A Coesão Nacional e o Desenvolvimento Sócio-económico Face à Instituição das Regiões

A instituição das regiões constitui no último quartel do século XX o grande e incontornável dilema que devide e apaixonou os portugueses. Enquanto uns a encaram como solução para o crónico atraso face à Europa, outros vêm nela o descalabro económico-financeiro do Estado e o gérmen da sua desagregação política. Um olhar crítico sobre a Lei-Quadro da Regionalização detecta a equívoca unanimidade que a aprovou, pelo que terá de ser revista, tal como a Constituição. Lembrando que as autonomias insulares foram, afínal, barreiras contra o separatismo, importa alcançar um consenso real, ainda menos abrangente

Hip deformities and femoroacetabular impingement

RESUMO: Conceptualmente, a conservação de uma estrutura anatómica é mais benéfica do que a sua substituição. No caso das articulações humanas, este conceito é particularmente importante face aos múltiplos problemas, ainda não resolvidos, relacionados com próteses e materiais usados na cirurgia ortopédica. Na articulação coxofemoral, o conceito de preservação, melhorando os parâmetros biomecânicos, assume uma complexidade técnica acrescida maioritariamente pelo facto de a circulação epifisária do fémur ser intra-articular e dada a proximidade de importantes estruturas neurovasculares. O conflito femoroacetabular (CFA) e a displasia acetabular no adulto jovem, são duas entidades patológicas comuns embora com múltiplas áreas ainda por investigar. A displasia infantil, não diagnosticada e não tratada, pode originar displasia acetabular residual na idade adulta e consequente sintomatologia e limitação funcional. O diagnóstico de CFA no adulto é baseado em critérios clínicos e radiográficos. Clinicamente apresenta-se igualmente com dor e limitação funcional. Radiologicamente, dois subtipos de CFA são habitualmente reconhecidos, o tipo Cam (mecanismo patológico decorrente de asfericidade femoral) e o tipo Pincer (por hipercobertura acetabular). Embora com padrões diferentes de envolvimento articular, os dois mecanismos de conflito condicionam dor, lesão estrutural do labrum e condropatia. Atualmente, a morfologia Cam é considerada como um dos principais fatores de risco morfológico que contribuem para o desenvolvimento de osteoartrose precoce da coxofemoral, eventualmente com necessidade de recurso a prótese total da anca. Apesar de a investigação inicial na área da cirurgia conservadora da anca ter documentado bons resultados cirúrgicos, atualmente a controvérsia é francamente superior ao consenso relativamente à melhor abordagem diagnóstica e terapêutica. Caracteristicamente, apesar de em muitos casos os achados clínicos e radiológicos serem inequívocos para o diagnóstico de CFA, um número substancial de doentes apresenta achados frustes ou equívocos. Por outro lado, múltiplos estudos descreveram uma alta prevalência de morfologia compatível com CFA na população adulta e em indivíduos saudáveis assintomáticos. Atualmente, não existe uma ferramenta de imagem ideal que facilite a alocação fidedigna de todos os doentes a um grupo patológico específico ou, por outro lado, exclua com confiança o diagnóstico de conflito. No entanto, os parâmetros de imagem podem ser utilizados para analisar e descrever as diferentes características morfológicas da anca e adicionalmente confirmar o diagnóstico de CFA. Esta tese enfoca, por um lado, a avaliação da morfologia coxofemoral em diferentes populações, investigando quais articulações estão mais predispostas ao desenvolvimento de sintomas e, por outro, os resultados do tratamento cirúrgico de uma coorte com o diagnóstico de CFA tipo Cam. Especificamente, a investigação efetuada: 1) examinou características morfológicas específicas da coxofemoral em diferentes populações (sintomáticas ou não sintomáticas); 2) desenhou um modelo estatístico baseado em preditores anatómicos no sentido de estabelecer as articulações em risco de desenvolvimento sintomático, incorporando geometrias articulares específicas e parâmetros espinhopélvicos; e 3) analisou os resultados de terapêutica cirúrgica numa coorte de doentes com o diagnóstico CFA tipo Cam. Durante a progressão clínica na área da imagiologia e nesta área patológica em particular, apercebemo-nos da existência de múltiplas lacunas de conhecimento que procurámos colmatar com a investigação agora publicada e descrita nesta tese. A sistematização por capítulos reflete precisamente a necessidade de abordar a questão em áreas de conhecimento, simultaneamente distintas e complementares. Os seis capítulos desta tese abrangem o espectro clínico desde o diagnóstico até ao tratamento da anca jovem. De modo a apresentar os objetivos desta tese numa sequência lógica, desde a anatomia geral até à morfologia e tratamento específicos do CFA, a análise da anca assintomática será descrita em primeiro lugar seguida pela análise da relação anatomoclínica entre morfologia articular e sintomas. Por último será abordada a terapêutica do doente sintomático. Na PARTE I, apresentamos os tópicos essenciais para compreender a abrangência do espectro da presente tese, designadamente a relevância e a contemporaneidade do tema “CFA” e adicionalmente o enquadramento anatómico, morfológico e vascular desta articulação. O Capítulo 1 é dedicado ao desenvolvimento e morfogénese da anca. No Capítulo 2, sublinhamos a importância e o papel da imagem através de uma revisão