Abstract
In the last 20 years, femoroacetabular impingement has been at the forefront of clinical practice as a cause of hip pain in young adults. As arthroscopic techniques for the hip continue to evolve, the possible presence of a new group of conditions creating mechanical conflict in and around the hip joint (ischiofemoral, subspine and iliopsoas impingement) has recently been elucidated whilst interest in already known ‘impingement’ syndromes (pelvic-trochanteric and pectineofoveal impingement) is now revived. This article attempts to increase awareness of these relatively uncommon clinical entities by describing their pathomorphology, contact mechanics, treatment and published results available to present. It is hoped that such knowledge will diversify therapeutic options for the clinician, thereby improving outcomes in a small but not negligible portion of patients with previously unexplained persistent symptoms.
Highlights
Femoroacetabular impingement (FAI) is established as an intra-articular condition creating mechanical conflict between the acetabulum and the femoral head–neck junction, resulting in labral tears and acetabular cartilage damage
FAI has been discussed in the anthropology literature for more than a century and lesions such as ‘Poirier’s facet’ and the ‘fossa of Allen’, corresponding to the better known today cam lesion and herniation pit, respectively, are believed to be related to hip extension, such that occurs in walking or running, and have been identified with high frequency in the fossils of ancient Greeks [3]
It was through the work of the Bernese group, led by Reinhold Ganz, that the orthopaedic community gained a solid insight into the pathophysiology of FAI and its potential for osteoarthritic degeneration, when left untreated [4]
Summary
Femoroacetabular impingement (FAI) is established as an intra-articular condition creating mechanical conflict between the acetabulum and the femoral head–neck junction, resulting in labral tears and acetabular cartilage damage. FAI has been discussed in the anthropology literature for more than a century and lesions such as ‘Poirier’s facet’ and the ‘fossa of Allen’, corresponding to the better known today cam lesion and herniation pit, respectively, are believed to be related to hip extension, such that occurs in walking or running, and have been identified with high frequency in the fossils of ancient Greeks [3]. It was through the work of the Bernese group, led by Reinhold Ganz, that the orthopaedic community gained a solid insight into the pathophysiology of FAI and its potential for osteoarthritic degeneration, when left untreated [4]. Today, armed with modern diagnostic tools (3-D CT, delayed gadolinium-enhanced MRI of cartilage, dynamic computer analysis), researchers are exploring novel-related fronts, like the concept of impingement-induced instability and the role of femoral/acetabular version on outcomes [7,8]
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