Background:

Abnormal proximal femoral morphology in femoroacetabular impingement syndrome (FAIS) identifiable on the anteroposterior (AP) pelvic radiograph has been described as the “pistol grip” deformity. The effect of a superior cam deformity identified on this radiographic view remains unknown.

Purposes:

To assess the relationship between AP cam deformity (AP alpha angle [AP AA] >55°) and cartilage injury; to assess the relationship between AP cam deformity and labral injury; and to determine if patient factors are correlated with cartilage and labral injury.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

Patients undergoing osteochondroplasty and labral repair for FAIS with a single surgeon were identified retrospectively. Intraoperative size, location, and severity of cartilage and labral damage were prospectively collected. Chondrolabral and femoral/acetabular cartilage damage were graded with the Beck labral and cartilage injury criteria. Radiographic data included the AP AA, lateral center-edge angle (LCEA), and maximum femoral alpha angle (MF AA). Patients with hip dysplasia (LCEA <18°; LCEA 18°-25° with acetabular index >10°) were excluded. Outcomes were compared across cartilage and labral severity grades. We report odds ratios (ORs) with 95% confidence intervals and P values from multivariable logistic regressions.

Results:

Of the 158 included hips (154 patients), 69% were female and the mean (± standard deviation [SD]) age was 30.3 ± 9.7 years. Increase in age, increase in body mass index (BMI), and male sex were associated with increasing severity of cartilage and labral injury. More severe cartilage damage was associated with increasing AP AA (P < .001) and MF AA (P < .001). The odds of developing a higher category of cartilage injury severity (grade ≥3) were 119% higher (OR, 2.19 [95% CI, 1.36-3.64]; P = .002) for every SD increase (16.7°) in AP AA, adjusting for age, sex, and BMI. The odds of developing a severe labral injury (grade ≥3) were 118% higher (OR, 2.18 [95% CI 1.17-4.32]; P = .018) for every SD increase (10.5°) in MF AA, adjusting for age, sex, BMI, and AP AA.

Conclusion:

Increasing age and BMI, and male sex are associated with increasing severity of cartilage and labral injury in FAIS. The odds of developing a cartilage injury are significantly higher with independent increases in AP AA and MF AA.

中文翻译：

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骨盆前后位 X 光片上凸轮畸形与股骨髋臼撞击综合征中更严重的软骨损伤的关联

背景：

在前后位 (AP) 骨盆 X 光片上可识别的股骨髋臼撞击综合征 (FAIS) 中的异常股骨近端形态被描述为“手枪式握把”畸形。在该 X 光片上确定的上凸轮畸形的影响仍然未知。

目的：

评估 AP 凸轮畸形（AP α 角 [AP AA] >55°）与软骨损伤之间的关系；评估AP凸轮畸形与盂唇损伤之间的关系；并确定患者因素是否与软骨和盂唇损伤相关。

学习规划：

病例对照研究；证据水平，3。

方法：

回顾性地确定了由一名外科医生接受骨软骨成形术和盂唇修复术的 FAIS 患者。前瞻性收集了术中软骨和盂唇损伤的大小、位置和严重程度。软骨盂和股骨/髋臼软骨损伤按照贝克盂唇和软骨损伤标准进行分级。射线照相数据包括 AP AA、外侧中心边缘角 (LCEA) 和最大股骨 α 角 (MF AA)。髋关节发育不良（LCEA <18°；LCEA 18°-25°，髋臼指数>10°）的患者被排除在外。比较了软骨和盂唇严重程度等级的结果。我们报告了具有 95% 置信区间的优势比 (OR) 和来自多变量逻辑回归的P值。

结果：

在包括的 158 名髋关节（154 名患者）中，69% 为女性，平均（± 标准差 [SD]）年龄为 30.3 ± 9.7 岁。年龄增加、体重指数（BMI）增加和男性性别与软骨和盂唇损伤的严重程度增加有关。更严重的软骨损伤与 AP AA ( P < .001) 和 MF AA ( P < .001) 增加有关。AP AA 中每 SD 增加 (16.7°)，发生更高类别的软骨损伤严重程度（≥3 级）的几率增加 119%（OR，2.19 [95% CI，1.36-3.64]；P = .002） ，根据年龄、性别和 BMI 进行调整。发生严重盂唇损伤（≥3 级）的几率高出 118%（OR，2.18 [95% CI 1.17-4.32]；P= .018) 对于 MF AA 中的每一个 SD 增加 (10.5°)，调整了年龄、性别、BMI 和 AP AA。

结论：

年龄和体重指数的增加以及男性性别与 FAIS 中软骨和盂唇损伤的严重程度增加有关。随着 AP AA 和 MF AA 的独立增加，发生软骨损伤的几率显着更高。