for diagnosing acetabular labral tears were 0.87 (95% CI, 0.84-0.89), 0.64 (95% CI, 0.57-0.71), 2.23 (95% CI, 1.57-3.16), 0.21 (95% CI, 0.16-0.27), 10.47 (95% CI, 7.09-15.48), 0.89, and 0.82, respectively. CONCLUSION MRI has high diagnostic efficacy for acetabular labral tears, and MRA has even higher diagnostic efficacy. Due to the limited quality and quantity of the included studies, the above results should be further validated.
Collapse
Affiliation(s)
- Zhihao Huang
- School of Big Data and Fundamental Sciences, Shandong Institute of Petroleum and Chemical Technology, Dongying, China
| | - Wenyu Liu
- Department of Pharmacy, Weifang People’s Hospital, Weifang, China
| | - Tianyu Li
- School of Big Data and Fundamental Sciences, Shandong Institute of Petroleum and Chemical Technology, Dongying, China
| | - Zhihao Liu
- School of Education and Modern Communication, Shandong Institute of Petroleum and Chemical Technology, Dongying, China
| | - Pengfei Zhao
- Department of Clinical Pharmacy, Weifang People’s Hospital, Weifang, China
- *Correspondence: Pengfei Zhao, Department of Clinical Pharmacy, Weifang People’s Hospital, No. 151 Guangwen Street, Kuiwen District, Weifang 261041, China (e-mail: )
| |
Collapse
|
3
|
Adib F, Hartline J, Donovan JS, Kalachi K, Dehghan P, Ochiai D. Two Novel Clinical Tests for the Diagnosis of Hip Labral Tears. Am J Sports Med 2023; 51:1007-1014. [PMID: 36803076 DOI: 10.1177/03635465221149748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND There are few well-studied clinical tests for the diagnosis of hip labral tears. As the differential diagnosis for hip pain is broad, accurate clinical examination is important in guiding advanced imaging and identifying patients who may benefit from surgical management. PURPOSE To determine the diagnostic accuracy of 2 novel clinical tests for the diagnosis of hip labral tears. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS Clinical examination findings including the Arlington, twist, and flexion-adduction-internal rotation (FADIR)/impingement tests as performed by a fellowship-trained orthopaedic surgeon specializing in hip arthroscopy were obtained from retrospective chart review. The Arlington test ranges the hip from flexion-abduction-external rotation to FADIR while applying subtle internal rotation and external rotation motion. The twist test involves internal rotation and external rotation of the hip while weightbearing. Diagnostic accuracy statistics for each of the tests were calculated using magnetic resonance arthrography as the reference standard. RESULTS A total of 283 patients were included in the study with a mean age of 40.7 years (range, 13-77 years) and 66.4% were women. The Arlington test was found to have a sensitivity of 0.94 (95% CI, 0.90-0.96), specificity of 0.33 (95% CI, 0.16-0.56), positive predictive value (PPV) of 0.95 (95% CI, 0.92-0.97), and negative predictive value (NPV) of 0.26 (95% CI, 0.13-0.46). The twist test was found to have a sensitivity of 0.68 (95% CI, 0.62-0.73), specificity of 0.72 (95% CI, 0.49-0.88), PPV of 0.97 (95% CI, 0.94-0.99), and NPV of 0.13 (95% CI, 0.08-0.21). The FADIR/impingement test was found to have a sensitivity of 0.43 (95% CI, 0.37-0.49), specificity of 0.56 (95% CI, 0.34-0.75), PPV of 0.93 (95% CI, 0.87-0.97), and NPV of 0.06 (95% CI, 0.03-0.11). The Arlington test was significantly more sensitive than both the twist and FADIR/impingement tests (P < .05), while the twist test was significantly more specific than the Arlington test (P < .05). CONCLUSION The Arlington test is more sensitive than the traditional FADIR/impingement test, while the twist test is more specific than the FADIR/impingement test in diagnosing hip labral tears in the hands of an experienced orthopaedic surgeon.
Collapse
Affiliation(s)
- Farshad Adib
- Nirschl Orthopaedic Center, Arlington, Virginia, USA
| | - Jacob Hartline
- University of Maryland, Department of Orthopaedics, Baltimore, Maryland, USA
| | - J Skye Donovan
- Marymount University, School of Health Sciences, Arlington, Virginia, USA
| | - Kourosh Kalachi
- University of Maryland, Department of Orthopaedics, Baltimore, Maryland, USA
| | - Pegah Dehghan
- Johns Hopkins School of Medicine, Department of Physical Medicine and Rehabilitation, Baltimore, Maryland, USA
| | - Derek Ochiai
- Nirschl Orthopaedic Center, Arlington, Virginia, USA
| |
Collapse
|
4
|
Diagnostic Accuracy of Clinical Tests and Imaging Exams for Femoroacetabular Impingement: An Umbrella Review of Systematic Reviews. Clin J Sport Med 2022; 32:635-647. [PMID: 34534982 DOI: 10.1097/jsm.0000000000000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/13/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To synthesize available evidence about diagnostic accuracy of clinical tests and imaging examinations for femoroacetabular impingement (FAI) syndrome. DESIGN Umbrella review. SETTING N/A. PARTICIPANTS N/A. INTERVENTIONS N/A. MAIN OUTCOME MEASURES Systematic reviews (SR) indexed in Embase, LIVIVO, PubMed, SCOPUS, the Cochrane Library, and Web of Science were searched in a 2-phase process. SR assessing diagnostic accuracy were considered eligible. RESULTS From 1520 studies, 6 SR were included, which evaluated 24 primary studies related to FAI syndrome. Of these, 5 SR assessed clinical tests, and a substantial heterogeneity was found concerning reference standards adopted across primary studies, which included arthroscopy, clinical examination (associated or not with imaging exams), intra-articular injections, and open surgery. Most clinical tests presented higher values of sensitivity compared with specificity, although evidence was considered limited because the same primary studies were often included across SR. Nonetheless, evidence around the flexion adduction internal rotation (FADIR) test was considered stronger and its use as a screening tool was consistently supported. Only one SR assessed the accuracy of imaging examinations, which adopted open surgery as the sole reference standard. Most imaging exams presented considerably high values of sensitivity, although specificity values were notably lower. CONCLUSIONS No robust recommendations can be provided for most clinical tests, although the FADIR test, in particular, was consistently supported as a screening tool. Moreover, although imaging examinations showed considerably high sensitivity values, evidence was considered sparse and further research is strongly recommended to validate its use as reference standards for diagnostic accuracy data.
