Imaging of Femoroacetabular Impingement.ppt

Labral tear Paralabralcyst Tannast. CORR 2008 All Pincer Cam Coxa profunda Without retroversion Offset 7mm α Angle =370 MRI and MRA Assessment of articular cartilage Be difficult for thinness and curved spherical contours Sensitivity: 47-93% Specificity: 77-89% Underestimates degree of articular cartilage injury Marrow edema: a clue Cartilage defect MRI and MRA Assessment of articular cartilage Often associated with labral tears and impingement Cam-type: anterosuperior delamination Pincer-type initially posteroinferior delamination Eventually become circumferential Conclusion FAI: a recently described disorder Recognize and accurately diagnose is important The two types often occur together and overlap X-Ray can often be nondiagnostic MRI and MRA are more accurate Thank you Imaging of Femoroacetabular Impingement Dalia A. Fadul, and John A. Carrino J Bone Joint Surg Am. 2009;91 Suppl 1:138-43 Impingement ↓ Degenerative change ↓ OA in young pts.(35yrs) ↓ Pain and disability Pathoanatomy Proximal femur Acetabulum Both Etiology factors Congenital Acquired Common mechanisms Pincer type Cam type Mixed type Consequence Abnormal stress Labral tear Cartilage damage Etiology and presentation Abnormal contact between F and A during flexion and IR Normal joint Has enough space between femoral head-neck junction and acetabulum Offset at the junction or excessive coverage Decrease normal space Induce impingement Etiology and presentation Young Active History of gradual onset of hip or groin pain Begin after a minor trauma Intermittent pain after athletic activity or prolong sitting Two mechanisms Pincer-type impingement Excess acetabular coverage Cam-type impingement Nonspherical femoral head Pincer-type impingement Causes Acetabular retroversion Coxa profunda Protrusio acetabuli Os acetabuli Retroversion of acetabulum Crossover or figure-of-eight sign on X-Ray Axial CT Increased coverage of anterior portion of femoral heads Coxa profunda Too deep acetabulum Medial wall