enfocada nas perspetivas atuais e futuras sobre este tópico (Artigo I). No Capítulo 3, realizamos uma revisão sistemática da literatura no sentido de descrever o estado da arte com foco na prevalência da morfologia de CFA em populações assintomáticas e sintomáticas. Este capítulo destaca as múltiplas lacunas de conhecimento relativas ao papel da morfologia da articulação coxofemoral na patogénese do CFA (Artigo II). Com base nesta parte introdutória, abordamos seguidamente os objetivos da presente tese, gerais e específicos, na PARTE II.Na PARTE III, descrevemos o corpo da investigação clínica original efetuada. O Capítulo 4 é dedicado à caracterização detalhada da morfologia da anca, designadamente óssea e vascular. A morfologia coxofemoral foi quantificada utilizando software com capacidade de semi-automatização analítica, permitindo estudar a prevalência e relação entre as diferentes morfologias articulares e o género, dominância e simetria articular (Artigo III). A morfologia Cam foi ainda alvo de caracterização mais aprofundada, através do desenvolvimento de um novo parâmetro quantitativo com potencialidade diagnóstica e de planeamento cirúrgico/ /prognóstico, primariamente testado numa coorte assintomática (Artigo IV) e seguidamente também em doentes com indicação cirúrgica (Artigo V). Na nossa atividade clínica diária apreciámos a necessidade urgente de melhor caracterizar a topografia da deformidade Cam e a respetiva relação com as artérias nutritivas da epífise femoral. A impressão clínica referida sugeria que a morfologia Cam frequentemente se estendia posteriormente ao quadrante póstero-superior, intersectando a região retinacular vascular. No entanto, por imagem a natureza arterial destas estruturas nunca havia sido confirmada. Por esta razão, a importância do parâmetro mencionado foi sublinhada e comprovada no estudo cadavérico com avaliação topográfica vascular do fémur proximal (Artigo VI). No Capítulo 5 testámos múltiplos parâmetros imagiológicos e respetivas variações/relações com diferentes morfologias coxofemorais, no sentido de identificar as articulações com risco clínico aumentado de desenvolvimento sintomático. Para este fim efetuámos estudos baseados em computação avançada com modelação estatística (Artigo VII) e também em ressonância magnética (RM) tridimensional (Artigo VIII). O Capítulo 6 descreve as opções de tratamento (Artigo IX) e os resultados clínicos num estudo clínico de uma coorte com follow-up mínimo de 2 anos, comparando a abordagem cirúrgica aberta e artroscópica (Artigo X). Os resultados dos diferentes capítulos estão sumarizados na PARTE IV, onde apresentamos a síntese geral, a discussão crítica dos resultados obtidos à luz da literatura atual e finalmente as conclusões relevantes. As oportunidades futuras de investigação são igualmente abordadas neste capítulo. Em resumo o trabalho constante da presente tese sugere: Primeiro, que a avaliação imagiológica detalhada da morfologia coxofemoral é essencial no sentido de compreender aprofundadamente não só a própria articulação como também a morfologia pélvica (Artigo I). Segundo, paradoxalmente, a definição clínica de um caso patológico e das diferentes entidades relacionadas, é ainda inexistente. Os parâmetros quantitativos e qualitativos que comummente estão associados com CFA tipo Pincer e Cam são francamente frequentes em diferentes populações (sintomáticas e assintomáticas) (Artigo II).Terceiro, em populações assintomáticas adultas, os intervalos de referência específicos para os parâmetros quantitativos associados a morfologia de CFA e displasia são mais latos e com limites superiores mais elevados do que os atualmente utilizados na prática clínica (Artigo III). A morfologia femoral bem como os epicentros/magnitudes das deformidades Cam são específicos de género, observando-se maiores valores de ângulo alfa e ómega em indivíduos do sexo masculino (Artigo IV). Quarto, é frequente a interseção entre a extensão póstero-superior da deformidade Cam e a convergência epifisária das estruturas vasculares retinaculares observadas em RM, aspetos que se revestem de primordial importância no planeamento cirúrgico. Adicionalmente a extensão radial da deformidade Cam (ângulo ómega) está significativamente mais relacionada com a sintomatologia clínica pré-cirúrgica do que o parâmetro mais comummente utilizado na prática clínica (ângulo alfa) (Artigo V). A origem das estruturas vasculares observadas por RM na prega retinacular é inequivocamente arterial, sendo que abrange uma extensão mais anterior do que classicamente assumido (Artigo VI). Quinto, as geometrias ovalares (em detrimento das morfologias esféricas e elipsoides) são melhor representativas de ambas as superfícies articulares da coxofemoral, designadamente do fémur e acetábulo, bem como das ancas sintomáticas que clinicamente exibem sinais de CFA (Pincer, Cam e misto) (Artigo VII). Indivíduos com maiores deformidades Cam, aspetos de hipocobertura acetabular e acentuação da anteflexão pélvica apresentam uma maior probabilidade de desenvolverem sintomas articulares (Artigo VIII). Esta observação é crítica, dado que fornece, na prática clínica, informação essencial acerca da potencial predisposição para fenómenos de exacerbação sintomática futura, permitindo desta forma instituição de medidas terapêuticas/preventivas adequadas. Na perspetiva do doente, um diagnóstico precoce e preciso, pode conceptualmente