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Chen YL, Chen W. Radial Planes in Hip Magnetic Resonance Imaging: Techniques, Applications, and Perspectives. J Magn Reson Imaging 2024; 60:8-20. [PMID: 37746892 DOI: 10.1002/jmri.29029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 09/26/2023] Open
Abstract
The hip cartilage and labrum, as the main targets of femoroacetabular impingement, sports-related or traumatic damage, as well as congenital and developmental abnormalities, have attracted increasing attention with the development of magnetic resonance imaging (MRI) and hip arthroscopy. MRI is a commonly used imaging modality to noninvasively visualize the hip cartilage and labral lesions. However, conventional orthogonal MRI planes encounter unique challenges given the ball-and-socket configuration of the hip joint, its anatomically abducted and anteverted orientation, and the thin, closely apposed cartilage enveloping the femoral head and acetabulum. Advancements in hip MRI's radial plane, which is acquired through the center of the hip joint, offer a solution. This technology provides true cross-sectional images of the cartilage and labrum perpendicular to the curvature of the joint, thereby mitigating the partial-volume-averaging effects. The integration of 3.0-Tesla high field strength and three-dimensional (3D) acquisition techniques further enhances the capabilities of the radial plane. This combination yields a high signal-to-noise ratio, high spatial resolution, high contrast between intraarticular structures, while minimizing partial-volume-averaging effects. Such improvements potentially facilitate the comprehensive detection of even minor chondral and labral lesions. The capability for multiplanar reconstruction from a single 3D volumetric acquisition further strengthens the usefulness of the radial plane by aiding in precise localization of hip cartilage and labral lesions, in line with hip arthroscopy findings. These advancements have the potential to standardize MRI evaluations and radiographic reporting systems for hip cartilage and labrum, offering precise guidance for hip arthroscopy. This article presents a comprehensive review of radial plane technology applied to the hip MRI, and discusses the morphological assessment and localization of hip cartilage and labral lesions utilizing this advanced imaging technique. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Yan-Li Chen
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- 7T Magnetic Resonance Imaging Translational Medical Center, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wei Chen
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
- 7T Magnetic Resonance Imaging Translational Medical Center, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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Dietrich TJ, Vaeth D, Wildermuth S, Waelti S, Leschka S, Graf N, Fischer T. Age-related prevalence and imaging characteristics of the superior acetabular roof notch in children, adolescents, and young adults. Skeletal Radiol 2024; 53:43-49. [PMID: 37261477 PMCID: PMC10661799 DOI: 10.1007/s00256-023-04370-z] [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: 04/24/2023] [Revised: 04/24/2023] [Accepted: 05/21/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To determine the age-related prevalence and imaging characteristics of the superior acetabular roof notch (SARN) on hip MRI and radiographs in a young study population. MATERIALS AND METHODS Retrospective analysis of 304 MRI examinations and corresponding available radiographs of patients between the ages of 4 and 24 years. Two observers classified SARN with fluid-like findings on MRI as type-1, whereas SARN with fat-like findings on MRI were classified as type-2. Sensitivity and specificity of radiographic SARN findings were determined using MRI as the reference standard. Logistic regression models were used to assess the age-related prevalence on MRI. RESULTS Twelve patients (3.9%) had fluid-like SARN type-1, 27 patients (8.9%) had fat-like SARN type-2, while 265 patients (87.2%) had no SARN on MRI. The odds ratio (OR) for age (years) with respect to the presence of a fluid-like SARN type-1 on MRI was 0.79 (95% CI: 0.70-0.89), meaning that with each year, the likelihood for SARN type-1 decreased by 21% (p < 0.001). The OR for age with respect to the presence of a fat-like SARN type-2 on MRI was 1.14 (95% CI: 1.02-1.27) (p = 0.017). The diagnostic sensitivity for detecting a SARN on radiographs compared to MRI as the reference standard was between 0.75 and 0.83 and the corresponding specificity was between 0.85 and 0.89 for both observers. CONCLUSION SARN is a common finding on MRI and radiographs. The present data suggest that SARN undergoes an age-related imaging characteristic from a fluid-like appearance to a fat-like appearance on MRI during adolescence.
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Affiliation(s)
- Tobias Johannes Dietrich
- Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland.
| | - Desiree Vaeth
- Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
| | - Simon Wildermuth
- Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
| | - Stephan Waelti
- Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
| | - Sebastian Leschka
- Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
| | - Nicole Graf
- Clinical Trials Unit, Kantonsspital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Tim Fischer
- Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
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Pruneski JA, Chan JJ, Wang KC, Matheney T, Bharam S. Acetabular Rim Disorders: Epidemiology, Etiology, Management, and Outcomes. JBJS Rev 2023; 11:01874474-202308000-00005. [PMID: 37549243 DOI: 10.2106/jbjs.rvw.23.00058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
» Anatomic disorders of the acetabular rim are a common, correctable source of hip pain in younger patients.» Some common conditions of involving abnormal acetabular rim morphology include developmental dysplasia of the hip, pincer-type femoroacetabular impingement, acetabular protrusion, and acetabular retroversion.» Treatment option for these conditions were historically limited to open osteotomy and osteoplasty procedures; however, there is increasing use of arthroscopic intervention for these patients.» Arthroscopic intervention has demonstrated short-term success in a variety of focal acetabular rim disorders; however, further research is needed to determine the long-term outcomes of these procedures and their utility in more global pathology.
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Affiliation(s)
- James A Pruneski
- Tripler Army Medical Center, Honolulu, Hawaii
- Boston Children's Hospital, Boston, Massachusetts
| | - Jimmy J Chan
- Boston Children's Hospital, Boston, Massachusetts
- Mount Sinai Health System, New York, New York
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Zhang CQ, Du DJ, Hsu PC, Song YY, Gao Y, Zhu ZZ, Jia WT, Gao YS, Zheng MH, Zhu HY, Hsiang FC, Chen SB, Jin DX, Sheng JG, Huang YG, Feng Y, Gao JJ, Li GY, Yin JM, Yao C, Jiang CY, Luo PB, Tao SC, Chen C, Zhu JY, Yu WB. Autologous Costal Cartilage Grafting for a Large Osteochondral Lesion of the Femoral Head: A 1-Year Single-Arm Study with 2 Additional Years of Follow-up. J Bone Joint Surg Am 2022; 104:2108-2116. [PMID: 36325763 DOI: 10.2106/jbjs.22.00542] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is currently no ideal treatment for osteochondral lesions of the femoral head (OLFH) in young patients. METHODS We performed a 1-year single-arm study and 2 additional years of follow-up of patients with a large (defined as >3 cm 2 ) OLFH treated with insertion of autologous costal cartilage graft (ACCG) to restore femoral head congruity after lesion debridement. Twenty patients ≤40 years old who had substantial hip pain and/or dysfunction after nonoperative treatment were enrolled at a single center. The primary outcome was the change in Harris hip score (HHS) from baseline to 12 months postoperatively. Secondary outcomes included the EuroQol visual analogue scale (EQ VAS), hip joint space width, subchondral integrity on computed tomography scanning, repair tissue status evaluated with the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score, and evaluation of cartilage biochemistry by delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) and T2 mapping. RESULTS All 20 enrolled patients (31.02 ± 7.19 years old, 8 female and 12 male) completed the initial study and the 2 years of additional follow-up. The HHS improved from 61.89 ± 6.47 at baseline to 89.23 ± 2.62 at 12 months and 94.79 ± 2.72 at 36 months. The EQ VAS increased by 17.00 ± 8.77 at 12 months and by 21.70 ± 7.99 at 36 months (p < 0.001 for both). Complete integration of the ACCG with the bone was observed by 12 months in all 20 patients. The median MOCART score was 85 (interquartile range [IQR], 75 to 95) at 12 months and 75 (IQR, 65 to 85) at the last follow-up (range, 24 to 38 months). The ACCG demonstrated magnetic resonance properties very similar to hyaline cartilage; the median ratio between the relaxation times of the ACCG and recipient cartilage was 0.95 (IQR, 0.90 to 0.99) at 12 months and 0.97 (IQR, 0.92 to 1.00) at the last follow-up. CONCLUSIONS ACCG is a feasible method for improving hip function and quality of life for at least 3 years in young patients who were unsatisfied with nonoperative treatment of an OLFH. Promising long-term outcomes may be possible because of the good integration between the recipient femoral head and the implanted ACCG. LEVEL OF EVIDENCE Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Chang-Qing Zhang
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Da-Jiang Du
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Pei-Chun Hsu
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yan-Yan Song
- Department of Biostatistics, Clinical Research Institute, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Yun Gao
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Zhen-Zhong Zhu
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Wei-Tao Jia
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - You-Shui Gao
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Ming-Hao Zheng
- School of Surgery, University of Western Australia, Perth, Australia
| | - Hong-Yi Zhu
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Fu-Chou Hsiang
- School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Sheng-Bao Chen
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Dong-Xu Jin
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jia-Gen Sheng
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yi-Gang Huang
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yong Feng
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jun-Jie Gao
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Guang-Yi Li
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Ji-Min Yin
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Chen Yao
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Chen-Yi Jiang
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Peng-Bo Luo
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Shi-Cong Tao
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Chun Chen
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jin-Yu Zhu
- School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Wei-Bin Yu
- Department of Radiology, Shanghai Sixth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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Presence of a Posterior Wall Sign in the Treatment of Femoroacetabular Impingement Syndrome: A Matched Comparative Cohort Analysis at Minimum 2-Year Follow-Up. J Arthroplasty 2022; 37:1520-1525. [PMID: 35405263 DOI: 10.1016/j.arth.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/30/2022] [Accepted: 04/02/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Acetabular retroversion may predispose to more severe femoroacetabular impingement syndrome (FAIS) and early labral damage given impaction of the femoral head-neck junction on the retroverted acetabular rim. The cross-over sign (COS), posterior wall sign (PWS), and ischial spine sign (ISS) are markers of acetabular retroversion (AR) on plain radiographs. METHODS Patients who underwent primary hip arthroscopy for FAIS from January 2012 to December 2018 with a positive PWS were matched in a 1:1 ratio by age, gender, and body mass index (BMI) to controls with a negative PWS. Preoperative and postoperative patient-reported outcomes (PROs; HOS-ADL, HOS-SS, mHHS, and iHOT-12) were compared using independent t-tests. Achievement of a Patient Acceptable Symptom State (PASS) or Minimal Clinically Important Difference (MCID) was compared using Fisher's exact test. RESULTS Two hundred and seventy five patients with a positive PWS and 275 controls were included in the final analysis. Most patients (64%) were female, with average age, and BMI of 37.6 (SD 8.6) and 25.1 (SD 4.4), respectively. PROs improved significantly for both groups from preoperatively to 2 years postoperatively. There were no statistically significant differences (P ≥ .05) in PROs or achievement of MCID or PASS. On a subgroup analysis, patients with all three positive signs had significantly lower postoperative PROs and lower rates of achievement of MCID and PASS. CONCLUSION Patients with an isolated PWS achieve similar outcomes following hip arthroscopy at 2 years. However, patients with a concomitant PWS, ISS, and COS demonstrate less favorable outcomes, suggesting the need for increased perioperative counseling and potential evaluation for planned concurrent or serial open procedures such as periacetabular osteotomy.
