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Schmaranzer F, Movahhedi M, Singh M, Kallini JR, Nanavati AK, Steppacher SD, Heimann AF, Kiapour AM, Novais EN. Computed tomography-based automated 3D measurement of femoral version: Validation against standard 2D measurements in symptomatic patients. J Orthop Res 2024. [PMID: 38678375 DOI: 10.1002/jor.25865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/20/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024]
Abstract
To validate 3D methods for femoral version measurement, we asked: (1) Can a fully automated segmentation of the entire femur and 3D measurement of femoral version using a neck based method and a head-shaft based method be performed? (2) How do automatic 3D-based computed tomography (CT) measurements of femoral version compare to the most commonly used 2D-based measurements utilizing four different landmarks? Retrospective study (May 2017 to June 2018) evaluating 45 symptomatic patients (57 hips, mean age 18.7 ± 5.1 years) undergoing pelvic and femoral CT. Femoral version was assessed using four previously described methods (Lee, Reikeras, Tomczak, and Murphy). Fully-automated segmentation yielded 3D femur models used to measure femoral version via femoral neck- and head-shaft approaches. Mean femoral version with 95% confidence intervals, and intraclass correlation coefficients were calculated, and Bland-Altman analysis was performed. Automatic 3D segmentation was highly accurate, with mean dice coefficients of 0.98 ± 0.03 and 0.97 ± 0.02 for femur/pelvis, respectively. Mean difference between 3D head-shaft- (27.4 ± 16.6°) and 3D neck methods (12.9 ± 13.7°) was 14.5 ± 10.7° (p < 0.001). The 3D neck method was closer to the proximal Lee (-2.4 ± 5.9°, -4.4 to 0.5°, p = 0.009) and Reikeras (2 ± 5.6°, 95% CI: 0.2 to 3.8°, p = 0.03) methods. The 3D head-shaft method was closer to the distal Tomczak (-1.3 ± 7.5°, 95% CI: -3.8 to 1.1°, p = 0.57) and Murphy (1.5 ± 5.4°, -0.3 to 3.3°, p = 0.12) methods. Automatic 3D neck-based-/head-shaft methods yielded femoral version angles comparable to the proximal/distal 2D-based methods, when applying fully-automated segmentations.
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Affiliation(s)
- Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mohammadreza Movahhedi
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mallika Singh
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer R Kallini
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andreas K Nanavati
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alexander F Heimann
- Department of Orthopaedic Surgery and Traumatology, HFR - Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Ata M Kiapour
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eduardo N Novais
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Lerch TD, Kaim T, Grob V, Hanke M, Schmaranzer F, Steppacher SD, Busch JD, Ziebarth K. MR-based Bony 3D models enable radiation-free preoperative patient-specific analysis and 3D printing for SCFE patients. J Child Orthop 2024; 18:162-170. [PMID: 38567038 PMCID: PMC10984152 DOI: 10.1177/18632521241229618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 01/12/2024] [Indexed: 04/04/2024] Open
Abstract
Objectives Slipped capital femoral epiphyses (SCFE) is a common pediatric hip disease with the risk of osteoarthritis and impingement deformities, and 3D models could be useful for patient-specific analysis. Therefore, magnetic resonance imaging (MRI) bone segmentation and feasibility of 3D printing and of 3D ROM simulation using MRI-based 3D models were investigated. Methods A retrospective study involving 22 symptomatic patients (22 hips) with SCFE was performed. All patients underwent preoperative hip MR with pelvic coronal high-resolution images (T1 images). Slice thickness was 0.8-1.2 mm. Mean age was 12 ± 2 years (59% male patients). All patients underwent surgical treatment. Semi-automatic MRI-based bone segmentation with manual corrections and 3D printing of plastic 3D models was performed. Virtual 3D models were tested for computer-assisted 3D ROM simulation of patients with knee images and were compared to asymptomatic contralateral hips with unilateral SCFE (15 hips, control group). Results MRI-based bone segmentation was feasible (all patients, 100%, in 4.5 h, mean 272 ± 52 min). Three-dimensional printing of plastic 3D models was feasible (all patients, 100%) and was considered helpful for deformity analysis by the treating surgeons for severe and moderate SCFE. Three-dimensional ROM simulation showed significantly (p < 0.001) decreased flexion (48 ± 40°) and IR in 90° of flexion (-14 ± 21°, IRF-90°) for severe SCFE patients with MRI compared to control group (122 ± 9° and 36 ± 11°). Slip angle improved significantly (p < 0.001) from preoperative 54 ± 15° to postoperative 4 ± 2°. Conclusion MRI-based 3D models were feasible for SCFE patients. Three-dimensional models could be useful for severe SCFE patients for preoperative 3D printing and deformity analysis and for ROM simulation. This could aid for patient-specific diagnosis, treatment decisions, and preoperative planning. MRI-based 3D models are radiation-free and could be used instead of CT-based 3D models in the future.
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Affiliation(s)
- Till D Lerch
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
- Department of Orthopaedic Surgery, Child and Young Adult Hip Preservation Program at Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Tilman Kaim
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Switzerland
| | - Valentin Grob
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
| | - Markus Hanke
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Jasmin D Busch
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
| | - Kai Ziebarth
- Department of Pediatric Surgery, section of pediatric orthopedic surgery, Inselspital, University of Bern, Bern, Switzerland
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Schmaranzer F, Justo P, Kallini JR, Ferrer MG, Miller P, Bixby SD, Novais EN. Hip Morphology on Post-Reduction MRI Predicts Residual Dysplasia 10 Years After Open or Closed Reduction. J Bone Joint Surg Am 2024; 106:110-119. [PMID: 37992184 DOI: 10.2106/jbjs.23.00333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND There is limited evidence supporting the value of morphological parameters on post-reduction magnetic resonance imaging (MRI) to predict long-term residual acetabular dysplasia (RAD) after closed or open reduction for the treatment of developmental dysplasia of the hip (DDH). METHODS We performed a retrospective study of 42 patients (47 hips) undergoing open or closed reduction with a minimum 10 years of follow-up; 39 (83%) of the hips were in female patients, and the median age at reduction was 6.3 months (interquartile range [IQR], 3.3 to 8.9 months). RAD was defined as additional surgery with an acetabular index >2 standard deviations above the age- and sex-specific population-based mean value or Severin classification grade of >2 at last follow-up. Acetabular version and depth-width ratio, coronal and axial femoroacetabular distance, cartilaginous and osseous acetabular indices, transverse ligament thickness, and the thickness of the medial and lateral (limbus) acetabular cartilage were measured on post-reduction MRI. RESULTS At the time of final follow-up, 24 (51%) of the hips had no RAD; 23 (49%) reached a failure end point at a median of 11.4 years (IQR, 7.6 to 15.4 years). Most post-reduction MRI measurements, with the exception of the cartilaginous acetabular index, revealed a significant distinction between the group with RAD and the group with no RAD when mean values were compared. The coronal femoroacetabular distance (area under the receiver operating characteristic curve [AUC], 0.95; 95% confidence interval [CI], 0.90 to 1.00), with a 5-mm cutoff, and limbus thickness (AUC, 0.91; 95% CI, 0.83 to 0.99), with a 4-mm cutoff, had the highest discriminatory ability. A 5-mm cutoff for the coronal femoroacetabular distance produced 96% sensitivity (95% CI, 78% to 100%), 83% specificity (95% CI, 63% to 95%), 85% positive predictive value (95% CI, 65% to 96%), and 95% negative predictive value (95% CI, 76% to 100%). A 4-mm cutoff for limbus thickness had 96% sensitivity (95% CI, 78% to 100%), 63% specificity (95% CI, 41% to 81%), 71% positive predictive value (95% CI, 52% to 86%), and 94% negative predictive value (95% CI, 70% to 100%). CONCLUSIONS Coronal femoroacetabular distance, a quantitative metric assessing a reduction's concentricity, and limbus thickness, a quantitative metric assessing the acetabulum's cartilaginous component, help to predict hips that will have RAD in the long term after closed or open reduction. LEVEL OF EVIDENCE Diagnostic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Florian Schmaranzer
- Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pedro Justo
- Child and Young Adult Hip Preservation Program, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Jennifer R Kallini
- Child and Young Adult Hip Preservation Program, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Mariana G Ferrer
- Child and Young Adult Hip Preservation Program, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Patricia Miller
- Child and Young Adult Hip Preservation Program, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Sarah D Bixby
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Eduardo N Novais
- Child and Young Adult Hip Preservation Program, Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts
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Heimann AF, Todorski IAS, Schmaranzer F, Viganò M, Lerch TD, Schwab JM, Steppacher SD, Tannast M. What Is the Influence of Femoral Version on Size, Tear Location, and Tear Pattern of the Acetabular Labrum in Patients With FAI? Clin Orthop Relat Res 2024:00003086-990000000-01466. [PMID: 38231022 DOI: 10.1097/corr.0000000000002961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/01/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Femoral version deformities have recently been identified as a major contributor to femoroacetabular impingement (FAI). An in-depth understanding of the specific labral damage patterns caused by femoral version deformities may help to understand the underlying pathomorphologies in symptomatic patients and select the appropriate surgical treatment. QUESTIONS/PURPOSES We asked: (1) Is there a correlation between femoral version and the mean cross-sectional area of the acetabular labrum? (2) Is there a difference in the location of lesions of the acetabular labrum between hips with increased femoral version and hips with decreased femoral version? (3) Is there a difference in the pattern of lesions of the acetabular labrum between hips with increased femoral version and hips with decreased femoral version? METHODS This was a retrospective, comparative study. Between November 2009 and September 2016, we evaluated 640 hips with FAI. We considered patients with complete diagnostic imaging including magnetic resonance arthrography (MRA) of the affected hip with radial slices of the proximal femur and axial imaging of the distal femoral condyles (allowing for calculation of femoral version) as eligible. Based on that, 97% (620 of 640 hips) were eligible; a further 77% (491 of 640 hips) were excluded because they had either normal femoral version (384 hips), incomplete imaging (20 hips), a lateral center-edge angle < 22° (43 hips) or > 39° (16 hips), age > 50 years (8 hips), or a history of pediatric hip disease (20 hips), leaving 20% (129 of 640 hips) of patients with a mean age of 27 ± 9 years for analysis, and 61% (79 of 129 hips) were female. Patients were assigned to either the increased (> 30°) or decreased (< 5°) femoral version group. The labral cross-sectional area was measured on radial MR images in all patients. The location-dependent labral cross-sectional area, presence of labral tears, and labral tear patterns were assessed using the acetabular clockface system and compared among groups. RESULTS In hips with increased femoral version, the labrum was normal in size (21 ± 6 mm2 [95% confidence interval 20 to 23 mm2]), whereas hips with decreased femoral version showed labral hypotrophy (14 ± 4 mm2 [95% CI 13 to 15 mm2]; p < 0.01). In hips with increased femoral version, labral tears were located more anteriorly (median 1:30 versus 12:00; p < 0.01). Hips with increased femoral version exhibited damage of the anterior labrum with more intrasubstance tears anterosuperiorly (17% [222 of 1322] versus 9% [93 of 1084]; p < 0.01) and partial tears anteroinferiorly (22% [36 of 165] versus 6% [8 of 126]; p < 0.01). Hips with decreased femoral version showed superior labral damage consisting primarily of partial labral tears. CONCLUSION In the evaluation of patients with FAI, the term "labral tear" is not accurate enough to describe labral pathology. Based on high-quality radial MR images, surgeons should always evaluate the combination of labral tear location and labral tear pattern, because these may provide insight into associated femoral version abnormalities, which can inform appropriate surgical treatment. Future studies should examine symptomatic patients with normal femoral version, as well as an asymptomatic control group, to describe the effect of femoral version on labral morphology across the entire spectrum of pathomorphologies. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Alexander F Heimann
- Department of Orthopaedic Surgery and Traumatology, HFR - Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Inga Almut Senta Todorski
- Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martino Viganò
- Department of Orthopaedic Surgery and Traumatology, HFR - Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Till D Lerch
- Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joseph M Schwab
- Department of Orthopaedic Surgery and Traumatology, HFR - Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic Surgery, Inselspital Bern, University Hospital, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery and Traumatology, HFR - Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
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Meier MK, Wagner M, Brunner A, Lerch TD, Steppacher SD, Vavron P, Schmaranzer E, Schmaranzer F. Correction: Can gadolinium contrast agents be replaced with saline for direct MR arthrography of the hip? A pilot study with arthroscopic comparison. Eur Radiol 2023; 33:9481. [PMID: 37402005 PMCID: PMC10667378 DOI: 10.1007/s00330-023-09844-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Affiliation(s)
- Malin K Meier
- Department of Orthopedic Surgery, Inselspital Bern, University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Moritz Wagner
- Department of Orthopaedic Surgery, District Hospital St. Johann in Tirol, Bahnhofstrasse 14, 6380, St. Johann in Tirol, Austria
| | - Alexander Brunner
- Department of Orthopaedic Surgery, District Hospital St. Johann in Tirol, Bahnhofstrasse 14, 6380, St. Johann in Tirol, Austria
| | - Till D Lerch
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopedic Surgery, Inselspital Bern, University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Peter Vavron
- Department of Orthopaedic Surgery, District Hospital St. Johann in Tirol, Bahnhofstrasse 14, 6380, St. Johann in Tirol, Austria
| | - Ehrenfried Schmaranzer
- Department of Radiology, District Hospital St. Johann in Tirol, Bahnhofstrasse 14, 6380, St. Johann in Tirol, Austria
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
- Department of Radiology, District Hospital St. Johann in Tirol, Bahnhofstrasse 14, 6380, St. Johann in Tirol, Austria.
