Alpha angle values predict the severity of hip chondral damage in patients with cam-type femoroacetabular impingement syndrome: a systematic review and meta-analysis.

PURPOSE: To assess the role of alpha angle (AA) in predicting the severity of hip chondral damage in patients with cam-type femoroacetabular impingement (FAI) syndrome. METHODS: Following PRISMA guidelines, a systematic review was performed to summarize and critically appraise studies analyzing the prognostic capability of AA values in predicting the severity of intraoperatively evaluated hip chondral damage in patients with cam-type FAI syndrome. The risk of bias was assessed through the QUIPS tool. Meta-analyses based on groups and individual data from studies with a low risk of bias were conducted. We employed a Cumulative Link Mixed Model (CLMM) to analyze the relationship between AA and the ordinal outcome (chondral damage). The model was adjusted for sex, age, and the lateral center-edge angle (LCEA). Interactions between sex and AA were also investigated, and probabilities were calculated. RESULTS: Twelve studies with 4,564 patients were included in a qualitative review (aged 30 to 39 years, 1,822 women [40%]). Studies with a low risk of bias (n = 4; 2945 patients) indicated that AA values are significantly smaller (MD [95% CI] of 10.5° [6.5° to 15°]) in the low-grade chondral damage group (grades 0/I/II) compared to the high-grade chondral damage group (III/IV). The CLMM with individual patient data from studies with low risk of bias (n = 3; 1460 patients) indicated that for each 1° increase in AA, the odds of being in a higher category of chondral damage increase by a factor of 1.04 (OR = 1.04, p < 0.0001). Men were at significantly higher risk (OR = 2.11, p < 0.0001) than women, but no significant interaction between sex and AA was observed (p=0.054). We estimate the average probability of having high-grade chondral damage to be greater than 33% when AA values surpass 71° for men and 90° for women, and greater than 50% when 89° for men and 108° for women. However, the heterogeneity observed across studies should be considered. CONCLUSION: The alpha angle is a significant predictor of hip chondral damage severity in patients with cam-type FAI syndrome, regardless of sex, and independently of age and LCEA. Additionally, men are at a higher risk of chondral damage than women, and this risk increases with aging but decreases with the magnitude of the LCEA. LEVEL OF EVIDENCE: Level III, systematic review of Level II and III studies.

Are visual assessments of the single-leg squat valid to be used in clinical practice? A systematic review of measurement properties based on the COSMIN guideline.

OBJECTIVE: Evaluate the discriminative and convergent validity of visual scales for the assessment of movement quality in the single-leg squat. METHODS: Searches performed in CINAHL, Cochrane, Embase, PubMed, SPORTDiscus and Web of Science databases. Studies evaluating discriminative and convergent validity of movement quality visual assessments in single-leg squats were included. The COSMIN risk of bias checklist was used to assess the risk of bias, and certainty of evidence was assessed by the GRADE modified version. RESULTS: Ten studies evaluating three different methods of visual assessment of the single-leg squat (Crossley scale; Whatman score and Medial knee displacement) were included. Very low certainty evidence suggests that the Crossley scale had sufficient discriminative validity for patient-centred outcomes. Very low to moderate certainty evidence suggests that the three visual methods of assessment of the single-leg squat had insufficient discriminative validity for surrogate outcomes and groups. None of the three methods had the convergent validity assessed. CONCLUSION: The Crossley scale exhibited sufficient discriminative validity for patient-centred outcomes, although the evidence supporting this conclusion is of very low certainty. Visual scales for the assessment of the single-leg squat movement quality should be used with caution in clinical practice as most methods had insufficient discriminative validity and no reports of convergent validity.

Does response to preoperative intra-articular anesthetic injections predict outcomes of femoroacetabular impingement syndrome?

INTRODUCTION: Some patients with femoroacetabular impingement syndrome (FAIS) who undergo surgery do not show satisfactory outcomes. Reliable tests that can inform prognosis of FAIS surgery are needed for optimized indications and contraindications to surgery. We aimed to review and critically appraise available literature on the capability of patient response to preoperative intra-articular anesthetic injections (PIAI) to predict post-surgical outcomes in patients with FAIS. MATERIALS AND METHODS: This study was conducted in accordance with the PRISMA statement. Studies that assessed the patient pain response to PIAI and post-surgical outcomes in patients with FAIS were considered eligible. Study selection and data collection were performed by three independent reviewers. Main outcomes evaluated were those measured by hip outcome scales often used in assessing postoperative pain and functional recovery, such as the modified Harris Hip Score (mHHS) and international Hip Outcome Tool (iHOT). The likelihood ratio of achieving satisfactory postoperative outcomes at the mHHS (LHR) was extracted or calculated-for patients with significant response to PIAI and for those without a significant response to PIAI. The risk of bias was assessed using the Quality In Prognosis Studies (QUIPS) tool. RESULTS: Six studies were considered eligible for analysis. Five studies indicated that patient response to PIAI are associated to surgical outcomes for patients with FAIS, with a greater reduction in pain typically indicating a better surgical outcome. Additionally, the LHR ranged from 1.15 to 1.92 for patients with significant response to PIAI (I2 = 90.6%). For patients without a significant response, the LHR ranged from 0.18 to 0.65 (I2 = 87.5). An overall high risk of bias was observed for all studies included in the analysis. Study attrition, the prognostic factor measurement and the presence of confounding factors were the main sources of bias. CONCLUSIONS: Greater reductions in pain with preoperative intra-articular anesthetic injections were found to be associated to better outcomes after FAIS surgery, but all available studies contain a high risk of bias.