Collapse
|
5
|
Baraka MM, Sallam HE, Abdelwahab MM. Periacetabular osteotomy: A novel application of modified Stoppa approach. SICOT J 2022; 8:33. [PMID: 35969124 PMCID: PMC9377214 DOI: 10.1051/sicotj/2022035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/27/2022] [Indexed: 11/27/2022] Open
Abstract
Background: The Bernese periacetabular osteotomy (PAO) is a well-established procedure for symptomatic hip dysplasia in adolescents and young adults. However, it remains a technically demanding procedure, and several major complications have been described, many of which are related to the approach and surgical exposure. The current study evaluates the efficacy and safety of PAO performed through a modified Stoppa approach. Methods: A prospective series of nine consecutive patients with hip dysplasia were treated PAO through the modified Stoppa approach. The mean age was 22.4 years (15–30 years) and the mean follow-up was 3.2 years (2–5 years). Harris hip score (HHS) was used as a functional score, and the radiographic indices included the lateral center-edge angle (LCEA) and Tönnis roof angle. Results: The approach allowed the osteotomy lines to be performed under direct visualization from the intra-pelvic surface of the acetabulum, aided by fluoroscopy. A lateral window was added to perform the final iliac cut and for subsequent mobilization and fixation of the acetabular fragment. The mean HHS improved significantly from 70.8 ± 4.9 points to 90.1 ± 3.3 points (p < 0.001). The mean LCEA improved from 8.2° ± 4.9 (range: 0–14) to 32.7° ± 5.3 (range: 26–40), with a mean improvement of 24.5°. The mean Tönnis angle improved from 28.4° ± 4.4 (range: 22–35) to 3.8° ± 3.3 (range: 0–10). Two patients had irritation from prominent screw heads that necessitated removal 1 year after the index procedure. One patient had radiographic progression of osteoarthritis. No cases of infection, non-union, heterotopic ossification, or nerve palsy were identified till the latest follow-up. Conclusion: Ganz PAO can be safely conducted through the modified Stoppa approach, providing direct exposure to the osteotomized surfaces, and protecting susceptible neuro-vascular structures. Level of evidence: IV.
Collapse
Affiliation(s)
- Mostafa M Baraka
- Division of Paediatric Orthopaedics and Limb Reconstruction, Department of Orthopaedic Surgery, Faculty of Medicine, Ain-Shams University, Abbasia 11517, Cairo, Egypt
| | - Haitham E Sallam
- Division of Hip Reconstruction, Department of Orthopaedic Surgery, Faculty of Medicine, Ain-Shams University, Abbasia 11517, Cairo, Egypt
| | - Mahmoud M Abdelwahab
- Division of Arthroscopy and Sports Medicine, Department of Orthopaedic Surgery, Faculty of Medicine, Ain-Shams University, Abbasia 11517, Cairo, Egypt
| |
Collapse
|
6
|
Zhang P, Li C, Wang W, Zhang B, Miao W, Liu Y. 3.0 T MRI is more recommended to detect acetabular labral tears than MR Arthrography: an updated meta-analysis of diagnostic accuracy. J Orthop Surg Res 2022; 17:126. [PMID: 35232459 PMCID: PMC8886969 DOI: 10.1186/s13018-022-02981-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background This meta-analysis aimed to evaluate the current evidence on the diagnostic performance of MRI/MRA for detecting acetabular labral tears (ALT). Methods We systematically searched the PubMed, Embase, and Cochrane library until February 5, 2021, to identify original research studies reporting the diagnostic performance of MRI/MRA for the detection of ALT. Study methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. The summary sensitivity (Se) and specificity (Sp) of the studies were estimated using a bivariate model. We calculated the post-test probability to assess the clinical utility of MRI/MRA. Univariate meta-regression and subgroup analyses were performed to assess between-study heterogeneity. Results We included 22 studies (n = 1670 patients). The meta-analytic summary Se and Sp for MRI were 0.8 (95% CI 0.51–0.94) and 0.77 (95% CI 0.68–0.84), respectively, while for MRA they were 0.89 (95% CI 0.82–0.93) and 0.69 (95% CI 0.56–0.80). MRA showed a higher area under the summary receiver operating curve (SROC) (0.87 vs. 0.80) than MRI. MRI could increase the post-test probability to 0.78 and could decrease the post-test probability to 0.21, MRA could increase the post-test probability to 0.74 and could decrease the post-test probability to 0.14. Meta-regression analysis showed two significant factors affecting study heterogeneity: MR field strength and reference standard. After dividing the studies into two subgroups based on the MR field strength, we found that the Se values of 3.0 T MRI were very close to MRA (0.87 vs. 0.89), the Sp values of 3.0 T MRI were superior to MRA (0.77 vs. 0.69). Conclusions Given that 3.0 T MRI could provide a non-invasive, fast and convenient method to recognize suspicious ALT cases, 3.0 T MRI is more recommended than MRA.