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Werner P, Kuscu BS, Coti I, Puchner S, Loewe C, Schmaranzer F, Ad N, Laufer G, Andreas M, Ehrlich M. Aortic root geometry following composite valve graft implantation: Implications for future valve-in-valve procedures. J Thorac Cardiovasc Surg 2023; 166:1635-1643.e1. [PMID: 37263524 DOI: 10.1016/j.jtcvs.2023.05.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/28/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Biological composite valve grafts (CVGs) are being performed more frequently, which increases the need for interventions treating bioprosthetic valve failure. The feasibility of valve-in-valve procedures in this population is uncertain. This study aimed to assess changes in aortic root geometry and coronary height following CVG implantation to better understand future interventions. METHODS We retrospectively identified 64 patients following bioprosthetic CVG replacement with pre- and postoperative computed tomography angiography. Root assessment was conducted as in preprocedural transcatheter aortic valve evaluation using a virtual valve simulation. RESULTS In 64 patients (age, 67.6 ± 9.3 years; 76.6% men) the preoperative coronary height was 14.3 ± 6.8 mm for the left coronary artery (LCA) and 17.9 ± 5.9 mm for the right coronary artery (RCA), which significantly decreased after CVG implantation, with 8.7 ± 4.4 mm for the LCA and 11.3 ± 4.4 mm for the RCA (P < .001). The virtual valve-to-coronary distances measured 4.0 ± 1.3 mm (LCA) and 4.6 ± 1.4 mm (RCA). Overall, 59.4% (n = 38) of patients with bio-CVGs would have been at risk for coronary obstruction, 29.7% (n = 19) for LCA, 10.9% (n = 7) for RCA, and 18.8% (n = 12) for combined LCA and RCA. CONCLUSIONS Coronary height significantly decreased following CVG implantation. The majority of patients after bio-CVG were at a potential risk for coronary obstruction in future valve-in-valve procedures. Further studies are needed to identify the best possible technique for coronary reimplantation and other measures to diminish the risk for future coronary obstruction in this population.
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Affiliation(s)
- Paul Werner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
| | - Begüm Sena Kuscu
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Iuliana Coti
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Puchner
- Division of Interventional Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Christian Loewe
- Division of Interventional Radiology, Department of Radiology, Medical University of Vienna, Vienna, Austria
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital Bern, University of Bern, Bern, Switzerland
| | - Niv Ad
- Department of Surgery, Johns Hopkins University, Baltimore, Md
| | - Günther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Marek Ehrlich
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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Lerch TD, Nanavati AK, Heimann AF, Meier MK, Steppacher SD, Wagner M, Brunner A, Vavron P, Schmaranzer E, Schwab JM, Tannast M, Schmaranzer F. Are degenerative findings detected on traction MR arthrography of the hip associated with failure of arthroscopic femoroacetabular impingement surgery? Eur Radiol 2023:10.1007/s00330-023-10419-3. [PMID: 37982837 DOI: 10.1007/s00330-023-10419-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/04/2023] [Accepted: 10/15/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES To identify preoperative degenerative features on traction MR arthrography associated with failure after arthroscopic femoroacetabular impingement (FAI) surgery. METHODS Retrospective study including 102 patients (107 hips) undergoing traction magnetic resonance arthrography (MRA) of the hip at 1.5 T and subsequent hip arthroscopic FAI surgery performed (01/2016 to 02/2020) with complete follow-up. Clinical outcomes were assessed using the International Hip Outcome Tool (iHOT-12) score. Clinical endpoint for failure was defined as an iHOT-12 of < 60 points or conversion to total hip arthroplasty. MR images were assessed by two radiologists for presence of 9 degenerative lesions including osseous, chondrolabral/ligamentum teres lesions. Uni- and multivariate Cox regression analysis was performed to assess the association between MRI findings and failure of FAI surgery. RESULTS Of the 107 hips, 27 hips (25%) met at least one endpoint at a mean 3.7 ± 0.9 years follow-up. Osteophytic changes of femur or acetabulum (hazard ratio [HR] 2.5-5.0), acetabular cysts (HR 3.4) and extensive cartilage (HR 5.1) and labral damage (HR 5.5) > 2 h on the clockface were univariate risk factors (all p < 0.05) for failure. Three risk factors for failure were identified in multivariate analysis: Acetabular cartilage damage > 2 h on the clockface (HR 3.2, p = 0.01), central femoral osteophyte (HR 3.1, p = 0.02), and femoral cartilage damage with ligamentum teres damage (HR 3.0, p = 0.04). CONCLUSION Joint damage detected by preoperative traction MRA is associated with failure 4 years following arthroscopic FAI surgery and yields promise in preoperative risk stratification. CLINICAL RELEVANCE STATEMENT Evaluation of negative predictors on preoperative traction MR arthrography holds the potential to improve risk stratification based on the already present joint degeneration ahead of FAI surgery. KEY POINTS • Osteophytes, acetabular cysts, and extensive chondrolabral damage are risk factors for failure of FAI surgery. • Extensive acetabular cartilage damage, central femoral osteophytes, and combined femoral cartilage and ligamentum teres damage represent independent negative predictors. • Survival rates following hip arthroscopy progressively decrease with increasing prevalence of these three degenerative findings.
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Affiliation(s)
- Till D Lerch
- Department of Diagnostic-, Interventional- and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Andreas K Nanavati
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Alexander F Heimann
- Department of Orthopaedic Surgery and Traumatology, HFR - Cantonal Hospital, University of Fribourg, Chemin Des Pensionnats 2-6, 1700, Fribourg, Switzerland
| | - Malin K Meier
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Moritz Wagner
- Department of Orthopaedic Surgery and Traumatology, District Hospital St. Johann in Tirol, Bahnhofstrasse 14, 6380, St. Johann in Tirol, Austria
| | - Alexander Brunner
- Department of Orthopaedic Surgery and Traumatology, District Hospital St. Johann in Tirol, Bahnhofstrasse 14, 6380, St. Johann in Tirol, Austria
| | - Peter Vavron
- Department of Orthopaedic Surgery and Traumatology, District Hospital St. Johann in Tirol, Bahnhofstrasse 14, 6380, St. Johann in Tirol, Austria
| | - Ehrenfried Schmaranzer
- Department of Radiology, District Hospital St. Johann in Tirol, Bahnhofstrasse 14, 6380, St. Johann in Tirol, Austria
| | - Joseph M Schwab
- Department of Orthopaedic Surgery and Traumatology, HFR - Cantonal Hospital, University of Fribourg, Chemin Des Pensionnats 2-6, 1700, Fribourg, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery and Traumatology, HFR - Cantonal Hospital, University of Fribourg, Chemin Des Pensionnats 2-6, 1700, Fribourg, Switzerland
| | - Florian Schmaranzer
- Department of Diagnostic-, Interventional- and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
- Department of Radiology, Balgrist University Hospital, Faculty of Medicine, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
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Heimann AF, Walther J, Tannast M, Schwab JM, Wagner M, Brunner A, Lerch TD, Steppacher SD, Vavron P, Schmaranzer E, Schmaranzer F. Hip MRI in flexion abduction external rotation for assessment of the ischiofemoral interval in patients with hip pain-a feasibility study. Insights Imaging 2023; 14:172. [PMID: 37840102 PMCID: PMC10577115 DOI: 10.1186/s13244-023-01524-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/10/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVES To assess the feasibility of flexion-abduction-external rotation (FABER) magnetic resonance imaging (MRI) of the hip to visualize changes in the ischiofemoral interval and ability to provoke foveal excursion over the acetabular rim. METHODS IRB-approved retrospective single-center study. Patients underwent non-contrast 1.5-T hip MRI in the neutral and FABER position. Two readers measured the ischiofemoral interval at three levels: proximal/distal intertrochanteric distance and ischiofemoral space. Subgroup analysis was performed for hips with/without high femoral torsion, or quadratus femoris muscle edema (QFME), respectively. A receiver operating curve with calculation of the area under the curve (AUC) for the prediction of QFME was calculated. The presence of foveal excursion in both positions was assessed. RESULTS One hundred ten patients (121 hips, mean age 34 ± 11 years, 67 females) were evaluated. FABER-MRI led to narrowing (both p < .001) of the ischiofemoral interval which decreased more at the proximal (mean decrease by 26 ± 7 mm) than at the distal (6 ± 7 mm) intertrochanteric ridge. With high femoral torsion/ QFME, the ischiofemoral interval was significantly narrower at all three measurement locations compared to normal torsion/no QFME (p < .05). Accuracy for predicting QFME was high with an AUC of .89 (95% CI .82-.94) using a threshold of ≤ 7 mm for the proximal intertrochanteric distance. With FABER-MRI foveal excursion was more frequent in hips with QFME (63% vs 25%; p = .021). CONCLUSION Hip MRI in the FABER position is feasible, visualizes narrowing of the ischiofemoral interval, and can provoke foveal excursion. CRITICAL RELEVANCE STATEMENT FABER MRI may be helpful in diagnosing ischiofemoral impingement and detecting concomitant hip instability by overcoming shortcomings of static MR protocols that do not allow visualization of dynamic changes in the ischiofemoral interval and thus may improve surgical decision making. KEY POINTS • FABER MRI enables visualization of narrowing of the ischiofemoral interval proximal to the lesser trochanter. • Proximal intertrochanteric distance of ≤ 7 mm accurately predicts quadratus femoris muscle edema. • Foveal excursion was more frequent in hips with quadratus femoris muscle edema.
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Affiliation(s)
- Alexander F Heimann
- Department of Orthopaedic Surgery, HFR - Cantonal Hospital, University of Fribourg, Chemin des pensionnats 2 - 6, CH-1700, Fribourg, Switzerland.
| | - Jonas Walther
- Department of Orthopaedic Surgery, Inselspital Bern, University Hospital, University of Bern, Freiburgstrasse 18, Bern, CH-3010, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery, HFR - Cantonal Hospital, University of Fribourg, Chemin des pensionnats 2 - 6, CH-1700, Fribourg, Switzerland
| | - Joseph M Schwab
- Department of Orthopaedic Surgery, HFR - Cantonal Hospital, University of Fribourg, Chemin des pensionnats 2 - 6, CH-1700, Fribourg, Switzerland
| | - Moritz Wagner
- Department of Orthopaedic Surgery, District Hospital St. Johann in Tirol, Bahnhofstraße 14, 6380, St. Johann in Tirol, Austria
| | - Alexander Brunner
- Department of Orthopaedic Surgery, District Hospital St. Johann in Tirol, Bahnhofstraße 14, 6380, St. Johann in Tirol, Austria
| | - Till D Lerch
- Department of Diagnostic-, Interventional- and Pediatric Radiology, Inselspital Bern, University Hospital, University of Bern, Freiburgstrasse 18, Bern, CH-3010, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic Surgery, Inselspital Bern, University Hospital, University of Bern, Freiburgstrasse 18, Bern, CH-3010, Switzerland
| | - Peter Vavron
- Department of Orthopaedic Surgery, District Hospital St. Johann in Tirol, Bahnhofstraße 14, 6380, St. Johann in Tirol, Austria
| | - Ehrenfried Schmaranzer
- Department of Radiology, District Hospital St. Johann in Tirol, Bahnhofstraße 14, St. Johann in Tirol, 6380, Austria
| | - Florian Schmaranzer
- Department of Diagnostic-, Interventional- and Pediatric Radiology, Inselspital Bern, University Hospital, University of Bern, Freiburgstrasse 18, Bern, CH-3010, Switzerland
- Department of Radiology, Balgrist University Hospital, Forchstrasse 340, Zurich, CH-8008, Switzerland
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9
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Noebauer-Huhmann IM, Koenig FRM, Chiari C, Schmaranzer F. [Femoroacetabular impingement in adolescents]. Radiologie (Heidelb) 2023; 63:749-757. [PMID: 37698653 PMCID: PMC10522737 DOI: 10.1007/s00117-023-01197-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 09/13/2023]
Abstract
Femoroacetabular impingement syndrome (FAIS) is caused by a repetitive mechanical conflict between the acetabulum and the proximal femur, occurring in flexion and internal rotation. In cam impingement, bony prominences of the femoral head-neck junction induce chondrolabral damage. The acetabular type of FAIS, termed pincer FAIS, may be either due to focal or global retroversion and/or acetabular overcoverage. Combinations of cam and pincer morphology are common. Pathological femoral torsion may aggravate or decrease the mechanical conflict in FAI but can also occur in isolation. Of note, a high percentage of adolescents with FAI-like shape changes remain asymptomatic. The diagnosis of FAIS is therefore made clinically, whereas imaging reveals the underlying morphology. X‑rays in two planes remain the primary imaging modality, the exact evaluation of the osseous deformities of the femur and chondrolabral damage is assessed by magnetic resonance imaging (MRI). Acetabular coverage and version are primarily assessed on radiographs. Evaluation of the entire circumference of the proximal femur warrants MRI which is further used in the assessment of chondrolabral lesions, and also bone marrow and adjacent soft tissue abnormalities. The MRI protocol should routinely include measurements of femoral torsion. Fluid-sensitive sequences should be acquired to rule out degenerative or inflammatory extra-articular changes.
