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Schmitt L, Pfirrmann CWA, Buck FM, Hany TF, Rosskopf AB. Value of MR arthrography for evaluation of children and adolescents with clinically suspected intraarticular cause of hip pain. Skeletal Radiol 2024; 53:1269-1278. [PMID: 38206356 PMCID: PMC11093865 DOI: 10.1007/s00256-023-04552-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE To evaluate the distribution of intra- and extraarticular MRI findings in children and adolescents with clinically suspected intraarticular cause of hip pain in order to assess the need for additional intraarticular contrast administration. MATERIAL AND METHODS Database was searched over a period of 34 months retrospectively for consecutive hip MR arthrography in young patients (8-17 years) with suspected intraarticular cause of hip or groin pain. Exclusion criteria were prior hip surgery, follow-up examination due to known intraarticular pathology, incomplete examination, qualitatively non-diagnostic examinations, and missing informed consent. Reports of fellowship-trained MSK radiologists were searched for intraarticular versus extraarticular findings explaining hip or groin pain. RESULTS Seventy patients (68% female; median age: 14.5 years; range:10.8-16.9 years) were analyzed. No reason for pain was found in 30 (42.9%) hips, extraarticular reasons in 20 (28.6%) cases, intraarticular in 14 (20.0%), and both (intra- and extraarticular) in 6 (8.6%) hips. Most common extraarticular reasons were apophysitis (14.3%), other bony stress reactions (12.9%), intramuscular edema (7%), tendinitis (5.7%), and trochanteric bursitis (4.3%). Labral pathology was the most common intraarticular finding (overall:34.3%; partial tear:15.7%, complete tear:15.7%), most frequent at the anterosuperior position (81.8%). Cartilage defects (1.4%), intraarticular neoplasia (1.4%), and tear of the femoral head ligament (2.8%) were rarely found. Synovitis and loose bodies were not observed. Cam-(37.1%) and pincer-configurations (47.1%) were common while hip dysplasia was rare (5.7%). CONCLUSION MRI in children and adolescents with hip pain should be done primarily without intraarticular contrast administration since most cases show an extraarticular pain reason or no diagnosis detectable with MRI.
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Affiliation(s)
- Laura Schmitt
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Christian W A Pfirrmann
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Medical Radiological Institute (MRI) Zurich, Schulthess Clinic, Lengghalde 2, CH-8008, Zurich, Switzerland
| | - Florian M Buck
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Medical Radiological Institute (MRI) Zurich, Schulthess Clinic, Lengghalde 2, CH-8008, Zurich, Switzerland
| | - Thomas F Hany
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Medical Radiological Institute (MRI) Zurich, Schulthess Clinic, Lengghalde 2, CH-8008, Zurich, Switzerland
| | - Andrea B Rosskopf
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.
- Medical Radiological Institute (MRI) Zurich, Schulthess Clinic, Lengghalde 2, CH-8008, Zurich, Switzerland.
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Criteria for the Operating Room Confirmation of the Diagnosis of Hip Instability: The Results of an International Expert Consensus Conference. Arthroscopy 2022; 38:2837-2849.e2. [PMID: 35378192 DOI: 10.1016/j.arthro.2022.03.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/20/2022] [Accepted: 03/02/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to establish an international expert consensus on operating room findings that aid in the diagnosis of hip instability. METHODS An expert panel was convened to build an international consensus on the operating room diagnosis/confirmation of hip instability. Seventeen surgeons who have published or lectured nationally or internationally on the topic of hip instability were invited to participate. Fifteen panel members completed a pre-meeting questionnaire and agreed to participate in a 1-day consensus meeting on May 15, 2021. A review of the literature was performed to identify published intraoperative reference criteria used in the diagnosis of hip instability. Studies were included for discussion if they reported and intraoperative findings associated with hip instability. The evidence for and against each criteria was discussed, followed by an anonymous voting process. For consensus, defined a priori, items were included in the final criteria set if at least 80% of experts agreed. RESULTS A review of the published literature identified 11 operating room criteria that have been used to facilitate the diagnosis of hip instability. Six additional criteria were proposed by panel members as part of the pre-meeting questionnaire. Consensus agreement was achieved for 8 criteria, namely ease of hip distraction under anesthesia (100.0% agreement), inside-out pattern of chondral damage (100.0% agreement), location of chondral damage on the acetabulum (93.3% agreement), pattern of labral damage (93.3% agreement), anteroinferior labrum chondral damage (86.7% agreement), perifoveal cartilage damage (97.6% agreement), a capsular defect (86.7% agreement), and capsular status (80.0% agreement). Consensus was not achieved for 9 items, namely ligamentum teres tear (66.7% agreement), arthroscopic stability tests (46.7% agreement), persistent distraction after removal of traction (46.7% agreement), findings of examination under anesthesia (46.7% agreement), the femoral head divot sign (40.0% agreement), inferomedial synovitis (26.7% agreement), drive-through sign (26.7% agreement), iliopsoas irritation (26.7% agreement) and ligamentum teres-labral kissing lesion (13.3% agreement). All experts agreed on the final list of 8 criteria items reaching consensus. CONCLUSION This expert panel identified 8 criteria that can be used in the operating room to help confirm the diagnosis of hip instability. LEVEL OF EVIDENCE Level V expert opinion.