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Alter TD, Knapik DM, Lambers F, Sivasundaram L, Malloy P, Chahla J, Nho SJ. Outcomes for the Arthroscopic Treatment of Femoroacetabular Impingement Syndrome With Acetabular Retroversion: A 3D Computed Tomography Analysis. Am J Sports Med 2022; 50:2155-2164. [PMID: 35604075 DOI: 10.1177/03635465221097118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Increased attention has been directed toward the acetabular morphology in the management of patients with femoroacetabular impingement syndrome (FAIS). Whether acetabular version influences patient-reported outcomes remains poorly understood. PURPOSE To use computed tomography (CT)-based 3-dimensional (3D) bone models to (1) quantify acetabular version in patients with FAIS, (2) compare acetabular version on 3D bone models with current plain radiographic parameters, and (3) explore the relationship between the magnitude of acetabular version and minimum 2-year clinical outcomes after hip arthroscopy. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Three-dimensional models of the pelvis and femur were generated by semiautomated segmentation and aligned to a standard coordinate system. Acetabular version was quantified at the 3-o'clock position, and 3 groups were identified: acetabular retroversion (AR; <15°), normal acetabular version (NV; 15°-25°), and acetabular anteversion (AA; >25°). Patient demographic characteristics, plain radiographic parameters, and clinical outcomes were analyzed, including the Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports Subscale, modified Harris Hip Score (mHHS), International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain and satisfaction. RESULTS Preoperative CT scans were acquired in 105 consecutive patients before hip arthroscopy for FAIS, of which 84 (80.0%) completed minimum 2-year patient-reported outcomes. The mean ± SD age and body mass index of patients were 33.9 ± 12.6 years and 26.0 ± 5.4, respectively; 70.2% were female. The number of patients and the mean central acetabular version within each group were as follows: AR (n = 12; 11.3°± 2.7°), NV (n = 56; 20.7°± 2.9°), and AA (n = 16; 28.5°± 2.7°). Posterior wall sign was the only plain radiographic parameter that was significantly more observed in the AR group than in the other 2 groups. At minimum 2-year follow-up, significant between-group differences in the mHHS, iHOT-12, and VAS for pain and satisfaction (P < .05) were appreciated, while post hoc analysis with Bonferroni correction (P < .0167) found lower scores on the mHHS, iHOT-12, and VAS for pain and satisfaction in patients with AR as compared with NV. Lower scores on the VAS for satisfaction were reported in patients with AR when compared with AA (P = .006) but not on the mHHS (P = .023), iHOT-12 (P = .032), or VAS for pain (P = .072). CONCLUSION Traditional plain radiographic indices to describe AR, including crossover sign and ischial spine sign, were not reliable in defining AR according to 3D models derived from CT scans. Only the posterior wall sign was observed in a higher proportion in the AR group. Patients with AR demonstrated inferior outcomes when compared with patients with NV and AA after hip arthroscopy for FAIS.
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Affiliation(s)
- Thomas D Alter
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Derrick M Knapik
- Department of Orthopedic Surgery, Washington University, St Louis, Missouri, USA
| | | | | | - Philip Malloy
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Arcadia University, Montgomery, Pennsylvania, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Vaeth D, Dietrich TJ, Wildermuth S, Leschka S, Waelti S, Graf N, Fischer T. Age dependent prevalence of the supraacetabular fossa in children, adolescents and young adults. Insights Imaging 2022; 13:91. [PMID: 35551532 PMCID: PMC9106784 DOI: 10.1186/s13244-022-01229-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/18/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The supraacetabular fossa (SAF) is an anatomical variant of the acetabular roof which may mimic a cartilage defect. Two different subtypes have been described: type 1 fluid-filled and type 2 cartilage-filled. The adult prevalence of SAF was reported between 10.5 and 12.6%. We aimed to determine SAF prevalence in a pediatric and young adult population and examine the potential remodeling of the subtypes over time. METHODS A retrospective search of the institutional database for hip MRI of participants aged 4-25 years was carried out between 2010 and 2020. A total of 401 eligible MRIs of 323 participants were analyzed by two readers. The documented features were: existence of SAF, definition of subtype and measurements of the SAF in three dimensions. Logistic regression models were calculated to estimate the influence of age on the presence of SAF. RESULTS Out of 323, 115 (35,6%) participants demonstrated a supraacetabular fossa. 63 (19.5%) participants presented subtype 1 and 51 (15.8%) type 2; one participant had both. The predicted probability for SAF increases until the age of 14, beyond 14 years, the combined predicted probability for both subtypes decreased again. In contrast to SAF type 1, SAF type 2 was more prevalent with older age. The size of the SAF decreased with aging. CONCLUSION The supraacetabular fossa is most frequent in adolescents. With higher age, the prevalence and the size of the SAF decreased. This data supports the theory that the SAF is a developmental variant.
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Affiliation(s)
- Desiree Vaeth
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland.
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland.
| | - Tobias Johannes Dietrich
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
| | - Simon Wildermuth
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
| | - Sebastian Leschka
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
| | - Stephan Waelti
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Nicole Graf
- Clinical Trials Unit, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Tim Fischer
- Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
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Zimmerer A, Schneider MM, Tramountanis K, Janz V, Miehlke W, Wassilew GI, Sobau C. Assessment of acetabular chondral damage and labral pathologies via direct MR arthrography: specialization matters. Arch Orthop Trauma Surg 2022; 142:1563-1569. [PMID: 34279704 PMCID: PMC9217772 DOI: 10.1007/s00402-021-04071-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 07/11/2021] [Indexed: 11/29/2022]
Abstract
AIMS To compare the diagnostic accuracy of investigators from different specialities (radiologists and orthopaedic surgeons) with varying levels of experience of 1.5 T direct magnetic resonance arthrography (dMRA) against intraoperative findings in patients with femoroacetabular impingement syndrome (FAIS). METHODS A total of 272 patients were evaluated with dMRA and subsequent hip arthroscopy. The dMRA images were evaluated independently by two non-hip-arthroscopy-trained orthopaedic surgeons, two fellowship-trained musculoskeletal radiologists, and two hip-arthroscopy-trained orthopaedic surgeons. The radiological diagnoses were compared with the intraoperative findings. RESULTS Hip arthroscopy revealed labral pathologies in 218 (79%) and acetabular chondral lesions in 190 (69%) hips. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for evaluating the acetabular labral pathologies were 79%, 18%, 79%, 18%, and 66% (non-hip-arthroscopy trained orthopaedic surgeons), 83%, 36%, 83%, 36%, and 74% (fellowship-trained musculoskeletal radiologists), and 88%, 53%, 88%, 54% and 81% (hip-arthroscopy trained orthopaedic surgeons). The sensitivity, specificity, PPV, NPV and accuracy of dMRA for assessing the acetabular chondral damage were 81%, 36%, 71%, 50%, and 66% (non-hip-arthroscopy trained orthopaedic surgeons), 84%, 38%, 75%, 52%, and 70% (fellowship-trained musculoskeletal radiologists), and 91%, 51%, 81%, 73%, and 79% (hip-arthroscopy trained orthopaedic surgeons). The hip-arthroscopy trained orthopaedic surgeons displayed the highest percentage of correctly diagnosed labral pathologies and acetabular chondral lesions, which is significantly higher than the other two investigator groups (p < 0.05). CONCLUSION The accuracy of dMRA on detecting labral pathologies or acetabular chondral lesions depends on the examiner and its level of experience in hip arthroscopy. The highest values are found for the hip-arthroscopy-trained orthopaedic surgeons. LEVEL OF EVIDENCE Retrospective cohort study; III.
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Affiliation(s)
- A. Zimmerer
- grid.491774.8ARCUS Sportklinik, Rastatter str, 17-19, 75179 Pforzheim, Germany ,grid.5603.0Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - MM. Schneider
- grid.491774.8ARCUS Sportklinik, Rastatter str, 17-19, 75179 Pforzheim, Germany ,grid.412581.b0000 0000 9024 6397University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455 Witten, Germany
| | - K. Tramountanis
- grid.491774.8ARCUS Sportklinik, Rastatter str, 17-19, 75179 Pforzheim, Germany
| | - V. Janz
- grid.5603.0Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - W. Miehlke
- grid.491774.8ARCUS Sportklinik, Rastatter str, 17-19, 75179 Pforzheim, Germany
| | - GI. Wassilew
- grid.5603.0Department of Orthopedics and Orthopedic Surgery, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - C. Sobau
- grid.491774.8ARCUS Sportklinik, Rastatter str, 17-19, 75179 Pforzheim, Germany
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Atria MG, Calvi M, Zorzetto G, Curti M, Celentano A, Duvia M, Venturini M, Genovese EA. Inter-observer concordance in normal and pathological findings of the hip joint in plain radiographs. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021219. [PMID: 34487077 PMCID: PMC8477112 DOI: 10.23750/abm.v92i4.11433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/30/2021] [Indexed: 11/23/2022]
Abstract
Background and aim: The purpose of the study was to compare the data obtained by two independent observers and statistically analyse the results using Cohen’s K to highlight the concordance or discordance in the diagnosis of normality, pathology and, in particular, the type of femoroacetabular impingement (FAI) on plain films. Methods: the study was conducted retrospectively. The only inclusion criterium was the minimum age of 20 years. All patients underwent a radiographic examination of the pelvis in standard anteroposterior projection in orthostasis. Results: A hundred patients were evaluated. A good concordance between the two operators in the examination of normal hip joint (k= 0.68 right/ 0,74 left) was found; a similar grade of agreement was found for the analysis of “pincer” type FAI (k = 0.73 right, 0,67 left). The best results in concordance were achieved in the examination of “cam” type FAI (k= 0.82 right, 0,88 left), “mixed” type FAI (k = 0.85 right, 0,86 left), and in findings of “coxa profunda” (k = 0.92 right, 0,88 left). Conclusion: We found a good concordance between the two readers; a few cases of disagreement were found in the diagnosis of “pincer” type FAI and absence of disease. This discrepancy may be due to the different weight given by the single observer to the clinical indication that leads the patient to examination, but also by the difficulty of a not dedicated radiologist to show some subtle signs indicative of early FAI.
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Affiliation(s)
- Maria Giovanna Atria
- Department of Diagnostic and Interventional Radiology, University of Insubria, Varese.
| | - Marco Calvi
- Department of Diagnostic and Interventional Radiology, University of Insubria, Varese.
| | - Giada Zorzetto
- Department of Diagnostic and Interventional Radiology, University of Insubria, Varese.
| | - Marco Curti
- Department of Diagnostic and Interventional Radiology, University of Insubria, Varese.
| | - Angelica Celentano
- Department of Diagnostic and Interventional Radiology, University of Insubria, Varese.
| | - Marta Duvia
- Department of Diagnostic and Interventional Radiology, University of Insubria, Varese.
| | - Massimo Venturini
- Department of Diagnostic and Interventional Radiology, University of Insubria, Varese.