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Affiliation(s)
- Iris-M Noebauer-Huhmann
- Universitätsklinik für Radiologie und Nuklearmedizin, Abteilung für Neuroradiologie und Muskuloskelettale Radiologie, Medizinische Universität Wien, Wien, Österreich.
| | - Felix R M Koenig
- Universitätsklinik für Radiologie und Nuklearmedizin, Abteilung für Neuroradiologie und Muskuloskelettale Radiologie, Medizinische Universität Wien, Wien, Österreich
| | - Catharina Chiari
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Wien, Österreich
- Abteilung für Kinderorthopädie und Fußchirurgie, Orthopädisches Spital Speising, Wien, Österreich
| | - Florian Schmaranzer
- Universitätsklinik für Diagnostische‑, Interventionelle- und Pädiatrische Radiologie, Inselspital Bern, Universität Bern, Bern, Schweiz
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10
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Meier MK, Wagner M, Brunner A, Lerch TD, Steppacher SD, Vavron P, Schmaranzer E, Schmaranzer F. Can gadolinium contrast agents be replaced with saline for direct MR arthrography of the hip? A pilot study with arthroscopic comparison. Eur Radiol 2023; 33:6369-6380. [PMID: 37042981 PMCID: PMC10415454 DOI: 10.1007/s00330-023-09586-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 04/13/2023]
Abstract
OBJECTIVE To compare image quality and diagnostic performance of preoperative direct hip magnetic resonance arthrography (MRA) performed with gadolinium contrast agent and saline solution. METHODS IRB-approved retrospective study of 140 age and sex-matched symptomatic patients with femoroacetabular impingement, who either underwent intra-articular injection of 15-20 mL gadopentetate dimeglumine (GBCA), 2.0 mmol/L ("GBCA-MRA" group, n = 70), or 0.9% saline solution ("Saline-MRA" group, n = 70) for preoperative hip MRA and subsequent hip arthroscopy. 1.5 T hip MRA was performed including leg traction. Two readers assessed image quality using a 5-point Likert scale (1-5, excellent-poor), labrum and femoroacetabular cartilage lesions. Arthroscopic diagnosis was used to calculate diagnostic accuracy which was compared between groups with Fisher's exact tests. Image quality was compared with the Mann-Whitney U tests. RESULTS Mean age was 33 years ± 9, 21% female patients. Image quality was excellent (GBCA-MRA mean range, 1.1-1.3 vs 1.1-1.2 points for Saline-MRA) and not different between groups (all p > 0.05) except for image contrast which was lower for Saline-MRA group (GBCA-MRA 1.1 ± 0.4 vs Saline-MRA 1.8 ± 0.5; p < 0.001). Accuracy was high for both groups for reader 1/reader 2 for labrum (GBCA-MRA 94%/ 96% versus Saline-MRA 96%/93%; p > 0.999/p = 0.904) and acetabular (GBCA-MRA 86%/ 83% versus Saline-MRA 89%/87%; p = 0.902/p = 0.901) and femoral cartilage lesions (GBCA-MRA 97%/ 99% versus Saline-MRA 97%/97%; both p > 0.999). CONCLUSION Diagnostic accuracy and image quality of Saline-MRA and GBCA-MRA is high in assessing chondrolabral lesions underlining the potential role of non-gadolinium-based hip MRA. KEY POINTS • Image quality of Saline-MRA and GBCA-MRA was excellent for labrum, acetabular and femoral cartilage, ligamentum teres, and the capsule (all p > 0.18). • The overall image contrast was lower for Saline-MRA (Saline-MRA 1.8 ± 0.5 vs. GBCA-MRA 1.1 ± 0.4; p < 0.001). • Diagnostic accuracy was high for Saline-MRA and GBCA-MRA for labrum (96% vs. 94%; p > 0.999), acetabular cartilage damage (89% vs. 86%; p = 0.902), femoral cartilage damage (97% vs. 97%; p > 0.999), and extensive cartilage damage (97% vs. 93%; p = 0.904).
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Affiliation(s)
- Malin K Meier
- Department of Orthopedic Surgery, Inselspital Bern, University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Moritz Wagner
- Department of Orthopaedic Surgery, District Hospital St. Johann in Tirol, Bahnhofstrasse 14, 6380, St. Johann in Tirol, Austria
| | - Alexander Brunner
- Department of Orthopaedic Surgery, District Hospital St. Johann in Tirol, Bahnhofstrasse 14, 6380, St. Johann in Tirol, Austria
| | - Till D Lerch
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopedic Surgery, Inselspital Bern, University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Peter Vavron
- Department of Orthopaedic Surgery, District Hospital St. Johann in Tirol, Bahnhofstrasse 14, 6380, St. Johann in Tirol, Austria
| | - Ehrenfried Schmaranzer
- Department of Radiology, District Hospital St. Johann in Tirol, Bahnhofstrasse 14, 6380, St. Johann in Tirol, Austria
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
- Department of Radiology, District Hospital St. Johann in Tirol, Bahnhofstrasse 14, 6380, St. Johann in Tirol, Austria.
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11
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Leibold CS, Whitlock P, Schmaranzer F, Ziebarth K, Tannast M, Steppacher SD. Development of acetabular retroversion in LCPD hips-an observational radiographic study from early stage to healing. Arch Orthop Trauma Surg 2023; 143:3945-3956. [PMID: 36274080 PMCID: PMC10293407 DOI: 10.1007/s00402-022-04612-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/03/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acetabular retroversion is observed frequently in healed Legg-Calvé-Perthes disease (LCPD). Currently, it is unknown at which stage and with what prevalence retroversion occurs because in non-ossified hips, retroversion cannot be measured with standard radiographic parameters. METHODS In a retrospective, observational study; we examined pelvic radiographs in children with LCPD the time point of occurrence of acetabular retroversion and calculated predictive factors for retroversion. Between 2004 and 2017, we included 55 children with a mean age of 5.7 ± 2.4 years at diagnosis. The mean radiographic follow-up was 7.0 ± 4.4 years. We used two new radiographic parameters which allow assessment of acetabular version in non-ossified hips: the pelvic width index and the ilioischial angle. They are based on the fact that the pelvic morphology differs depending on the acetabular version. These parameters were compared among the four Waldenström stages and to the contralateral side. Logistic regression analysis was performed to determine predictive factors for acetabular retroversion. RESULTS Both parameters differed significantly among the stages of Waldenström (p < 0.003 und 0.038, respectively). A more retroverted acetabulum was found in stage II and III (prevalence ranging from 54 to 56%) compared to stage I and IV (prevalence ranging from 23 to 39%). In hips of the contralateral side without LCPD, the prevalence of acetabular retroversion was 0% in all stages for both parameters. Predictive factors for retroversion were younger age at stage II and IV, collapse of the lateral pillar in stage II or a non-dysplastic hip. CONCLUSIONS This is the first study evaluating acetabular version in children with LCPD from early stage to healing. In the developing hip, LCPD may result in acetabular retroversion and is most prevalent in the fragmentation (stage II) and early healing stage (stage III). Partial correction of acetabular retroversion can occur after healing. This has a potential clinical impact on the timing and type of surgical correction, especially in pelvic osteotomies for correction of acetabular version. LEVEL OF EVIDENCE Level III, retrospective observational study.
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Affiliation(s)
- Christiane Sylvia Leibold
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Patrick Whitlock
- Division of Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Florian Schmaranzer
- Department of Diagnostic-, Interventional- and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Kai Ziebarth
- Department of Pediatric Surgery, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery and Traumatology, HFR Cantonal Hospital, University of Fribourg, Chemin des Pensionnats 2-6, Villars-sur-Glâne, 1752 Fribourg, Switzerland
| | - Simon Damian Steppacher
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
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12
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Meier MK, Scheuber S, Hanke MS, Haefeli PC, Ruckli AC, Liechti EF, Gerber N, Lerch TD, Tannast M, Siebenrock KA, Steppacher SD, Schmaranzer F. Does the dGEMRIC Index Recover 3 Years After Surgical FAI Correction and an Initial dGEMRIC Decrease at 1-Year Follow-up? A Controlled Prospective Study. Am J Sports Med 2023:3635465231167854. [PMID: 37183998 DOI: 10.1177/03635465231167854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) allows objective and noninvasive assessment of cartilage quality. An interim analysis 1 year after correction of femoroacetabular impingement (FAI) previously showed that the dGEMRIC index decreased despite good clinical outcome. PURPOSE To evaluate dGEMRIC indices longitudinally in patients who underwent FAI correction and in a control group undergoing nonoperative treatment for FAI. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This prospective, comparative longitudinal study included 39 patients (40 hips) who received either operative (n = 20 hips) or nonoperative (n = 20 hips) treatment. Baseline demographic characteristics and presence of osseous deformities did not differ between groups. All patients received indirect magnetic resonance arthrography at 3 time points (baseline, 1 and 3 years of follow-up). The 3-dimensional cartilage models were created using a custom-developed deep learning-based software. The dGEMRIC indices were determined separately for acetabular and femoral cartilage. A mixed-effects model was used for statistical analysis in repeated measures. RESULTS The operative group showed an initial (preoperative to 1-year follow-up) decrease of dGEMRIC indices: acetabular from 512 ± 174 to 392 ± 123 ms and femoral from 530 ± 173 to 411 ± 117 ms (both P < .001). From 1-year to 3-year follow-up, dGEMRIC indices improved again: acetabular from 392 ± 123 to 456 ± 163 ms and femoral from 411 ± 117 to 477 ± 169 ms (both P < .001). The nonoperative group showed no significant changes in dGEMRIC indices in acetabular and femoral cartilage from baseline to either follow-up point (all P > .05). CONCLUSION This study showed that 3 years after FAI correction, the dGEMRIC indices improved compared with short-term 1-year follow-up. This may be due to normalized joint biomechanics or regressive postoperative activation of the inflammatory cascade after intra-articular surgery.