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Hwang DS, Kang C, Lee JK, Park JY, Zheng L, Hwang JM. The utility of hip arthroscopy for patients with painful borderline hip dysplasia. J Orthop Surg (Hong Kong) 2021; 28:2309499020923162. [PMID: 32410527 DOI: 10.1177/2309499020923162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE We measured the width of the acetabular labra in, and the clinical outcomes of, patients with borderline hip dysplasia (HD) who underwent arthroscopy. METHODS A total of 1436 patients who underwent hip arthroscopy to treat symptomatic, acetabular labral tears were enrolled. From this cohort, we extracted a borderline HD group (162 cases). Lateral labral widths were evaluated using preoperative magnetic resonance imaging scans. Clinical data including the modified Harris hip score (mHHS), non-arthritic hip score (NAHS), hip outcome score-activity of daily living (HOS-ADL) score, visual analog scale (VAS) pain score, and Tönnis grade were collected. In addition, patient satisfaction with arthroscopy outcomes was rated. All complications and reoperations were noted. RESULTS The mean follow-up time was 87.4 months. The lateral labral width was 7.64 mm in those with normal hips and 7.73 mm in borderline HD patients, respectively (p = 0.870). The Tönnis grade progressed mildly from 0.46 to 0.76 (p = 0.227). At the last follow-up, clinical outcome scores (mHHS, NAHS, and HOS-ADL scores) and the VAS score were improved (p < 0.001). The mean patient satisfaction was scored at 8.2. The reoperation rate was higher in those who underwent labral debridement (25.6%) than labral repair (4.1%). CONCLUSIONS The lateral labral width did not differ significantly between the borderline HD group and the nondysplastic control group. Arthroscopy relieved the symptoms of painful borderline HD and did not accelerate osteoarthritis. Therefore, if such patients do not respond to conservative treatment, hip arthroscopy can be considered for further treatment.
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Affiliation(s)
- Deuk-Soo Hwang
- Department of Orthopedic Surgery, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Chan Kang
- Department of Orthopedic Surgery, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Jeong-Kil Lee
- Department of Orthopedic Surgery, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Jae-Young Park
- Department of Orthopedic Surgery, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Long Zheng
- Department of Orthopedic Surgery, Chungnam National University College of Medicine, Daejeon, South Korea.,Department of Orthopedic Surgery, Yanbian University Hospital, Yanji, China
| | - Jung-Mo Hwang
- Department of Orthopedic Surgery, Chungnam National University College of Medicine, Daejeon, South Korea
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Lee SH, Jang WY, Choi GW, Lee YK, Jung HW. Author Reply to Regarding '"Is the Transverse Acetabular Ligament Hypertrophied and Hindering Reduction in Developmental Dysplasia of Hip?'". Arthroscopy 2018; 34:2272-2273. [PMID: 30077251 DOI: 10.1016/j.arthro.2018.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/08/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Soon Hyuck Lee
- Department of Orthopedic Surgery, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Woo Young Jang
- Department of Orthopedic Surgery, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Gi Won Choi
- Department of Orthopedic Surgery, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Young Keun Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hae Woon Jung
- Department of Pediatrics, Kyung Hee University Medical Center, Seoul, Korea
