Correlation of Patient Symptoms With Labral and Articular Cartilage Damage in Femoroacetabular Impingement

Trevor Grace; Michael A. Samaan; Richard B. Souza; Thomas M. Link; Sharmila Majumdar; Alan L. Zhang

doi:10.1177/2325967118778785

Correlation of Patient Symptoms With Labral and Articular Cartilage Damage in Femoroacetabular Impingement

Trevor Grace, Michael A. Samaan, Richard B. Souza, Thomas M. Link, Sharmila Majumdar, Alan L. Zhang

Research output: Contribution to journal › Article › peer-review

17 Scopus citations

Abstract

Background: Femoroacetabular impingement (FAI) can lead to labral and articular cartilage injuries as well as early osteoarthritis of the hip. Currently, the association of patient symptoms with the progression of labral and articular cartilage injuries due to FAI is poorly understood. Purpose: To evaluate the correlation between patient-reported outcome (PRO) scores and cartilage compositional changes seen on quantitative magnetic resonance imaging (MRI) as well as cartilage and labral damage seen during arthroscopic surgery in patients with FAI. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were prospectively enrolled before hip arthroscopic surgery for symptomatic FAI. Patients were included if they had cam-type FAI without radiographic arthritis. All patients completed PRO scores, including the Hip disability and Osteoarthritis Outcome Score (HOOS) and a visual analog scale for pain. MRI with mapping sequences (T_1ρ and T₂) on both the acetabular and femoral regions was performed before surgery to quantitatively assess the cartilage composition. During arthroscopic surgery, cartilage and labral injury grades were recorded using the Beck classification. Pearson and Spearman correlation coefficients were then obtained to evaluate the association between chondrolabral changes and PRO scores. Results: A total of 46 patients (46 hips) were included for analysis (mean age, 35.5 years; mean body mass index [BMI], 23.9 kg/m²; 59% male). Increasing BMI was correlated with a more severe acetabular cartilage grade (ρ = 0.37; 95% CI, 0.08-0.65). A greater alpha angle was correlated with an increased labral tear grade (ρ = 0.59; 95% CI, 0.37-0.82) and acetabular cartilage injuries (ρ = 0.61; 95% CI, 0.42-0.80). With respect to PRO scores, increasing femoral cartilage damage in the anterosuperior femoral head region, as measured on quantitative MRI using T_1ρ and T₂ mapping, correlated with lower (worse) scores on the HOOS Activities of Daily Living (r = 0.35; 95% CI, 0.06-0.64), Symptoms (r = 0.32; 95% CI, 0.06-0.57), and Pain (r = 0.31; 95% CI, 0.06-0.55) subscales. There was no correlation between PRO scores and acetabular cartilage damage or labral tearing found on quantitative MRI or during arthroscopic surgery. Conclusion: Femoral cartilage damage, as measured on T_1ρ and T₂ mapping, appears to have a greater correlation with clinical symptoms than acetabular cartilage damage or labral tears in patients with symptomatic FAI.

Original language	English
Journal	Orthopaedic Journal of Sports Medicine
Volume	6
Issue number	6
DOIs	https://doi.org/10.1177/2325967118778785
State	Published - Jun 1 2018

Bibliographical note

Funding Information:
§Address correspondence to Alan L. Zhang, MD, Department of Orthopaedic Surgery, University of California–San Francisco, 1500 Owens Street, Box 3004, San Francisco, CA 94158, USA (email: alan.zhang@ucsf.edu). *Department of Orthopaedic Surgery, University of California–San Francisco, San Francisco, California, USA. †Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, California, USA. ‡Department of Physical Therapy and Rehabilitation Science, University of California–San Francisco, San Francisco, California, USA. One or more of the authors has declared the following potential conflict of interest or source of funding: This study was funded by the American Orthopaedic Society for Sports Medicine (YIG-2016-1) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (P50 AR060752 and F32 AR069458). A.L.Z. is a consultant for Stryker, has received educational support from Arthrex, and has received research support from Zimmer. T.M.L. has served on the Scientific Advisory Board for Pfizer (2015 and 2016), Regeneron Pharmaceuticals (2016), and GE Healthcare (2016). This study was approved by the University of California–San Francisco Institutional Review Board (#14-14736).

Publisher Copyright:
© The Author(s) 2018.