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Affiliation(s)
- Malin Kristin Meier
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Samira Scheuber
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus Simon Hanke
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pascal Cyrill Haefeli
- Department of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Adrian Cyrill Ruckli
- Personalized Medicine Research, School of Biomedical and Precision Engineering, University of Bern, Bern, Switzerland
| | - Emanuel Francis Liechti
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Gerber
- Personalized Medicine Research, School of Biomedical and Precision Engineering, University of Bern, Bern, Switzerland
| | - Till Dominic Lerch
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Klaus Arno Siebenrock
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon Damian Steppacher
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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13
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Rutsch N, Amrein P, Exadaktylos AK, Benneker LM, Schmaranzer F, Müller M, Albers CE, Bigdon SF. Cervical spine trauma - Evaluating the diagnostic power of CT, MRI, X-Ray and LODOX. Injury 2023:S0020-1383(23)00401-1. [PMID: 37164902 DOI: 10.1016/j.injury.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/01/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Traumatic cervical spine (c-spine) injuries account for 10% of all spinal injuries. The c-spine is prone to injury by blunt acceleration/deceleration traumas. The Canadian C-Spine rule and NEXUS criteria guide clinical decision-making but lack consensus on imaging modality when necessary. This study aims to evaluate the sensitivity and specificity of CT, MRI, X-Ray, and, for the first time, LODOX-Statscan in identifying c-spine injuries in patients with blunt trauma and neck pain. METHODS We conducted a retrospective monocenter cohort study using patient data from the emergency department at Inselspital, Bern, Switzerland's largest level one trauma center. We identified patients presenting with trauma and neck pain during the recruitment period from 01.01.2012 to 31.12.2017. We included all patients that required a radiographic c-spine evaluation according to the NEXUS criteria. Certified spine surgeons reviewed each case, analyzed patient demographics, injury classification, trauma mechanism, and emergency management. The retrospective full case review was established as gold standard to decide whether the c-spine was injured. Sensitivity and specificity were calculated for CT, MRI, LODOX, and X-Ray imaging methods. RESULTS We identified 4996 patients, of which 2321 met the inclusion criteria. 91.3% (n = 2120) patients received a CT scan, 8.9% (n = 206) a MRI, 9.3% (n = 215) an X-ray, and 21.5% (n = 498) a LODOX scan. By retrospective case review, 186 participants were classified as injured. The sensitivity of CT was 88.6% (specificity 99%), and 89.8% (specificity 99.2%) with orthopedic surgeon consultation. MRI had a sensitivity of 88.5% (specificity of 96.9%); highlighting 14 cases correctly diagnosed as injured by MRI and misdiagnosed by CT. Projection radiography (36.4% sensitivity, 95.1% specificity) and LODOX (5.3% sensitivity, 100% specificity) were unsuitable for ruling out spinal injury. CONCLUSION While CT offers high sensitivity for detecting traumatic c-spine injury, MRI holds clinical significance in revealing injuries not recognized by CT in symptomatic patients. LODOX and projection radiography are insufficient for accurately ruling out c-spine injury. For patients with neurological symptoms, we recommend extended MRI use when CT scans are negative.
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Affiliation(s)
- Niklas Rutsch
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, Freiburgstrasse 3010, Bern, Switzerland
| | - Pascale Amrein
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, Freiburgstrasse 3010, Bern, Switzerland
| | - Aristomenis K Exadaktylos
- Department of Emergency Medicine, Inselspital, Bern University Hospital, Freiburgstrasse 3010, Bern, Switzerland
| | - Lorin M Benneker
- Spine Service, Orthopedic Department, Sonnenhofspital, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Radiology, Inselspital, Bern University Hospital, Freiburgstrasse 3010, Bern, Switzerland
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, Freiburgstrasse 3010, Bern, Switzerland
| | - Christoph E Albers
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, Freiburgstrasse 3010, Bern, Switzerland
| | - Sebastian F Bigdon
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, Freiburgstrasse 3010, Bern, Switzerland.
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14
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Lerch TD, Kaim T, Hanke MS, Schmaranzer F, Steppacher SD, Busch JD, Novais EN, Ziebarth K. Assessment of femoral retroversion on preoperative hip magnetic resonance imaging in patients with slipped capital femoral epiphysis: Theoretical implications for hip impingement risk estimation. J Child Orthop 2023; 17:116-125. [PMID: 37034201 PMCID: PMC10080244 DOI: 10.1177/18632521221149044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/10/2022] [Indexed: 04/11/2023] Open
Abstract
Purpose Slipped capital femoral epiphysis is a common pediatric hip disease and was associated with femoral retroversion, but femoral version was rarely measured. Therefore, mean femoral version, mean femoral neck version, and prevalence of femoral retroversion were analyzed for slipped capital femoral epiphysis patients. Methods A retrospective observational study evaluating preoperative hip magnetic resonance imaging of 27 patients (49 hips) was performed. Twenty-seven untreated slipped capital femoral epiphysis patients (28 slipped capital femoral epiphysis hips and 21 contralateral hips, age 10-16 years) were evaluated (79% stable slipped capital femoral epiphysis, 22 patients; 43% severe slipped capital femoral epiphysis, 12 patients). Femoral version was measured using Murphy method on magnetic resonance imaging (January 2014-December 2021, rapid bilateral 3-dimensional T1 water-only Dixon-based images of pelvis and knee). All slipped capital femoral epiphysis patients underwent surgery after magnetic resonance imaging. Results Mean femoral version of slipped capital femoral epiphysis patients (-1° ± 15°) was significantly (p < 0.001) lower compared to contralateral side (15° ± 14°). Femoral version of slipped capital femoral epiphysis patients had significantly (p < 0.001) wider range from -42° to 35° (range 77°) compared to contralateral side (-5° to 44°, range 49°). Mean femoral neck version of slipped capital femoral epiphysis patients (6° ± 15°) was lower compared to contralateral side (11° ± 12°). Fifteen slipped capital femoral epiphysis patients (54%) had absolute femoral retroversion (femoral version < 0°). Six of the 12 hips (50%) with severe slips and 4 of the 8 hips (50%) with mild slips had absolute femoral retroversion (femoral version < 0°). Ten slipped capital femoral epiphysis patients (40%) had absolute femoral neck retroversion (femoral neck version < 0°). Conclusion Although slipped capital femoral epiphysis patients showed asymmetrically lower femoral version compared to contralateral side, there was a wide range of femoral version, underlining the importance of patient-specific femoral version analysis on preoperative magnetic resonance imaging. Absolute femoral retroversion was prevalent in half of slipped capital femoral epiphysis patients, in half of severe slipped capital femoral epiphysis patients, and in half of mild slipped capital femoral epiphysis patients. This has implications for anterior hip impingement and for surgical treatment with in situ pinning or femoral osteotomy (e.g. proximal femoral derotation osteotomy) or other hip preservation surgery.
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Affiliation(s)
- Till D Lerch
- Department of Diagnostic,
Interventional and Paediatric Radiology, Inselspital, University of Bern, Bern,
Switzerland
- Department of Orthopaedic Surgery,
Child and Young Adult Hip Preservation Program, Boston Children’s Hospital and
Harvard Medical School, Boston, MA, USA
- Till D Lerch, Department of Diagnostic,
Interventional and Paediatric Radiology, Inselspital, University of Bern,
Freiburgstrasse, 3010 Bern, Switzerland. Emails:
;
| | - Tilman Kaim
- Department of Diagnostic,
Interventional and Paediatric Radiology, Inselspital, University of Bern, Bern,
Switzerland
- Department of Orthopaedic Surgery,
Inselspital, University of Bern, Bern, Switzerland
| | - Markus S Hanke
- Department of Orthopaedic Surgery,
Inselspital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Diagnostic,
Interventional and Paediatric Radiology, Inselspital, University of Bern, Bern,
Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic Surgery,
Inselspital, University of Bern, Bern, Switzerland
| | - Jasmin D Busch
- Department of Diagnostic,
Interventional and Paediatric Radiology, Inselspital, University of Bern, Bern,
Switzerland
| | - Eduardo N Novais
- Department of Orthopaedic Surgery,
Child and Young Adult Hip Preservation Program, Boston Children’s Hospital and
Harvard Medical School, Boston, MA, USA
| | - Kai Ziebarth
- Department of Paediatric Surgery,
Inselspital, University of Bern, Bern, Switzerland
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15
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Lerch TD, Schmaranzer F. [Preoperative MR imaging for hip dysplasia : Assessment of associated deformities and intraarticular pathologies]. Orthopadie (Heidelb) 2023; 52:300-312. [PMID: 36976331 PMCID: PMC10063507 DOI: 10.1007/s00132-023-04356-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) is a known reason for hip pain for adolescents and young adults. Preoperative imaging is increasingly recognized as an important factor due to the recent advances in MR imaging. OBJECTIVES The aim of this article is to give an overview of preoperative imaging for DDH. The acetabular version and morphology, associated femoral deformities (cam deformity, valgus and femoral antetorsion) and intraarticular pathologies (labrum and cartilage damage) and cartilage mapping are described. METHODS After an initial evaluation with AP radiographs, CT or MRI represent the methods of choice for the preoperative evaluation of the acetabular morphology and cam deformity, and for the measurement of femoral torsion. Different measurement techniques and normal values should be considered, especially for patients with increased femoral antetorsion because this could lead to misinterpretation and misdiagnosis. MRI allows analysis of labrum hypertrophy and subtle signs for hip instability. 3D MRI for cartilage mapping allows quantification of biochemical cartilage degeneration and yields great potential for surgical decision-making. 3D-CT and, increasingly, 3D MRI of the hip to generate 3D pelvic bone models and subsequent 3D impingement simulation can help to detect posterior extraarticular ischiofemoral impingement. RESULTS AND DISCUSSION Acetabular morphology can be divided in anterior, lateral and posterior hip dysplasia. Combined osseous deformities are common, such as hip dysplasia combined with cam deformity (86%). Valgus deformities were reported in 44%. Combined hip dysplasia and increased femoral antetorsion can occur in 52%. Posterior extraarticular ischiofemoral impingement between the lesser trochanter and the ischial tuberosity can occur in patients with increased femoral antetorsion. Typically, labrum damage and hypertrophy, cartilage damage, subchondral cysts can occur in hip dysplasia. Hypertrophy of the muscle iliocapsularis is a sign for hip instability. Acetabular morphology and femoral deformities (cam deformity and femoral anteversion) should be evaluated before surgical therapy for patients with hip dysplasia, considering the different measurement techniques and normal values of femoral antetorsion.
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Affiliation(s)
- Till D Lerch
- Universitätsinstitut für diagnostische, interventionelle und pädiatrische Radiologie, Inselspital Bern, Universität Bern, Freiburgstr. 8, 3010, Bern, Schweiz.
| | - Florian Schmaranzer
- Universitätsinstitut für diagnostische, interventionelle und pädiatrische Radiologie, Inselspital Bern, Universität Bern, Freiburgstr. 8, 3010, Bern, Schweiz
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Thirumaran AJ, Murphy NJ, Eyles JP, Linklater J, Reichenbach S, Schmaranzer F, Lerch TD, Venkatesha V, Heller G, O'Donnell J, Hunter DJ. Do patients with femoroacetabular impingement syndrome who undergo hip arthroscopy display improved alpha angle (magnetic resonance imaging) and radiographic hip morphology? Int J Rheum Dis 2023; 26:354-359. [PMID: 36502534 PMCID: PMC10946938 DOI: 10.1111/1756-185x.14530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 11/14/2022] [Accepted: 11/26/2022] [Indexed: 12/14/2022]
Abstract
AIMS To compare (a) the change in radiological bony morphology between participants with femoroacetabular impingement (FAI) syndrome who underwent arthroscopic hip surgery compared to physiotherapist-led non-surgical care and (b) the change in radiological bony morphology between participants with FAI syndrome who underwent arthroscopic hip surgery involving cam resection or acetabular rim trimming or combined cam resection and acetabular rim trimming. METHODS Maximum alpha angle measurements on magnetic resonance imaging and Hip2 Norm standardized hip measurements on radiographs were recorded at baseline and at 12 months postoperatively. One-way analysis of covariance and independent T tests were conducted between participants who underwent arthroscopic hip surgery and physiotherapist-led non-surgical care. Independent T tests and analysis of variance were conducted between participants who underwent the 3 different arthroscopic hip procedures. RESULTS Arthroscopic hip surgery resulted in significant improvements to mean alpha angle measurements (decreased from 70.8° to 62.1°) (P value < .001, 95% CI -11.776, -4.772), lateral center edge angle (LCEA) (P value = .030, 95% CI -3.403, -0.180) and extrusion index (P value = 0.002, 95% CI 0.882, 3.968) compared to physiotherapist-led management. Mean maximum 1-year postoperative alpha angle was 59.0° (P value = .003, 95% CI 4.845, 18.768) for participants who underwent isolated cam resection. Measurements comparing the 3 different arthroscopic hip procedures only differed in total femoral head coverage (F[2,37] = 3.470, P = .042). CONCLUSION Arthroscopic hip surgery resulted in statistically significant improvements to LCEA, extrusion index and alpha angle as compared to physiotherapist-led management. Measured outcomes between participants who underwent cam resection and/or acetabular rim trimming only differed in total femoral head coverage.