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Is the Transverse Acetabular Ligament Hypertrophied and Hindering Reduction in Developmental Dysplasia of Hip? Arthroscopy 2018; 34:1219-1226. [PMID: 29287953 DOI: 10.1016/j.arthro.2017.10.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the arthroscopic pathoanatomy of the transverse acetabular ligament (TAL) and determine whether a TAL incision is necessary for the concentric reduction of developmental dysplasia of the hip (DDH) in infants and young children. METHODS We retrospectively reviewed patients who underwent arthroscopic-assisted reduction for DDH between July 2008 and April 2016. The indications for this intervention included patients in whom closed reduction failed and those who did not require bone operations. The arthroscopic findings and the effect of the TAL incision on DDH reduction were evaluated. TAL pathology was apparent when it was pulled superiorly or hypertrophied. RESULTS We identified a consecutive series of 13 patients (13 hips). Two patients with teratologic dislocation were excluded. There were 9 girls, 8 first-born infants, and 3 breech-position infants. Six patients showed positive Ortolani test findings. In all cases the TAL was considered not hypertrophied when it appeared as a narrow, cord-like structure that was continuous and in smooth transition with the TAL-labral ring, without prominence or elongation. All postreduction magnetic resonance imaging scans showed reduced femoral heads; however, residual subluxation was observed in 8 of 11 hips owing to the interposed anteroinferior labrum. On arthrography at 6 weeks after reduction, the femoral head was located deeper in the acetabulum and the medial dye pool width was within 2 mm in all patients. CONCLUSIONS The TAL was not observed to be hypertrophied or stretched in any of the DDH patients, and it did not act as an obstacle to reduction. After the TAL incision, the gap of the cut margin was not remarkably widened, although there were varying degrees of release. The incision of the TAL does not appear to result in the immediate alteration of the TAL-labral ring in favor of deeper acetabular seating or to enhance reduction. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Studer K, Williams N, Studer P, Baker M, Glynn A, Foster BK, Cundy PJ. Obstacles to reduction in infantile developmental dysplasia of the hip. J Child Orthop 2017; 11:358-366. [PMID: 29081850 PMCID: PMC5643929 DOI: 10.1302/1863-2548.11.170031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Identification of anatomical structures that block -reduction in developmental dysplasia of the hip (DDH) is -important for the management of this challenging condition. Obstacles to reduction seen on arthrogram are well-known. However, despite the increasing use of MRI in the assessment of adequacy of reduction in DDH, the interpretation of MRI patho-anatomy is ill-defined with a lack of relevant literature to guide clinicians. METHOD This is a retrospective analysis of the MRI of patients with DDH treated by closed reduction over a five-year period (between 2009 and 2014). Neuromuscular and genetic disorders were excluded. Each MRI was analysed by two orthopaedic surgeons and a paediatric musculoskeletal radiologist to identify the ligamentum teres, pulvinar, transverse acetabular ligament (TAL), capsule, labrum and acetabular roof cartilage hypertrophy. Inter- and intraobserver reliability was calculated. The minimum follow-up was 12 months. RESULTS A total of 29 patients (38 hips) underwent closed reduction for treatment of DDH. Eight hips showed persistent subluxation on post-operative MRI. Only three of these eight hips showed an abnormality on arthrogram. The pulvinar was frequently interpreted as 'abnormal' on MRI. The main obstacles identified on MRI were the ligamentum teres (15.8%), labrum (13.1%) and acetabular roof cartilage hypertrophy (13.2%). The inter-rater reliability was good for TAL, capsule and pulvinar; moderate for ligamentum teres and labrum; and poor for hypertrophied cartilage. CONCLUSION The labrum, ligamentum teres and acetabular roof cartilage hypertrophy are the most important structures seen on MRI preventing complete reduction of DDH. Focused interpretation of these structures may assist in the management of DDH.