Keywords

biology of cartilage
femoroacetabular impingement
hip
hip arthroscopic surgery
magnetic resonance imaging

ASJC Scopus subject areas

Orthopedics and Sports Medicine

Access to Document

10.1177/2325967118778785

Cite this

@article{b670b6e2658b4caf942f4bc9e6ba53ac,

title = "Correlation of Patient Symptoms With Labral and Articular Cartilage Damage in Femoroacetabular Impingement",

abstract = "Background: Femoroacetabular impingement (FAI) can lead to labral and articular cartilage injuries as well as early osteoarthritis of the hip. Currently, the association of patient symptoms with the progression of labral and articular cartilage injuries due to FAI is poorly understood. Purpose: To evaluate the correlation between patient-reported outcome (PRO) scores and cartilage compositional changes seen on quantitative magnetic resonance imaging (MRI) as well as cartilage and labral damage seen during arthroscopic surgery in patients with FAI. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were prospectively enrolled before hip arthroscopic surgery for symptomatic FAI. Patients were included if they had cam-type FAI without radiographic arthritis. All patients completed PRO scores, including the Hip disability and Osteoarthritis Outcome Score (HOOS) and a visual analog scale for pain. MRI with mapping sequences (T1ρ and T2) on both the acetabular and femoral regions was performed before surgery to quantitatively assess the cartilage composition. During arthroscopic surgery, cartilage and labral injury grades were recorded using the Beck classification. Pearson and Spearman correlation coefficients were then obtained to evaluate the association between chondrolabral changes and PRO scores. Results: A total of 46 patients (46 hips) were included for analysis (mean age, 35.5 years; mean body mass index [BMI], 23.9 kg/m2; 59% male). Increasing BMI was correlated with a more severe acetabular cartilage grade (ρ = 0.37; 95% CI, 0.08-0.65). A greater alpha angle was correlated with an increased labral tear grade (ρ = 0.59; 95% CI, 0.37-0.82) and acetabular cartilage injuries (ρ = 0.61; 95% CI, 0.42-0.80). With respect to PRO scores, increasing femoral cartilage damage in the anterosuperior femoral head region, as measured on quantitative MRI using T1ρ and T2 mapping, correlated with lower (worse) scores on the HOOS Activities of Daily Living (r = 0.35; 95% CI, 0.06-0.64), Symptoms (r = 0.32; 95% CI, 0.06-0.57), and Pain (r = 0.31; 95% CI, 0.06-0.55) subscales. There was no correlation between PRO scores and acetabular cartilage damage or labral tearing found on quantitative MRI or during arthroscopic surgery. Conclusion: Femoral cartilage damage, as measured on T1ρ and T2 mapping, appears to have a greater correlation with clinical symptoms than acetabular cartilage damage or labral tears in patients with symptomatic FAI.",

keywords = "biology of cartilage, femoroacetabular impingement, hip, hip arthroscopic surgery, magnetic resonance imaging",

author = "Trevor Grace and Samaan, {Michael A.} and Souza, {Richard B.} and Link, {Thomas M.} and Sharmila Majumdar and Zhang, {Alan L.}",

note = "Funding Information: §Address correspondence to Alan L. Zhang, MD, Department of Orthopaedic Surgery, University of California–San Francisco, 1500 Owens Street, Box 3004, San Francisco, CA 94158, USA (email: alan.zhang@ucsf.edu). *Department of Orthopaedic Surgery, University of California–San Francisco, San Francisco, California, USA. †Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, California, USA. ‡Department of Physical Therapy and Rehabilitation Science, University of California–San Francisco, San Francisco, California, USA. One or more of the authors has declared the following potential conflict of interest or source of funding: This study was funded by the American Orthopaedic Society for Sports Medicine (YIG-2016-1) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (P50 AR060752 and F32 AR069458). A.L.Z. is a consultant for Stryker, has received educational support from Arthrex, and has received research support from Zimmer. T.M.L. has served on the Scientific Advisory Board for Pfizer (2015 and 2016), Regeneron Pharmaceuticals (2016), and GE Healthcare (2016). This study was approved by the University of California–San Francisco Institutional Review Board (#14-14736). Publisher Copyright: {\textcopyright} The Author(s) 2018.",

year = "2018",

month = jun,

day = "1",

doi = "10.1177/2325967118778785",

language = "English",

volume = "6",

number = "6",

}

TY - JOUR

T1 - Correlation of Patient Symptoms With Labral and Articular Cartilage Damage in Femoroacetabular Impingement

AU - Grace, Trevor

AU - Samaan, Michael A.

AU - Souza, Richard B.

AU - Link, Thomas M.

AU - Majumdar, Sharmila

AU - Zhang, Alan L.