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Affiliation(s)
| | - Nicholas J Murphy
- Sydney Musculoskeletal Health, Kolling Institute of Medical ResearchUniversity of SydneyCamperdownNew South WalesAustralia
- Department of Orthopedic SurgeryJohn Hunter HospitalNew LambtonNew South WalesAustralia
| | - Jillian Peta Eyles
- Sydney Musculoskeletal Health, Kolling Institute of Medical ResearchUniversity of SydneyCamperdownNew South WalesAustralia
- Department of RheumatologyRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - James M. Linklater
- Department of Musculoskeletal ImagingCastlereagh ImagingSt LeonardsNew South WalesAustralia
| | - Stephan Reichenbach
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Department of Rheumatology, Immunology and AllergologyUniversity Hospital and University of BernBernSwitzerland
- Department of Diagnostic, Interventional and Pediatric Radiology, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Till D. Lerch
- Department of Diagnostic, Interventional and Pediatric Radiology, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Venkatesha Venkatesha
- Northern Sydney Local Health District ExecutiveRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Gillian Heller
- Department of Statistics, Faculty of Science and EngineeringMacquarie UniversitySydneyNew South WalesAustralia
| | - John O'Donnell
- Hip Arthroscopy AustraliaMelbourneVictoriaAustralia
- St Vincent's Private HospitalMelbourneVictoriaAustralia
| | - David J. Hunter
- Sydney Musculoskeletal Health, Kolling Institute of Medical ResearchUniversity of SydneyCamperdownNew South WalesAustralia
- Department of RheumatologyRoyal North Shore HospitalSydneyNew South WalesAustralia
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Meier MK, Schmaranzer F, Kaim T, Tannast M, Novais EN, Siebenrock KA, Steppacher SD, Lerch TD. Combined femoral and acetabular version is sex-related and differs between patients with hip dysplasia and acetabular retroversion. Eur J Radiol 2023; 158:110634. [PMID: 36462225 DOI: 10.1016/j.ejrad.2022.110634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022]
Abstract
AIMS Frequency of abnormal femoral and acetabular version (AV) and combinations are unclear in patients with developmental dysplasia of the hip (DDH). This study aimed to investigate femoral version (FV), the proportion of increased FV and femoral retroversion, and combined-version (CV, FV+AV) in DDH patients and acetabular-retroversion (AR). PATIENTS AND METHODS A retrospective IRB-approved observational study was performed with 78 symptomatic DDH patients (90 hips) and 65 patients with femoroacetabular-impingement (FAI) due to AR (77 hips, diagnosis on AP radiographs). CT/MRI-based measurement of FV (Murphy method) and central AV were compared. Frequency of increased FV(FV > 25°), severely increased FV (FV > 35°) and excessive FV (FV > 45°) and of decreased FV (FV < 10°) and CV (McKibbin-index/COTAV-index) was analysed. RESULTS Mean FV and CV was significantly (p < 0.001) increased of DDH patients (mean ± SD of 25 ± 11° and 47 ± 18°) compared to AR (16 ± 11° and 28 ± 13°). Mean FV of female DDH patients (27 ± 16°) and AR (19 ± 12°) was significantly (p < 0.001) increased compared to male DDH patients (18 ± 13°) and AR (13 ± 8°). Frequency of increased FV (>25°) was 47% and of severely increased FV (>35°) was 23% for DDH patients. Proportion of femoral retroversion (FV < 10°) was significantly (p < 0.001) higher in patients AR (31%) compared to DDH patients (17%). 18% of DDH patients had AV > 25° combined with FV > 25°. Of patients with AR, 12% had FV < 10° combined with AV < 10°. CONCLUSION Patients with DDH and AR have remarkable sex-related differences of FV and CV. Frequency of severely increased FV > 35° (23%) is considerable for patients with DDH, but 17% exhibited decreased FV, that could influence management. The different combinations underline the importance of patient-specific evaluation before open hip preservation surgery (periacetabular osteotomy and femoral derotation osteotomy) and hip-arthroscopy.
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Affiliation(s)
- Malin K Meier
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland.
| | - Tilman Kaim
- Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland.
| | - Eduardo N Novais
- Department of Pediatric Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Klaus A Siebenrock
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Simon D Steppacher
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Till D Lerch
- Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland.
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Schmaranzer F, Justo P, Kallini JR, Ferrer MG, Miller PE, Matheney T, Bixby SD, Novais EN. MRI hip morphology is abnormal in unilateral DDH and increased lateral limbus thickness is associated with residual DDH at minimum 10-year follow-up. J Child Orthop 2022; 17:86-96. [PMID: 37034197 PMCID: PMC10080238 DOI: 10.1177/18632521221144060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/20/2022] [Indexed: 12/28/2022] Open
Abstract
Purpose: The purpose of the study was to compare the post-reduction magnetic resonance imaging morphology for hips that developed residual acetabular dysplasia, hips without residual dysplasia, and uninvolved contralateral hips in patients with unilateral developmental dysplasia of the hip undergoing closed or open reduction and had a minimum 10-year follow-up. Methods: Retrospective study of patients with unilateral dysplasia of the hip who underwent open/closed hip reduction followed by post-reduction magnetic resonance imaging. Twenty-eight patients with a mean follow-up of 13 ± 3 years were included. In the treated hips, residual dysplasia was defined as subsequent surgery for residual acetabular dysplasia or for Severin grade > 2 at latest follow-up. On post-reduction, magnetic resonance imaging measurements were performed by two readers and compared between the hips with/without residual dysplasia and the contralateral uninvolved side. Magnetic resonance imaging measurements included acetabular version, coronal/ axial femoroacetabular distance, acetabular depth–width ratio, osseous/cartilaginous acetabular indices, and medial/lateral (limbus) cartilage thickness. Results: Fifteen (54%) and 13 (46%) hips were allocated to the “no residual dysplasia” group and to the “residual dysplasia” group, respectively. All eight magnetic resonance imaging parameters differed between hips with residual dysplasia and contralateral uninvolved hips (all p < 0.05). Six of eight parameters differed (all p < 0.05) between hips with and without residual dysplasia. Among these, increased limbus thickness had the largest effect (odds ratio = 12.5; p < 0.001) for increased likelihood of residual dysplasia. Conclusions: We identified acetabular morphology and reduction quality parameters that can be reliably measured on the post-reduction magnetic resonance imaging to facilitate the differentiation between hips that develop with/without residual acetabular dysplasia at 10 years postoperatively. Level of evidence: level III, prognostic case-control study.
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Affiliation(s)
- Florian Schmaranzer
- Department of Orthopaedic Surgery,
Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Diagnostic,
Interventional and Pediatric Radiology, Inselspital, Bern University Hospital,
University of Bern, Bern, Switzerland
| | - Pedro Justo
- Department of Orthopaedic Surgery,
Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jennifer R Kallini
- Department of Orthopaedic Surgery,
Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Marianna G Ferrer
- Department of Orthopaedic Surgery,
Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Patricia E Miller
- Department of Orthopaedic Surgery,
Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Travis Matheney
- Department of Orthopaedic Surgery,
Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah D Bixby
- Department of Orthopaedic Surgery,
Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Eduardo N Novais
- Department of Orthopaedic Surgery,
Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
- Eduardo N Novais, Department of Orthopaedic
Surgery, Boston Children’s Hospital, Harvard Medical School, 300 Longwood
Avenue, Boston, MA 02115, USA.
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Hecker A, Schmaranzer F, Huber C, Maurer J, Egli RJ, Eberlein SC, Klenke FM. Treatment of Knee Dislocation With Primary Repair and Suture Augmentation: A Viable Solution. Orthop J Sports Med 2022; 10:23259671221132555. [PMID: 36425010 PMCID: PMC9678999 DOI: 10.1177/23259671221132555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Different surgical techniques have been described for the treatment of knee
dislocation (KD). Nonoperative approaches are frequently combined with
surgical reconstruction using auto- or allograft. Purpose: To evaluate the midterm results of primary surgical repair and suture
augmentation to treat KD. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 patients (5 women, 17 men; mean age, 45 ± 15 years) with KD
were evaluated at a mean of 49 ± 16 months after surgical treatment that
included primary repair and suture augmentation. Magnetic resonance imaging,
stress radiographs, and outcome scores were obtained at the follow-up.
Clinical examination including hop tests and force measurements for flexion
and extension was performed. Results: The mean difference in pre- to postinjury Tegner scores was –2 ± 1. The
outcome scores showed mean values of 84 ± 15 (Lysholm), 73 ± 15
(International Knee Documentation Committee) and 65 ± 25 (Anterior Cruciate
Ligament–Return to Sport after Injury scale). Compared with the uninjured
knee, the range of motion of the injured knee was reduced by 21° ± 12°.
Twelve patients felt fit enough to perform hop tests and showed a mean
deficit of 7% ± 17%° compared with the uninjured leg. The mean force deficit
was 19% ± 18% for extension and 8% ± 16% for flexion. Stress radiographs
revealed an 11 ± 7–mm higher anteroposterior translation on the injured
side. Four patients had secondary ligament reconstructions due to persistent
instability and 7 underwent arthroscopic arthrolysis due to stiffness. A
significant increase of osteoarthritis was found for the medial, lateral,
and patellofemoral compartments (P = .007, .004, and .006,
respectively). Conclusion: Primary repair and suture augmentation of KD led to satisfactory clinical
midterm results despite persistent radiological instability and a
significant increase in osteoarthritis. This technique allows the return to
activities of daily living without subjective instability in most
nonathletic patients. Secondary ligament reconstructions should be performed
if relevant instability persists to decrease the risk of secondary meniscal
and cartilage damage.
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Affiliation(s)
- Andreas Hecker
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Florian Schmaranzer
- Department for Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Christoph Huber
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Jonas Maurer
- Department of Physiotherapy, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Rainer J. Egli
- Department for Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Sophie C. Eberlein
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Frank M. Klenke
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Switzerland
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Abstract
Aims To evaluate how abnormal proximal femoral anatomy affects different femoral version measurements in young patients with hip pain. Methods First, femoral version was measured in 50 hips of symptomatic consecutively selected patients with hip pain (mean age 20 years (SD 6), 60% (n = 25) females) on preoperative CT scans using different measurement methods: Lee et al, Reikerås et al, Tomczak et al, and Murphy et al. Neck-shaft angle (NSA) and α angle were measured on coronal and radial CT images. Second, CT scans from three patients with femoral retroversion, normal femoral version, and anteversion were used to create 3D femur models, which were manipulated to generate models with different NSAs and different cam lesions, resulting in eight models per patient. Femoral version measurements were repeated on manipulated femora. Results Comparing the different measurement methods for femoral version resulted in a maximum mean difference of 18° (95% CI 16 to 20) between the most proximal (Lee et al) and most distal (Murphy et al) methods. Higher differences in proximal and distal femoral version measurement techniques were seen in femora with greater femoral version (r > 0.46; p < 0.001) and greater NSA (r > 0.37; p = 0.008) between all measurement methods. In the parametric 3D manipulation analysis, differences in femoral version increased 11° and 9° in patients with high and normal femoral version, respectively, with increasing NSA (110° to 150°). Conclusion Measurement of femoral version angles differ depending on the method used to almost 20°, which is in the range of the aimed surgical correction in derotational femoral osteotomy and thus can be considered clinically relevant. Differences between proximal and distal measurement methods further increase by increasing femoral version and NSA. Measurement methods that take the entire proximal femur into account by using distal landmarks may produce more sensitive measurements of these differences. Cite this article: Bone Jt Open 2022;3(10):759–766.
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Affiliation(s)
- Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University Bern, Bern, Switzerland
| | - Malin K. Meier
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University Bern, Bern, Switzerland
| | - Till D. Lerch
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University Bern, Bern, Switzerland
| | - Andreas Hecker
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University Bern, Bern, Switzerland
| | - Simon D. Steppacher
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University Bern, Bern, Switzerland
| | - Eduardo N. Novais
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ata M. Kiapour
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Lerch TD, Antioco T, Boschung A, Meier MK, Schmaranzer F, Novais EN, Tannast M, Steppacher SD. Hip Impingement Location in Maximal Hip Flexion in Patients With Femoroacetabular Impingement With and Without Femoral Retroversion. Am J Sports Med 2022; 50:2989-2997. [PMID: 36037094 DOI: 10.1177/03635465221110887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Symptomatic patients with femoroacetabular impingement (FAI) have limitations in daily activities and sports and report the exacerbation of hip pain in deep flexion. Yet, the exact impingement location in deep flexion and the effect of femoral version (FV) are unclear. PURPOSE To investigate the acetabular and femoral locations of intra- or extra-articular hip impingement in flexion in patients with FAI with and without femoral retroversion. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS An institutional review board-approved retrospective study involving 84 hips (68 participants) was performed. Of these, symptomatic patients (37 hips) with anterior FAI and femoral retroversion (FV <5°) were compared with symptomatic patients (21 hips) with anterior FAI (normal FV) and with a control group (26 asymptomatic hips without FAI and normal FV). All patients were symptomatic, had anterior hip pain, and had positive anterior impingement test findings. Most of the patients had hip/groin pain in maximal flexion or deep flexion or during sports. All 84 hips underwent pelvic computed tomography (CT) to measure FV as well as validated dynamic impingement simulation with patient-specific CT-based 3-dimensional models using the equidistant method. RESULTS In maximal hip flexion, femoral impingement was located anterior-inferior at 4 o'clock (57%) and 5 o'clock (32%) in patients with femoral retroversion and mostly at 5 o'clock in patients without femoral retroversion (69%) and in asymptomatic controls (76%). Acetabular intra-articular impingement was located anterior-superior (2 o'clock) in all 3 groups. In 125° of flexion, patients with femoral retroversion had a significantly (P < .001) higher prevalence of anterior extra-articular subspine impingement (54%) and anterior intra-articular impingement (89%) compared with the control group (29% and 62%, respectively). CONCLUSION Knowing the exact location of hip impingement in deep flexion has implications for surgical treatment, sports, and physical therapy and confirms previous recommendations: Deep flexion (eg, during squats/lunges) should be avoided in patients with FAI and even more in patients with femoral retroversion. Patients with femoral retroversion may benefit and have less pain when avoiding deep flexion. For these patients, the femoral location of the impingement conflict in flexion was different (anterior-inferior) and distal to the cam deformity compared with the location during the anterior impingement test (anterior-superior). This could be important for preoperative planning and bone resection (cam resection or acetabular rim trimming) during hip arthroscopy or open hip preservation surgery to ensure that the region of impingement is appropriately identified before treatment.