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Affiliation(s)
- K. Studer
- Paediatric Orthopaedic Department, Women’s and Children’s Hospital, 72 King William Road, North Adelaide, Adelaide, SA 5006, Australia and Paediatric Orthopaedic Department, Children’s Hospital of Eastern Switzerland,, Claudiusstrasse 6, 9006 St Gallen, Switzerland,Correspondence should be sent to K. Studer, Paediatric Orthopedic Department, Children’s Hospital of Eastern Switzerland, Claudiusstrasse 6, CH-9006 St Gallen, Switzerland. E-mail:
| | - N. Williams
- Paediatric Orthopaedic Department, Women’s and Children’s Hospital, 72 King William Road, North Adelaide, Adelaide, SA 5006, Australia and University of Adelaide, Centre for Orthopaedic and Trauma Research, Adelaide, SA, Australia
| | - P. Studer
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia
| | - M. Baker
- Young Adult Limb Preservation and Reconstruction, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK
| | - A. Glynn
- Division of Medical Imaging, Women’s and Children’s Hospital, 72 King William Road, North Adelaide, Adelaide, SA 5006, Australia
| | - B. K. Foster
- Paediatric Orthopaedic Department, Women’s and Children’s Hospital, 72 King William Road, North Adelaide, Adelaide, SA 5006, Australia and University of Adelaide, Centre for Orthopaedic and Trauma Research, Adelaide, SA, Australia
| | - P. J. Cundy
- Paediatric Orthopaedic Department, Women’s and Children’s Hospital, 72 King William Road, North Adelaide, Adelaide, SA 5006, Australia and University of Adelaide, Centre for Orthopaedic and Trauma Research, Adelaide, SA, Australia
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Harris JD, Gerrie BJ, Lintner DM, Varner KE, McCulloch PC. Microinstability of the Hip and the Splits Radiograph. Orthopedics 2016; 39:e169-75. [PMID: 26730687 DOI: 10.3928/01477447-20151228-08] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 05/27/2015] [Indexed: 02/03/2023]
Abstract
A normal hip has a natural tendency toward stability because of both osseous and soft tissue structures. Hip motion is primarily rotational around a center of rotation. When the femoral head and its center of rotation translate, with or without rotation, the inherent stability of the femoroacetabular articulation may be lost. The spectrum of hip instability ranges from subtle microinstability to traumatic dislocation. Microinstability may be the cause or the effect of several other hip pathologies. Soft tissue contributions to stability include the static capsule, dynamic musculotendinous units, and underlying generalized connective tissue (eg, Ehlers-Danlos). Osseous contributions include multiple femoral and acetabular radiographic coverage parameters. Iatrogenic contributions include an unrepaired capsulotomy, overresection of the acetabular rim (iatrogenic dysplasia), overresection of cam osteochondroplasty, iliopsoas tenotomy, labral debridement, and ligamentum teres debridement. Patients with hip microinstability often have deep groin pain, exhibited by a C sign. These patients frequently participate in flexibility sports and activities, such as ballet, gymnastics, figure skating, and martial arts. On physical examination, generalized hypermobility syndromes should be assessed, as should loss of log-roll external rotation recoil, excessive abduction, trochanteric-pelvic impingement, and abductor fatigue. Standard imaging, including plain radiographs, magnetic resonance imaging, and computed tomography, should be analyzed for all causes of hip pain. A new plain radiograph, the splits radiograph is introduced here, consistently showing lateral femoral head translation and creation of a vacuum sign, showing hip microinstability. The splits radiograph is illustrated in a 22-year-old female dancer who presented with bilateral deep anterolateral groin pain.
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MRI–Arthroscopy Correlation of the Hip: A Primer for Radiologists. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0165-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Garabekyan T, Ashwell Z, Chadayammuri V, Jesse MK, Pascual-Garrido C, Petersen B, Mei-Dan O. Lateral Acetabular Coverage Predicts the Size of the Hip Labrum. Am J Sports Med 2016; 44:1582-9. [PMID: 26989071 DOI: 10.1177/0363546516634058] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bony morphological abnormalities of the hip joint are often accompanied by adaptive soft tissue changes. These adaptive changes, if better understood and characterized, may serve to inform clinical decision making. PURPOSE To investigate the correlation between the size of the hip labrum and lateral acetabular coverage in patients at our hip preservation clinic. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A cohort of 236 patients seen at a dedicated hip preservation service between June 2013 and June 2015 were retrospectively analyzed. Patients were grouped according to the degree of acetabular coverage, as measured by the lateral center-edge angle (LCEA): normal acetabular coverage (25°-39.9°), acetabular overcoverage (≥40°), borderline dysplasia (20°-24.9°), and frank dysplasia (<20°). Preoperative magnetic resonance imaging was utilized to measure the length of the labrum at 3 locations: laterally, anteriorly, and anteroinferiorly. RESULTS Frankly dysplastic and borderline dysplastic hips exhibited larger values of labral length at all locations when compared with hips with normal acetabular coverage (P < .001) or acetabular overcoverage (P < .001). Interestingly, mean labral length values in frank dysplasia were statistically similar to corresponding measurements in borderline dysplasia. In hips with frank dysplasia, borderline dysplasia, or normal acetabular coverage, labral length was consistently greatest at the lateral labrum and correspondingly lowest at the anteroinferior labrum (P < .001). In hips with acetabular overcoverage, labral length did not vary significantly between the lateral, anterior, and anteroinferior locations. Multivariate analyses confirmed LCEA to be the strongest predictor of labral length, irrespective of measurement location. CONCLUSION Patients with borderline dysplasia and frank dysplasia exhibited increased values of labral length in the weightbearing zone, potentially indicating a compensatory reaction to the lack of bony coverage. Labral length may serve as an instability marker and inform clinical decision making for patients with borderline dysplasia.
