Many high-level athletes suffer from chronic groin pain at very young ages already. This presumably results from an extensive athletic activity before skeletal maturity. The frequently associated osteoarthritis particularly occurs in significant contact sports such as football, but also pertains to rowing sports, deep squatting activities, or horseback riding, often bringing a professional athlete’s career to an early end. One of the underlying conditions is femoroacetabular impingement (FAI), where a misshapen femoral head impacts the acetabular socket, causing damage in the articular cartilage. The selection of the appropriate surgical treatment, however, depends on the amount of pre-existing articular cartilage damage – which is difficult to determine before surgery: X-ray images provide an incomplete view of the cartilage and may show a joint space, while there is nevertheless a significant loss of cartilage within the hip.

Young-Jo Kim, MD/PhD, Assistant Professor for Orthopedic Surgery at Harvard Medical School’s Children’s Hospital, and his colleagues found the delayed Gadolinium-Enhanced MRI of Cartilage (dGEMRIC) technique helpful for the presurgical evaluation of cartilage damage. The technique displays the glycosaminoglycan (GAG) concentration of the particular cartilage. By using cartilage GAG as an imaging biomarker, the physicians at Harvard measure the viability of the cartilage with a Siemens MAGNETOM® Avanto MRI system.

The utility of dGEMRIC is illustrated in the case of a 19-year-old college hockey player. She suffered from right hip pain that initially limited her playing and eventually also constricted her everyday activity. Plain radiographs showed no evidence of osteoarthritis. However, the dGEMRIC scan suggested significant articular cartilage damage. Based on this information, the patient was scheduled for an open surgical dislocation and osteoplasty rather than a limited anterior open arthrotomy and osteochondroplasty. The subsequent surgery verified the extent of articular cartilage damage in the acetabulum.

As Kim states: “The addition of dGEMRIC to our clinical hip imaging protocol allows us to improve patient selection and thereby enhances the success of our surgical procedure. We can avoid unnecessary surgery due to the improved initial assessment of the articular damage. Furthermore, dGEMRIC provides the full complement of diagnostic imaging sequences within a 30-minutes scan as part of routine clinical imaging.