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Affiliation(s)
- Till D Lerch
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tiziano Antioco
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adam Boschung
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Malin K Meier
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Eduardo N Novais
- Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Moritz Tannast
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Orthopedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Simon D Steppacher
- Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Ruckli AC, Schmaranzer F, Meier MK, Lerch TD, Steppacher SD, Tannast M, Zeng G, Burger J, Siebenrock KA, Gerber N, Gerber K. Automated quantification of cartilage quality for hip treatment decision support. Int J Comput Assist Radiol Surg 2022; 17:2011-2021. [PMID: 35976596 PMCID: PMC9515031 DOI: 10.1007/s11548-022-02714-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022]
Abstract
Purpose Preservation surgery can halt the progress of joint degradation, preserving the life of the hip; however, outcome depends on the existing cartilage quality. Biochemical analysis of the hip cartilage utilizing MRI sequences such as delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), in addition to morphological analysis, can be used to detect early signs of cartilage degradation. However, a complete, accurate 3D analysis of the cartilage regions and layers is currently not possible due to a lack of diagnostic tools. Methods A system for the efficient automatic parametrization of the 3D hip cartilage was developed. 2D U-nets were trained on manually annotated dual-flip angle (DFA) dGEMRIC for femoral head localization and cartilage segmentation. A fully automated cartilage sectioning pipeline for analysis of central and peripheral regions, femoral-acetabular layers, and a variable number of section slices, was developed along with functionality for the automatic calculation of dGEMRIC index, thickness, surface area, and volume. Results The trained networks locate the femoral head and segment the cartilage with a Dice similarity coefficient of 88 ± 3 and 83 ± 4% on DFA and magnetization-prepared 2 rapid gradient-echo (MP2RAGE) dGEMRIC, respectively. A completely automatic cartilage analysis was performed in 18s, and no significant difference for average dGEMRIC index, volume, surface area, and thickness calculated on manual and automatic segmentation was observed. Conclusion An application for the 3D analysis of hip cartilage was developed for the automated detection of subtle morphological and biochemical signs of cartilage degradation in prognostic studies and clinical diagnosis. The segmentation network achieved a 4-time increase in processing speed without loss of segmentation accuracy on both normal and deformed anatomy, enabling accurate parametrization. Retraining of the networks with the promising MP2RAGE protocol would enable analysis without the need for B1 inhomogeneity correction in the future.
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Affiliation(s)
- Adrian C Ruckli
- sitem Center for Translational Medicine and Biomedical Entrepreneurship, Personalised Medicine, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Diagnostic-, Interventional- and Pediatric Radiology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Malin K Meier
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Till D Lerch
- Department of Diagnostic-, Interventional- and Pediatric Radiology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Guodong Zeng
- sitem Center for Translational Medicine and Biomedical Entrepreneurship, Personalised Medicine, University of Bern, Bern, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Jürgen Burger
- sitem Center for Translational Medicine and Biomedical Entrepreneurship, Personalised Medicine, University of Bern, Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Nicolas Gerber
- sitem Center for Translational Medicine and Biomedical Entrepreneurship, Personalised Medicine, University of Bern, Bern, Switzerland.
| | - Kate Gerber
- sitem Center for Translational Medicine and Biomedical Entrepreneurship, Personalised Medicine, University of Bern, Bern, Switzerland
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Meier MK, Reche J, Schmaranzer F, von Tengg-Kobligk H, Steppacher SD, Tannast M, Novais EN, Lerch TD. How frequent is absolute femoral retroversion in symptomatic patients with cam- and pincer-type femoroacetabular impingement? Bone Jt Open 2022; 3:557-565. [PMID: 35819309 PMCID: PMC9350700 DOI: 10.1302/2633-1462.37.bjo-2022-0049.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims The frequency of severe femoral retroversion is unclear in patients with femoroacetabular impingement (FAI). This study aimed to investigate mean femoral version (FV), the frequency of absolute femoral retroversion, and the combination of decreased FV and acetabular retroversion (AR) in symptomatic patients with FAI subtypes. Methods A retrospective institutional review board-approved observational study was performed with 333 symptomatic patients (384 hips) with hip pain due to FAI evaluated for hip preservation surgery. Overall, 142 patients (165 hips) had cam-type FAI, while 118 patients (137 hips) had mixed-type FAI. The allocation to each subgroup was based on reference values calculated on anteroposterior radiographs. CT/MRI-based measurement of FV (Murphy method) and AV were retrospectively compared among five FAI subgroups. Frequency of decreased FV < 10°, severely decreased FV < 5°, and absolute femoral retroversion (FV < 0°) was analyzed. Results A significantly (p < 0.001) lower mean FV was found in patients with cam-type FAI (15° (SD 10°)), and in patients with mixed-type FAI (17° (SD 11°)) compared to severe over-coverage (20° (SD 12°). Frequency of decreased FV < 10° was significantly (p < 0.001) higher in patients with cam-type FAI (28%, 46 hips) and in patients with over-coverage (29%, 11 hips) compared to severe over-coverage (12%, 5 hips). Absolute femoral retroversion (FV < 0°) was found in 13% (5 hips) of patients with over-coverage, 6% (10 hips) of patients with cam-type FAI, and 5% (7 hips) of patients with mixed-type FAI. The frequency of decreased FV< 10° combined with acetabular retroversion (AV < 10°) was 6% (8 hips) in patients with mixed-type FAI and 5% (20 hips) in all FAI patients. Of patients with over-coverage, 11% (4 hips) had decreased FV < 10° combined with acetabular retroversion (AV < 10°). Conclusion Patients with cam-type FAI had a considerable proportion (28%) of decreased FV < 10° and 6% had absolute femoral retroversion (FV < 0°), even more for patients with pincer-type FAI due to over-coverage (29% and 13%). This could be important for patients evaluated for open hip preservation surgery or hip arthroscopy, and each patient requires careful personalized evaluation. Cite this article: Bone Jt Open 2022;3(7):557–565.
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Affiliation(s)
- Malin K. Meier
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jelena Reche
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hendrik von Tengg-Kobligk
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon D. Steppacher
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Eduardo N. Novais
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Till D. Lerch
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Anwander H, Alkhatatba M, Lerch T, Schmaranzer F, Krause FG. Evaluation of Radiographic Features Including Metatarsus Primus Elevatus in Hallux Rigidus. J Foot Ankle Surg 2022; 61:831-835. [PMID: 34974984 DOI: 10.1053/j.jfas.2021.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/24/2021] [Accepted: 11/29/2021] [Indexed: 02/03/2023]
Abstract
The etiology of hallux rigidus remains a controversial issue in foot and ankle surgery, i.e., the relationship between metatarsus primus elevatus (MPE) and hallux rigidus. The purpose of this study was to evaluate several radiographic parameters including first metatarsal elevation in patients with hallux rigidus compared to a matched control group. A retrospective case control study was performed including 50 feet, 25 feet with and 25 feet without hallux rigidus. In the patients with hallux rigidus, the first metatarsal was more elevated than in the control group (8.3 ± 1.7 mm vs 3.0 ± 2.0 mm, p < .001) and in 60% of patients with hallux rigidus MPE was diagnosed, compared to zero patients in the control group (p < .001). The lateral 1 to 2 intermetatarsal angle was higher in patients with hallux rigidus (3.6 ± 2.5 vs -0.7 ± 2.8; p < .001). The first metatarsal declination angle was not different between the 2 groups. Intraclass correlation coefficient between 2 observers for measuring the first metatarsal elevation was 0.929 (p < .001). In the current study, increased elevation of the first metatarsal, a higher incidence of MPE and increased lateral 1 to 2 intermetatarsal angle were found in patients with hallux rigidus compared to the control group. These findings support the theory of an association between MPE and hallux rigidus. Further high reliability of first metatarsal elevation measurement was found in our study.
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Affiliation(s)
- Helen Anwander
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mohammad Alkhatatba
- Department of Special Surgery, Jordan University of Science and Technology, Irbid, Jordan
| | - Till Lerch
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabian G Krause
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Lerch T, Meier M, Steppacher S, Zeng G, Schmaranzer F. Deep Learning for Automatic Bone Segmentation of the Pelvis using MRI with T1 VIBE Dixon for FAI Patients. Semin Musculoskelet Radiol 2022. [DOI: 10.1055/s-0042-1750642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lerch T, Schmaranzer F, Hanke M, Meier M, Steppacher S. Femoral Torsion Measurement Using MRI with T1 VIBE Dixon Compared with Matched CT of Adult Femoroacetabular Impingement Patients. Semin Musculoskelet Radiol 2022. [DOI: 10.1055/s-0042-1750669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Meier M, Zeng G, Lerch T, Gerber N, Tannast M, Siebenrock K, Steppacher S, Schmaranzer F. Deep Learning Fully Automated 3D Models of Hip Labrum Based on MR Arthrography Are Feasible and Allow Detection of Differences in Labrum Volume among Different Hip Deformities: A Pilot Study. Semin Musculoskelet Radiol 2022. [DOI: 10.1055/s-0042-1750631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lerch T, Hanke M, Schmaranzer F, Steppacher S, Ziebarth K, Busch J. MR-based 3D Models for SCFE Patients for Patient-specific Preoperative Planning of Modified Dunn Procedure or Hip Preservation Surgery: Feasibility Study. Semin Musculoskelet Radiol 2022. [DOI: 10.1055/s-0042-1750633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lerch TD, Antioco T, Meier MK, Boschung A, Hanke MS, Tannast M, Siebenrock KA, Schmaranzer F, Steppacher SD. Combined abnormalities of femoral version and acetabular version and McKibbin Index in FAI patients evaluated for hip preservation surgery. J Hip Preserv Surg 2022; 9:67-77. [PMID: 35854804 PMCID: PMC9291377 DOI: 10.1093/jhps/hnac016] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/20/2022] [Accepted: 03/07/2022] [Indexed: 01/04/2023] Open
Abstract
Frequencies of combined abnormalities of femoral version (FV) and acetabular version (AV) and of abnormalities of the McKibbin index are unknown. To investigate the prevalence of combined abnormalities of FV and AV and of abnormalities of the McKibbin index in symptomatic patients with femoroacetabular impingement (FAI), a retrospective, Institutional Review Board (IRB)-approved study of 333 symptomatic patients (384 hips) that were presented with hip pain and FAI was performed. The computed tomography/magnetic resonance imaging based measurement of central AV, cranial AV and FV was compared among five subgroups with distinguished FAI subgroups and patients that underwent a hip preservation surgery. The allocation to each subgroup was based on AP radiographs. Normal AV and FV were 10–25°. The McKibbin index is the sum of central AV and FV. Of patients that underwent a hip preservation surgery, 73% had a normal McKibbin index (20–50°) but 27% had an abnormal McKibbin index. Of all patients, 72% had a normal McKibbin index, but 28% had abnormal McKibbin index. The prevalence of combined abnormalities of FV and AV varied among subgroups: a higher prevalence of decreased central AV combined with decreased FV of patients with acetabular-retroversion group (12%) and overcoverage (11%) was found compared with mixed-type FAI (5%). Normal AV combined with normal FV was present in 41% of patients with cam-type FAI and in 34% of patients with overcoverage. Patients that underwent a hip preservation surgery had normal mean FV (17 ± 11°), central AV (19 ± 7°), cranial AV (16 ± 10°) and McKibbin index (36 ± 14°). Frequency of combined abnormalities of AV and FV differs between subgroups of FAI patients. Aggravated and compensated McKibbin index was prevalent in FAI patients. This has implications for open hip preservation surgery (surgical hip dislocation or femoral derotation osteotomy) or hip arthroscopy or non-operative treatment.