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Affiliation(s)
- Tigran Garabekyan
- Division of Sports Medicine and Hip Preservation, Department of Orthopaedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Zachary Ashwell
- Division of Musculoskeletal Radiology, Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Mary Kristen Jesse
- Division of Musculoskeletal Radiology, Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Cecilia Pascual-Garrido
- Division of Sports Medicine and Hip Preservation, Department of Orthopaedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Brian Petersen
- Division of Musculoskeletal Radiology, Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado, USA Inland Imaging, Spokane, Washington, USA
| | - Omer Mei-Dan
- Division of Sports Medicine and Hip Preservation, Department of Orthopaedics, University of Colorado School of Medicine, Aurora, Colorado, USA
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Petersen BD, Wolf B, Lambert JR, Clayton CW, Glueck DH, Jesse MK, Mei-Dan O. Lateral acetabular labral length is inversely related to acetabular coverage as measured by lateral center edge angle of Wiberg. J Hip Preserv Surg 2016; 3:190-6. [PMID: 27583157 PMCID: PMC5005055 DOI: 10.1093/jhps/hnv084] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/01/2015] [Accepted: 12/24/2015] [Indexed: 11/14/2022] Open
Abstract
Patients with developmental dysplasia of the hip often have compensatory labral hypertrophy, which presumably lends stability to an unstable joint. Conversely, patients with acetabular overcoverage may have small or ossified labra. The purpose of this study is to explore the interaction of labral length with the degree of acetabular hip coverage. A retrospective cohort of patients with hip pain presenting to a hip preservation center, who had undergone hip magnetic resonance imaging and AP pelvis radiographs were studied. General linear multivariate models were used to assess the association between three measures of labral length (lateral, anterior and anterior inferior locations along the acetabular rim) and the X-ray derived lateral center edge angle (LCEA) of Wiberg. Of the three acetabular labral locations measured, only the lateral labrum was associated with LCEA Wiberg (P = 0.0008). Lateral labral length increases as LCEA of Wiberg decreases. The anterior and anterior inferior labral locations did not show a predictable increase in labral length as LCEA Wiberg decreased.