Collapse
Affiliation(s)
- Peng Zhang
- Department of Sports Medicine, Characteristic Medical Center of Chinese People's Armed Police Forces, No. 220, Chenglin Road, Tianjin, 300162, People's Republic of China.,Chinese PLA Medical School, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
| | - Chunbao Li
- Department of Orthopedics Surgery, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
| | - Wenliang Wang
- Department of Sports Medicine, Characteristic Medical Center of Chinese People's Armed Police Forces, No. 220, Chenglin Road, Tianjin, 300162, People's Republic of China
| | - Baiqing Zhang
- Chinese PLA Medical School, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
| | - Weicheng Miao
- Department of Sports Medicine, Characteristic Medical Center of Chinese People's Armed Police Forces, No. 220, Chenglin Road, Tianjin, 300162, People's Republic of China
| | - Yujie Liu
- Department of Orthopedics Surgery, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China.
| |
Collapse
|
7
|
Ashberg L, Close MR, Perets I, Walsh JP, Chaharbakhshi EO, Domb BG. The Hip-Spine Connection: How to Differentiate Hip Conditions From Spine Pathology. Orthopedics 2021; 44:e699-e706. [PMID: 34618633 DOI: 10.3928/01477447-20211001-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Practitioners treating spine pathology commonly encounter patients with hip pain. These patients frequently manifest groin, buttock, trochanteric, or knee pain. Complex biomechanical interaction between the axial and the appendicular skeleton may result in compensatory adaptation. Cross-innervation of the hip and surrounding tissues may make diagnosis of the primary source difficult, leading to delayed diagnosis. This review elucidates the interaction between the hip and the spine and can assist clinicians in recognizing the hip as a potential source of pain. Diagnostic guidelines enabling a streamlined workup of patients presenting with confusing symptoms related to the hip that masquerade as a spine disorder are presented. [Orthopedics. 2021;44(6):e699-e706.].
Collapse
|
8
|
Ishøi L, Nielsen MF, Krommes K, Husted RS, Hölmich P, Pedersen LL, Thorborg K. Femoroacetabular impingement syndrome and labral injuries: grading the evidence on diagnosis and non-operative treatment-a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF). Br J Sports Med 2021; 55:1301-1310. [PMID: 34531185 DOI: 10.1136/bjsports-2021-104060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 11/03/2022]
Abstract
This statement summarises and appraises the evidence on diagnostic tests and clinical information, and non-operative treatment of femoroacetabular impingement (FAI) syndrome and labral injuries. We included studies based on the highest available level of evidence as judged by study design. We evaluated the certainty of evidence using the Grading of Recommendations Assessment Development and Evaluation framework. We found 29 studies reporting 23 clinical tests and 14 different forms of clinical information, respectively. Restricted internal hip rotation in 0° hip flexion with or without pain was best to rule in FAI syndrome (low diagnostic effectiveness; low quality of evidence; interpretation of evidence: may increase post-test probability slightly), whereas no pain in Flexion Adduction Internal Rotation test or no restricted range of motion in Flexion Abduction External Rotation test compared with the unaffected side were best to rule out (very low to high diagnostic effectiveness; very low to moderate quality of evidence; interpretation of evidence: very uncertain, but may reduce post-test probability slightly). No forms of clinical information were found useful for diagnosis. For treatment of FAI syndrome, 14 randomised controlled trials were found. Prescribed physiotherapy, consisting of hip strengthening, hip joint manual therapy techniques, functional activity-specific retraining and education showed a small to medium effect size compared with a combination of passive modalities, stretching and advice (very low to low quality of evidence; interpretation of evidence: very uncertain, but may slightly improve outcomes). Prescribed physiotherapy was, however, inferior to hip arthroscopy (small effect size; moderate quality of evidence; interpretation of evidence: hip arthroscopy probably increases outcome slightly). For both domains, the overall quality of evidence ranged from very low to moderate indicating that future research on diagnosis and treatment may alter the conclusions from this review.
Collapse
Affiliation(s)
- Lasse Ishøi
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | - Mathias Fabricius Nielsen
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | - Kasper Krommes
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | - Rasmus Skov Husted
- Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Department of Orthopedic Surgery and Physical Therapy, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Clinical Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Per Hölmich
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | | | - Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| |
Collapse
|
9
|
Taniguchi T, Harada T, Iidaka T, Hashizume H, Taniguchi W, Oka H, Asai Y, Muraki S, Akune T, Nakamura K, Kawaguchi H, Yoshida M, Tanaka S, Yamada H, Yoshimura N. Prevalence and associated factors of pistol grip deformity in Japanese local residents. Sci Rep 2021; 11:6025. [PMID: 33727622 PMCID: PMC7966377 DOI: 10.1038/s41598-021-85521-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/02/2021] [Indexed: 11/26/2022] Open
Abstract
Pistol grip deformity (PGD) may be the main factor in femoroacetabular impingement development. This study aimed to clarify the epidemiological indices and factors related to PGD in Japanese people. This population-based cohort study included 1575 local Japanese residents. PGD, center edge angle, and joint space width were measured radiographically. We investigated the relationship between PGD and spino-pelvic parameters. Factors associated with PGD were examined using multiple logistic regression analysis, with the presence/absence of PGD as an objective variable, and sex, age, body mass index (BMI), and the presence/absence of hip pain or spino-pelvic parameters as explanatory variables. In the entire cohort, 4.9% (10.6% men, 2.1% women) had PGD on at least one side. A trend was observed between PGD and increasing age in both men and women (men: p < 0.0001, women: p = 0.0004). No relationship was observed between PGD and hip pain (risk ratio 1.0 [95% confidence interval 0.97–1.03]). Factors significantly associated with PGD were age, sex, and BMI in the multivariate model. Acquired factors may be related to PGD in Japanese people as the PGD prevalence increased with age and PGD was not significantly associated with hip pain. This study provides new insights into the etiology and clinical significance of PGD.
Collapse
Affiliation(s)
- Takaya Taniguchi
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan.
| | - Teiji Harada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
| | - Toshiko Iidaka
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
| | - Wataru Taniguchi
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yoshiki Asai
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
| | - Shigeyuki Muraki
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Toru Akune
- Rehabilitation Services Bureau, National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa, Saitama, Japan
| | - Kozo Nakamura
- Department of Orthopaedic Surgery, Towa Hospital, Towa, Adachi-ku, Tokyo, Japan
| | - Hiroshi Kawaguchi
- Department of Orthopaedics and Spine, Tokyo Neurological Center, 4-1-17 Toranomon, Minato-ku, Tokyo, Japan
| | - Munehito Yoshida
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, Japan
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| |
Collapse
|
10
|
Balci S, Karanfil Y, Oguz B, Aydingoz U. Validity of US measurements of cam-type femoroacetabular impingement parameters: a preliminary study in an asymptomatic adult population. Jpn J Radiol 2020; 38:1082-1089. [DOI: 10.1007/s11604-020-01005-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 06/10/2020] [Indexed: 10/24/2022]
|
11
|
Mohan R, Unnikrishnan PN, Gudena R. Validity of direct magnetic resonance arthrogram in patients with femoroacetabular impingement and their outcome post hip arthroscopy. J Orthop 2020; 18:204-208. [PMID: 32055144 DOI: 10.1016/j.jor.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 11/02/2019] [Indexed: 11/29/2022] Open
Abstract
Femoroacetabular Impingement is an established cause of labral tears and chondral delamination. The aim was to test the validity of direct magnetic resonance arthrogram [dMRA] in the diagnosis of the same. We also looked at the short term functional outcome in these patients post hip arthroscopy. The dMRA is valuable in diagnosing labral tears nevertheless poor in detecting cartilage delamination. Hip arthroscopic intervention provided a good short-term functional outcome; however, should be offered with caution in patients over 40 years. To our knowledge, this is the single largest series published with similar methodology.
