2017 ISAKOS Biennial Congress ePoster #2506

 

Association Between Cam-Fai Deformity And Inguinal Pathologies.

Gian Nicola Bisciotti, PhD, Doha QATAR
Francesco Di Marzo, MD, Pontremoli ITALY
Alessio Auci, MD, Massa Carrara ITALY
Giulia Carimati, MD, Milano ITALY
Piero Volpi, MD, Rozzano (Mi) ITALY

Qatar Orthopaedic and Sport Medicine Hospital., DOHA, QATAR

FDA Status Not Applicable

Summary

A descriptive study evaluating the eventual association between CAM-FAI and groin pain in a selected population of 30 subjects practiced sport activities

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Abstract

The femoroacetabular impingement (FAI) is a pathological condition in which is present an abnormal contact between the articular rim of the acetabulum and the proximal femoral parts at femoris head-neck junction level(1). Recent studies have suggested that FAI and inguinal pathologies frequently coincide (2). The purpose of this study is to establish a possible relationship between FAI, especially Cam-FAI, and inguinal pathologies (IP).

INTRODUCTION.

Cam-FAI is an osteochondral bump at femoral head-neck junction leading to a diminution of the normal femoral head-neck offset (1). Cam-FAI impingement is then identified by measuring the alpha angle on the Dunn view x-ray. An alpha angle measuring 55° or greater is considered radiographic evidence of Cam-FAI (3).

Materials And Methods

In this study we considered 30 patients (27 men and 3 women), all the subjects practiced sport activities and complained a groin pain syndrome (GPS) from in average 9.5±6.2 months (range 3 -18 months). All patients were examined by a single experienced sports medicine physician and by an abdominal surgeon in conformity with the clinical examination protocol established during the first Groin Pain Syndrome Italian Consensus Conference on terminology, clinical evaluation and imaging assessment in groin pain in athletes (4). All the subject performed a radiological evaluation in which was calculated the alpha angle and a dynamic US for IP assessment.

Results

All the subject showed a clinical and radiological (dynamic US) evocative for IP. The recorded alpha angle value was significantly higher than standard alpha angle (p< 0.05) and equal to 63.89±14.11° for right hip and 67.19 ±13.35° for left hip. Basing on clinical and imaging assessment all the subject was surgically treated for mesh placement with trans-abdominal pre peritoneal laparoscopic technique (TAPP). During surgery the IP was confirmed in all subjects: 20 patient showed a bilateral sport hernia, 7 patient showed a sport hernia coupled to a direct inguinal hernia (M1 in according to European Hernia Society classification), and 3 patients showed a monolateral direct inguinal hernia (M1).

Discussion

In our series an alpha angle greater than 55° showed a cause-effect relationship with IP. This association may be explained by the fact that in athletes with Cam-FAI, functional range of motion (ROM) required in athletic competition is often greater than the limited physiologic motion (5) . This limitation of ROM at femur-acetabulum level caused by Cam-FAI deformity can be compensated by an iper-mobility of the symphyseal articulation. This iper-mobility at symphyseal articulation level stress the posterior inguinal wall favouring the onset of IP (4,5). This hypothesis is in line with the data of several studies showing that GPS caused by IP occurs during high-energy twisting activities in which abnormal hip ROM and resultant perturbed pelvic motion lead to shearing across the pubic symphysis and posterior inguinal wall (6).

Conclusions

The athletes that shows an alpha angle greater than 55° are predisposed to the development of IP. For this reason they represent a “at risk population” which requires particular medical attention.