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Parafoveal Chondral Defects Associated with Femoroacetabular Impingement

  • Symposium: ABJS Carl T. Brighton Workshop on Hip Preservation Surgery
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Cam-type, pincer, and mixed femoroacetabular impingement (FAI) are accepted causes of labral and acetabular rim injury; however, the abnormal contact stresses associated with motion may damage other areas of the hip. Although cartilage damage to the femoral head has been reported previously in athletes, FAI-associated focal parafoveal chondral defects differ from previously reported lesions and represent a rare manifestation of the complex pathomechanics associated with FAI.

Questions/Purposes

We describe the clinical, radiographic, and surgical characteristics of a rare focal anterolateral parafoveal femoral chondral defect associated with FAI.

Methods

We retrospectively reviewed 10 patients with symptomatic FAI diagnosed with this unique focal defect confirmed at the time of surgical dislocation. Patients presented with hip pain, clinical findings of FAI, and, frequently, with an identifiable lesion on MRI arthrography. The minimum clinical followup was 12 months (mean, 29 months; range, 12–72 months).

Results

The consistent characteristics of these lesions associated with FAI differ from previously reported femoral chondral damage reported after hip dislocation or lateral impact in that there was no discrete injury such as a fall or dislocation/subluxation, no associated traumatic femoral lesion, and all were localized to the posterosuperior femoral head. Eight of 10 were diagnosed preoperatively using MR arthrography.

Conclusions

Despite radiographic similarities to findings of osteoarthritis and osteonecrosis, these FAI-associated femoral chondral defects were amenable to surgical reconstruction using first- or second-generation cartilage repair techniques during surgical treatment of impingement. The etiology of these lesions may be related to complex intraarticular forces generated by FAI-associated transient hip subluxation or forceful nonconcentric motion.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, William Beaumont Hospital, 3535 W 13 Mile Road #744, Royal Oak, MI, 48073, USA

    Ira Zaltz MD

  2. Schulthess Klinik, Lengghalde 2, Zurich, CH-8008, Switzerland

    Michael Leunig MD

Authors
  1. Ira Zaltz MD
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  2. Michael Leunig MD
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Correspondence to Ira Zaltz MD.

Additional information

Each author certifies that he or she, or a member of their immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at William Beaumont Hospital, Royal Oak, MI, USA; and the Schulthess Klinik, Zurich, Switzerland.

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Zaltz, I., Leunig, M. Parafoveal Chondral Defects Associated with Femoroacetabular Impingement. Clin Orthop Relat Res 470, 3383–3389 (2012). https://doi.org/10.1007/s11999-012-2453-x

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  • DOI: https://doi.org/10.1007/s11999-012-2453-x

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