Collapse
Affiliation(s)
- Rahul Mohan
- Department of Trauma and Orthopaedics, St Helens and Knowsley NHS Trust, Whiston Hospital, Warrington Road, L35 5DR, United Kingdom
| | - P Nithin Unnikrishnan
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, SY10 7AG, United Kingdom
| | - Ravindra Gudena
- Department of Trauma and Orthopaedics, St Helens and Knowsley NHS Trust, Whiston Hospital, Warrington Road, L35 5DR, United Kingdom
| |
Collapse
|
12
|
Combining results from hip impingement and range of motion tests can increase diagnostic accuracy in patients with FAI syndrome. Knee Surg Sports Traumatol Arthrosc 2020; 28:3382-3392. [PMID: 32335699 PMCID: PMC7511272 DOI: 10.1007/s00167-020-06005-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/16/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Clinical examination is an important part in the diagnosis of femoroacetabular impingement (FAI) syndrome. However, knowledge on reliability and validity of clinical diagnostic tests is scarce. The aims were to evaluate the inter-rater agreement and diagnostic accuracy of clinical tests to detect patients with FAI syndrome. METHODS Eighty-one patients (49% women) were recruited. Two experienced raters performed impingement and range of motion (ROM) tests. Three criteria had to be fulfilled for the diagnosis of FAI syndrome: (1) symptoms; (2) CAM and/or Pincer morphology; and (3) being responder to intra-articular block injection. For inter-rater agreement, the Cohen's kappa statistics were used (0.41-0.60 = moderate, 0.61-0.80 = substantial agreement). For diagnostic accuracy, sensitivity, specificity, positive and negative predictive values were calculated. RESULTS Anterior impingement test (AIMT), FADIR test and FABER test showed kappa values above 0.6. All passive hip ROM, except extension, had kappa values above 0.4. AIMT and FADIR showed the highest sensitivity, i.e., 80%, with a specificity of 26% and 25%, respectively. Passive hip ROM in internal rotation with neutral hip position had a sensitivity of 29% and a specificity of 94%. CONCLUSION The AIMT, FADIR and FABER tests were reliable between two experienced raters, while results from different raters for hip ROM should be interpreted with caution. The AIMT and FADIR test can only be used to rule out patients with FAI syndrome, while evaluation of ROM in internal rotation with neutral position may be more suitable to rule in patients with FAI syndrome. LEVEL OF EVIDENCE II.
Collapse
|
13
|
Pierannunzii L, Di Benedetto P, Carulli C, Fiorentino G, Munegato D, Panascì M, Potestio D, Randelli F, Della Rocca F, Rosolen V, Giangreco M, Santori N. Mid-term outcome after arthroscopic treatment of femoroacetabular impingement: development of a predictive score. Hip Int 2019; 29:303-309. [PMID: 29987953 DOI: 10.1177/1120700018786025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To build a post-arthroscopy outcome-predictive score (POPS) associated with the likelihood of lasting benefit after arthroscopic treatment of femoroacetabular impingement (FAI) and based solely on unambiguous preoperative information. METHODS A population of 220 FAI patients, operated on with standard techniques by orthopaedic surgeons trained in hip arthroscopy in 6 different centres, was evaluated physically or by telephone interview 2 to 5 years after surgery. The criteria of successful mid-term outcome (SMO) were agreed upon by all authors. A multivariate logistic regression, adjusted for patient's age and centre, was applied to predict SMO. In the model, the variables associated with the outcome were included and the relative ORs (odds ratios) were used to compute the FAI-POPS (FAI - post-arthroscopy outcome-predictive score). A ROC (receiver operating characteristic) curve was plotted and the optimum cut-off was calculated. RESULTS 155 patients out of 220 showed a successful mid-term outcome. The optimum cut-off of FAI-POPS was calculated to be 6.3 and with this threshold it proved a sensitivity of 0.66 and a specificity of 0.69, a positive predictive value of 0.84 and a negative predictive value of 0.46. CONCLUSIONS The standard arthroscopic treatment of FAI resulted in satisfactory persistent symptom relief for about 70% of patients. No or minimal osteoarthritis, short time elapsed from the appearance of symptoms and high preoperative modified Harris Hip Score are independent predictive factors of SMO. The FAI-POPS is obtained as sum of 3 odds ratios corresponding to the above prognostic factors and is a useful predictor of mid-term outcome after conventional arthroscopic FAI treatment.
