This study examined the relationship between cam-type femoroacetabular impingement (FAI) and markers of polycystic ovary syndrome (PCOS) in women. Fifteen women with cam FAI had significantly higher alpha angles and antral follicle counts per ovary compared to thirteen controls, indicating an association between cam FAI and hyperandrogenism. Further research is needed to understand the hormonal influences on proximal femoral development during adolescence.

1. Cam type Femoroacetabular
Impingement associated with
Marker for Hyperandrogenism in
Women
Andrew B. Wolff, MDa
Torie Plowden, MDb
Alexandra Napoli, BAa
Benjamin McArthur, MDa
Erin F. Wolff, MDb
a
Washington Orthopaedics and Sports Medicine, Washington DC;
b
Program in Reproductive and Adult Endocrinology, NICHD,
National Institutes of Health, Bethesda, MD

2. Andrew B. Wolff, MD
• I have the following financial relationships to
disclose:
– Consulting: Arthrex, Pivot medical

3. Etiology of Cam Type FAI
• Remains undefined, but evidence shows:
– Develops during adolescence1,2,3
– More common in males4
– Associated with vigorous sporting activities3
– Can be result of silent slipped capital femoral
epiphysis5,6
• More common in males5,6
• Associated with endocrine disorders7

4. Polycystic Ovary Syndrome
• Polycystic Ovary Syndrome (PCOS)
– Important cause of androgen excess in women
– Affects 6.5 - 8 percent of women
– Associated with menstrual irregularity, hirsutism,
obesity, glucose intolerance, dyslipidemia,
obstructive sleep apnea

5. Polycystic Ovary Syndrome
• Polycystic Ovary Syndrome (PCOS)
– Characterized and diagnosed in part by increased
number and size of antral follicles on imaging8,9

6. Cam-type FAI and PCOS
• Both develop in the peri-pubertal period
• Both associated with or defined by endocrine
dysfunction
• Cam-type FAI seen more in men than in
women
• PCOS characterized by hyperandrogenism

7. Hypothesis
• Cam-type FAI will be associated with marker
for PCOS (hyperandrogenism)

8. Methods
• Prospective cohort of reproductive aged
women who were indicated for arthroscopic
hip surgery were assessed.
• Presence or absence of cam morphology was
determined by measurement of alpha angles
on 45 degree Dunn lateral radiographs.
– Cam FAI was defined as an angle of >55 degrees10

9. Methods
• Antral follicles were assessed by MRI.
• As only one ovary was frequently seen on
MRI, the average number of antral follicles per
ovary were recorded.

10. Results
• Fifteen women with cam FAI and 13 without were found to have
median alpha angle of 62 (range 56-72) and 46 (range 40-54),
respectively (P<0.0001).
• Average ages were similar between groups (27.7+7.2 vs 24.1+10.8,
P=0.30).
• Antral follicle counts per ovary were significantly higher in women
with cam FAI than controls, respectively (13.7+5.3 vs 8.5+2.9,
P=0.004).
• Univariate analysis revealed a statistically significant correlation
between alpha angle measurements and antral follicle counts per
ovary (R=0.30, P=0.03), indicating that cam type FAI appears to be
more consistent with a continuum rather than cut-point with
respect to antral follicle counts.

11. Results
• Fifteen women with cam FAI and 13 without were found to have
median alpha angle of 62 (range 56-72) and 46 (range 40-54),
respectively (P<0.0001).
• Average ages were similar between groups (27.7+7.2 vs 24.1+10.8,
P=0.30).
• Antral follicle counts per ovary were significantly higher in women
with cam FAI than controls, respectively (13.7+5.3 vs 8.5+2.9,
P=0.004).
• Univariate analysis revealed a statistically significant correlation
between alpha angle measurements and antral follicle counts per
ovary (R=0.30, P=0.03), indicating that cam type FAI appears to be
more consistent with a continuum rather than cut-point with
respect to antral follicle counts.

12. Discussion and Conclusion
• Cam-type FAI was found to be strongly
associated with increased antral follicle
numbers--a marker for PCOS and
hyperandrogenism.
• Further study is needed to assess hormonal
influence such as PCOS and
hyperandrogenism on development of the
proximal femur during adolescence

13. References
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2. The cam-type deformity of the proximal femur arises in childhood in response to vigorous sporting activity. Siebenrock, KA et al.
CORR 2011
3. Prevalence of cam-type deformity and hip pain in elite ice hockey players before and after the end of growth. Siebenrock, KA et al.
Am J Sports Med 2013.
4. The alpha angle in cam-type femoroacetabular impingement: new reference intervals based on 2038 healthy young adults. Laborie
LB et al. Bone Joint J 2014.
5. Radiological findings that may indicate a prior silent slipped capital femoral epiphysis in a cohort of 2072 young adults. Lehmann TG
et al. Bone Joint J. 2013.
6. The frequency of sequelae of slipped upper femoral epiphysis in cam-type femoroacetabular impingement. Murgier J et al. Bone
Joint J. 2014.
7. Slipped capital femoral epiphysis and its association with endocrine, metabolic and chronic diseases: a systematic review of the
literature. Witbreuk M et al. J Child Orthop. 2013.
8. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Rotterdam
ESHRE/ASRM-Sponsored PCOS consensus workshop group. Hum Reprod. 2004.
9. Ovarian morphology assessed by magnetic resonance imaging in women with and without polycystic ovary syndrome and
associations with antimüllerian hormone, free testosterone, and glucose disposal rate. Leonhardt H. Fertil Steril. 2014.
10. Femoral head-neck offset measurements in 339 subjects: distribution and implications for femoroacetabular impingement. Fraitzl
CR et al. Knee Surg Sports Traumatol Arthrosc. 2013.