prevenir, numa primeira fase, alterações condropáticas articulares e, numa segunda instância, progressão para artrose estabelecida. Sexto, documentamos resultados clínicos e funcionais significativamente favoráveis quando comparamos a abordagem artroscópica e aberta no tratamento cirúrgico da deformidade Cam, sendo de observar que o género feminino está associado a menor score funcional na avaliação pré-operatória (Artigos IX e X). Futuramente, a imagiologia e a cirurgia conservadora da anca irão desenvolver-se conjuntamente e em paralelo com novos e maiores desafios. A descrição de novos parâmetros analíticos para avaliação da patoanatomia coxofemoral, associada à inovação tecnológica crescente e à implementação da inteligência artificial, impõem uma evolução clínica oposta à assunção de classificações patológicas demasiadamente simplistas. Nesse sentido a existência de guidelines de diagnóstico e terapêutica mais efetivas e baseadas na evidência, que nos levem além da pura diferenciação entre CFA e displasia, são urgentes. A história natural das deformidades Cam e Pincer, sintomáticas ou assintomáticas, é ainda grandemente desconhecida, assumindo-se como uma área determinante de investigação no que concerne ao diagnóstico, terapêutica e prognóstico.ABSTRACT: Conceptually, the preservation of a human anatomical structure makes more sense than its replacement. This concept is even more striking in the case of human joints due to the multitude of unsolved problems related to implants used in orthopaedic surgery. With respect to the hip, joint preservation assumes an increased technical complexity when compared to other joints; this is due to two main reasons: the intra-articular epiphyseal circulation of the femur and the proximity of large neurovascular structures. Femoroacetabular impingement (FAI) and acetabular dysplasia (DHD) in young adults are two common but poorly characterised pathological entities. If undiagnosed and untreated, dysplasia in childhood may lead to residual DHD in young adults, as diagnosed on radiographs, and may also give rise to symptoms such as hip pain and restricted range of motion. The diagnosis of FAI in adults is based on clinical and imaging criteria. The most frequently noticed symptoms of FAI include hip pain and restricted function. Radiologically, two main subtypes of FAI are recognised: The Cam-type, with the pathoanatomical mechanism located on the femoral side, and the Pincertype on the acetabular side. Although with different pathological patterns, both types cause pain and articular damage of the labrum and cartilage. While Cam-type FAI is believed to be a major contributing factor to the early onset of hip osteoarthritis (OA), which eventually requires a total hip replacement, the relationship of other shapes and morphologies with OA are still under debate. Despite the initial promising reports on outcomes following surgical management of these conditions, the best approach to diagnose and manage them still remains controversial. Although for some patients there are unambiguous clinical and imaging findings of FAI, for a substantial number of patients there are minimal or intermediate findings. Moreover, several studies have reported a high prevalence of FAI morphology among the “normal” population and in asymptomatic healthy individuals. At present, there is no adequate imaging tool to facilitate the reliable allocation of all patients into the correct diagnostic group or to confidently rule out diagnosis. However, imaging parameters can be used to describe different hip morphological characteristics and additionally confirm or preclude the diagnosis of FAI.This thesis focuses on assessing hip morphology in different populations by investigating which specific joints are more prone to developing symptoms and by evaluating treatment outcomes of a FAI cohort. Specifically, this research concentrates on the following: 1) examining population-specific (symptomatic and non-symptomatic) characteristics of hip morphology; 2) developing an anatomic-based model to establish “at-risk” hip joints, incorporating subject-specific hip geometries and spinopelvic parameters and 3) investigating treatment outcomes in a Cam-type FAI cohort. In our clinical progression in imaging and in this particular area of pathology, we became aware of the existence of several gaps that we sought to fill with the now published research hereby described. The systematisation by chapters precisely reflects the need to address the issue in simultaneously distinct and complementary areas of knowledge. This thesis consists of six chapters, which cover the entire spectrum from the diagnosis to treatment of the young hip. To present the aims of this thesis in a sequential manner from general morphology to more specific FAI-related topics, the analysis of the asymptomatic hip will be presented first, followed by how joint morphology is associated with symptoms and, finally, will conclude with treatment. In PART I, we introduce the topics that are relevant to understand the full scope of our thesis; we aim to accomplish this by addressing the relevance and contemporariness of the “FAI” theme and by describing the general and vascular anatomy of the hip. Chapter 1 is devoted to hip development and morphogenesis. In Chapter 2, we address the importance of imaging by conducting a thorough review of current and future perspectives on this topic (Paper