Collapse
Affiliation(s)
| | - Paolo Di Benedetto
- 2 Clinica Ortopedica, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | | | - Gennaro Fiorentino
- 4 Department of Orthopaedics and Traumatology, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Daniele Munegato
- 5 Orthopaedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | | | - Filippo Randelli
- 8 Hip Department and Trauma, IRCCS Policlinico San Donato, S. Donato Milanese, Milan, Italy
| | | | | | | | | |
Collapse
|
14
|
Position paper on magnetic resonance imaging protocols in the musculoskeletal system (excluding the spine) by the Italian College of Musculoskeletal Radiology. Radiol Med 2019; 124:522-538. [DOI: 10.1007/s11547-019-00992-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/14/2019] [Indexed: 12/12/2022]
|
15
|
Matcuk GR, Price SE, Patel DB, White EA, Cen S. Acetabular labral tear description and measures of pincer and cam-type femoroacetabular impingement and interobserver variability on 3 T MR arthrograms. Clin Imaging 2018; 50:194-200. [PMID: 29655063 DOI: 10.1016/j.clinimag.2018.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/27/2018] [Accepted: 04/02/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the inter-rater agreement for description of labral tears and measures of femoroacetabular impingement (FAI) on 3 T hip MR arthrography. MATERIALS AND METHODS 53 hip MR arthrograms were reviewed by three musculoskeletal radiologists. Labral tears were described (Czerny classification) with extents recorded. Cam- and pincer-type FAI measures were performed. Intraclass correlation (ICC) and kappa statistic (κ) assessed inter-observer agreement. RESULTS There was fair agreement for labral tear description (κ = 0.25-0.39) and for alpha angles (ICC = 0.54), and fair to excellent agreement for other measures of FAI (ICC = 0.51-0.90). CONCLUSION There is moderate inter-observer variability reporting labral tears and measures of FAI.
Collapse
Affiliation(s)
- George R Matcuk
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States.
| | - Spencer E Price
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States
| | - Dakshesh B Patel
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States
| | - Eric A White
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States
| | - Steven Cen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, United States
| |
Collapse
|
16
|
Cunningham DJ, Paranjape CS, Harris JD, Nho SJ, Olson SA, Mather RC. Advanced Imaging Adds Little Value in the Diagnosis of Femoroacetabular Impingement Syndrome. J Bone Joint Surg Am 2017; 99:e133. [PMID: 29257021 DOI: 10.2106/jbjs.16.00963] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) syndrome is an increasingly recognized source of hip pain and disability in young active adults. In order to confirm the diagnosis, providers often supplement physical examination maneuvers and radiographs with intra-articular hip injection, magnetic resonance imaging (MRI), or magnetic resonance arthrography (MRA). Since diagnostic imaging represents the fastest rising cost segment in U.S. health care, there is a need for value-driven diagnostic algorithms. The purpose of this study was to identify cost-effective diagnostic strategies for symptomatic FAI, comparing history and physical examination (H&P) alone (utilizing only radiographic imaging) with supplementation with injection, MRI, or MRA. METHODS A simple-chain decision model run as a cost-utility analysis was constructed to assess the diagnostic value of the MRI, MRA, and injection that are added to the H&P and radiographs in diagnosing symptomatic FAI. Strategies were compared using the incremental cost-utility ratio (ICUR) with a willingness to pay (WTP) of $100,000/QALY (quality-adjusted life year). Direct costs were measured using the Humana database (PearlDiver). Diagnostic test accuracy, treatment outcome probabilities, and utilities were extracted from the literature. RESULTS H&P with and without supplemental diagnostic injection was the most cost-effective. Adjunct injection was preferred in situations with a WTP of >$60,000/QALY, low examination sensitivity, and high FAI prevalence. With low disease prevalence and low examination sensitivity, as may occur in a general practitioner's office, H&P with injection was the most cost-effective strategy, whereas in the reciprocal scenario, H&P with injection was only favored at exceptionally high WTP (∼$990,000). CONCLUSIONS H&P and radiographs with supplemental diagnostic injection are preferred over advanced imaging, even with reasonable deviations from published values of disease prevalence, test sensitivity, and test specificity. Providers with low examination sensitivity in situations with low disease prevalence may benefit most from including injection in their diagnostic strategy. Providers with high examination sensitivity in situations with high disease prevalence may not benefit from including injection in their diagnostic strategy. Providers should not routinely rely on advanced imaging to diagnose FAI syndrome, although advanced imaging may have a role in challenging clinical scenarios. LEVEL OF EVIDENCE Economic and Decision Analysis Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
| | | | | | - Shane J Nho
- Rush University Medical Center, Chicago, Illinois
| | | | | |
Collapse
|
17
|
Reiman MP, Thorborg K, Goode AP, Cook CE, Weir A, Hölmich P. Diagnostic Accuracy of Imaging Modalities and Injection Techniques for the Diagnosis of Femoroacetabular Impingement/Labral Tear: A Systematic Review With Meta-analysis. Am J Sports Med 2017; 45:2665-2677. [PMID: 28129509 DOI: 10.1177/0363546516686960] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Diagnosing femoroacetabular impingement/acetabular labral tear (FAI/ALT) and subsequently making a decision regarding surgery are based primarily on diagnostic imaging and intra-articular hip joint injection techniques of unknown accuracy. PURPOSE Summarize and evaluate the diagnostic accuracy and clinical utility of various imaging modalities and injection techniques relevant to hip FAI/ALT. STUDY DESIGN Systematic review with meta-analysis. METHODS A computer-assisted literature search was conducted of MEDLINE, CINAHL, and EMBASE databases using keywords related to diagnostic accuracy of hip joint pathologic changes. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used for the search and reporting phases of the study. Quality assessment of bias and applicability was conducted using the Quality of Diagnostic Accuracy Studies (QUADAS) tool. Random effects models were used to summarize sensitivities (SN), specificities (SP), likelihood ratios (+LR and -LR), diagnostic odds ratios (DOR), and respective confidence intervals (CI). RESULTS The search strategy and assessment for risk of bias revealed 25 articles scoring above 10/14 on the items of the QUADAS. Four studies investigated FAI, and the data were not pooled. Twenty articles on ALT qualified for meta-analysis. Pretest probability of ALT in the studies in this review was 81% (72%-88%), while the pretest probability of FAI diagnosis was 74% (95% CI, 51%-91%). The meta-analysis showed that computed tomography arthrography (CTA) demonstrated the strongest overall diagnostic accuracy: pooled SN 0.91 (95% CI, 0.83-0.96); SP 0.89 (95% CI, 0.74-0.97); +LR 6.28 (95% CI, 2.78-14.21); -LR 0.11 (95% CI, 0.06-0.21); and DOR 64.38 (95% CI, 19.17-216.21). CONCLUSION High pretest probability of disease was demonstrated. Positive imaging findings increased the probability that a labral tear existed by a minimal to small degree with the use of magnetic resonance imaging/magnetic resonance angiogram (MRI/MRA) and ultrasound (US) and by a moderate degree for CTA. Negative imaging findings decreased the probability that a labral tear existed by a minimal degree with the use of MRI and US, a small to moderate degree with MRA, and a moderate degree with CTA. CLINICAL RELEVANCE Although findings of the included studies suggested potentially favorable use of these modalities for the diagnosis of ALT and FAI, our results suggest that these findings have limited generalizability and clinical utility given very high pretest prevalence, large confidence intervals, and selection criteria of the studies. Registration: PROSPERO Registration #CRD42015027745.