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Schmaranzer F, Afacan O, Lerch TD, Kim YJ, Siebenrock KA, Ith M, Cullmann JL, Kober T, Klarhoefer M, Tannast M, Bixby SD, Novais EN, Jung B. Magnetization-prepared 2 Rapid Gradient-Echo MRI for B 1 Insensitive 3D T1 Mapping of Hip Cartilage: An Experimental and Clinical Validation. Radiology 2021; 299:150-158. [PMID: 33620288 DOI: 10.1148/radiol.2021200085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Often used for T1 mapping of hip cartilage, three-dimensional (3D) dual-flip-angle (DFA) techniques are highly sensitive to flip angle variations related to B1 inhomogeneities. The authors hypothesized that 3D magnetization-prepared 2 rapid gradient-echo (MP2RAGE) MRI would help provide more accurate T1 mapping of hip cartilage at 3.0 T than would 3D DFA techniques. Purpose To compare 3D MP2RAGE MRI with 3D DFA techniques using two-dimensional (2D) inversion recovery T1 mapping as a standard of reference for hip cartilage T1 mapping in phantoms, healthy volunteers, and participants with hip pain. Materials and Methods T1 mapping at 3.0 T was performed in phantoms and in healthy volunteers using 3D MP2RAGE MRI and 3D DFA techniques with B1 field mapping for flip angle correction. Participants with hip pain prospectively (July 2019-January 2020) underwent indirect MR arthrography (with intravenous administration of 0.2 mmol/kg of gadoterate meglumine), including 3D MP2RAGE MRI. A 2D inversion recovery-based sequence served as a T1 reference in phantoms and in participants with hip pain. In healthy volunteers, cartilage T1 was compared between 3D MP2RAGE MRI and 3D DFA techniques. Paired t tests and Bland-Altman analysis were performed. Results Eleven phantoms, 10 healthy volunteers (median age, 27 years; range, 26-30 years; five men), and 20 participants with hip pain (mean age, 34 years ± 10 [standard deviation]; 17 women) were evaluated. In phantoms, T1 bias from 2D inversion recovery was lower for 3D MP2RAGE MRI than for 3D DFA techniques (mean, 3 msec ± 11 vs 253 msec ± 85; P < .001), and, unlike 3D DFA techniques, the deviation found with MP2RAGE MRI did not correlate with increasing B1 deviation. In healthy volunteers, regional cartilage T1 difference (109 msec ± 163; P = .008) was observed only for the 3D DFA technique. In participants with hip pain, the mean T1 bias of 3D MP2RAGE MRI from 2D inversion recovery was -23 msec ± 31 (P < .001). Conclusion Compared with three-dimensional (3D) dual-flip-angle techniques, 3D magnetization-prepared 2 rapid gradient-echo MRI enabled more accurate T1 mapping of hip cartilage, was less affected by B1 inhomogeneities, and showed high accuracy against a T1 reference in participants with hip pain. © RSNA, 2021.
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Affiliation(s)
- Florian Schmaranzer
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Onur Afacan
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Till D Lerch
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Young-Jo Kim
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Klaus A Siebenrock
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Michael Ith
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Jennifer L Cullmann
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Tobias Kober
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Markus Klarhoefer
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Moritz Tannast
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Sarah D Bixby
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Eduardo N Novais
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
| | - Bernd Jung
- From the Department of Diagnostic, Interventional and Pediatric Radiology (F.S., T.D.L., M.I., J.L.C., B.J.) and Department of Orthopaedic Surgery (K.A.S., M.T.), Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland; Departments of Orthopaedic Surgery (F.S., Y.J.K., E.N.N.) and Radiology (O.A., S.D.B.), Boston Children's Hospital, Harvard Medical School, Boston, Mass; Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland (T.K.); Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (T.K.); LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland (T.K.); Siemens Healthcare, Zürich, Switzerland (M.K.); and Department of Orthopaedic Surgery, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland (M.T.)
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Osseous defect of the anteroinferior femoral head: is it associated with femoroacetabular impingement (FAI)? Skeletal Radiol 2021; 50:1781-1790. [PMID: 33543340 PMCID: PMC8277648 DOI: 10.1007/s00256-021-03730-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/21/2021] [Accepted: 01/28/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the prevalence, morphology, and clinical significance of a repeatedly observed yet not examined circumscript osseous defect at the anteroinferior aspect of the femoral head, termed femoral head defect. MATERIALS AND METHODS Retrospective study with approval of the institutional review board. There was informed consent by all individuals. Magnetic resonance imaging (MRI) hip examinations of 970 individuals (age 15 to 55) were analyzed for femoral head defect. Patients with femoral head defect were matched for age and gender with patients without defect. Two readers independently assessed MRI images regarding presence, location, and morphology of the defect. MR images and radiographs were analyzed for findings of femoroacetabular impingement (FAI). Femoral torsion was measured. Independent t test and chi-square test were used for statistics. RESULTS Sixty-eight (7%) of 970 MRI examinations exhibited a femoral head defect in an anteroinferior location of the femoral head (29/400 men, 7.3%; 39/570 women, 6.8%; p = 0.8). The most frequent morphology of femoral head defect was type I, dent-like (34; 50%), followed by type II, crater-like (27; 40%), and III, cystic (7; 10%). Femoral head defect was slightly more common on the right hip (39 individuals; 57%) compared to left (29 individuals; 43%), non-significantly (p = 0.115). There was no association between FAI or its subtypes and the presence of femoral head defect (p = 0.890). Femoral antetorsion was reduced in patients with femoral head defect (12.9° ± 8.6) compared to patients without defect (15.2° ± 8.5), without statistical significance (p = 0.121). CONCLUSION The femoral head defect is a common finding in MRI examinations of the hip and is situated in the anteroinferior location. There was no association with FAI yet a non-significant trend towards lower femoral antetorsion in patients with femoral head defects.
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Tahoun MF, Tey M, Ormazabal I, Elsayed AS, Said HG, Monllau JC. Promising radiological outcome after repair of acetabular chondral defects by microfracture augmented with chitosan-based scaffold: mid-term T2 mapping evaluation. Knee Surg Sports Traumatol Arthrosc 2021; 29:324-328. [PMID: 32462269 DOI: 10.1007/s00167-020-06068-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 05/14/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Radiological evaluation of the repair tissue produced after arthroscopic treatment of acetabular chondral lesions associated with femoroacetabular impingement (FAI) by the chitosan-based scaffold. METHODS Patients of age 18-55 years with clinical and radiological features of FAI and non-arthritic non-dysplastic hips were selected for arthroscopic treatment. Full-thickness acetabular chondral defects were filled with chitosan-based scaffold material after microfracture. T2 mapping was carried out for all patients after 24 months using a 1.5-T machine. Nine regions of interest (ROIs) were localized from three consecutive sagittal slices including the area of repair. T2 relaxation times of ROIs in the repair area were compared with the corresponding posterior cartilage. RESULTS Twenty-one patients, 17 men and 4 women, underwent arthroscopic treatment of full-thickness acetabular chondral defects with mean size of 3.6 ± 1 cm2 (range 2-6 cm2). Zone 2 was affected in all cases while zone 3 was involved in 13 cases. T2 relaxation values were collected from 189 ROIs for quantitative analysis. Within the peripheral repair area, the mean T2 value was 49.1 ± 7.2 ms (ms), while ROIs of the central repair area had mean T2 values of 50.2 ± 7.1 ms. Posterior cartilage showed mean T2 value of 46.2 ± 7.6 ms CONCLUSION: Arthroscopic microfracture of large full-thickness acetabular chondral defects with chitosan-based scaffold produced a homogenous repair tissue similar to the corresponding native cartilage of the same joint on quantitative T2 mapping at mid-term follow-up. CLINICAL RELEVANCE augmentation of the microfracture by chitosan-based scaffold is a promising modality for treatment of large full-thickness acetabular defects. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Mahmoud Fathy Tahoun
- Department of Orthopedics, Menoufia University, Shibīn al-Kawm, Egypt.
- Department of Orthopedics, Parc de Salut Mar, UAB, Hospital de l'Esperanca, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain.
| | - Marc Tey
- Department of Orthopedics, Parc de Salut Mar, UAB, Hospital de l'Esperanca, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
- Hip Unit, iMove Traumatologia, Clínica Mitrestorres, Barcelona, Spain
| | | | | | | | - Joan Carles Monllau
- Department of Orthopedics, Parc de Salut Mar, UAB, Hospital de l'Esperanca, Sant Josep de la Muntanya, 12, 08024, Barcelona, Spain
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Schlung J, Schiffman S, Chaturvedi A. Top Ten Adult Manifestations of Childhood Hip Disorders. Radiol Clin North Am 2020; 58:529-548. [DOI: 10.1016/j.rcl.2020.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Lerch TD, Vuilleumier S, Schmaranzer F, Ziebarth K, Steppacher SD, Tannast M, Siebenrock KA. Patients with severe slipped capital femoral epiphysis treated by the modified Dunn procedure have low rates of avascular necrosis, good outcomes, and little osteoarthritis at long-term follow-up. Bone Joint J 2019; 101-B:403-414. [PMID: 30929481 DOI: 10.1302/0301-620x.101b4.bjj-2018-1303.r1] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIMS The modified Dunn procedure has the potential to restore the anatomy in hips with severe slipped capital femoral epiphyses (SCFE). However, there is a risk of developing avascular necrosis of the femoral head (AVN). In this paper, we report on clinical outcome, radiological outcome, AVN rate and complications, and the cumulative survivorship at long-term follow-up in patients undergoing the modified Dunn procedure for severe SCFE. PATIENTS AND METHODS We performed a retrospective analysis involving 46 hips in 46 patients treated with a modified Dunn procedure for severe SCFE (slip angle > 60°) between 1999 and 2016. At nine-year-follow-up, 40 hips were available for clinical and radiological examination. Mean preoperative age was 13 years, and 14 hips (30%) presented with unstable slips. Mean preoperative slip angle was 64°. Kaplan-Meier survivorship was calculated. RESULTS At the latest follow-up, the mean Merle d'Aubigné and Postel score was 17 points (14 to 18), mean modified Harris Hip Score was 94 points (66 to 100), and mean Hip Disability and Osteoarthritis Outcome Score was 91 points (67 to 100). Postoperative slip angle was 7° (1° to 16°). One hip (2%) had progression of osteoarthritis (OA). Two hips (5%) developed AVN of the femoral head and required further surgery. Three other hips (7%) underwent implant revision due to screw breakage or change of wires. Cumulative survivorship was 86% at ten-year follow-up. CONCLUSION The modified Dunn procedure for severe SCFE resulted in a low rate of AVN, low risk of progression to OA, and high functional scores at long-term follow-up. The slip deformities were mainly corrected but secondary impingement deformities can develop in some hips and may require further surgical treatment. Cite this article: Bone Joint J 2019;101-B:403-414.