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Affiliation(s)
- Brian D Petersen
- 1. Division of Musculoskeletal Radiology, Department of Radiology and Orthopaedics, University of Colorado School of Medicine, University of Colorado Denver, Aurora, CO, USA; 2. Inland Imaging, PS. Division of the Musculoskeletal Radiology, Spokane, WA, USA
| | - Bryan Wolf
- 3. Department of Radiology, University of Colorado School of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Jeffrey R Lambert
- 4. Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Carolyn W Clayton
- 4. Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Deborah H Glueck
- 3. Department of Radiology, University of Colorado School of Medicine, University of Colorado Denver, Aurora, CO, USA; 4. Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Mary Kristen Jesse
- 1. Division of Musculoskeletal Radiology, Department of Radiology and Orthopaedics, University of Colorado School of Medicine, University of Colorado Denver, Aurora, CO, USA
| | - Omer Mei-Dan
- 5. Division of Sports Medicine and Hip Preservation, Department of Orthopaedics, University of Colorado School of Medicine, University of Colorado Denver, Aurora, CO, USA
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Devitt BM, Philippon MJ, Goljan P, Peixoto LP, Briggs KK, Ho CP. Preoperative diagnosis of pathologic conditions of the ligamentum teres: is MRI a valuable imaging modality? Arthroscopy 2014; 30:568-74. [PMID: 24630124 DOI: 10.1016/j.arthro.2014.01.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 12/31/2013] [Accepted: 01/08/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine the accuracy of 3-Tesla magnetic resonance imaging (MRI) in detecting ligamentum teres (LT) lesions in patients before they undergo hip arthroscopy for the treatment of femoroacetabular impingement. METHODS From 2010 to 2011, data were prospectively collected on all patients presenting for treatment of hip pain. All patients underwent MRI followed by arthroscopic surgery. A radiologist prospectively documented MRI findings, and the surgeon recorded the findings at arthroscopy. Radiologic and surgical data included classification of the LT as not torn, hypertrophic, partially torn, or completely torn. All MR images were read by a single radiologist, and all surgery was performed by a single surgeon. Arthroscopy was considered the diagnostic gold standard. RESULTS One hundred forty-two patients with a mean patient age of 35 years (range, 19 to 73 years) met the inclusion criteria. Only one complete LT tear was found in the study. The accuracy of MRI for the diagnosis of LT partial tears was 64%. The sensitivity and specificity of MRI for diagnosing partial tears of the LT were 9% and 91%, [corrected] respectively. The positive predictive value and negative predictive value were 31% and 67%, [corrected] respectively. The sensitivity and specificity of MRI for diagnosing hypertrophic LT were 32% and 78%, respectively. CONCLUSIONS In this patient population, MRI demonstrated sensitivity and specificity of 34% and 50%, [corrected] respectively, in identifying any pathologic process of the LT. MRI is capable of ruling out [corrected] partial tears of the LT with high sensitivity (91%) and negative [corrected] predictive value (67%). LEVEL OF EVIDENCE Level II, development of diagnostic criteria on basis of consecutive patients with universally applied gold standard.
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Affiliation(s)
- Brian M Devitt
- The Steadman Philippon Research Institute, 181 W. Meadow Dr., Ste. 100, Center for Outcomes-Based Orthopaedic Research, Vail, Colorado U.S.A
| | - Marc J Philippon
- The Steadman Philippon Research Institute, 181 W. Meadow Dr., Ste. 100, Center for Outcomes-Based Orthopaedic Research, Vail, Colorado U.S.A.
| | - Peter Goljan
- The Steadman Philippon Research Institute, 181 W. Meadow Dr., Ste. 100, Center for Outcomes-Based Orthopaedic Research, Vail, Colorado U.S.A
| | - Lourenço P Peixoto
- The Steadman Philippon Research Institute, 181 W. Meadow Dr., Ste. 100, Center for Outcomes-Based Orthopaedic Research, Vail, Colorado U.S.A
| | - Karen K Briggs
- The Steadman Philippon Research Institute, 181 W. Meadow Dr., Ste. 100, Center for Outcomes-Based Orthopaedic Research, Vail, Colorado U.S.A
| | - Charles P Ho
- The Steadman Philippon Research Institute, 181 W. Meadow Dr., Ste. 100, Center for Outcomes-Based Orthopaedic Research, Vail, Colorado U.S.A
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Li LY, Zhang LJ, Li QW, Zhao Q, Jia JY, Huang T. Development of the osseous and cartilaginous acetabular index in normal children and those with developmental dysplasia of the hip. ACTA ACUST UNITED AC 2012. [PMID: 23188902 DOI: 10.1302/0301-620x.94b12.29958] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The purpose of this study was to investigate the development of the osseous acetabular index (OAI) and cartilaginous acetabular index (CAI) using MRI. The OAI and CAI were measured on the coronal MR images of the hip in 81 children with developmental dysplasia of the hip (DDH), with a mean age of 19.6 months (3 to 70), and 241 normal control children with a mean age of 5.1 years (1 month to 12.5 years). Additionally the developmental patterns of the OAI and CAI in normal children were determined by age-based cross-sectional analysis. Unlike the OAI, the normal CAI decreased rapidly from a mean of 10.17° (sd 1.60) to a mean of 8.25° (sd 1.90) within the first two years of life, and then remained constant at a mean of 8.04° (sd 1.65) until adolescence. Although no difference in OAI was found between the uninvolved hips in children with unilateral DDH and normal hips (p = 0.639), the CAI was significantly different between them both (p < 0.001). The normal CAI has fully formed at birth, and is maintained constantly throughout childhood. The CAI in the unaffected hips in children with unilateral DDH is also mildly dysplastic.
