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Intraoperative findings on hips with
Femoroacetabular impingement type
CAM without symptoms
• Bernardo Aguilera MD ** John Fonseca MD***Alexander Martinez MD****Erika Cantor
• *****Juan M Nossa MD*****William Marquez MD
*Orthopedics and Traumatology - Clinic hip preservation of bones and join Diseases Institute at Imbanaco Medical Center.
**Orthopedics and Traumatology ** - Fellow Hip preservation surgery - Pontificia Universidad Javeriana (Cali) - Institute of Bones
and join Diseases Imbanaco Medical Center
*** Chief Epidemiologist Research Department Imbanaco Medical Center, Valley University.
**** Statistical Specialist, Department of Medical Imbanaco Research Center.
******Orthopedics and Traumatology - Clinic hip preservation
-Patients with radiological findings
of FAI in bilateral hips.
-Symptomatic hip and the other hip
without symptoms (pain)
Literature supports the morphological changes of
the hip produce damage in condrolabral Union in
the labrum and articular cartilage.
Given that one hip is similar in morphology to the
other hip and also your genetics is identical
Our Hypothesis
“Patients with severe deformities type CAM and
decrease in internal rotation bilaterally with pain in
a hip and other hip without pain; have a silent
alteration in condrolabral junction and articular
cartilage in asymptomatic hip.”
Objective
Observational and descriptive study
-Describe the arthroscopic findings in condrolabral
union, labrum and articular cartilage (Acetabulo
and Femoral Head) in patients diagnosed with
femoroacetabular impingement type CAM whit
decreased internal rotation without pain
symptoms (WOMAC pain 0-1)
In profilactic surgery for femoroacetabular
impingement indicated?: a Systematic
review.
Collins J, Ward J, Youm T. Am J Sports Med 2013 aug 21
-Search criteria was Asymptomatic with radiographic findings and
arthroscopic surgery PFA.
-840 references.
-NO STUDIES REPORTED
Population: 19 patients
diagnosed with FAI type CAM and
decreased internal rotation with pain
in one hip and the other hip without
pain; Underwent arthroscopic
technique since January 1, 2011
through January 31-2014 with
asymptomatic hip in pre-surgical
(pain <1 WOMAC VAS <1), that meet
the selection criteria.
VARIABLES
Outcome variable
Degree of UCL injury and labrum.
Clasificación de
Czerny modificada.
Degree of acetabular cartilage injury.
Degree of injury of femoral head
cartilage
Clasificación de
Sampson
Selection criteria
Inclusion Criteria
-Patients with FAI type CAM and decreased internal rotation bilateral whit
surgery for hip arthroscopy technique during the time of the study in the hip
with WOMAC pain score <1 in the pre-surgical
-Special informed consent that explains the evidence in literature about
management in asymptomatic patients.
Exclusion Criteria
-Patients under 18
-Patients with evidence of osteoarthritis> Tonnis 2 pre surgical
-Patients without registration full graphic video of arthroscopic diagnosis of
asymptomatic hip
-Patient with CAM type impingement secondary to femoral epiphysis slip
capital Legg calve Perthes sequelae of fracture or
-Patient with previous surgery in the asymptomatic hip, either via open or
arthroscopic method
Statistical analysis
Descriptive analysis using
frequency tables, analysis of
central tendency and dispersion
for quantitative and qualitative
variable respectively.
For the analysis of causality was
performed a model of logistic
regression.
This analysis is supported
through Epiinfo v7 and STATA ®
11.0 software.
IB
Ángulo
Alfa
Media
(Rango)
CE
Media
(Rango)
Rotación
Interna
Media
(Rango)
HNO
Media
(Rango)
HNOR
Media
(Rango)
Escala de Czerny- Lesión de Labrum
IIA
IIB
IIIA
Escala de Sampson- Cartílago Acetabular
IIIB
76 (76–
76)
81 (8181)
83 (8085)
84.9 (78–
89)
84 (8286)
36 (36 36)
45.5 (4348)
36.6 (3242)
35.9 (3044)
40.3 (3843)
0 (0 -0)
20 (0 -40)
3 (-20 15)
1.9 (-20 –
25)
2.3 (0 -5)
5 (4 -6)
5 (2-8)
6.3 (6 -7)
7 ( 7-7)
0.11
(0.110.11)
6 (5 -7)
0.11(0.89
-0.13)
0.09(0.08
-0.10)
0.09(0.03
-0.14)
0.10(0.08
-0.11)
Ángulo
Alfa
Media
(Rango)
CE
Media
(Rango)
Rotación
Interna
Media
(Rango)
HNO
Media
(Rango)
HNOR
Media
(Rango)
AC1
wTj
AC1
wD
AC1
WTjD
AC2
AC2 Tj
83.3(7889)
82.8(8186)
81.7(7685)
85(8585)
85(8088)
34.2(3038)
42(3848)
36.7(3440)
42(4242)
37.8(3244)
8.3(-1525)
11(0-40)
5(0-10)
-20(-2020)
-5(-2015)
6(5-8)
5.8(4-7)
6(5-7)
4(4-4)
4.3(2-7)
0.11(0.0
9-0.14)
0.09(0.07
-0.13)
0.10(0.09
-0.11)
0.08(0.08
-0.08)
0.08(0.03
-0.12)
Outcomes
Arthroscopic Findings
• 100% of patients had
damage in the
condrolabral junction,
labrum and acetabular
cartilage of equal or
greater severity.
Patient #8
Soccer player
22 years old
Asymptomatic hip
Abstract
100% of patients had injury condrolabral union and acetabular
cartilage.
Lesion pattern is characteristic of the proposed CAM type and
injury related to osteoarthritis.
There is a direct relationship between the severity of CAM (alpha
angle, and HNOr HNO) and decrease internal rotation with the
degree of severity of injury UCL labrum and articular cartilage.
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