I). In Chapter 3, we perform a systematic review of the literature to write a state-of-the-art overview, focussing on asymptomatic and symptomatic FAI morphology prevalence and highlighting the multiple gaps in knowledge regarding the role of hip morphology in the pathogenesis of FAI (Paper II). Building on the first part, we address the rationale and aims of this thesis in PART II. In PART III, we describe the original research that was performed and published. Chapter 4 focusses on the detailed characterisation of hip morphology, both osseous and vascular. Bony hip morphology was quantified using a semi-automated software, which allows to robustly study in detail shape variants in an asymptomatic population and their relationship with sex, side and limb dominance (Paper III). Cam morphology was further defined by developing a novel quantitative parameter, with diagnostic and treatment planning capabilities using a cohort of both asymptomatic individuals (Paper IV) and patients undergoing surgery (Paper V). Moreover, we felt the need to better characterise the topography of the deformity and its relationship with the nourishing arteries of the femoral head, as Cam morphology frequently has a posterior a bstr extension that overlaps the retinacular vascular structures. However, its arterial origin has never been described or confirmed in the literature. For this reason, the importance of the aforementioned parameter has been outlined by the cadaveric arterial topographic study of the proximal femur (Paper VI). In Chapter 5, we test multiple parameters and their associated shape variants to detect which ones allow identifying a risk-increased joint in various populations. To this end, we use both advanced computing for shape modelling (Paper VII) and three dimensional (3D) magnetic resonance imaging (MRI) (Paper VIII). Chapter 6 describes the various treatment options (Paper IX) and outcomes in a cohort clinical study, comparing open surgery with arthroscopic surgery in terms of treating Cam deformities (Paper X). The results of the aforementioned chapters are summarised in PART IV, presenting the general synthesis, discussing the results in the light of current literature and detailing the conclusions of this thesis. The scope of potential future research within this field is also presented in this chapter. In brief, this thesis suggests the following: First, detailed imaging assessment of hip morphology is paramount to better understanding both the hip joint and pelvic morphology (Paper I). Second, the case definitions of different morphologies and clinical entities are missing as far as FAI and related disorders are concerned. Qualitative and quantitative radiographic findings thought to be associated with Cam- and Pincer-type FAI, as well as the coexistence between them, are quite common among different populations (Paper II). Third, in adult asymptomatic populations, sex-specific reference intervals for hip measurements for DHD and FAI morphology are wider than currently accepted values (Paper III). Moreover, femoral morphology with distinct Cam magnitudes and epicentres is also sex-specific, with higher mean alpha angle (α°) and omega angle (Ω°) values seen in males (Paper IV). Forth, Cam deformity frequently overlaps with the retinacular vascular structures seen in an MRI; this finding has practical surgical relevance. Additionally, the radial extension of the Cam deformity (Ω°) is more significantly associated with the patients’ symptoms prior to surgery than the α° (paper V). The origin of the vascular structures seen in the retinacular fold is unequivocally arterial in nature, and these structures have a more anterior distribution than classically assumed (Paper VI). Fifth, ovoid geometries are more representative of both articular surfaces of the hip joint as well as of Cam, Pincer and mixed impinged hips when compared to spherical or ellipsoidal shapes (Paper VII). Individuals with larger Cam deformities, decreased acetabular coverage and increased pelvic anteflexion are more likely to experience hip symptoms (Paper VIII). This provides clinicians with indications of how the pathology exacerbates, allowing them to perform the correct clinical assessments and proceed with the correct form of care. From a patient’s perspective, an early and accurate diagnosis could prevent cartilage degradation and progression to OA. Sixth, similar outcomes and significant functional improvement are observed when comparing open and arthroscopic surgery in the treatment of Cam deformities (follow-up time of two years). It should be noted that the female gender was associated with poor hip function in the preoperative evaluation (papers IX and X). Looking ahead, imaging and hip preserving surgery (HPS) will evolve hand-in-hand in the face of new and greater challenges. The increasing number of analytic parameters describing hip joint pathomorphologies as well as new sophisticated 3D imaging-analysis together with emerging artificial intelligence-based technologies have transported us beyond simple classification systems. Moreover, more reliable diagnostic and treatment guidelines that go beyond differentiation into pure FAI and dysplasia are paramount. The largely unknown natural course of both hips with symptomatic FAI and asymptomatic individuals continues to present research opportunities as far as diagnosis, treatment and prognosis are concerned