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Affiliation(s)
- L. Y. Li
- Shengjing Hospital of China Medical University, Department
of Pediatric Orthopaedics, No.36 Sanhao Street, Heping
District, Shenyang City, China
| | - L. J. Zhang
- Shengjing Hospital of China Medical University, Department
of Pediatric Orthopaedics, No.36 Sanhao Street, Heping
District, Shenyang City, China
| | - Q. W. Li
- Shengjing Hospital of China Medical University, Department
of Pediatric Orthopaedics, No.36 Sanhao Street, Heping
District, Shenyang City, China
| | - Q. Zhao
- Shengjing Hospital of China Medical University, Department
of Pediatric Orthopaedics, No.36 Sanhao Street, Heping
District, Shenyang City, China
| | - J. Y. Jia
- Shengjing Hospital of China Medical University, Department
of Pediatric Orthopaedics, No.36 Sanhao Street, Heping
District, Shenyang City, China
| | - T. Huang
- Shengjing Hospital of China Medical University, Department
of Pediatric Orthopaedics, No.36 Sanhao Street, Heping
District, Shenyang City, China
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Cerezal L, Arnaiz J, Canga A, Piedra T, Altónaga JR, Munafo R, Pérez-Carro L. Emerging topics on the hip: ligamentum teres and hip microinstability. Eur J Radiol 2011; 81:3745-54. [PMID: 21723682 DOI: 10.1016/j.ejrad.2011.04.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 03/22/2011] [Indexed: 10/18/2022]
Abstract
Microinstability and ligament teres lesions are emergent topics on the hip pathology. These entities are an increasingly recognized cause of persistent hip pain and should be considered in the differential diagnosis of the patient with hip pain. Conventional (non-arthrographic) CT and MR have a very limited role in the evaluation of these entities. CTa and MRa have emerged as the modalities of choice for pre-operative imaging of ligamentum teres injuries and microinstability. To date, pre-operative imaging detection of these pathologies is not widespread but with appropriate imaging and a high index of suspicion, preoperative detection should improve. This article discusses current concepts regarding anatomy, biomechanics, clinical findings, diagnosis and treatment of ligament teres lesions and microinstability.
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Affiliation(s)
- Luis Cerezal
- Diagnóstico Médico Cantabria, C/Castilla 6, 39002 Santander, Spain.
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Cerezal L, Kassarjian A, Canga A, Dobado MC, Montero JA, Llopis E, Rolón A, Pérez-Carro L. Anatomy, Biomechanics, Imaging, and Management of Ligamentum Teres Injuries. Radiographics 2010; 30:1637-51. [DOI: 10.1148/rg.306105516] [Citation(s) in RCA: 119] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Magnetic resonance evaluation of acetabular residual dysplasia in developmental dysplasia of the hip: a preliminary study of 27 patients. J Pediatr Orthop 2010; 30:37-43. [PMID: 20032740 DOI: 10.1097/bpo.0b013e3181c877d7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Thirty-one hips in 27 young girls, treated for developmental dysplasia of the hip in the authors' institute since 2003, showed persistent radiographic evidence of residual acetabular dysplasia. These hips were registered as candidates for pelvic osteotomy. A prospective study was conducted and these hips were evaluated by magnetic resonance imaging (MRI); the average age of the patients was 5 years. MRI measurement of acetabular angle and acetabular head index in 2 different landmarks (bone and cartilage) was performed. The results were correlated with plain radiographic film evolution. MRI studies revealed sufficient cartilaginous acetabular coverage in 27 hips, cartilaginous acetabular dysplasia in 2 hips, and short acetabulum in 2 others. The 27 hips with thick cartilage of the acetabular roof were subsequently followed up by plain radiographs. The average follow-up period was 2.1 years. The authors observed a spontaneous progressive ossification of the cartilaginous acetabular roof in all the 27 cases. In 4 cases, the correction of the acetabular angle was complete. They concluded that MRI promotes more accurate selection of patients for pelvic osteotomy and aids in the choice of the most appropriate type of osteotomy. Clinical imaging examples are presented and need to be further evaluated.