Collapse
Affiliation(s)
- Michael P Reiman
- Duke University Medical Center, Department of Orthopedic Surgery, Durham, North Carolina, USA.,Sports Orthopedic Research Centre-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark
| | - Kristian Thorborg
- Sports Orthopedic Research Centre-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark.,Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C) and Departments of Orthopaedic Surgery and Physical Therapy, Copenhagen University Hospital, Copenhagen, Denmark
| | - Adam P Goode
- Duke University Medical Center, Department of Orthopedic Surgery, Durham, North Carolina, USA
| | - Chad E Cook
- Duke University Medical Center, Department of Orthopedic Surgery, Durham, North Carolina, USA
| | - Adam Weir
- AMC, Amsterdam Center of Evidence Based Sports Medicine (ACES), Amsterdam, North Holland, The Netherlands.,Aspetar Sports Groin Pain Center, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Per Hölmich
- Sports Orthopedic Research Centre-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark.,Aspetar Sports Groin Pain Center, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| |
Collapse
|
18
|
Rajeev A, Tuinebreijer W, Mohamed A, Newby M. The validity and accuracy of MRI arthrogram in the assessment of painful articular disorders of the hip. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:71-77. [DOI: 10.1007/s00590-017-2022-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/24/2017] [Indexed: 11/28/2022]
|
19
|
Saied AM, Redant C, El-Batouty M, El-Lakkany MR, El-Adl WA, Anthonissen J, Verdonk R, Audenaert EA. Accuracy of magnetic resonance studies in the detection of chondral and labral lesions in femoroacetabular impingement: systematic review and meta-analysis. BMC Musculoskelet Disord 2017; 18:83. [PMID: 28209142 PMCID: PMC5314626 DOI: 10.1186/s12891-017-1443-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 02/03/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Several types of Magnetic resonance imaging (MRI) are commonly used in imaging of femoroacetabular impingement (FAI), however till now there are no clear protocols and recommendations for each type. The aim of this meta-analysis is to detect the accuracy of conventional magnetic resonance imaging (cMRI), direct magnetic resonance arthrography (dMRA) and indirect magnetic resonance arthrography (iMRA) in the diagnosis of chondral and labral lesions in femoroacetabular impingement (FAI). METHODS A literature search was finalized on the 17th of May 2016 to collect all studies identifying the accuracy of cMRI, dMRA and iMRA in diagnosing chondral and labral lesions associated with FAI using surgical results (arthroscopic or open) as a reference test. Pooled sensitivity and specificity with 95% confidence intervals using a random-effects meta-analysis for MRI, dMRA and iMRA were calculated also area under receiver operating characteristic (ROC) curve (AUC) was retrieved whenever possible where AUC is equivocal to diagnostic accuracy. RESULTS The search yielded 192 publications which were reviewed according inclusion and exclusion criteria then 21 studies fulfilled the eligibility criteria for the qualitative analysis with a total number of 828 cases, lastly 12 studies were included in the quantitative meta-analysis. Meta-analysis showed that as regard labral lesions the pooled sensitivity, specificity and AUC for cMRI were 0.864, 0.833 and 0.88 and for dMRA were 0.91, 0.58 and 0.92. While in chondral lesions the pooled sensitivity, specificity and AUC for cMRI were 0.76, 0.72 and 0.75 and for dMRA were 0.75, 0.79 and 0.83, while for iMRA were sensitivity of 0.722 and specificity of 0.917. CONCLUSIONS The present meta-analysis showed that the diagnostic test accuracy was superior for dMRA when compared with cMRI for detection of labral and chondral lesions. The diagnostic test accuracy was superior for labral lesions when compared with chondral lesions in both cMRI and dMRA. Promising results are obtained concerning iMRA but further studies still needed to fully assess its diagnostic accuracy.
Collapse
Affiliation(s)
- A M Saied
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium. .,Department of Orthopaedic Surgery, Mansoura University Hospital, Mansoura University, Mansoura, Egypt.
| | - C Redant
- Department of Physical Medicine and Rehabilitation, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium
| | - M El-Batouty
- Department of Orthopaedic Surgery, Mansoura University Hospital, Mansoura University, Mansoura, Egypt
| | - M R El-Lakkany
- Department of Orthopaedic Surgery, Mansoura University Hospital, Mansoura University, Mansoura, Egypt
| | - W A El-Adl
- Department of Orthopaedic Surgery, Mansoura University Hospital, Mansoura University, Mansoura, Egypt
| | - J Anthonissen
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium
| | - R Verdonk
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium
| | - E A Audenaert
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium
| |
Collapse
|
20
|
Chahla J, LaPrade RF, Mardones R, Huard J, Philippon MJ, Nho S, Mei-Dan O, Pascual-Garrido C. Biological Therapies for Cartilage Lesions in the Hip: A New Horizon. Orthopedics 2016; 39:e715-23. [PMID: 27359284 DOI: 10.3928/01477447-20160623-01] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/01/2016] [Indexed: 02/03/2023]
Abstract
Treatment of hip cartilage disease is challenging, and there is no clear algorithm to address this entity. Biomarkers are arising as promising diagnostic tools because they could play a role in the early assessment of the prearthritic joint and as a prognostic factor before and after treatment. The potential effect of biomarkers may be used to categorize individuals at risk of evolving to severe osteoarthritis, to develop new measures for clinical progression of the disease, and to develop new treatment options for the prevention of osteoarthritis progression. A trend toward a less invasive biological treatment will usher in a new treatment era. With the growth of surgical skills in hip arthroscopy, cartilage restoration techniques are evolving in a fast and exponential manner. Biological and surgical treatments have been proposed to treat these pathologies. Biological treatments include platelet-rich plasma, stem cells or bone marrow aspirate concentration, hyaluronic acid, losartan, and fish oil. Surgical treatments include microfracture alone or augmented, direct repair, autologous chondrocyte implantation, matrix-induced chondrocyte implantation, autologous matrix-induced chondrogenesis, mosaicplasty, osteochondral allograft transplantation, and stem cells implanted in matrix (stem cells in membranes/expanded stem cells). This article reviews new evidence available on treatment options for chondral lesions and early osteoarthritis of the hip. [Orthopedics. 2016; 39(4):e715-e723.].