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Affiliation(s)
- T D Lerch
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - S Vuilleumier
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - F Schmaranzer
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - K Ziebarth
- Department of Paediatric Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - S D Steppacher
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - M Tannast
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - K A Siebenrock
- Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, Bern, Switzerland
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Hip arthroscopy-MRI correlation and differences for hip anatomy and pathology: What radiologists need to know. Clin Imaging 2018; 52:315-327. [DOI: 10.1016/j.clinimag.2018.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/18/2018] [Accepted: 09/05/2018] [Indexed: 11/18/2022]
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Woodward RM, Philippon MJ. Persistent or recurrent symptoms after arthroscopic surgery for femoroacetabular impingement: A review of imaging findings. J Med Imaging Radiat Oncol 2018; 63:15-24. [DOI: 10.1111/1754-9485.12822] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/26/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Rebecca M Woodward
- Steadman Philippon Research Institute Vail Colorado USA
- Auckland Radiology Group Auckland New Zealand
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Bensler S, Dietrich TJ, Zubler V, Pfirrmann CWA, Sutter R. Pincer-type MRI morphology seen in over a third of asymptomatic healthy volunteers without femoroacetabular impingement. J Magn Reson Imaging 2018; 49:1296-1303. [PMID: 30318790 DOI: 10.1002/jmri.26297] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/21/2018] [Accepted: 07/23/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In daily routine, pincer femoroacetabular impingement (FAI) findings are often seen without a clinical diagnosis of pincer FAI. PURPOSE To assess the presence of pincer FAI MRI findings in asymptomatic volunteers with negative impingement test versus patients with clinically confirmed FAI. STUDY TYPE Case-control study. POPULATION Sixty-three asymptomatic volunteers and 63 matched patients with FAI were included. FIELD STRENGTH/ SEQUENCE A coronal T1 -weighted turbo spin-echo sequence as well as a 3D oblique transverse water-excitation true fast imaging sequence at 1.5T. ASSESSMENT The volunteers underwent standard MRI of the hip, and patients underwent MR arthrography of the symptomatic hip using the same MR sequences. Measurements of cranial acetabular version, acetabular depth, and lateral center-edge angle were performed independently by three fellowship-trained musculoskeletal radiologists. STATISTICAL TESTS Descriptive statistics, Mann-Whitney U-test, Unpaired t-test, receiver operating characteristics (ROC), Intraclass correlation coefficient (ICC). RESULTS Forty-one percent (26/63, reader 1), 32% and 37% (20 and 23/63, reader 2/3) of asymptomatic volunteers had at least one positive MR finding for pincer-FAI. Patients with pincer or mixed-type FAI had cranial retroversion of the acetabulum of -0.2° ± 7.1 (mean ± standard deviation) for reader 1 and -0.3° ± 5.5/-0.2° ± 4.8 for reader 2 / reader 3, while asymptomatic volunteers had an anteversion of 6.2° ± 6.4 (reader 1) and 3.2° ± 4.9/3.1° ± 6.5 (readers 2/3): This difference was statistically significant (P ≤ 0.002), but there was a large overlap between the groups. Acetabular depth measurements were very similar for patients with either pincer or mixed-type FAI (5.1-5.3 mm ± 3.1) and volunteers (5.2-6.1 mm ± 2.6), without a statistically significant difference (P ≤ 0.50). Lateral center-edge angle was also similar in patients with either pincer or mixed-type FAI (32.1-35.1° ± 9.1) and volunteers (30.7-33.2° ± 6.5), without a statistically significant difference (P ≤ 0.28). DATA CONCLUSION There is a large overlap in pincer-type MRI findings between patients with symptomatic FAI and asymptomatic volunteers. More than a third of volunteers exhibited at least one positive pincer-type MRI finding. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:1296-1303.
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Affiliation(s)
- Susanne Bensler
- Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland.,University of Zurich, Faculty of Medicine, Zurich, Switzerland
| | - Tobias J Dietrich
- University of Zurich, Faculty of Medicine, Zurich, Switzerland.,Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Veronika Zubler
- Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland.,University of Zurich, Faculty of Medicine, Zurich, Switzerland
| | - Christian W A Pfirrmann
- Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland.,University of Zurich, Faculty of Medicine, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland.,University of Zurich, Faculty of Medicine, Zurich, Switzerland
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Annabell L, Master V, Rhodes A, Moreira B, Coetzee C, Tran P. Hip pathology: the diagnostic accuracy of magnetic resonance imaging. J Orthop Surg Res 2018; 13:127. [PMID: 29843749 PMCID: PMC5975565 DOI: 10.1186/s13018-018-0832-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/10/2018] [Indexed: 11/10/2022] Open
Abstract
Background Hip arthroscopy has led to a greater understanding of intra-articular hip pathology. Non-contrast magnetic resonance imaging (MRI) is currently the gold standard in non-invasive imaging diagnosis, with high sensitivity in identifying labral pathology but equivocal results for ligamentum teres damage and chondral defects. The aim of this study is to determine the accuracy of non-contrast MRI for diagnosis of intra-articular hip derangements and identify radiological features that could increase the accuracy of the diagnosis. Methods A prospective study of 71 hips on 68 patients undergoing hip arthroscopy was conducted comparing pre-operative analysis of MRI imaging versus an arthroscopic examination. Two musculoskeletal radiologists reported the data independently. All hip arthroscopies were performed by a single surgeon. Patients with MRIs performed within 6 months before hip arthroscopy were included. Outcome measures included observer accuracy identifying ligamentum teres tears, labral lesions, and chondral rim damage. Secondary outcome measures included inter-observer variability and correctly staged ligamentum teres tears. Results The accuracy of radiology reporting for ligamentum teres tears, labral damage, and chondral rim lesions was 85.92% for each instance. The MRI findings most consistent with labral tears include the presence of linear high signal traversing the articular surface into the labrum, presence of intra-labral fluid signal, and loss of homogenous low signal triangular morphology. Chondral rim damage was difficult to diagnose, but abnormal signal at the chondrolabral junction with partial thickness defects would suggest damage. Ligamentum teres tears are commonly found but poorly graded. Thickening and increased signal suggests synovitis while discontinuity and fraying suggests partial tearing. Conclusion Conventional non-arthrographic MRI offers an accurate non-invasive method to screen patients with symptoms referable to the hip by revealing the presence of labral tears, chondral defects, and ligamentum teres tears/synovitis. This study demonstrates that tears and synovitis of the ligamentum teres as potential sources of hip pain can be accurately identified on conventional non-arthrographic MRI. However, MRI has poor specificity and negative predictive value, and thus, a negative MRI result may warrant further investigation.
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Affiliation(s)
- Lucas Annabell
- Department of Orthopaedics, Western Health, 160 Gordon Street, Footscray, Melbourne, VIC, 3011, Australia
| | - Vahid Master
- Department of Radiology, Western Health, 160 Gordon Street, Footscray, Melbourne, VIC, 3011, Australia
| | - Alexander Rhodes
- Department of Radiology, Western Health, 160 Gordon Street, Footscray, Melbourne, VIC, 3011, Australia
| | - Brett Moreira
- Department of Orthopaedics, Western Health, 160 Gordon Street, Footscray, Melbourne, VIC, 3011, Australia
| | - Cassandra Coetzee
- Department of Orthopaedics, Western Health, 160 Gordon Street, Footscray, Melbourne, VIC, 3011, Australia.
| | - Phong Tran
- Department of Orthopaedics, Western Health, 160 Gordon Street, Footscray, Melbourne, VIC, 3011, Australia
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20
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Heerey JJ, Kemp JL, Mosler AB, Jones DM, Pizzari T, Souza RB, Crossley KM. What is the prevalence of imaging-defined intra-articular hip pathologies in people with and without pain? A systematic review and meta-analysis. Br J Sports Med 2018. [PMID: 29540366 DOI: 10.1136/bjsports-2017-098264] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Intra-articular hip pathologies are thought to be associated with the development of hip and groin pain. A better understanding of the relationship between symptoms and imaging findings may improve the management of individuals with intra-articular hip pathologies. OBJECTIVE To undertake a systematic review and meta-analysis to determine the prevalence of intra-articular hip pathologies in individuals with and without pain. METHODS Seven electronic databases were searched in February 2017 for studies investigating the prevalence of intra-articular hip pathologies using MRI, MRA or CT. Two independent reviewers conducted the search, study selection, quality appraisal and data extraction. Meta-analysis was performed when studies were deemed homogenous, with a strength of evidence assigned to pooled results. RESULTS In general, studies were moderate to high risk of bias, with only five studies adjudged to be low risk of bias. The 29 studies reporting on the prevalence of intra-articular hip pathologies identified limited evidence of a labral tear prevalence of 62% (95% CI 47% to 75%) in symptomatic individuals, with moderate evidence identifying a labral tear prevalence of 54% (95% CI 41% to 66%) in asymptomatic individuals. Limited evidence demonstrated a cartilage defect prevalence of 64% (95% CI 25% to 91%) in symptomatic individuals, compared with moderate evidence of a cartilage defect prevalence of 12% (95% CI 7% to 21%) in asymptomatic individuals. CONCLUSION The prevalence of intra-articular hip pathologies is highly variable in both symptomatic and asymptomatic populations. The prevalence of intra-articular hip pathologies appears to be higher in symptomatic individuals. However, imaging-defined intra-articular hip pathologies are also frequently seen in asymptomatic individuals, highlighting a potential discordant relationship between imaging pathology and pain. PROSPERO REGISTRATION NUMBER CRD42016035444.
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Affiliation(s)
- Joshua J Heerey
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Andrea B Mosler
- Rehabilitation Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Denise M Jones
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Richard B Souza
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, California, USA
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
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21
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Magnetic Resonance Imaging (MRI) and Hip Arthroscopy Correlations. Sports Med Arthrosc Rev 2017; 25:199-209. [PMID: 29095399 DOI: 10.1097/jsa.0000000000000166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The hip is a complex joint which commonly generates referrals to orthoaedic surgeons. Hip arthroscopy continues to expand its indications for addressing hip pathology. Before operative intervention, the appropriate information must be obtained with magnetic resonance imaging playing a significant role in the workup given its outstanding characterization of soft tissue anatomy. We attempt to highlight multiple hip findings to correlate intraoperative arthroscopic findings with specific magnetic resonance imaging images and sequences.
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Abstract
Femoroacetabular impingement (FAI) describes the repetitive painful contact between the acetabulum, the pelvis and the proximal femur. This bony abutment can lead to a characteristic pattern of chondrolabral damage and is one of the main etiological factors in the development of juvenile osteoarthritis of the hip joint. This article describes the current treatment concepts of FAI and the radiological assessment including an overview of standard measurement methods, coxometric parameters and cut-off values. Furthermore, the authors stress the importance of a profound understanding of the entire configuration of the pelvis and the dynamic interplay of its components.
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Hegazi TM, Belair JA, McCarthy EJ, Roedl JB, Morrison WB. Sports Injuries about the Hip: What the Radiologist Should Know. Radiographics 2017; 36:1717-1745. [PMID: 27726744 DOI: 10.1148/rg.2016160012] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Injuries of the hip and surrounding structures represent a complex and commonly encountered scenario in athletes, with improper diagnosis serving as a cause of delayed return to play or progression to a more serious injury. As such, radiologists play an essential role in guiding management of athletic injuries. Familiarity with hip anatomy and the advantages and limitations of various imaging modalities is of paramount importance for accurate and timely diagnosis. Magnetic resonance (MR) imaging is often the modality of choice for evaluating many of the injuries discussed, although preliminary evaluation with conventional radiography and use of other imaging modalities such as ultrasonography (US), computed tomography, and bone scintigraphy may be supplementary or preferred in certain situations. Stress fractures, thigh splints, and posterior hip dislocations are important structural injuries to consider in the athlete, initially imaged with radiographs and often best diagnosed with MR imaging. Apophyseal injuries are particularly important to consider in young athletes and may be acute or related to chronic repetitive microtrauma. Femoroacetabular impingement has been implicated in development of labral tears and cartilage abnormalities. Tear of the ligamentum teres is now recognized as a potential cause of hip pain and instability, best evaluated with MR arthrography. Greater trochanteric pain syndrome encompasses a group of conditions leading to lateral hip pain, with US playing an increasingly important role for both evaluation and image-guided treatment. Muscle injuries and athletic pubalgia are common in athletes. Lastly, snapping hip syndrome and Morel-Lavallée lesions are two less common but nonetheless important considerations. ©RSNA, 2016.