Prioritization of Software and System Requirements through Natural Language Processing for Testing Software

Tese de mestrado, Ciência de Dados, Universidade de Lisboa, Faculdade de Ciências, 2021Safety¬critical systems have been a constant and increased presence in industrial production, such as railways and vehicles. These systems are highly configurable and must be intensively tested by system engineers before being deliverable to customers. This process is highly time¬consuming and might require associations between the product features and requirements demanded by customers. Requirement prioritization looks to recognize the most relevant requirements of a system, aiming to reduce the costs and time of the testing process. Machine Learning has been shown useful in helping engineers in this task, automating associations between features and requirements. However, its application can be more difficult when requirements are written in natural language and if a ground truth dataset does not exist with them. In our work, we present ARRINA, a Natural Language Processing¬based recommendation system able to extract and associate components from safety¬critical systems with their specifications written in natural language and process customer requirements and map them to components. The system integrates a Weight Association Rule Mining framework to extract the components and their associations and generates visualizations that can help engineers understand which components are generally introduced in project requirements. The system also includes a recommendation framework that can associate in put requirements to existing subsystems, reducing engineers’ effort in terms of requirement analysis and prioritization. We performed several experiments to evaluate the different components of ARRINA over four railway’s subsystems and input requirements. As a result, the system achieved 90% of accuracy, which denotes its importance in reducing the time¬consuming of engineers in discovering the correct subsystem links and prioritizing requirements for the testing process