Collapse
|
21
|
Pacheco-Carrillo A, Medina-Porqueres I. Physical examination tests for the diagnosis of femoroacetabular impingement. A systematic review. Phys Ther Sport 2016; 21:87-93. [PMID: 27150967 DOI: 10.1016/j.ptsp.2016.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 12/16/2015] [Accepted: 01/14/2016] [Indexed: 11/27/2022]
Abstract
UNLABELLED Numerous clinical tests have been proposed to diagnose FAI, but little is known about their diagnostic accuracy. OBJECTIVES To summarize and evaluate research on the accuracy of physical examination tests for diagnosis of FAI. METHODS A search of the PubMed, SPORTDiscus and CINAHL databases was performed. Studies were considered eligible if they compared the results of physical examination tests to those of a reference standard. Methodological quality and internal validity assessment was performed by two independent reviewers using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. RESULTS The systematic search strategy revealed 298 potential articles, five of which articles met the inclusion criteria. After assessment using the QUADAS score, four of the five articles were of high quality. Clinical tests included were Impingement sign, IROP test (Internal Rotation Over Pressure), FABER test (Flexion-Abduction-External Rotation), Stinchfield/RSRL (Resisted Straight Leg Raise) test, Scour test, Maximal squat test, and the Anterior Impingement test. IROP test, impingement sign, and FABER test showed the most sensitive values to identify FAI. CONCLUSIONS The diagnostic accuracy of physical examination tests to assess FAI is limited due to its heterogenecity. There is a strong need for sound research of high methodological quality in this area.
Collapse
Affiliation(s)
- Aitana Pacheco-Carrillo
- Faculty of Health Sciences, University of Malaga, C/ Arquitecto Francisco Peñalosa, Ampliación Campus Teatinos, 29071 Málaga, Spain.
| | - Ivan Medina-Porqueres
- Faculty of Health Sciences, University of Malaga, C/ Arquitecto Francisco Peñalosa, Ampliación Campus Teatinos, 29071 Málaga, Spain
| |
Collapse
|
22
|
Abstract
OBJECTIVE Unenhanced MRI, indirect MR arthrography, and direct MR arthrography have been used in the radiologic evaluation of patients with suspected labral tears and chondral lesions of the hip. The purpose of this article is to examine the existing evidence for the use of these techniques in patients with hip pain and suspected labral or chondral abnormalities. CONCLUSION Evidence from a review of the radiologic literature supports the use of direct MR arthrography over unenhanced MRI and indirect MR arthrography for the detection of labral and cartilage abnormalities in the hip. Although high-resolution unenhanced 3-T MRI appears promising, limited information in the literature supports its use in the detection and characterization of chondrolabral lesions.
Collapse
|
23
|
Imaging prevalence of femoroacetabular impingement in symptomatic patients, athletes, and asymptomatic individuals: A systematic review. Eur J Radiol 2015; 85:73-95. [PMID: 26724652 DOI: 10.1016/j.ejrad.2015.10.016] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/29/2015] [Accepted: 10/25/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is a wide discrepancy in reported prevalence rates for cam, pincer, and mixed femoroacetabular impingement (FAI), particularly among distinct populations, namely asymptomatic or symptomatic subjects and athletes. No systematic analysis to date has yet compared studies among these groups to determine differences in radiographic signs of FAI. METHODS A systematic review of existing literature was performed to determine the prevalence of radiographic signs of FAI among athletes, asymptomatic subjects, and symptomatic patients. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied to systematically search PubMed, MEDLINE, CINAHL, and Cochrane databases. RESULTS We identified 361 studies in our literature search. After considering the exclusion criteria, 60 were included in this systematic review: 15 in athletes, 10 in purely asymptomatic patients, and 35 in symptomatic, non-athlete populations. Cam impingement was significantly (p=0.0003) more common in athletes versus asymptomatic subjects but not compared to symptomatic patients (p=0.107). In addition, cam FAI was significantly more common in symptomatic versus asymptomatic cases (p=0.009). The percentage of patients with cam-type FAI showed significant differences across groups (p=0.006). No significant differences were found between pincer-type FAI morphology prevalence when comparing athletes to symptomatic patients. However, mixed-type FAI was significantly more common in athletes versus asymptomatic subjects (p=0.03) and in asymptomatic versus symptomatic subjects (p=0.015). The percentage of patients with mixed-type FAI showed significant differences across groups (p=0.041). The mean alpha angle was significantly greater in the symptomatic group versus either the asymptomatic or athlete group (p<0.001). Significant differences in mean alpha angles were noted across groups (p=0.0000). CONCLUSIONS Imaging suspicion of FAI is common among athletes, asymptomatic, and symptomatic populations. However, significant differences in type and imaging signs of FAI exist among these groups that need to be considered in patients' decision making.