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Affiliation(s)
- Tarek M Hegazi
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, 1079A Main Building, Philadelphia, PA 19107 (T.M.H., J.A.B., E.J.M., J.B.R., W.B.M.); and Department of Radiology, University of Dammam, Dammam, Saudi Arabia (T.M.H.)
| | - Jeffrey A Belair
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, 1079A Main Building, Philadelphia, PA 19107 (T.M.H., J.A.B., E.J.M., J.B.R., W.B.M.); and Department of Radiology, University of Dammam, Dammam, Saudi Arabia (T.M.H.)
| | - Eoghan J McCarthy
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, 1079A Main Building, Philadelphia, PA 19107 (T.M.H., J.A.B., E.J.M., J.B.R., W.B.M.); and Department of Radiology, University of Dammam, Dammam, Saudi Arabia (T.M.H.)
| | - Johannes B Roedl
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, 1079A Main Building, Philadelphia, PA 19107 (T.M.H., J.A.B., E.J.M., J.B.R., W.B.M.); and Department of Radiology, University of Dammam, Dammam, Saudi Arabia (T.M.H.)
| | - William B Morrison
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, 1079A Main Building, Philadelphia, PA 19107 (T.M.H., J.A.B., E.J.M., J.B.R., W.B.M.); and Department of Radiology, University of Dammam, Dammam, Saudi Arabia (T.M.H.)
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HOFMANN ULFKRISTER, IPACH INGMAR, RONDAK INACHRISTINE, SYHA ROLAND, GÖTZE MARCO, MITTAG FALK. INFLUENCE OF AGE ON PARAMETERS FOR FEMOROACETABULAR IMPINGEMENT AND HIP DYSPLASIA IN X-RAYS. ACTA ORTOPEDICA BRASILEIRA 2017; 25:197-201. [PMID: 29081704 PMCID: PMC5608738 DOI: 10.1590/1413-785220172505173951] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: While several radiographic parameters have been established to describe the geometry and pathology of the hip, their reference values and clinical significance remain a matter of dispute. The present study tests the hypothesis that age has a relevant impact on radiographic hip parameters. Method: Pelvic antero-posterior views were measured for CE angle, Sharp’s angle, acetabular depth-to-width ratio, femoral head extrusion index, roof obliquity, caput-collum-diaphyseal (CCD) angle, and Murray’s femoral head ratio, and the values obtained were correlated with age. Results: Significant weak and moderate linear correlations (all Ps<0.001) were observed between age and CE angle (ρ=0.31), Sharp’s angle (ρ=-0.38), extrusion index (ρ=-0.22), CCD angle (ρ=-0.15), depth-to-width ratio (ρ=-0.38), and roof obliquity (ρ=-0.19), while Murray’s femoral head ratio (ρ=0.05; P=0.274) was not associated with age. Interestingly, the parameters describing the acetabulum all showed a relevant increase in coverage with age, leading to CE-angles well beyond 40° and a Sharp’s angle below 35° in a large portion of asymptomatic older adults. Conclusion: While a decrease in CCD angle with age is described in most orthopedic textbooks, the changes observed with age in acetabular geometry far exceed those measured at the femoral head-neck junction. We recommend considering these alterations that may be attributable to age when formulating a radiographic diagnosis. Level of Evidence III, Diagnostic Studies - Investigating a Diagnostic Test.
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25
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Atkins PR, Elhabian SY, Agrawal P, Harris MD, Whitaker RT, Weiss JA, Peters CL, Anderson AE. Quantitative comparison of cortical bone thickness using correspondence-based shape modeling in patients with cam femoroacetabular impingement. J Orthop Res 2017; 35:1743-1753. [PMID: 27787917 PMCID: PMC5407942 DOI: 10.1002/jor.23468] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 10/23/2016] [Indexed: 02/04/2023]
Abstract
UNLABELLED The proximal femur is abnormally shaped in patients with cam-type femoroacetabular impingement (FAI). Impingement may elicit bone remodeling at the proximal femur, causing increases in cortical bone thickness. We used correspondence-based shape modeling to quantify and compare cortical thickness between cam patients and controls for the location of the cam lesion and the proximal femur. Computed tomography images were segmented for 45 controls and 28 cam-type FAI patients. The segmentations were input to a correspondence-based shape model to identify the region of the cam lesion. Median cortical thickness data over the region of the cam lesion and the proximal femur were compared between mixed-gender and gender-specific groups. Median [interquartile range] thickness was significantly greater in FAI patients than controls in the cam lesion (1.47 [0.64] vs. 1.13 [0.22] mm, respectively; p < 0.001) and proximal femur (1.28 [0.30] vs. 0.97 [0.22] mm, respectively; p < 0.001). Maximum thickness in the region of the cam lesion was more anterior and less lateral (p < 0.001) in FAI patients. Male FAI patients had increased thickness compared to male controls in the cam lesion (1.47 [0.72] vs. 1.10 [0.19] mm, respectively; p < 0.001) and proximal femur (1.25 [0.29] vs. 0.94 [0.17] mm, respectively; p < 0.001). Thickness was not significantly different between male and female controls. CLINICAL SIGNIFICANCE Studies of non-pathologic cadavers have provided guidelines regarding safe surgical resection depth for FAI patients. However, our results suggest impingement induces cortical thickening in cam patients, which may strengthen the proximal femur. Thus, these previously established guidelines may be too conservative. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1743-1753, 2017.
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Affiliation(s)
- Penny R. Atkins
- Department of Bioengineering, University of Utah, Salt Lake City, Utah 84112
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, Utah 84108
| | - Shireen Y. Elhabian
- Scientific Computing and Imaging Institute, Salt Lake City, Utah 84112
- School of Computing, University of Utah, Salt Lake City, Utah 84112
| | - Praful Agrawal
- Scientific Computing and Imaging Institute, Salt Lake City, Utah 84112
- School of Computing, University of Utah, Salt Lake City, Utah 84112
| | - Michael D. Harris
- Program of Physical Therapy, Washington University School of Medicine, Saint Louis, Missouri 63110
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, Missouri 63110
| | - Ross T. Whitaker
- Department of Bioengineering, University of Utah, Salt Lake City, Utah 84112
- Scientific Computing and Imaging Institute, Salt Lake City, Utah 84112
- School of Computing, University of Utah, Salt Lake City, Utah 84112
| | - Jeffrey A. Weiss
- Department of Bioengineering, University of Utah, Salt Lake City, Utah 84112
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, Utah 84108
- Scientific Computing and Imaging Institute, Salt Lake City, Utah 84112
- School of Computing, University of Utah, Salt Lake City, Utah 84112
| | - Christopher L. Peters
- Department of Bioengineering, University of Utah, Salt Lake City, Utah 84112
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, Utah 84108
| | - Andrew E. Anderson
- Department of Bioengineering, University of Utah, Salt Lake City, Utah 84112
- Department of Orthopaedics, University of Utah, 590 Wakara Way Rm A100, Salt Lake City, Utah 84108
- Scientific Computing and Imaging Institute, Salt Lake City, Utah 84112
- Department of Physical Therapy, University of Utah, Salt Lake City, Utah 84108
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Kim CHO, Dietrich TJ, Zingg PO, Dora C, Pfirrmann CWA, Sutter R. Arthroscopic Hip Surgery: Frequency of Postoperative MR Arthrographic Findings in Asymptomatic and Symptomatic Patients. Radiology 2017; 283:779-788. [DOI: 10.1148/radiol.2016161078] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Chan-Hi Olaf Kim
- From the Departments of Radiology (C.H.O.K., T.J.D., C.W.A.P., R.S.) and Orthopedic Surgery (P.O.Z., C.D.), Orthopedic University Hospital Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland; and Faculty of Medicine, University of Zurich, Zurich, Switzerland (C.H.O.K., T.J.D., P.O.Z., C.D., C.W.A.P., R.S.)
| | - Tobias J. Dietrich
- From the Departments of Radiology (C.H.O.K., T.J.D., C.W.A.P., R.S.) and Orthopedic Surgery (P.O.Z., C.D.), Orthopedic University Hospital Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland; and Faculty of Medicine, University of Zurich, Zurich, Switzerland (C.H.O.K., T.J.D., P.O.Z., C.D., C.W.A.P., R.S.)
| | - Patrick O. Zingg
- From the Departments of Radiology (C.H.O.K., T.J.D., C.W.A.P., R.S.) and Orthopedic Surgery (P.O.Z., C.D.), Orthopedic University Hospital Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland; and Faculty of Medicine, University of Zurich, Zurich, Switzerland (C.H.O.K., T.J.D., P.O.Z., C.D., C.W.A.P., R.S.)
| | - Claudio Dora
- From the Departments of Radiology (C.H.O.K., T.J.D., C.W.A.P., R.S.) and Orthopedic Surgery (P.O.Z., C.D.), Orthopedic University Hospital Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland; and Faculty of Medicine, University of Zurich, Zurich, Switzerland (C.H.O.K., T.J.D., P.O.Z., C.D., C.W.A.P., R.S.)
| | - Christian W. A. Pfirrmann
- From the Departments of Radiology (C.H.O.K., T.J.D., C.W.A.P., R.S.) and Orthopedic Surgery (P.O.Z., C.D.), Orthopedic University Hospital Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland; and Faculty of Medicine, University of Zurich, Zurich, Switzerland (C.H.O.K., T.J.D., P.O.Z., C.D., C.W.A.P., R.S.)
| | - Reto Sutter
- From the Departments of Radiology (C.H.O.K., T.J.D., C.W.A.P., R.S.) and Orthopedic Surgery (P.O.Z., C.D.), Orthopedic University Hospital Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland; and Faculty of Medicine, University of Zurich, Zurich, Switzerland (C.H.O.K., T.J.D., P.O.Z., C.D., C.W.A.P., R.S.)
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A narrative overview of the current status of MRI of the hip and its relevance for osteoarthritis research - what we know, what has changed and where are we going? Osteoarthritis Cartilage 2017; 25:1-13. [PMID: 27621214 DOI: 10.1016/j.joca.2016.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 08/24/2016] [Accepted: 08/28/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To review and discuss the role of magnetic resonance imaging (MRI) in the context of hip osteoarthritis (OA) research. DESIGN The content of this narrative review, based on an extensive PubMed database research including English literature only, describes the advances in MRI of the hip joint and its potential usefulness in hip OA research, reviews the relevance of different MRI features in regard to symptomatic and structural progression in hip OA, and gives an outlook regarding future use of MRI in hip OA research endeavors. RESULTS Recent technical advances have helped to overcome many of the past difficulties related to MRI assessment of hip OA. MRI-based morphologic scoring systems allow for detailed assessment of several hip joint tissues and, in combination with the recent advances in MRI, may increase reproducibility and sensitivity to change. Compositional MRI techniques may add to our understanding of disease onset and progression. Knowledge about imaging pitfalls and anatomical variants is crucial to avoid misinterpretation. In comparison to research on knee OA, the associations between MRI features and the incidence and progression of disease as well as with clinical symptoms have been little explored. Anatomic alterations of the hip joint as seen in femoro-acetabular impingement (FAI) seem to play a role in the onset and progression of structural damage. CONCLUSIONS With the technical advances occurring in recent years, MRI may play a major role in investigating the natural history of hip OA and provide an improved method for assessment of the efficacy of new therapeutic approaches.