Mimics and Pitfalls of Imaging Assessment

Axial spondyloarthritis (axSpA) is a chronic inflammatory disorder that predominantly involves the axial skeleton. Imaging findings of axSpA can be divided into active changes, which include bone marrow edema, synovitis, enthesitis, capsulitis, and intra-articular effusion, and structural changes, which include erosions, sclerosis, bone fatty infiltration, fat deposition in an erosion cavity, and bone bridging or ankylosis. The ability to distinguish between imaging lesions suggestive of axSpA and artifacts or lesions suggestive of other disorders is critical for the accurate diagnosis of axSpA. Diagnosis may be challenging, particularly in early-stage disease and magnetic resonance imaging (MRI) plays a key role in the detection of subtle or inflammatory changes. MRI also allows the detection of structural changes in the subchondral bone marrow that are not visible on conventional radiography and is of prognostic and monitoring value. However, bone structural changes are more accurately depicted using computed tomography. Conventional radiography, on the other hand, has limitations, but it is easily accessible and may provide insight on gross changes as well as rule out other pathological features of the axial skeleton. This review outlines the imaging evaluation of axSpA with a focus on imaging mimics and potential pitfalls when assessing the axial skeleton.publishersversionpublishe

Imaging Characterization of the Lower Lumbar Spine and Pelvis for Surgical Planning

Funding Information: The present publication was funded by Fundação Ciência e Tecnologia, IP national support through CHRC (UIDP/04923/2020). The remaining authors have no conflicts to report.Objective: To determine and compare pelvic and lumbosacral reference parameters with computed tomography in patients with low back pain (LBP) and a control group of asymptomatic patients to provide quantification data and morphological correlations for L5S1 transforaminal endoscopic approach (L5S1TEA). Methods: We prospectively evaluated 100 patients with LBP and a control group of 100 individuals, with spinopelvic computed tomography. We measured lumbopelvic and L5S1 transforaminal approach parameters: maximum approach angle (maxAA) and minimum approach angle (minAA) and skin incision (maxSI and minSI), iliac crest (IC) projection at intersection point (ICPi), distance between the projected intersection of maxAA with the ilium (ICi) and the posterior limit of the IC (ΔICi-ICpost), and distance between ICi and spinous process (ΔICi-SP). Results: Females and ICPi were increased in the LBP group: maxAA: 48.38° ± 5.09°; minAA:32.5° ± 3.90°; maxSI: 11.39 ± 1.86 cm; and minSI: 8.30 ± 1.48 cm. Ilium intersection was increased in males; IC projection at the highest point (ICPh) was higher than ICPi; maxAA intersected the ilium in 28% and minAA in 1.5% of cases; ICi was positively correlated with facet angle, ICPh, and ICPi and negatively with ΔICi-SP. Conclusions: Our results set preliminary reference values for L5S1TEA surgical planning. Besides higher ICPi, there were no differences between groups in measured parameters. Traditional IC height (ICPh) does not correspond to the point of intersection of the approach and is significantly higher than ICPi. ICi correlated to higher facet angle values, ICPh and ICPi grades, and lower ΔICi-SP. Potential conflict with the ilium is increased in the male population. IC is not impeditive of L5S1TEA in most cases.proofepub_ahead_of_prin

Surgical Technique

Funding Information: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: P.D. reports research funding from CUF related to this study as part of a doctoral scholarship grant; and speaking and lecture fees from Smith & Nephew and DePuy Synthes. S.B.G. reports financial support was provided by Portuguese Foundation for Science and Technology, through IDMEC, under LAETA, project UIDB/50022/2020. J.M. reports financial support was provided by Portuguese Foundation for Science and Technology, through IDMEC, under LAETA, project UIDB/50022/2020. M.T.d.S. reports financial support was provided by Portuguese Foundation for Science and Technology, through IDMEC, under LAETA, project UIDB/50022/2020. All other authors (S.r.G., V.M., J.G.C.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Publisher Copyright: © 2024 The AuthorsThe femoroacetabular contact force and pressure are increased in the anterosuperior segment of the acetabulum in femoroacetabular impingement syndrome. We developed a special device for femoroacetabular contact force measurement in hip arthroscopy and present the surgical technique for measuring femoroacetabular contact force in the intact joint with a cam morphology and after cam resection, with the hip in different positions in a cadaver specimen. The device is introduced into the joint peripheral compartment. After joint distraction, the sensor is deployed through the cannula and advanced into the central compartment under direct arthroscopic control. We show a decrease in the contact force measured with this device after cam resection. This force analysis is limited to the anterosuperior femoroacetabular junction, which is the most frequent location for labral and chondral pathology in cam-type femoroacetabular impingement syndrome. We believe that this device also can be used in the evaluation of the contact forces in other joint conditions and in the assessment of diverse techniques of labral repair or reconstruction.proofinpres