N1 - Funding Information: §Address correspondence to Alan L. Zhang, MD, Department of Orthopaedic Surgery, University of California–San Francisco, 1500 Owens Street, Box 3004, San Francisco, CA 94158, USA (email: alan.zhang@ucsf.edu). *Department of Orthopaedic Surgery, University of California–San Francisco, San Francisco, California, USA. †Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, California, USA. ‡Department of Physical Therapy and Rehabilitation Science, University of California–San Francisco, San Francisco, California, USA. One or more of the authors has declared the following potential conflict of interest or source of funding: This study was funded by the American Orthopaedic Society for Sports Medicine (YIG-2016-1) and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (P50 AR060752 and F32 AR069458). A.L.Z. is a consultant for Stryker, has received educational support from Arthrex, and has received research support from Zimmer. T.M.L. has served on the Scientific Advisory Board for Pfizer (2015 and 2016), Regeneron Pharmaceuticals (2016), and GE Healthcare (2016). This study was approved by the University of California–San Francisco Institutional Review Board (#14-14736). Publisher Copyright: © The Author(s) 2018.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background: Femoroacetabular impingement (FAI) can lead to labral and articular cartilage injuries as well as early osteoarthritis of the hip. Currently, the association of patient symptoms with the progression of labral and articular cartilage injuries due to FAI is poorly understood. Purpose: To evaluate the correlation between patient-reported outcome (PRO) scores and cartilage compositional changes seen on quantitative magnetic resonance imaging (MRI) as well as cartilage and labral damage seen during arthroscopic surgery in patients with FAI. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were prospectively enrolled before hip arthroscopic surgery for symptomatic FAI. Patients were included if they had cam-type FAI without radiographic arthritis. All patients completed PRO scores, including the Hip disability and Osteoarthritis Outcome Score (HOOS) and a visual analog scale for pain. MRI with mapping sequences (T1ρ and T2) on both the acetabular and femoral regions was performed before surgery to quantitatively assess the cartilage composition. During arthroscopic surgery, cartilage and labral injury grades were recorded using the Beck classification. Pearson and Spearman correlation coefficients were then obtained to evaluate the association between chondrolabral changes and PRO scores. Results: A total of 46 patients (46 hips) were included for analysis (mean age, 35.5 years; mean body mass index [BMI], 23.9 kg/m2; 59% male). Increasing BMI was correlated with a more severe acetabular cartilage grade (ρ = 0.37; 95% CI, 0.08-0.65). A greater alpha angle was correlated with an increased labral tear grade (ρ = 0.59; 95% CI, 0.37-0.82) and acetabular cartilage injuries (ρ = 0.61; 95% CI, 0.42-0.80). With respect to PRO scores, increasing femoral cartilage damage in the anterosuperior femoral head region, as measured on quantitative MRI using T1ρ and T2 mapping, correlated with lower (worse) scores on the HOOS Activities of Daily Living (r = 0.35; 95% CI, 0.06-0.64), Symptoms (r = 0.32; 95% CI, 0.06-0.57), and Pain (r = 0.31; 95% CI, 0.06-0.55) subscales. There was no correlation between PRO scores and acetabular cartilage damage or labral tearing found on quantitative MRI or during arthroscopic surgery. Conclusion: Femoral cartilage damage, as measured on T1ρ and T2 mapping, appears to have a greater correlation with clinical symptoms than acetabular cartilage damage or labral tears in patients with symptomatic FAI.

AB - Background: Femoroacetabular impingement (FAI) can lead to labral and articular cartilage injuries as well as early osteoarthritis of the hip. Currently, the association of patient symptoms with the progression of labral and articular cartilage injuries due to FAI is poorly understood. Purpose: To evaluate the correlation between patient-reported outcome (PRO) scores and cartilage compositional changes seen on quantitative magnetic resonance imaging (MRI) as well as cartilage and labral damage seen during arthroscopic surgery in patients with FAI. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were prospectively enrolled before hip arthroscopic surgery for symptomatic FAI. Patients were included if they had cam-type FAI without radiographic arthritis. All patients completed PRO scores, including the Hip disability and Osteoarthritis Outcome Score (HOOS) and a visual analog scale for pain. MRI with mapping sequences (T1ρ and T2) on both the acetabular and femoral regions was performed before surgery to quantitatively assess the cartilage composition. During arthroscopic surgery, cartilage and labral injury grades were recorded using the Beck classification. Pearson and Spearman correlation coefficients were then obtained to evaluate the association between chondrolabral changes and PRO scores. Results: A total of 46 patients (46 hips) were included for analysis (mean age, 35.5 years; mean body mass index [BMI], 23.9 kg/m2; 59% male). Increasing BMI was correlated with a more severe acetabular cartilage grade (ρ = 0.37; 95% CI, 0.08-0.65). A greater alpha angle was correlated with an increased labral tear grade (ρ = 0.59; 95% CI, 0.37-0.82) and acetabular cartilage injuries (ρ = 0.61; 95% CI, 0.42-0.80). With respect to PRO scores, increasing femoral cartilage damage in the anterosuperior femoral head region, as measured on quantitative MRI using T1ρ and T2 mapping, correlated with lower (worse) scores on the HOOS Activities of Daily Living (r = 0.35; 95% CI, 0.06-0.64), Symptoms (r = 0.32; 95% CI, 0.06-0.57), and Pain (r = 0.31; 95% CI, 0.06-0.55) subscales. There was no correlation between PRO scores and acetabular cartilage damage or labral tearing found on quantitative MRI or during arthroscopic surgery. Conclusion: Femoral cartilage damage, as measured on T1ρ and T2 mapping, appears to have a greater correlation with clinical symptoms than acetabular cartilage damage or labral tears in patients with symptomatic FAI.

KW - biology of cartilage

KW - femoroacetabular impingement

KW - hip

KW - hip arthroscopic surgery

KW - magnetic resonance imaging

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Correlation of Patient Symptoms With Labral and Articular Cartilage Damage in Femoroacetabular Impingement

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