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Evaluation of Cam-type femoroacetabular impingement by ultrasound

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In the diagnosis of femoroacetabular impingement (FAI), magnetic resonance imaging (MRI) and X-ray are widely accepted methods for detection. When evaluating the hip head-neck junction using MRI, oblique axial sequences are required. However, the construction and analysis of these images are restricted to specialist radiologists and surgeons in the field of hip joint MRI. This study sought to investigate whether ultrasound, a simple and inexpensive method, can be used as a reliable tool for diagnosing Cam-type FAI.


Forty patients, with a mean age of 39 years (range, 18–61 years), were consecutively included in this prospective study, following a diagnosis of Cam-type FAI on an oblique axial MRI. All patients underwent ultrasound examination in the ventral longitudinal section at 20° external rotation, neutral position and 20° internal rotation. The alpha angle, anterior offset, offset-ratio, and anterior femoral distance (AFD) were measured using MRI and ultrasound.


No significant differences were detected between the alpha angle on MRI and that using ultrasound in the neutral position or in 20° internal rotation, with strong correlations observed between these parameters (r = 0.67 for neutral position, r = 0.77 for 20° internal rotation). The Pearson’s correlation coefficient for the alpha angle on MRI and the ratio of AFD/anterior offset on ultrasound in internal rotation was 0.76 (p < 0.0001).


The results show strong correlations between MRI and ultrasound measurements in patients with Cam-type FAI. Consequently, ultrasound may provide a useful tool for the early diagnosis of Cam-type FAI in daily practice.

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  1. Ganz R, Parvizi J, Beck M et al (2003) Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 417:112–120

    PubMed  Google Scholar 

  2. Harris WH (1986) Etiology of osteoarthritis of the hip. Clin Orthop Relat Res 213:20–33

    PubMed  Google Scholar 

  3. Tanzer M, Noiseux N (2004) Osseous abnormalities and early osteoarthritis: the role of hip impingement. Clin Orthop Relat Res 429:170-7

    Google Scholar 

  4. Imam S, Khanduja V (2011) Current concepts in the diagnosis and management of femoroacetabular impingement. Int Orthop 35:1427–1435

    Article  PubMed  Google Scholar 

  5. Kusma M, Bachelier F, Schneider G, Dienst M (2009) Femoroacetabular impingement. Clinical and radiological diagnostics. Orthopade 38:402–411

    Article  PubMed  CAS  Google Scholar 

  6. Mamisch TC, Werlen S, Zilkens C et al (2009) Radiological diagnosis of femoroacetabular impingement. Radiologe 49:425–433

    Article  PubMed  CAS  Google Scholar 

  7. Cavaignac E, Chiron P, Espie A et al (2012) Experimental study of an original radiographic view for diagnosis of cam-type anterior femoroacetabular impingement. Int Orthop 36:1783–1788

    Article  PubMed  Google Scholar 

  8. Notzli HP, Wyss TF, Stoecklin CH et al (2002) The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 84:556–560

    Article  PubMed  CAS  Google Scholar 

  9. Eijer H, Leunig M, Mahomed MN, Ganz R (2001) Cross-table lateral radiographs for screening of anterior femoral head-neck offset in patients with femoro-acetabular impingement. Hip Int 11:37–41

    Google Scholar 

  10. Burstein D, Velyvis J, Scott KT et al (2001) Protocol issues for delayed Gd(DTPA)(2-)-enhanced MRI (dGEMRIC) for clinical evaluation of articular cartilage. Magn Reson Med 45:36–41

    Article  PubMed  CAS  Google Scholar 

  11. Troelsen A, Jacobsen S, Bolvig L et al (2007) Ultrasound versus magnetic resonance arthrography in acetabular labral tear diagnostics: a prospective comparison in 20 dysplastic hips. Acta Radiol 48:1004–1010

    Article  PubMed  CAS  Google Scholar 

  12. Troelsen A, Mechlenburg I, Gelineck J et al (2009) What is the role of clinical tests and ultrasound in acetabular labral tear diagnostics? Acta Orthop 80:314–318

    Article  PubMed  Google Scholar 

  13. Lohan DG, Seeger LL, Motamedi K et al (2009) Cam-type femoral-acetabular impingement: is the alpha angle the best MR arthrography has to offer? Skeletal Radiol 38:855–862

    Article  PubMed  Google Scholar 

  14. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310

    Article  PubMed  CAS  Google Scholar 

  15. Casartelli NC, Leunig M, Item-Glatthorn JF et al (2012) Hip flexor muscle fatigue in patients with symptomatic femoroacetabular impingement. Int Orthop 36:967–973

    Article  PubMed  CAS  Google Scholar 

  16. Beck M, Kalhor M, Leunig M, Ganz R (2005) Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br 87:1012–1018

    Article  PubMed  CAS  Google Scholar 

  17. Dudda M, Albers C, Mamisch TC et al (2009) Do normal radiographs exclude asphericity of the femoral head-neck junction? Clin Orthop Relat Res 467:651–659

    Article  PubMed  Google Scholar 

  18. Ito K, Minka MA, Leunig M et al (2001) Femoroacetabular impingement and the cam-effect. A MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br 83:171–176

    Article  PubMed  CAS  Google Scholar 

  19. Meyer DC, Beck M, Ellis T et al (2006) Comparison of six radiographic projections to assess femoral head/neck asphericity. Clin Orthop Relat Res 445:181–185

    PubMed  Google Scholar 

  20. Pfirrmann CW, Mengiardi B, Dora C et al (2006) Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. Radiology 240:778–785

    Article  PubMed  Google Scholar 

  21. Papalia R, Del BA, Franceschi F et al (2012) Femoroacetabular impingement syndrome management: arthroscopy or open surgery? Int Orthop 36:903–914

    Article  PubMed  Google Scholar 

  22. Domayer SE, Ziebarth K, Chan J et al (2011) Femoroacetabular cam-type impingement: diagnostic sensitivity and specificity of radiographic views compared to radial MRI. Eur J Radiol 80:805–810

    Article  PubMed  CAS  Google Scholar 

  23. Nepple JJ, Martel JM, Kim YJ et al (2012) Do plain radiographs correlate with CT for imaging of Cam-type femoroacetabular impingement? Clin Orthop Relat Res 470:3313–3320

    Article  PubMed  Google Scholar 

  24. Rakhra KS, Sheikh AM, Allen D, Beaule PE (2009) Comparison of MRI alpha angle measurement planes in femoroacetabular impingement. Clin Orthop Relat Res 467:660–665

    Article  PubMed  Google Scholar 

  25. Barton C, Salineros MJ, Rakhra KS, Beaule PE (2011) Validity of the alpha angle measurement on plain radiographs in the evaluation of cam-type femoroacetabular impingement. Clin Orthop Relat Res 469:464–469

    Article  PubMed  Google Scholar 

  26. Kutty S, Schneider P, Faris P et al (2012) Reliability and predictability of the centre-edge angle in the assessment of pincer femoroacetabular impingement. Int Orthop 36:505–510

    Article  PubMed  Google Scholar 

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Correspondence to Solveig Lerch.

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Lerch, S., Kasperczyk, A., Warnecke, J. et al. Evaluation of Cam-type femoroacetabular impingement by ultrasound. International Orthopaedics (SICOT) 37, 783–788 (2013).

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