Importance Biomarkers have promising potential to provide a cost-effective tool to identify patients with femoroacetabular impingement (FAI) who are most at risk and who may benefit most from early joint preservation surgery.
Objective To assess the potential role of biomarkers in the diagnosis and prognosis of FAI.
Evidence review Three databases (PubMed, Ovid (MEDLINE) and Embase) were searched on 20 August 2017 from database inception, and two reviewers independently and in duplicate screened the resulting literature. Methodological quality of all included papers was assessed using the Methodological Index for Non-Randomized Studies criteria. The results are presented in a narrative summary fashion using descriptive statistics including means, proportions and ranges.
Findings Seven studies (one retrospective laboratory series and six controlled laboratory studies) were identified including a total of 227 patients. The mean age of the patients was 41.6 years (range: 13–80), with a mean follow-up period of 29.9 months (SD=3.2). Markers of articular cartilage breakdown, including cartilage oligomeric matrix protein (COMP) and fibronectin–aggrecan complex (FAC), were identified in high concentrations in the serum and synovial fluid of patients with FAI, respectively. Moreover, mRNA expression of catabolic cytokines in the articular cartilage of patients with FAI has been reported.
Conclusions and relevance Although not yet used in clinical settings, several biomarkers of articular cartilage damage have been identified in the serum, synovial fluid and articular cartilage of patients with FAI. These findings provide promising insight into the potential role of biomarkers in guiding clinical practice and assisting with patient selection and preoperative counselling in patients with FAI and should be evaluated further.
Level of evidence IV, systematic review of level III and IV studies.
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Contributors JK: lead author, contributed to all elements of the study, specifically: study design; primary literature reviewer; responsible for executing the search of data; data abstraction, analysis and presentation; primary manuscript writer; and responsible for all encompassing and all subsequent revisions throughout the editing process. MM: contributed to study design, third reviewer responsible for searching data, and contributed to data abstraction, manuscript preparation and revision. VZZ: served as a second reviewer responsible for searching data, contributed to data abstraction and contributed to study design, data analysis and manuscript preparation. NS, AD, NB and MRS: content expert and contributed to study design, data analysis and manuscript preparation and revision. ORA: study supervisor and content expert; contributed to all elements of the study, specifically: study design; development of the literature search strategy and grading process; assisted with data analysis and presentation; and manuscript preparation and revision.
Competing interests None declared.
Provenance and peer review Commissioned; externally peer reviewed.
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