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Chiamil SM, Abarca CA. Imaging of the hip: a systematic approach to the young adult hip. Muscles Ligaments Tendons J 2016; 6:265-280. [PMID: 28066731 DOI: 10.11138/mltj/2016.6.3.265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Great advances in knowledge and understanding of the biomechanics of the hip, both in arthroscopic procedures and imaging techniques, have expanded and improved the diagnosis of pathologies of the young adult hip. The anatomy of the hip joint is complex due to its morphology and orientation. The inter-pretation of the images requires deep knowledge of the osseous and soft tissue anatomy: muscles, tendons, ligaments, vessels and nerves. There are multiple imaging tools. Diagnostic techniques have different utilities and often are complementary. METHODS In this article the various diagnostic imaging techniques for evaluation of hip pathologies are discussed, their indications and usefulness, with emphasis on those resolved arthroscopically. CONCLUSION Young adult hip disorders are increasingly diagnosed and treated as arthroscopic procedures improved. Radiology is a fundamental contribution in the diagnostic process. Plain radiography (X-ray) is always the initial examination. LEVEL OF EVIDENCE V.
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Tresch F, Dietrich TJ, Pfirrmann CW, Sutter R. Hip MRI: Prevalence of articular cartilage defects and labral tears in asymptomatic volunteers. A comparison with a matched population of patients with femoroacetabular impingement. J Magn Reson Imaging 2016; 46:440-451. [DOI: 10.1002/jmri.25565] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/07/2016] [Indexed: 12/25/2022] Open
Affiliation(s)
- Florian Tresch
- Department of Radiology; Orthopedic University Hospital Balgrist; Zurich Switzerland
- University of Zurich, Faculty of Medicine; Zurich Switzerland
| | - Tobias J. Dietrich
- Department of Radiology; Orthopedic University Hospital Balgrist; Zurich Switzerland
- University of Zurich, Faculty of Medicine; Zurich Switzerland
| | - Christian W.A. Pfirrmann
- Department of Radiology; Orthopedic University Hospital Balgrist; Zurich Switzerland
- University of Zurich, Faculty of Medicine; Zurich Switzerland
| | - Reto Sutter
- Department of Radiology; Orthopedic University Hospital Balgrist; Zurich Switzerland
- University of Zurich, Faculty of Medicine; Zurich Switzerland
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Pozzi G, Lanza E, Parra CG, Merli I, Sconfienza LM, Zerbi A. Incidence of greater trochanteric pain syndrome in patients suspected for femoroacetabular impingement evaluated using magnetic resonance arthrography of the hip. Radiol Med 2016; 122:208-214. [PMID: 27943098 DOI: 10.1007/s11547-016-0716-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We evaluated the incidence of greater trochanter pain syndrome (GTPS) in patients who underwent magnetic resonance arthrography (MRA) of the hip for a suspected femoroacetabular impingement (FAI) syndrome. METHODS Hip MRA performed at our institution (3/2012-1/2014) were reviewed. The absence/presence of FAI (cam, pincer, and mixed) was noted. GTPS diagnosis was based on gluteus medius/minimus tendinopathy/tears, trochanteric bursitis, fascia lata thickening, and trochanter bone oedema/erosion. Subgroup analysis for age (under/over 40 years) and FAI type (cam, pincer, and mixed) was also performed. RESULTS N = 189 patients were included (n = 125 males; age 39 ± 12 years). FAI was diagnosed in n = 133 (70, 4%): cam type, n = 85 (63, 9%); pincer type, n = 22 (16, 6%); and mixed type, n = 26 (19, 5%). N = 72 patients (38.1%) had tendinopathy, n = 14 (7.4%) had trochanter erosion, n = 31 (16.4%) had bursitis, n = 4 had bone oedema (2.1%), and n = 3 (1.6%) had fascia lata thickening, resulting in GTPS diagnosis in n = 74 patients (39.2%). The association of normal hip morphology/GTPS was significantly higher (P = 0.023) than that of FAI/GTPS. Under 40 years, GTPS incidence was higher in patients with normal hip and pincer-type FAI (P = 0.028). Over 40 years, no difference between patients with/without FAI (P = 0.119) was seen. CONCLUSIONS GTPS was more frequently observed in patients with normal hip morphology than in patients with FAI, particularly in patients under 40.
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Affiliation(s)
- Grazia Pozzi
- Unità Operativa di Radiologia/Diagnostica per Immagini con Servizio di Radiologia Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Ezio Lanza
- Dipartimento di Radiologia, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Italy.
| | - Cleber Garcia Parra
- Unità di Ortopedia e Traumatologia, ASST-Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| | - Ilaria Merli
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Luca Maria Sconfienza
- Unità Operativa di Radiologia/Diagnostica per Immagini con Servizio di Radiologia Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
| | - Alberto Zerbi
- Unità Operativa di Radiologia/Diagnostica per Immagini con Servizio di Radiologia Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
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Albers CE, Wambeek N, Hanke MS, Schmaranzer F, Prosser GH, Yates PJ. Imaging of femoroacetabular impingement-current concepts. J Hip Preserv Surg 2016; 3:245-261. [PMID: 29632685 PMCID: PMC5883171 DOI: 10.1093/jhps/hnw035] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 09/12/2016] [Indexed: 02/07/2023] Open
Abstract
Following the recognition of femoroacetabular impingement (FAI) as a clinical entity, diagnostic tools have continuously evolved. While the diagnosis of FAI is primarily made based on the patients' history and clinical examination, imaging of FAI is indispensable. Routine diagnostic work-up consists of a set of plain radiographs, magnetic resonance imaging (MRI) and MR-arthrography. Recent advances in MRI technology include biochemically sensitive sequences bearing the potential to detect degenerative changes of the hip joint at an early stage prior to their appearance on conventional imaging modalities. Computed tomography may serve as an adjunct. Advantages of CT include superior bone to soft tissue contrast, making CT applicable for image-guiding software tools that allow evaluation of the underlying dynamic mechanisms causing FAI. This article provides a summary of current concepts of imaging in FAI and a review of the literature on recent advances, and their application to clinical practice.
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Affiliation(s)
- Christoph E. Albers
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Nicholas Wambeek
- Department of Radiology, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia
| | - Markus S. Hanke
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Florian Schmaranzer
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Gareth H. Prosser
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia
- Faculty of Medicine, Dentistry and Health Sience, University of Western Australia, Perth, Australia
| | - Piers J. Yates
- Department of Orthopaedic Surgery, Fiona Stanley Hospital and Fremantle Hospital, Perth, Australia
- Faculty of Medicine, Dentistry and Health Sience, University of Western Australia, Perth, Australia
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Zoga AC, Hegazi TM, Roedl JB. Algorithm for Imaging the Hip in Adolescents and Young Adults. Radiol Clin North Am 2016; 54:913-30. [DOI: 10.1016/j.rcl.2016.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Morphological and Quantitative 7 T MRI of Hip Cartilage Transplants in Comparison to 3 T—Initial Experiences. Invest Radiol 2016; 51:552-9. [DOI: 10.1097/rli.0000000000000264] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chahla J, LaPrade RF, Mardones R, Huard J, Philippon MJ, Nho S, Mei-Dan O, Pascual-Garrido C. Biological Therapies for Cartilage Lesions in the Hip: A New Horizon. Orthopedics 2016; 39:e715-23. [PMID: 27359284 DOI: 10.3928/01477447-20160623-01] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/01/2016] [Indexed: 02/03/2023]
Abstract
Treatment of hip cartilage disease is challenging, and there is no clear algorithm to address this entity. Biomarkers are arising as promising diagnostic tools because they could play a role in the early assessment of the prearthritic joint and as a prognostic factor before and after treatment. The potential effect of biomarkers may be used to categorize individuals at risk of evolving to severe osteoarthritis, to develop new measures for clinical progression of the disease, and to develop new treatment options for the prevention of osteoarthritis progression. A trend toward a less invasive biological treatment will usher in a new treatment era. With the growth of surgical skills in hip arthroscopy, cartilage restoration techniques are evolving in a fast and exponential manner. Biological and surgical treatments have been proposed to treat these pathologies. Biological treatments include platelet-rich plasma, stem cells or bone marrow aspirate concentration, hyaluronic acid, losartan, and fish oil. Surgical treatments include microfracture alone or augmented, direct repair, autologous chondrocyte implantation, matrix-induced chondrocyte implantation, autologous matrix-induced chondrogenesis, mosaicplasty, osteochondral allograft transplantation, and stem cells implanted in matrix (stem cells in membranes/expanded stem cells). This article reviews new evidence available on treatment options for chondral lesions and early osteoarthritis of the hip. [Orthopedics. 2016; 39(4):e715-e723.].
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Hwang JT, Lee WY, Kang C, Hwang DS, Kim DY, Zheng L. Usefulness of Arthroscopic Treatment of Painful Hip after Acetabular Fracture or Hip Dislocation. Clin Orthop Surg 2015; 7:443-8. [PMID: 26640626 PMCID: PMC4667111 DOI: 10.4055/cios.2015.7.4.443] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 08/09/2015] [Indexed: 11/11/2022] Open
Abstract
Background Painful hip following hip dislocation or acetabular fracture can be an important signal for early degeneration and progression to osteoarthritis due to intraarticular pathology. However, there is limited literature discussing the use of arthroscopy for the treatment of painful hip. The purpose of this retrospective study was to analyze the effectiveness and benefit of arthroscopic treatment for patients with a painful hip after major trauma. Methods From July 2003 to February 2013, we reviewed 13 patients who underwent arthroscopic treatment after acetabular fracture or hip dislocation and were followed up for a minimum of 2 postoperative years. The degree of osteoarthritis based on the Tonnis classification pre- and postoperatively at final follow-up was determined. Clinical outcomes were evaluated using visual analogue scale for pain (VAS) and modified Harris hip score (MHHS), and range of motion (ROM) of the hip pre- and postoperatively at final follow-up. Results There were nine male and four female patients with a mean age at surgery of 28 years (range, 20 to 50 years). The mean follow-up period of the patients was 59.8 months (range, 24 to 115 months), and the mean interval between initial trauma and arthroscopic treatment was 40.8 months (range, 1 to 144 months). At the final follow-up, VAS and MHHS improved significantly from 6.3 and 53.4 to 3.0 and 88.3, respectively (p = 0.002 and p < 0.001, respectively). However, there were no significant differences in hip flexion, abduction, adduction, external rotation, and internal rotation as minor improvements from 113.1°, 38.5°, 28.5°, 36.5°, and 22.7° to 118.5°, 39.0°, 29.2°, 38.9°, and 26.5° were observed, respectively (p = 0.070, p = 0.414, p = 0.317, p = 0.084, and p = 0.136, respectively). None of the patients exhibited progression of osteoarthritis of the hip at the final follow-up. Conclusions Arthroscopic treatment after acetabular fracture or hip dislocation is effective and delays the progression of traumatic osteoarthritis.
