From the Guidelines
Management of a 17-year-old male with bilateral cam-type femoroacetabular impingement (FAI) should begin with conservative treatment, focusing on activity modification, physical therapy, and pain management, before considering surgical options. The initial approach should prioritize avoiding movements that exacerbate symptoms, particularly those involving hip flexion and internal rotation, as these can worsen the condition 1.
Conservative Management
Conservative management should include:
- Activity modification to avoid exacerbating movements
- Physical therapy for 6-12 weeks, with 2-3 sessions weekly, focusing on core strengthening, hip stabilization, and improving range of motion
- Pain management with NSAIDs such as ibuprofen (400-600mg three times daily with food) or naproxen (500mg twice daily) for short periods during symptom flares
Diagnostic Imaging
Diagnostic imaging, such as anteroposterior (AP) pelvis and lateral femoral head–neck radiographs, should be used to assist in diagnosing the hip conditions characterized by hip-related pain, and MRI/magnetic resonance arthrogram (MRA) or CT scan where three-dimensional morphological assessment is indicated 1. However, diagnosis of the primary cause of hip-related pain should never be made using imaging alone, but rather in combination with the patient’s symptoms and clinical signs.
Surgical Intervention
If conservative measures fail after 3-6 months and the patient has significant pain or functional limitations, surgical intervention may be considered, typically arthroscopic surgery to reshape the femoral head and address labral damage. The timing of surgery is particularly important in adolescents, as intervention before skeletal maturity must be carefully considered to avoid growth disturbances 1.
Considerations
It is essential to recognize that cam morphology does not always cause symptoms, and some patients may remain asymptomatic with appropriate activity modifications and strengthening exercises despite the anatomical abnormality. Therefore, a balanced approach that considers both symptom management and the potential risks of surgical intervention is crucial.
From the Research
Cam Morphology in Both Hips of a 17-Year-Old Male
- Cam morphology, associated with femoroacetabular impingement (FAI), can be present in asymptomatic individuals, with studies suggesting a prevalence of 12% to 31% in asymptomatic hips 2, 3, 4.
- The development of cam morphology is significantly associated with open growth plates, suggesting that it mostly develops before proximal femoral growth plate closure 5.
- Cam morphology can be identified using imaging modalities such as MRI arthrography or computed tomography (CT) scans, with the alpha angle being a key measurement for diagnosing cam-type FAI 2, 4.
Management Approach for Cam Morphology
- The management approach for a 17-year-old male with cam morphology of both hips should consider the presence of symptoms, such as hip and groin pain, and the impact on hip function and range of motion 6.
- Studies have shown that cam morphology is associated with limited hip flexion and internal rotation, but the differences may not exceed the minimal clinical important difference 6.
- A comprehensive evaluation, including clinical examination, imaging studies, and patient history, is necessary to determine the best course of management for cam morphology in both hips.
Key Considerations
- Cam morphology is more common in males, with studies suggesting a higher prevalence in men than in women 3.
- The development of cam morphology is associated with participation in high-level sports, such as football, and may be influenced by factors such as growth plate status and genetic predisposition 5.
- Further research is needed to fully understand the relationship between cam morphology and hip and groin symptoms, as well as the optimal management approach for individuals with cam morphology 6.