Central Femoral Head Chondromalacia Is Associated with a Diagnosis of Hip Instability

Overview

Journal Arthrosc Sports Med Rehabil

Date 2022 May 2

PMID 35494289

Authors

W Michael Pullen

Daniel M Curtis

Marc R Safran

Affiliations

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Abstract

Purpose: To compare the locations and patterns of femoral head chondral damage in patients with instability in contrast to those with femoroacetabular impingement (FAI) without instability.

Methods: All consecutive hip arthroscopies were reviewed from 2013 to 2020 from a single surgeon. Intraoperative records were reviewed on all patients identified to have femoral head chondromalacia. Data were collected to include laterality, location of femoral head chondromalacia, intraoperative diagnosis (instability and/or FAI subtype), and ease of distractibility. The location of the femoral head chondromalacia was defined on the basis of intraoperative description. Chi-squared and Fisher's exact tests were used for categorical variables, and a two-sample test was used for continuous variables. Statistical significance was set at < .05.

Results: A total of 64 patients were in the study cohort, with 32 patients identified as having non-central head chondromalacia and 32 patients identified as having central head chondromalacia. Of the patients with central head chondromalacia, 81% were diagnosed with instability. Central head chondromalacia was associated with a sensitivity of 84% (71%-97%), specificity of 82% (69%-95%), and positive predictive value of 81% (67%-95%).

Conclusions: A high percentage of patients with central femoral head chondromalacia were found to have hip microinstability. These results suggest that there is a pattern of femoral head chondral damage in patients with hip microinstability.

Level Of Evidence: Level III, case-control study.

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References

Saadat A, Lall A, Battaglia M, Mohr M, Maldonado D, Domb B . Prevalence of Generalized Ligamentous Laxity in Patients Undergoing Hip Arthroscopy: A Prospective Study of Patients' Clinical Presentation, Physical Examination, Intraoperative Findings, and Surgical Procedures. Am J Sports Med. 2019; 47(4):885-893. DOI: 10.1177/0363546518825246. View

Hoppe D, Truntzer J, Shapiro L, Abrams G, Safran M . Diagnostic Accuracy of 3 Physical Examination Tests in the Assessment of Hip Microinstability. Orthop J Sports Med. 2017; 5(11):2325967117740121. PMC: 5714089. DOI: 10.1177/2325967117740121. View

Signorelli C, Lopomo N, Bonanzinga T, Marcheggiani Muccioli G, Safran M, Marcacci M . Relationship between femoroacetabular contact areas and hip position in the normal joint: an in vitro evaluation. Knee Surg Sports Traumatol Arthrosc. 2012; 21(2):408-14. DOI: 10.1007/s00167-012-2151-y. View

Kapron A, Aoki S, Peters C, Anderson A . In-vivo hip arthrokinematics during supine clinical exams: Application to the study of femoroacetabular impingement. J Biomech. 2015; 48(11):2879-86. PMC: 4536131. DOI: 10.1016/j.jbiomech.2015.04.022. View

Parvaresh K, Rasio J, Azua E, Nho S . Hip Instability in the Athlete: Anatomy, Etiology, and Management. Clin Sports Med. 2021; 40(2):289-300. DOI: 10.1016/j.csm.2020.11.005. View

Charbonnier C, Kolo F, Duthon V, Magnenat-Thalmann N, Becker C, Hoffmeyer P . Assessment of congruence and impingement of the hip joint in professional ballet dancers: a motion capture study. Am J Sports Med. 2010; 39(3):557-66. DOI: 10.1177/0363546510386002. View

Dangin A, Tardy N, Wettstein M, May O, Bonin N . Microinstability of the hip: A review. Orthop Traumatol Surg Res. 2016; 102(8S):S301-S309. DOI: 10.1016/j.otsr.2016.09.002. View

Boykin R, Anz A, Bushnell B, Kocher M, Stubbs A, Philippon M . Hip instability. J Am Acad Orthop Surg. 2011; 19(6):340-9. DOI: 10.5435/00124635-201106000-00004. View

Safran M . Microinstability of the Hip-Gaining Acceptance. J Am Acad Orthop Surg. 2018; 27(1):12-22. DOI: 10.5435/JAAOS-D-17-00664. View

10.

Kalisvaart M, Safran M . Hip instability treated with arthroscopic capsular plication. Knee Surg Sports Traumatol Arthrosc. 2016; 25(1):24-30. DOI: 10.1007/s00167-016-4377-6. View

11.

Mitchell R, Gerrie B, McCulloch P, Murphy A, Varner K, Lintner D . Radiographic Evidence of Hip Microinstability in Elite Ballet. Arthroscopy. 2016; 32(6):1038-1044.e1. DOI: 10.1016/j.arthro.2015.12.049. View

12.

Domb B, Stake C, Lindner D, El-Bitar Y, Jackson T . Arthroscopic capsular plication and labral preservation in borderline hip dysplasia: two-year clinical outcomes of a surgical approach to a challenging problem. Am J Sports Med. 2013; 41(11):2591-8. DOI: 10.1177/0363546513499154. View

13.

Duthon V, Charbonnier C, Kolo F, Magnenat-Thalmann N, Becker C, Bouvet C . Correlation of clinical and magnetic resonance imaging findings in hips of elite female ballet dancers. Arthroscopy. 2013; 29(3):411-9. DOI: 10.1016/j.arthro.2012.10.012. View

14.

Kolo F, Charbonnier C, Pfirrmann C, Duc S, Lubbeke A, Duthon V . Extreme hip motion in professional ballet dancers: dynamic and morphological evaluation based on magnetic resonance imaging. Skeletal Radiol. 2012; 42(5):689-98. DOI: 10.1007/s00256-012-1544-9. View

15.

Shibata K, Matsuda S, Safran M . Is there a distinct pattern to the acetabular labrum and articular cartilage damage in the non-dysplastic hip with instability?. Knee Surg Sports Traumatol Arthrosc. 2016; 25(1):84-93. DOI: 10.1007/s00167-016-4342-4. View

16.

Rosinsky P, Mayo B, Kyin C, Shapira J, Maldonado D, Meghpara M . The Femoral Head "Divot" Sign: A Useful Arthroscopic Sign of Hip Microinstability. Orthop J Sports Med. 2020; 8(5):2325967120917919. PMC: 7238801. DOI: 10.1177/2325967120917919. View

17.

Han S, Alexander J, Thomas V, Choi J, Harris J, Doherty D . Does Capsular Laxity Lead to Microinstability of the Native Hip?. Am J Sports Med. 2018; 46(6):1315-1323. DOI: 10.1177/0363546518755717. View

18.

Woodward R, Vesey R, Bacon C, White S, Brick M, Blankenbaker D . Microinstability of the hip: a systematic review of the imaging findings. Skeletal Radiol. 2020; 49(12):1903-1919. DOI: 10.1007/s00256-020-03516-7. View

19.

Safran M, Lopomo N, Zaffagnini S, Signorelli C, Vaughn Z, Lindsey D . In vitro analysis of peri-articular soft tissues passive constraining effect on hip kinematics and joint stability. Knee Surg Sports Traumatol Arthrosc. 2012; 21(7):1655-63. PMC: 6319387. DOI: 10.1007/s00167-012-2091-6. View