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Affiliation(s)
- Jung-Taek Hwang
- Department of Orthopaedic Surgery, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Woo-Yong Lee
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Chan Kang
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Deuk-Soo Hwang
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Dong-Yeol Kim
- Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Long Zheng
- Department of Orthopaedic Surgery, Yanbian University School of Medicine, Yanji, China
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Schmaranzer F, Klauser A, Kogler M, Henninger B, Forstner T, Reichkendler M, Schmaranzer E. MR arthrography of the hip with and without leg traction: Assessing the diagnostic performance in detection of ligamentum teres lesions with arthroscopic correlation. Eur J Radiol 2015; 85:489-97. [PMID: 26781156 DOI: 10.1016/j.ejrad.2015.11.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 11/15/2015] [Accepted: 11/22/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To retrospectively assess the diagnostic performance of hip MR arthrography with and without traction in detecting ligamentum teres (LT) lesions with arthroscopic correlation and to evaluate the effect of traction on the imaging appearance of the LT. METHODS 73 MR arthrograms (73 consecutive patients, mean age, 34.5 years; range, 14-55 years) obtained without and with leg traction (application of 15-23 kg, use of a supporting plate for the contralateral leg) were included. Two blinded readers independently evaluated LT lesions on MR arthrograms on separate occasions: coronal images without traction; coronal images with traction; a multiplanar traction protocol. MR findings were correlated with arthroscopic records. Sensitivity/specificity of traction and non-traction imaging was compared on coronal images with the exact McNemar test. Imaging appearance of the LT with and without traction was assessed in consensus and compared on coronal images using McNemar and McNemar-Bowker tests. (p<0.05, * corrected for type I error). RESULTS With arthroscopy 29 (40%) LT lesions were identified in 73 patients. Sensitivity was 72%/90% (without traction/with traction; p=0.25*), specificity was 89%/77% (p=0.25*) for reader 1 in assessing coronal images and for reader 2 sensitivity was 59%/86% (p=0.044*) and specificity was 93%/82% (p=0.25*). Alterations in fiber orientation, signal intensity, surface, dimension, fiber continuity after application of traction were observed in 33/73 (45%, p=0.002*), 6/73 (8%, p=0.223), 9/73 (12%, p=0.36*), 6/73 (8%, p=0.031) respectively 9/73 (12%, p=0.003) cases. Traction-related alterations in at least one criterion were observed in 41/73 (56%) cases. CONCLUSION Application of traction can considerably alter the imaging appearance of the LT and resulted in higher rates of true-positive and false-positive findings compared to conventional MR arthrography.
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Affiliation(s)
- Florian Schmaranzer
- Inselspital, University of Bern, Department of Orthopaedic Surgery, Freiburgstrasse, 3010 Bern, Switzerland; Medical University Innsbruck, Department of Radiology, Anichstraße 35, 6020 Innsbruck, Austria.
| | - Andrea Klauser
- Medical University Innsbruck, Department of Radiology, Anichstrasse 35, 6020 Innsbruck, Austria.
| | - Michael Kogler
- District Hospital St. Johann in Tyrol, Department of Radiology, Bahnhofstraße 14, 6380 St. Johann in Tyrol, Austria.
| | - Benjamin Henninger
- Medical University Innsbruck, Department of Radiology, Anichstrasse 35, 6020 Innsbruck, Austria.
| | - Thomas Forstner
- Johannes Keppler University, Department for Applied Systems Research and Statistics, Altenbergerstraße 69, 4040 Linz, Austria.
| | - Markus Reichkendler
- District Hospital St. Johann in Tyrol, Department of Orthopedic Surgery, Bahnhofstraße 14, 6380 St. Johann in Tyrol, Austria.
| | - Ehrenfried Schmaranzer
- District Hospital St. Johann in Tyrol, Department of Radiology, Bahnhofstraße 14, 6380 St. Johann in Tyrol, Austria.
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Abstract
OBJECTIVE Imaging of hip cartilage is challenging because of its limited thickness and complex geometry and therefore requires advanced MRI techniques. However, cartilage abnormalities are found in a number of disease entities, and their diagnosis may impact patient management. This article will provide pertinent information about the motivation to image hip cartilage, which imaging techniques to use, and how to analyze cartilage; finally, we will discuss disease entities with regional cartilage lesions, including the typical MRI findings. CONCLUSION Because the detection and quantification of regional cartilage abnormalities are critical for guidance of operative and nonoperative management of hip disorders, radiologists should be familiar with imaging and analysis techniques for assessing hip cartilage.
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Jackson KA, Glyn-Jones S, Batt ME, Arden NK, Newton JL. Assessing risk factors for early hip osteoarthritis in activity-related hip pain: a Delphi study. BMJ Open 2015; 5:e007609. [PMID: 26419679 PMCID: PMC4593156 DOI: 10.1136/bmjopen-2015-007609] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Hip pain and injury as a result of activity can lead to the development of early hip osteoarthritis (OA) in susceptible individuals. Our understanding of the factors that increase susceptibility continues to evolve. The ability to clearly identify individuals (and cohorts) with activity-related hip pain who are at risk of early hip OA is currently lacking. The purpose of this study was to gain expert consensus on which key clinical measures might help predict the risk of early hip OA in individuals presenting with activity-related hip pain. The agreed measures would constitute a standardised approach to initial clinical assessment to help identify these individuals. METHODS This Dephi study used online surveys to gain concordance of expert opinion in a structured process of 'rounds'. In this study, we asked 'What outcome measures are useful in predicting hip OA in activity-related hip pain?' The Delphi panel consisted of experts from sport and exercise medicine, orthopaedics, rheumatology, physiotherapy and OA research. RESULTS The study identified key clinical measures in the history, examination and investigations (plain anteroposterior radiograph and femoroacetabular impingement views) that the panel agreed would be useful in predicting future risk of hip OA when assessing activity-related hip pain. The panel also agreed that certain investigations and tests (eg, MR angiography) did not currently have a role in routine assessment. There was a lack of consensus regarding the role of MRI, patient-reported outcome measures (PROMs) and certain biomechanical and functional assessments. CONCLUSIONS We provide a standardised approach to the clinical assessment of patients with activity-related hip pain. Assessment measures rejected by the Delphi panel were newer, more expensive investigations that currently lack evidence. Assessment measures that did not reach consensus include MRI and PROMs. Their role remains ambiguous and would benefit from further research.
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Affiliation(s)
- K A Jackson
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Oxford, Botnar Research Centre, Oxford, UK
| | - S Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Oxford, Botnar Research Centre, Oxford, UK
| | - M E Batt
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queen's Medical Centre, Nottingham, UK
| | - N K Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Oxford, Botnar Research Centre, Oxford, UK
| | - J L Newton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Oxford, Botnar Research Centre, Oxford, UK
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Assessment of Femoral Antetorsion With MRI: Comparison of Oblique Measurements to Standard Transverse Measurements. AJR Am J Roentgenol 2015; 205:130-5. [PMID: 26102391 DOI: 10.2214/ajr.14.13617] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Abnormal femoral antetorsion is associated with the development of femoroacetabular impingement (FAI). Anatomically correct antetorsion measurements are performed on transverse MR images over the proximal and distal femur, but some authors use alternative measurements on oblique images parallel to the femoral neck axis. We set out to assess the relationship between these two measurement methods and to obtain reference values for oblique measurements in patients with FAI and healthy control subjects. We also evaluated whether the oblique measurements could be used to predict the standard transverse measurements. SUBJECTS AND METHODS MRI data of 126 individuals, 63 asymptomatic volunteers and 63 patients with FAI (age 20-50 years), were included in this prospective study. Two readers independently assessed antetorsion with oblique measurements and standard transverse measurements. Differences between subgroups were compared with the unpaired t test. Trigonometric calculations were used to predict standard antetorsion measurements on the basis of oblique measurements. Interobserver agreement and Bland-Altman plots were calculated. RESULTS Reference values for assessing femoral antetorsion with the oblique method were established, with mean (± SD) values of 9.4° ± 7.9° (reader 1) and 9.8° ± 8.4° (reader 2) for patients and 9.2° ± 8.4° (reader 1) and 9.6° ± 9.1° (reader 2) for asymptomatic volunteers. The oblique method generated smaller antetorsion values than the standard transverse method (p < 0.001), with an average difference of 3.5° ± 3.2° for reader 1 and 3.6° ± 3.5° for reader 2. Differences between predicted antetorsion values based on oblique measurements and standard measurements were minimal: 0.1° ± 2.9° (p = 0.62) for reader 1 and 0.3° ± 3.3° (p = 0.29) for reader 2. Interobserver agreement was high for all antetorsion measurements (intra-class correlation coefficient, 0.945-0.977). CONCLUSION Oblique measurements of femoral antetorsion were smaller than standard transverse measurements, but they can be used to accurately predict standard measurements.
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Das instabile Sprunggelenk. ARTHROSKOPIE 2015. [DOI: 10.1007/s00142-015-0006-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Cam-type deformities: Concepts, criteria, and multidetector CT features. RADIOLOGIA 2015; 57:213-24. [PMID: 25660594 DOI: 10.1016/j.rx.2014.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 10/20/2014] [Accepted: 11/03/2014] [Indexed: 11/23/2022]
Abstract
Interpreting imaging studies of a painful hip requires detailed knowledge of the regional anatomy. Some variants of the proximal femur, such as cam-type deformities, can course asymptomatically or cause femoroacetabular impingement. The principal numerical criterion for defining cam-type deformities, the alpha angle, has some limitations. In this article, we review the anatomic variants of the anterior aspect of the proximal femur, focusing on cam-type deformities. Using diagrams and multidetector CT images, we describe the parameters that are useful for characterizing these deformities in different imaging techniques. We also discuss the potential correspondence of imaging findings of cam-type deformities with the terms coined by anatomists and anthropologists to describe these phenomena.
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Ehrmann C, Rosskopf AB, Pfirrmann CW, Sutter R. Beyond the alpha angle: Alternative measurements for quantifying cam-type deformities in femoroacetabular impingement. J Magn Reson Imaging 2015; 42:1024-31. [DOI: 10.1002/jmri.24861] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 01/12/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Christine Ehrmann
- Department of Radiology; Orthopedic University Hospital Balgrist; Zurich Switzerland
- University of Zurich, Faculty of Medicine; Zurich Switzerland
| | - Andrea B. Rosskopf
- Department of Radiology; Orthopedic University Hospital Balgrist; Zurich Switzerland
- University of Zurich, Faculty of Medicine; Zurich Switzerland
| | - Christian W.A. Pfirrmann
- Department of Radiology; Orthopedic University Hospital Balgrist; Zurich Switzerland
- University of Zurich, Faculty of Medicine; Zurich Switzerland
| | - Reto Sutter
- Department of Radiology; Orthopedic University Hospital Balgrist; Zurich Switzerland
- University of Zurich, Faculty of Medicine; Zurich Switzerland
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Blum A, Raymond A, Teixeira P. Strategy and optimization of diagnostic imaging in painful hip in adults. Orthop Traumatol Surg Res 2015; 101:S85-99. [PMID: 25599865 DOI: 10.1016/j.otsr.2014.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/28/2014] [Accepted: 11/27/2014] [Indexed: 02/02/2023]
Abstract
Diagnostic imaging strategy in painful hip depends on many factors, but in all cases, plain X-ray is the first investigation. It may be sufficient to reach diagnosis and determine treatment options. More effective but more expensive exploration is indicated in two circumstances: when plain X-ray is non-contributive, and when diagnosis has been established but more accurate imaging assessment is needed to guide treatment. Following radiography, the choice of imaging techniques depends not only on the suspected pathology but also on the availability of equipment and its performance. MRI is probably the technique that provides the most comprehensive results; recent improved accessibility has significantly simplified the diagnostic algorithm. CT remains invaluable, and current techniques have reduced patient irradiation to a level similar to that of standard X-ray. Finally, cost is an important consideration in choosing the means of exploration, but the overall financial impact of the various strategies for diagnosis of painful hip is not well established. This article aims to provide a simple and effective diagnostic strategy for the assessment of painful hip, taking account of the clinical situation, and to detail the most typical semiologic patterns of each disease affecting this joint.