Oxford consensus on primary cam morphology and femoroacetabular impingement syndrome: part 1—definitions, terminology, taxonomy and imaging outcomes

Introduction Primary cam morphology is a mostly benign bony prominence that develops at the femoral head-neck junction of the hip, but it is highly prevalent in many athlete populations. In the small proportion of athletes for whom it is not benign, the resulting hip osteoarthritis can be debilitating. Clinicians, athletes, patients and researchers do not yet agree on important primary cam morphology elements. We aimed to ascertain and improve the level of agreement on primary cam morphology definitions, terminology, taxonomy and imaging outcome measures. Methods To collect and aggregate informed opinions, an expert panel—the Young Athlete’s Hip Research Collaborative—rated primary cam morphology definition, terminology, taxonomy and imaging outcome statements through an online Delphi exercise followed by an online meeting to explore areas of tension and dissent. Reporting followed Conducting and REporting DElphi Studies. Results A diverse and inclusive Delphi panel (n=65 for rounds 1 and 2, representing 18 countries; 6 stakeholder groups; 40% women) agreed on 35 of 47 statements in 4 domains, while surfacing areas of tension and dissent. This Delphi panel agreed on four key issues essential to moving research and clinical care forward around primary cam morphology. They agreed on: (1) definition, confirming its conceptual attributes (tissue type, size, location, shape and ownership); (2) terminology—use ‘morphology’ and not terms with a negative connotation like ‘lesion’, ‘abnormality’ or ‘deformity’; (3) taxonomy, distinguishing between primary and secondary cam morphology, and (4) imaging outcomes, a continuous bone/cartilage alpha angle on radial femoral head-neck MRI for primary cam morphology aetiology research. Conclusion This consensus provides athletes, patients, clinicians and researchers with a strong foundation to guide more precise communication, better clinical decision-making and higher value research about primary cam morphology and its natural history

Oxford consensus on primary cam morphology and femoroacetabular impingement syndrome: part 1—definitions, terminology, taxonomy and imaging outcomes

INTRODUCTION: Primary cam morphology is a mostly benign bony prominence that develops at the femoral head-neck junction of the hip, but it is highly prevalent in many athlete populations. In the small proportion of athletes for whom it is not benign, the resulting hip osteoarthritis can be debilitating. Clinicians, athletes, patients and researchers do not yet agree on important primary cam morphology elements. We aimed to ascertain and improve the level of agreement on primary cam morphology definitions, terminology, taxonomy and imaging outcome measures. METHODS: To collect and aggregate informed opinions, an expert panel-the Young Athlete's Hip Research Collaborative-rated primary cam morphology definition, terminology, taxonomy and imaging outcome statements through an online Delphi exercise followed by an online meeting to explore areas of tension and dissent. Reporting followed Conducting and REporting DElphi Studies. RESULTS: A diverse and inclusive Delphi panel (n=65 for rounds 1 and 2, representing 18 countries; 6 stakeholder groups; 40% women) agreed on 35 of 47 statements in 4 domains, while surfacing areas of tension and dissent. This Delphi panel agreed on four key issues essential to moving research and clinical care forward around primary cam morphology. They agreed on: (1) definition, confirming its conceptual attributes (tissue type, size, location, shape and ownership); (2) terminology-use 'morphology' and not terms with a negative connotation like 'lesion', 'abnormality' or 'deformity'; (3) taxonomy, distinguishing between primary and secondary cam morphology, and (4) imaging outcomes, a continuous bone/cartilage alpha angle on radial femoral head-neck MRI for primary cam morphology aetiology research. CONCLUSION: This consensus provides athletes, patients, clinicians and researchers with a strong foundation to guide more precise communication, better clinical decision-making and higher value research about primary cam morphology and its natural history