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Affiliation(s)
| | - Tiziano Antioco
- Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Malin K Meier
- Department of Orthopaedic Surgery, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Adam Boschung
- Department of Orthopaedic Surgery, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland
- Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Markus S Hanke
- Department of Orthopaedic Surgery, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland
- Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopaedic Surgery, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic Surgery, University of Bern, Inselspital, Bern University Hospital, Bern, Switzerland
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Lerch TD, Schmaranzer F, Steppacher SD, Ziebarth K, Tannast M, Siebenrock KA. Most of patients with femoral derotation osteotomy for posterior extraarticular hip impingement and high femoral version would do surgery again. Hip Int 2022; 32:253-264. [PMID: 32866044 DOI: 10.1177/1120700020953100] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIMS To assess (1) hip pain and function and ROM; (2) subsequent surgeries, complications; and (3) subjective satisfaction and PROMs in patients undergoing femoral derotation osteotomies. METHODS Femoral derotation subtrochanteric osteotomies to treat symptomatic posterior extraarticular ischiofemoral hip impingement were performed in 23 patients (25 hips) between 2013 and 2017. The mean age was 26 ± 8 years (96% female) with a minimum 2-year follow-up (mean follow-up of 4 ± 1 years). Surgical indication was a positive posterior impingement test and limited external rotation (mean 16° ± 8°) in extension in patients with abnormal high femoral version (mean 46° ± 9, measured on CT scans with the Murphy method) and high McKibbin instability index (mean 67°). Femoral osteotomies were combined with a surgical hip dislocation in 96% for cam resection and labrum or cartilage treatment. Preoperative MRI and 3D-CT with dynamic impingement simulation were evaluated. RESULTS (1) The posterior impingement test decreased significantly from preoperatively 100% to 4% (p < 0.001). External rotation in extension increased significantly (p < 0.001) from preoperative 16° ± 8 to 44° ± 16°. The MdA score increased significantly from 14 ± 1 to 16 ± 2 (p < 0.001) points.(2) At follow-up, all 25 hips were preserved. No conversion to THA and no revision osteosynthesis was performed. 64% underwent complete hardware removal.(3) 80% of the patients reported at follow-up that they would undergo surgery again. Subjective satisfaction (SHV) increased significantly (p < 0.001) from preoperatively 24% to 84% postoperatively. CONCLUSIONS Femoral derotation subtrochanteric osteotomies for the treatment of posterior extraarticular ischiofemoral hip impingement are safe and improve posterior hip pain and function and external rotation in mostly female patients with high femoral version and a high McKibbin instability index.
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Affiliation(s)
- Till D Lerch
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kai Ziebarth
- Department of Paediatric Orthopaedics, Children`s Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital, University of Fribourg, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Lerch TD, Meier MK, Boschung A, Steppacher SD, Siebenrock KA, Tannast M, Schmaranzer F. Diagnosis of acetabular retroversion: Three signs positive and increased retroversion index have higher specificity and higher diagnostic accuracy compared to isolated positive cross over sign. Eur J Radiol Open 2022; 9:100407. [PMID: 35242888 PMCID: PMC8885617 DOI: 10.1016/j.ejro.2022.100407] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/13/2022] [Accepted: 02/17/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives The crossover-sign (COS) is a radiographic sign for diagnosis of acetabular-retroversion(AR) in patients with femoroacetabular-impingement (FAI) but overestimates AR. Three signs combined with retroversion-index (RI) could potentially improve diagnostic-accuracy. Aims To calculate central acetabular-version (AV, CT/MRI) in patients with isolated positive COS and in patients with three radiographic signs for AR on radiographs (AP). To calculate diagnostic performance of positive COS and of three signs combined with retroversion-index (RI) > 30% on radiographs (AP) to detect global AR (AV < 10°, CT/MRI).
Methods A retrospective, IRB-approved, controlled diagnostic study comparing radiographic signs for AR (AP radiographs) with MRI/CT-based measurement of central AV was performed. 462 symptomatic patients (538 hips) with FAI or hip-dysplasia were compared to control-group (48 hips). Three signs for AR(on radiographs) were analyzed: COS, posterior-wall-sign and ischial-spine-sign. RI (synonym cross-over-index) quantifies overlap of anterior and posterior wall in case of positive COS. Diagnostic performance for COS and for three signs combined with RI > 30% to detect central AV < 10° (global AR) was calculated. Results Central AV was significantly (p < 0.001) decreased (13 ± 6°, CT/MRI) in patients with three signs for AR and RI > 30% on radiographs compared to patients with positive COS (18 ± 7°). Sensitivity and specificity of three signs combined with RI > 30% on radiographs was 85% and 63% (87% and 23% for COS). Negative-predictive-value (NPV) was 94% (93% for COS) to rule out global AR (AV < 10°, CT/MRI). Diagnostic accuracy increased significantly (p < 0.001) from 31% (COS) to 68% using three signs.
Conclusion Improved specificity and diagnostic accuracy for diagnosis of global AR can help to avoid misdiagnosis. Global AR can be ruled out with a probability of 94% (NPV) in the absence of three radiographic signs combined with retroversion-index < 30% (e.g. isolated COS positive).
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Zeng G, Degonda C, Boschung A, Schmaranzer F, Gerber N, Siebenrock KA, Steppacher SD, Tannast M, Lerch TD. Three-Dimensional Magnetic Resonance Imaging Bone Models of the Hip Joint Using Deep Learning: Dynamic Simulation of Hip Impingement for Diagnosis of Intra- and Extra-articular Hip Impingement. Orthop J Sports Med 2021; 9:23259671211046916. [PMID: 34938819 PMCID: PMC8685729 DOI: 10.1177/23259671211046916] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/23/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Dynamic 3-dimensional (3D) simulation of hip impingement enables better
understanding of complex hip deformities in young adult patients with
femoroacetabular impingement (FAI). Deep learning algorithms may improve
magnetic resonance imaging (MRI) segmentation. Purpose: (1) To evaluate the accuracy of 3D models created using convolutional neural
networks (CNNs) for fully automatic MRI bone segmentation of the hip joint,
(2) to correlate hip range of motion (ROM) between manual and automatic
segmentation, and (3) to compare location of hip impingement in 3D models
created using automatic bone segmentation in patients with FAI. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The authors retrospectively reviewed 31 hip MRI scans from 26 symptomatic
patients (mean age, 27 years) with hip pain due to FAI. All patients had
matched computed tomography (CT) and MRI scans of the pelvis and the knee.
CT- and MRI-based osseous 3D models of the hip joint of the same patients
were compared (MRI: T1 volumetric interpolated breath-hold examination
high-resolution sequence; 0.8 mm3 isovoxel). CNNs were used to
develop fully automatic bone segmentation of the hip joint, and the 3D
models created using this method were compared with manual segmentation of
CT- and MRI-based 3D models. Impingement-free ROM and location of hip
impingement were calculated using previously validated collision detection
software. Results: The difference between the CT- and MRI-based 3D models was <1 mm, and the
difference between fully automatic and manual segmentation of MRI-based 3D
models was <1 mm. The correlation of automatic and manual MRI-based 3D
models was excellent and significant for impingement-free ROM
(r = 0.995; P < .001), flexion
(r = 0.953; P < .001), and internal
rotation at 90° of flexion (r = 0.982; P
< .001). The correlation for impingement-free flexion between automatic
MRI-based 3D models and CT-based 3D models was 0.953 (P
< .001). The location of impingement was not significantly different
between manual and automatic segmentation of MRI-based 3D models, and the
location of extra-articular hip impingement was not different between CT-
and MRI-based 3D models. Conclusion: CNN can potentially be used in clinical practice to provide rapid and
accurate 3D MRI hip joint models for young patients. The created models can
be used for simulation of impingement during diagnosis of intra- and
extra-articular hip impingement to enable radiation-free and
patient-specific surgical planning for hip arthroscopy and open hip
preservation surgery.
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Affiliation(s)
- Guodong Zeng
- Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Switzerland
| | - Celia Degonda
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Adam Boschung
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern, Switzerland
| | - Nicolas Gerber
- Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Till D Lerch
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern, Switzerland
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Schmaranzer F, Haefeli PC, Liechti EF, Hanke MS, Tannast M, Büchler L. Improved Cartilage Quality on Delayed Gadolinium-Enhanced MRI of Hip Cartilage after Subchondral Drilling of Acetabular Cartilage Flaps in Femoroacetabular Impingement Surgery at Minimum 5-Year Follow-Up. Cartilage 2021; 13:617S-629S. [PMID: 32686503 PMCID: PMC8808901 DOI: 10.1177/1947603520941241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To assess whether subchondral drilling of acetabular cartilage flaps during femoroacetabular impingement (FAI) surgery improves (1) acetabular dGEMRIC indices and (2) morphologic magnetic resonance imaging (MRI) scores, compared with hips in which no additional treatment of cartilage lesions had been performed; and (3) whether global dGEMRIC indices and MRI scores correlate. DESIGN Prospective cohort study of consecutive patients with symptomatic FAI treated with open surgery between 2000 and 2007. Patients with subchondral drilling of acetabular cartilage flaps were allocated to the study group, those without drilling to the control group. All patients underwent indirect 3-T MR arthrography to assess cartilage quality by dGEMRIC indices and a semiquantitative morphologic MRI score at minimum 5 years after surgery. dGEMRIC indices and morphologic MRI scores were compared between and among groups using analysis of covariance/paired t tests. RESULTS No significant difference was found between the global dGEMRIC indices of the study group (449 ± 147 ms, 95% CI 432-466 ms) and the control group (428 ± 143 ms, 95% CI 416-442 ms; P = 0.235). In regions with cartilage flaps, the study group showed higher dGEMRIC indices (472 ± 160 ms, 95% CI 433-510 ms) compared with the control group (390 ± 122 ms, 95% CI 367-413 ms; P < 0.001). No significant differences were found for the morphologic MRI scores. A strong inversely linear correlation between the dGEMRIC indices and the morphologic MRI scores (r = -0.727, P < 0.001) was observed. CONCLUSIONS Treatment of acetabular cartilage flaps with subchondral drilling leads to better cartilage quality in regions with cartilage flaps at minimum 5 years of follow-up.
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Affiliation(s)
- Florian Schmaranzer
- Department of Diagnostic, Interventional
and Pediatric Radiology, Inselspital Bern, University of Bern, Bern,
Switzerland,Department of Orthopaedic Surgery and
traumatology, inselspital Bern, University of Bern, Bern, Switzerland,Florian Schmaranzer, University of Bern,
Freiburgstraße, Bern, 3010, Switzerland.
| | - Pascal C. Haefeli
- Department of Orthopaedic Surgery,
Kantonsspital Luzern, Luzern, Switzerland
| | - Emanuel F. Liechti
- Department of Orthopaedic Surgery and
traumatology, inselspital Bern, University of Bern, Bern, Switzerland
| | - Markus S. Hanke
- Department of Orthopaedic Surgery and
traumatology, inselspital Bern, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery and
Traumatology, Kantonsspital Fribourg, University of Fribourg Faculty of Science and
Medicine, Fribourg, Switzerland
| | - Lorenz Büchler
- Department of Orthopaedic Surgery and
Traumatology, Kantonsspital Aarau AG, Aarau, Switzerland
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Meier MK, Lerch TD, Steppacher SD, Siebenrock KA, Tannast M, Vavron P, Schmaranzer E, Schmaranzer F. High prevalence of hip lesions secondary to arthroscopic over- or undercorrection of femoroacetabular impingement in patients with postoperative pain. Eur Radiol 2021; 32:3097-3111. [PMID: 34842955 PMCID: PMC9038890 DOI: 10.1007/s00330-021-08398-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/28/2021] [Accepted: 10/27/2021] [Indexed: 11/30/2022]
Abstract
Objectives To compare the prevalence of pre- and postoperative osseous deformities and intra-articular lesions in patients with persistent pain following arthroscopic femoroacetabular impingement (FAI) correction and to identify imaging findings associated with progressive cartilage damage. Methods Retrospective study evaluating patients with hip pain following arthroscopic FAI correction between 2010 and 2018. Pre- and postoperative imaging studies were analyzed independently by two blinded readers for osseous deformities (cam-deformity, hip dysplasia, acetabular overcoverage, femoral torsion) and intra-articular lesions (chondro-labral damage, capsular lesions). Prevalence of osseous deformities and intra-articular lesions was compared with paired t-tests/McNemar tests for continuous/dichotomous data. Association between imaging findings and progressive cartilage damage was assessed with logistic regression. Results Forty-six patients (mean age 29 ± 10 years; 30 female) were included. Postoperatively, 74% (34/46) of patients had any osseous deformity including 48% (22/46) acetabular and femoral deformities. Ninety-six percent (44/46) had an intra-articular lesion ranging from 20% (9/46) for femoral to 65% (30/46) for acetabular cartilage lesions. Prevalence of hip dysplasia increased (2 to 20%, p = 0.01) from pre- to postoperatively while prevalence of cam-deformity decreased (83 to 28%, p < 0.001). Progressive cartilage damage was detected in 37% (17/46) of patients and was associated with extensive preoperative cartilage damage > 2 h, i.e., > 60° (OR 7.72; p = 0.02) and an incremental increase in postoperative alpha angles (OR 1.18; p = 0.04). Conclusion Prevalence of osseous deformities secondary to over- or undercorrrection was high. Extensive preoperative cartilage damage and higher postoperative alpha angles increase the risk for progressive degeneration. Key Points • The majority of patients presented with osseous deformities of the acetabulum or femur (74%) and with intra-articular lesions (96%) on postoperative imaging. • Prevalence of hip dysplasia increased (2 to 20%, p = 0.01) from pre- to postoperatively while prevalence of a cam deformity decreased (83 to 28%, p < 0.001). • Progressive cartilage damage was present in 37% of patients and was associated with extensive preoperative cartilage damage > 2 h (OR 7.72; p = 0.02) and with an incremental increase in postoperative alpha angles (OR 1.18; p = 0.04). Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08398-4.