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Affiliation(s)
- A Blum
- Service d'imagerie Guilloz, CHU de Nancy, 54000 Nancy, France.
| | - A Raymond
- Service d'imagerie Guilloz, CHU de Nancy, 54000 Nancy, France
| | - P Teixeira
- Service d'imagerie Guilloz, CHU de Nancy, 54000 Nancy, France
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Lazik A, Körsmeier K, Claßen T, Jäger M, Kamminga M, Kraff O, Lauenstein TC, Theysohn JM, Landgraeber S. 3 Tesla high-resolution and delayed gadolinium enhanced MR imaging of cartilage (dGEMRIC) after autologous chondrocyte transplantation in the hip. J Magn Reson Imaging 2014; 42:624-33. [PMID: 25522716 DOI: 10.1002/jmri.24821] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 11/18/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND To evaluate the feasibility of 3 Tesla (T) high-resolution and gadolinium enhanced MRI of cartilage (dGEMRIC) in the thin and rounded hip cartilage of patients after acetabular matrix-based autologous chondrocyte transplantation (MACT). METHODS Under general ethics approval, 24 patients were prospectively examined 6-31 months after acetabular MACT at 3T using high-resolution proton-density weighted (PDw) images (bilateral PD SPACE, 0.8 mm isotropic; unilateral PD-TSE coronal/sagittal, 0.8 × 0.8 resp. 0.5 × 0.5 × 2.5 mm) as well as T1 mapping (3D-FLASH, 0.78 mm isotropic) in dGEMRIC technique, and clinically scored. The cartilage transplant was evaluated using an adapted MOCART score (maximum 85 points). T1 relaxation times were measured independently by two radiologists. Here, regions of interest were placed manually in automatically calculated relaxation-maps, both in the transplant and adjacent healthy cartilage regions. Interobserver reliability was estimated by means of intraclass-correlation (ICC). RESULTS The transplant was morphologically definable in the PDw images of 23 patients with a mean MOCART score of 69 points (60-80 points, SD 6.5). T1 maps showed a clear differentiation between acetabular and femoral cartilage, but correlation with PDw images was necessary to identify the transplant. Mean T1 relaxation times of the transplant were 616.3 ms (observer 1) resp. 610.1 ms (observer 2), and of adjacent healthy acetabular cartilage 574.5 ms (observer 1) resp. 604.9 ms (observer 2). Interobserver reliability of the relaxation times in the transplant was excellent (ICC-coefficient 0.88) and in adjacent healthy regions good (0.77). CONCLUSION High-resolution PDw imaging with adapted MOCART scoring and dGEMRIC is feasible after MACT in the thin and rounded hip cartilage.
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Affiliation(s)
- Andrea Lazik
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | | | - Tim Claßen
- Department of Orthopaedics, University Hospital Essen, Germany
| | - Marcus Jäger
- Department of Orthopaedics, University Hospital Essen, Germany
| | | | - Oliver Kraff
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Germany
| | - Thomas C Lauenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Jens M Theysohn
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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Schmaranzer F, Klauser A, Kogler M, Henninger B, Forstner T, Reichkendler M, Schmaranzer E. Diagnostic performance of direct traction MR arthrography of the hip: detection of chondral and labral lesions with arthroscopic comparison. Eur Radiol 2014; 25:1721-30. [PMID: 25465714 DOI: 10.1007/s00330-014-3534-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 10/27/2014] [Accepted: 11/20/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess diagnostic performance of traction MR arthrography of the hip in detection and grading of chondral and labral lesions with arthroscopic comparison. METHODS Seventy-five MR arthrograms obtained ± traction of 73 consecutive patients (mean age, 34.5 years; range, 14-54 years) who underwent arthroscopy were included. Traction technique included weight-adapted traction (15-23 kg), a supporting plate for the contralateral leg, and intra-articular injection of 18-27 ml (local anaesthetic and contrast agent). Patients reported on neuropraxia and on pain. Two blinded readers independently assessed femoroacetabular cartilage and labrum lesions which were correlated with arthroscopy. Interobserver agreement was calculated using κ values. Joint distraction ± traction was evaluated in consensus. RESULTS No procedure had to be stopped. There were no cases of neuropraxia. Accuracy for detection of labral lesions was 92 %/93 %, 91 %/83 % for acetabular lesions, and 92 %/88 % for femoral cartilage lesions for reader 1/reader 2, respectively. Interobserver agreement was moderate (κ = 0.58) for grading of labrum lesions and substantial (κ = 0.7, κ = 0.68) for grading of acetabular and femoral cartilage lesions. Joint distraction was achieved in 72/75 and 14/75 hips with/without traction, respectively. CONCLUSION Traction MR arthrography safely enabled accurate detection and grading of labral and chondral lesions. KEY POINTS • The used traction technique was well tolerated by most patients. • The used traction technique almost consistently achieved separation of cartilage layers. • Traction MR arthrography enabled accurate detection of chondral and labral lesions.
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Affiliation(s)
- Florian Schmaranzer
- Department of Radiology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria,
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Sahin M, Calisir C, Omeroglu H, Inan U, Mutlu F, Kaya T. Evaluation of Labral Pathology and Hip Articular Cartilage in Patients with Femoroacetabular Impingement (FAI): Comparison of Multidetector CT Arthrography and MR Arthrography. Pol J Radiol 2014; 79:374-80. [PMID: 25352941 PMCID: PMC4211418 DOI: 10.12659/pjr.890910] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 05/12/2014] [Indexed: 11/09/2022] Open
Abstract
Background To compare the multidetector computed tomography (MDCT) arthrography (CTa) and magnetic resonance (MR) arthrography (MRa) findings with surgical findings in patients with femoroacetabular impingement (FAI) and to evaluate the diagnostic performance of these methods. Material/Methods Labral pathology and articular cartilage were prospectively evaluated with MRa and CTa in 14 hips of 14 patients. The findings were evaluated by two musculoskeletal radiologists with 10 and 20 years of experience, respectively. Sensitivity, specificity, accuracy, and positive predictive value were determined using surgical findings as the standard of reference. Results While the disagreement between observers was recorded in two cases of labral tearing with MRa, there was a complete consensus with CTa. Disagreement between observers was found in four cases of femoral cartilage loss with both MRa and CTa. Disagreement was also recorded in only one case of acetabular cartilage loss with both methods. The percent sensitivity, specificity, and accuracy for correctly assessing the labral tearing were as follows for MRa/CTa, respectively: 100/100, 50/100, 86/100 (p<0.05). The same values for acetabular cartilage assessment were 89/56, 40/60, 71/71 (p>0.05) and for femoral cartilage assessment were 100/75, 90/70, 86/71 (p>0.05). Inter-observer reliability value showed excellent agreement for labral tearing with CTa (κ=1.0). Inter-observer agreement was substantial to excellent with regard to acetabular cartilage assessment with MRa and CTa (κ=0.76 for MRa and κ=0.86 for CTa) Conclusions Inter-observer reliability with CTa is excellent for labral tearing assessment. CTa seems to have an equal sensitivity and a higher specificity than MRa for the detection of labral pathology. MRa is better, but not statistically significantly, in demonstrating acetabular and femoral cartilage pathology.
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Affiliation(s)
- Murat Sahin
- Department of Radiology, Eskisehir Osmangazi University, School of Medicine, Eskisehir, Turkey
| | - Cuneyt Calisir
- Department of Radiology, Eskisehir Osmangazi University, School of Medicine, Eskisehir, Turkey
| | - Hakan Omeroglu
- Department of Orthopaedics, Eskisehir Osmangazi University, School of Medicine, Eskisehir, Turkey
| | - Ulukan Inan
- Department of Orthopaedics, Eskisehir Osmangazi University, School of Medicine, Eskisehir, Turkey
| | - Fezan Mutlu
- Department of Biostatics, Eskisehir Osmangazi University, School of Medicine, Eskisehir, Turkey
| | - Tamer Kaya
- Department of Radiology, Eskisehir Osmangazi University, School of Medicine, Eskisehir, Turkey
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Schmaranzer F, Klauser A, Kogler M, Henninger B, Forstner T, Reichkendler M, Schmaranzer E. Improving visualization of the central compartment of the hip with direct MR arthrography under axial leg traction: a feasibility study. Acad Radiol 2014; 21:1240-7. [PMID: 24981959 DOI: 10.1016/j.acra.2014.04.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 04/26/2014] [Accepted: 04/30/2014] [Indexed: 11/25/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the feasibility of a modified approach for direct magnetic resonance (MR) arthrography of the hip under leg traction in achieving a sufficient femoroacetabular interface and improving the visualization of the ligamentum teres. MATERIALS AND METHODS Forty-six MR arthrograms of 44 patients who underwent MR arthrography with and without leg traction were included into the study. Traction approach included injection of 18-27 mL of fluid (local anesthetic, contrast agent), application of weight-adapted traction load (15-23 kg), and the use of a supporting plate. Patients were instructed to report on pain and complications with an integer pain scale. Joint distraction was measured on coronal images obtained with and without traction, and two radiologists independently evaluated whether femoroacetabular cartilage layers and the ligamentum teres could be seen as distinct entities. McNemar test was used and interobserver agreement was assessed. RESULTS No patient asked for termination of the examination. There were no cases of neuropraxia. Mean difference in distraction was 3.7 mm/3.6 mm (reader 1/reader 2). Cartilage layers could be seen as distinct entities in 43/43 (93.5%/93.5%) and 6/8 (13%/17.4%) of the joints with/without traction (P < .001/P < .001), respectively. The ligamentum teres could be differentiated in 33/30 (71.7%/65.2%) cases with traction, in 33/30 (71.7%/65.2%) cases without traction (P < .999/P < .999), and in 40/37 (87%/80.4%) cases with both the techniques combined. CONCLUSIONS Traction MR arthrography is safe and technically feasible. It enabled the differentiation between femoroacetabular cartilage layers in most cases. Visualization of the ligamentum teres was optimal by combining imaging with both modalities.
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Aydingoz U. Radial Imaging of the Hip Also for Properly Measuring the α Angle. Radiographics 2014; 34:1141-2. [PMID: 25019446 DOI: 10.1148/rg.344135159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ustun Aydingoz
- Department of Radiology, Hacettepe University School of Medicine, 06100 Ankara, Turkey
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