Collapse
|
24
|
Miozzari HH, Celia M, Clark JM, Werlen S, Naal FD, Nötzli HP. No regeneration of the human acetabular labrum after excision to bone. Clin Orthop Relat Res 2015; 473:1349-57. [PMID: 25367108 PMCID: PMC4353545 DOI: 10.1007/s11999-014-4021-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treatment options for a symptomatic, torn, irreparable, or completely ossified acetabular labrum are limited to either excision and/or reconstruction with grafts. In a previous animal model, regeneration of the acetabular labrum after excision to the bony rim has been shown. In humans, less is known about the potential of regeneration of the labrum. Recent studies seem to confirm labral regrowth, but it is still unclear if wide excision might be a surgical option in cases where repair is not possible. QUESTIONS/PURPOSES The purposes of this study were (1) to determine the extent of acetabular labrum regeneration after excision to the bony rim; and (2) to determine whether this procedure results in higher hip scores. METHODS We reviewed all patients treated with surgical dislocation for symptomatic femoroacetabular impingement by a single surgeon at one institution between 2003 and 2008, of whom 14 underwent wide labral excision (of at least 60°) down to bone; we used this approach when there was an absence of reparable tissue. Of these 14, nine were available for voluntary reexamination. The mean age at surgery was 38 ± 9 SD years and the mean followup was 4 ± 1 SD years. All patients consented to a physical examination and an MRI arthrogram, which was evaluated for evidence of new tissue formation by four observers. A modified Harris hip score and the UCLA were recorded. RESULTS Regrowth of a structure equivalent to normal labrum was not observed on the MRI arthrograms. Six of nine hips had segmental defects, bone formation was found in five, and the capsule was confluent with the new tissue in six. The mean Harris hip score at latest followup was 83 ± 14, and the mean UCLA score was 6 ± 2. CONCLUSIONS Resection of a nonreparable acetabular labrum down to a bleeding bony surface does not stimulate regrowth of tissue that appears to be capable of normal function by MR arthrography, and patients who underwent this procedure had lower hip scores at midterm than previously reported from the same institution for patients undergoing labral repair or sparse débridement. Based on these results, we believe that future studies should evaluate alternatives to reconstructing the labrum, perhaps using ligamentum teres, because resection seems neither to result in regrowth nor the restoration of consistently high hip scores.
Collapse
Affiliation(s)
- Hermes H Miozzari
- Division of Orthopaedics and Trauma Surgery, University Hospitals of Geneva and University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland,
| | | | | | | | | | | |
Collapse
|
25
|
Reiman MP, Goode AP, Cook CE, Hölmich P, Thorborg K. Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis. Br J Sports Med 2014; 49:811. [PMID: 25515771 DOI: 10.1136/bjsports-2014-094302] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Surgery for hip femoroacetabular impingement/acetabular labral tear (FAI/ALT) is exponentially increasing despite lacking investigation of the accuracy of various diagnostic measures. Useful clinical utility of these measures is necessary to support diagnostic imaging and subsequent surgical decision-making. OBJECTIVE Summarise/evaluate the current diagnostic accuracy of various clinical tests germane to hip FAI/ALT pathology. METHODS A computer-assisted literature search of MEDLINE, CINAHL and EMBASE databases using keywords related to diagnostic accuracy of the hip joint, as well as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for the search and reporting phases of the study. Quality assessment of bias and applicability was conducted using the Quality of Diagnostic Accuracy Studies-2 (QUADAS-2). Random effects models were used to summarise sensitivities (SN), specificities (SP), diagnostic odds ratio (DOR) and respective confidence intervals (CI). RESULTS The employed search strategy revealed 21 potential articles, with one demonstrating high quality. Nine articles qualified for meta-analysis. The meta-analysis demonstrated that flexion-adduction-internal rotation (pooled SN ranging from 0.94 (95% CI 0.90 to 0.97) to 0.99 (95% CI 0.98 to 1.00); DOR 5.71 (95% CI 0.84 to 38.86) to 7.82 (95% CI 1.06 to 57.84)) and flexion-internal rotation (pooled SN 0.96 (95% CI 0.81 to 0.99); DOR 8.36 (95% CI 0.41 to 171.3) tests possess only screening accuracy. CONCLUSIONS Few hip physical examination tests for diagnosing FAI/ALT have been investigated in enough studies of substantial quality to direct clinical decision-making. Further high-quality studies across a wider spectrum of hip pathology patients are recommended to discern the confirmed clinical utility of these tests. TRIALS REGISTRATION NUMBER PROSPERO Registration # CRD42014010144.
Collapse
Affiliation(s)
- M P Reiman
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, USA Duke University Medical Center, Durham, North Carolina, USA
| | - A P Goode
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - C E Cook
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - P Hölmich
- Sports Orthopedic Research Centre-Copenhagen (SORC-C), Arthroscopic Center Amager, Copenhagen University Hospital, Copenhagen, Denmark. Aspetar Sports Groin Pain Center, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - K Thorborg
- Sports Orthopedic Research Centre-Copenhagen (SORC-C), Arthroscopic Center Amager, Copenhagen University Hospital, Copenhagen, Denmark. Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), and Departments of Orthopaedic Surgery and Physical Therapy, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
26
|
Tian CY, Wang JQ, Zheng ZZ, Ren AH. 3.0T conventional hip MR and hip MR arthrography for the acetabular labral tears confirmed by arthroscopy. Eur J Radiol 2014; 83:1822-7. [DOI: 10.1016/j.ejrad.2014.05.034] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 05/04/2014] [Accepted: 05/27/2014] [Indexed: 10/25/2022]
|
27
|
Abstract
Hip pain is a common complaint in the young, athletic patient population. Primary, intra-articular sources of hip pain are becoming increasingly recognized by primary care providers and sports medicine specialists. Prior to deciding among the various treatment options for the many sources of hip pain in the athletic patient population, the clinician must be able to recognize and accurately diagnose the underlying pathology. Advances in imaging modalities and our understanding of the pathophysiology have improved our ability to accurately understand and diagnose the source of hip pain in this patient population. This review presents a comprehensive strategy for the workup and diagnosis of young, athletic patients presenting with hip pain, and provides the sports medicine specialist with the tools to correlate the patient's history, physical examination, and imaging findings and to treat these challenging patients.
Collapse
Affiliation(s)
- Rachel M Frank
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
| | | | | | | | | |
Collapse
|
28
|
Rho M, Mautner K, Nichols JT, Kennedy DJ. Image-guided Diagnostic Injections With Anesthetic Versus Magnetic Resonance Arthrograms for the Diagnosis of Suspected Hip Pain. PM R 2013; 5:795-800. [DOI: 10.1016/j.pmrj.2013.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 07/30/2013] [Indexed: 10/26/2022]
|