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Abstract
Advances in hip arthroscopy have renewed interest in the ligamentum teres. Considered by many to be a developmental vestige, it is now recognised as a significant potential source of pain and mechanical symptoms arising from the hip joint. Despite improvements in imaging, arthroscopy remains the optimum method of diagnosing lesions of the ligamentum teres. Several biological or mechanical roles have been proposed for the ligament. Unless these are disproved, the use of surgical procedures that sacrifice the ligamentum teres, as in surgical dislocation of the hip, should be carefully considered. This paper provides an update on the development, structure and function of the ligamentum teres, and discusses associated clinical implications.
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Affiliation(s)
- N V Bardakos
- The Wellington Hospital, South Building, St John's Wood, London, UK.
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19
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Abstract
This is a series of 7 children (14 hips) with a mean age of 7.3 years (range, 3.3-10.5 years) and an underlying diagnosis of developmental dysplasia of the hips and no previous open-hip surgery who underwent plain radiographic and magnetic resonance imaging (MRI) measures of bony acetabular index. There was a significant correlation between the measurement of acetabular index using plain radiography and MRI, with a Spearman correlation coefficient of 0.88 (95% confidence interval, 0.61-0.96; P<0.001) and a mean difference between the 2 measures of 0.36+/-6.5 degrees. Furthermore, the bony and cartilaginous acetabular indexes as measured by MRI had a significant correlation with a Spearman correlation coefficient of 0.88 (95% confidence interval, 0.80-0.98; P<0.001). We suggest that plain radiography is still an appropriate tool for follow-up for the nonoperated hip with developmental dysplasia and may be a good indicator of hip cartilaginous development.
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Fordham LA. Congenital abnormalities of the musculoskeletal system: Perinatal evaluation and long-term outcome. Semin Roentgenol 2004; 39:304-22. [PMID: 15143691 DOI: 10.1053/j.ro.2003.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Many musculoskeletal malformations can be detected by prenatal US. Whether isolated or part of a syndrome, these anomalies can have a significant impact on the entire life of the individual. Nonfatal conditions may be subtle and become more recognizable in the second and third trimester. After delivery, radiography helps confirm the diagnosis. US, CT, and MRI all have a role in imaging the primary abnormality, the follow-up effects of treatment, and in monitoring for potential complications that may develop over time. Three-dimensional imaging has an increasing role, in US, CT, and MRI, both in the prenatal and postnatal periods.
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Affiliation(s)
- Lynn Ansley Fordham
- Department of Radiology, University of North Carolina School of Medicine, CB #7510, Chapel Hill, NC 27514-7510, USA
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21
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Leunig M, Podeszwa D, Beck M, Werlen S, Ganz R. Magnetic resonance arthrography of labral disorders in hips with dysplasia and impingement. Clin Orthop Relat Res 2004:74-80. [PMID: 15043096 DOI: 10.1097/00003086-200401000-00013] [Citation(s) in RCA: 198] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Despite the fact that classic studies on osteoarthritis of the hip have shown the periphery of the hip to be prone to degeneration, it was not until recently that an abnormal acetabular labrum has been associated with osteoarthritis. This study was designed to determine whether magnetic resonance arthrography can show differences in disorders of the labrum (tears, size, ganglion formation) expected in symptomatic patients with developmental dysplasia of the hip and anterior femoroacetabular impingement. Fourteen patients in each group were evaluated preoperatively not only clinically but also with conventional radiographs and magnetic resonance arthrographs. In both conditions, disorders of the labrum localized identically with a predilection to the anterosuperior quadrant of the acetabulum. Labral tears were observed in nine hips of each group. The labrum was enlarged in 12 hips with dysplasia but in none of the hips with impingement. Ganglion formation in the periacetabular area was seen in 10 hips with dysplasia and three hips with impingement. These findings provide evidence that the anterosuperior acetabulum represents the initial fatiguing site of the hip under both conditions. Based on these data, the size of the labrum and the presence of soft tissue ganglia seem to be good predictors for the presence of developmental dysplasia, whereas the presence of tears did not differentiate between conditions. The capability of magnetic resonance arthrography to show these differences in labral disorders suggests this method is a helpful diagnostic tool that can aid in defining the most appropriate treatment strategy.
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Affiliation(s)
- Michael Leunig
- Department of Orthopaedic Surgery, University of Berne, Inselspital, Berne, Switzerland.
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