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Affiliation(s)
- Malin K Meier
- Department of Orthopedic Surgery and Traumotology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Till D Lerch
- Department of Diagnostic-, Interventional- and Pediatric Radiology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopedic Surgery and Traumotology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopedic Surgery and Traumotology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery, Fribourg Cantonal Hospital, University of Fribourg, Chemin des Pensionnats 2-6, 1752, Villars-sur-Glâne, Switzerland
| | - Peter Vavron
- Department of Orthopaedic Surgery, District Hospital St. Johann in Tirol, Bahnhofstrasse 14, 6380, St. Johann in Tirol, Austria
| | - Ehrenfried Schmaranzer
- Department of Radiology, District Hospital St. Johann in Tirol, Bahnhofstrasse 14, 6380, St. Johann in Tirol, Austria
| | - Florian Schmaranzer
- Department of Diagnostic-, Interventional- and Pediatric Radiology, Inselspital Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland. .,Department of Radiology, District Hospital St. Johann in Tirol, Bahnhofstrasse 14, 6380, St. Johann in Tirol, Austria.
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Lerch TD, Boschung A, Schmaranzer F, Todorski IAS, Vanlommel J, Siebenrock KA, Steppacher SD, Tannast M. Lower pelvic tilt, lower pelvic incidence, and increased external rotation of the iliac wing in patients with femoroacetabular impingement due to acetabular retroversion compared to hip dysplasia. Bone Jt Open 2021; 2:813-824. [PMID: 34619033 PMCID: PMC8558448 DOI: 10.1302/2633-1462.210.bjo-2021-0069.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS The effect of pelvic tilt (PT) and sagittal balance in hips with pincer-type femoroacetabular impingement (FAI) with acetabular retroversion (AR) is controversial. It is unclear if patients with AR have a rotational abnormality of the iliac wing. Therefore, we asked: are parameters for sagittal balance, and is rotation of the iliac wing, different in patients with AR compared to a control group?; and is there a correlation between iliac rotation and acetabular version? METHODS A retrospective, review board-approved, controlled study was performed including 120 hips in 86 consecutive patients with symptomatic FAI or hip dysplasia. Pelvic CT scans were reviewed to calculate parameters for sagittal balance (pelvic incidence (PI), PT, and sacral slope), anterior pelvic plane angle, pelvic inclination, and external rotation of the iliac wing and were compared to a control group (48 hips). The 120 hips were allocated to the following groups: AR (41 hips), hip dysplasia (47 hips) and cam FAI with normal acetabular morphology (32 hips). Subgroups of total AR (15 hips) and high acetabular anteversion (20 hips) were analyzed. Statistical analysis was performed using analysis of variance with Bonferroni correction. RESULTS PI and PT were significantly decreased comparing AR (PI 42° (SD 10°), PT 4° (SD 5°)) with dysplastic hips (PI 55° (SD 12°), PT 10° (SD 6°)) and with the control group (PI 51° (SD 9°) and PT 13° (SD 7°)) (p < 0.001). External rotation of the iliac wing was significantly increased comparing AR (29° (SD 4°)) with dysplastic hips (20°(SD 5°)) and with the control group (25° (SD 5°)) (p < 0.001). Correlation between external rotation of the iliac wing and acetabular version was significant and strong (r = 0.81; p < 0.001). Correlation between PT and acetabular version was significant and moderate (r = 0.58; p < 0.001). CONCLUSION These findings could contribute to a better understanding of hip pain in a sitting position and extra-articular subspine FAI of patients with AR. These patients have increased iliac external rotation, a rotational abnormality of the iliac wing. This has implications for surgical therapy with hip arthroscopy and acetabular rim trimming or anteverting periacetabular osteotomy (PAO). Cite this article: Bone Jt Open 2021;2(10):813-824.
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Affiliation(s)
- Till Dominic Lerch
- Department of Orthopedic Surgery and Traumatology, Inselspital Bern, University Hospital of Bern, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital Bern, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Adam Boschung
- Department of Orthopedic Surgery and Traumatology, Inselspital Bern, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Orthopedic Surgery and Traumatology, Inselspital Bern, University Hospital of Bern, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital Bern, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Inga A S Todorski
- Department of Orthopedic Surgery and Traumatology, Inselspital Bern, University Hospital of Bern, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital Bern, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Jan Vanlommel
- Department of Orthopaedic Surgery and Traumatology, Orthoclinic, Bruges, Belgium
| | - Klaus A Siebenrock
- Department of Orthopedic Surgery and Traumatology, Inselspital Bern, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopedic Surgery and Traumatology, Inselspital Bern, University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopedic Surgery and Traumatology, Inselspital Bern, University Hospital of Bern, University of Bern, Bern, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
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Schmaranzer F, Lerch TD, Steppacher SD, Siebenrock KA, Schmaranzer E, Tannast M. Femoral cartilage damage occurs at the zone of femoral head necrosis and can be accurately detected on traction MR arthrography of the hip in patients undergoing joint preserving hip surgery. J Hip Preserv Surg 2021; 8:28-39. [PMID: 34567598 PMCID: PMC8460158 DOI: 10.1093/jhps/hnab038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 11/12/2022] Open
Abstract
The primary purpose was to answer the following question: What is the location and pattern of necrosis and associated chondrolabral lesions and can they be accurately detected on traction MR arthrography compared with intra-operative findings in patients undergoing hip preservation surgery for femoral head necrosis (FHN)? Retrospective, diagnostic case series on 23 patients (23 hips; mean age 29 ± 6 years) with diagnosis of FHN undergoing open/arthroscopic joint preserving surgery for FHN and pre-operative traction MR arthrography of the hip. A MR-compatible device for weight-adapted application of leg traction (15-23 kg) was used and coronal, sagittal and radial images were acquired. Location and pattern of necrosis and chondrolabral lesions was assessed by two readers and compared with intra-operative findings to calculate diagnostic accuracy of traction MR arthrography. On MRI all 23 (100%) hips showed central FHN, most frequently antero-superiorly (22/23, 96%) where a high prevalence of femoral cartilage damage was detected (18/23, 78%), with delamination being the most common (16/23, 70%) damage pattern. Intra-operative inspection showed central femoral head cartilage damage most frequently located antero-superiorly (18/23, 78%) with femoral cartilage delamination being most common (14/23, 61%). Traction MR arthrography enabled detection of femoral cartilage damage with a sensitivity/specificity of 95%/75% for reader 1 and 89%/75% for reader 2. To conclude, femoral cartilage damage occurs at the zone of necrosis and can be accurately detected using traction MR arthrography of the hip which may be helpful for surgical decision making in young patients with FHN.
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Affiliation(s)
- F Schmaranzer
- Department of Orthopaedic Surgery, Inselspital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital Bern, University of Bern, Freiburgstrasse 3010 Bern, Switzerland
| | - T D Lerch
- Department of Orthopaedic Surgery, Inselspital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital Bern, University of Bern, Freiburgstrasse 3010 Bern, Switzerland
| | - S D Steppacher
- Department of Orthopaedic Surgery, Inselspital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - K A Siebenrock
- Department of Orthopaedic Surgery, Inselspital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - E Schmaranzer
- Department of Radiology, District Hospital St. Johann in Tirol, Freiburgstrasse, 6380 St. Johann in Tirol, Austria
| | - M Tannast
- Department of Orthopaedic Surgery, Inselspital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Chemin des Pensionnats, 1752 Villars-sur-Glâne, Switzerland
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Hunter DJ, Eyles J, Murphy NJ, Spiers L, Burns A, Davidson E, Dickenson E, Fary C, Foster NE, Fripp J, Griffin DR, Hall M, Kim YJ, Linklater JM, Molnar R, Neubert A, O'Connell RL, O'Donnell J, O'Sullivan M, Randhawa S, Reichenbach S, Schmaranzer F, Singh P, Tran P, Wilson D, Zhang H, Bennell KL. Multi-centre randomised controlled trial comparing arthroscopic hip surgery to physiotherapist-led care for femoroacetabular impingement (FAI) syndrome on hip cartilage metabolism: the Australian FASHIoN trial. BMC Musculoskelet Disord 2021; 22:697. [PMID: 34399702 PMCID: PMC8369620 DOI: 10.1186/s12891-021-04576-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/04/2021] [Indexed: 11/29/2022] Open
Abstract
Background Arthroscopic surgery for femoroacetabular impingement syndrome (FAI) is known to lead to self-reported symptom improvement. In the context of surgical interventions with known contextual effects and no true sham comparator trials, it is important to ascertain outcomes that are less susceptible to placebo effects. The primary aim of this trial was to determine if study participants with FAI who have hip arthroscopy demonstrate greater improvements in delayed gadolinium-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) index between baseline and 12 months, compared to participants who undergo physiotherapist-led management. Methods Multi-centre, pragmatic, two-arm superiority randomised controlled trial comparing physiotherapist-led management to hip arthroscopy for FAI. FAI participants were recruited from participating orthopaedic surgeons clinics, and randomly allocated to receive either physiotherapist-led conservative care or surgery. The surgical intervention was arthroscopic FAI surgery. The physiotherapist-led conservative management was an individualised physiotherapy program, named Personalised Hip Therapy (PHT). The primary outcome measure was change in dGEMRIC score between baseline and 12 months. Secondary outcomes included a range of patient-reported outcomes and structural measures relevant to FAI pathoanatomy and hip osteoarthritis development. Interventions were compared by intention-to-treat analysis. Results Ninety-nine participants were recruited, of mean age 33 years and 58% male. Primary outcome data were available for 53 participants (27 in surgical group, 26 in PHT). The adjusted group difference in change at 12 months in dGEMRIC was -59 ms (95%CI − 137.9 to - 19.6) (p = 0.14) favouring PHT. Hip-related quality of life (iHOT-33) showed improvements in both groups with the adjusted between-group difference at 12 months showing a statistically and clinically important improvement in arthroscopy of 14 units (95% CI 5.6 to 23.9) (p = 0.003). Conclusion The primary outcome of dGEMRIC showed no statistically significant difference between PHT and arthroscopic hip surgery at 12 months of follow-up. Patients treated with surgery reported greater benefits in symptoms at 12 months compared to PHT, but these benefits are not explained by better hip cartilage metabolism. Trial registration details Australia New Zealand Clinical Trials Registry reference: ACTRN12615001177549. Trial registered 2/11/2015. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04576-z.
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Affiliation(s)
- David J Hunter
- Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney, Camperdown, Australia. .,Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia.
| | - Jillian Eyles
- Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney, Camperdown, Australia.,Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia
| | - Nicholas J Murphy
- Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney, Camperdown, Australia.,Department of Orthopaedic Surgery, Gosford and Wyong Hospitals, Gosford, New South Wales, Australia
| | - Libby Spiers
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Parkville, Australia
| | | | - Emily Davidson
- Department of Radiology, Royal Prince Alfred Hospital, Sydney, New South Wales, 2035, Australia
| | - Edward Dickenson
- Warwick Medical School, University of Warwick, Coventry, UK.,University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Camdon Fary
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC, Australia
| | - Nadine E Foster
- STARS Education and Research Alliance, School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Australia.,Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Newcastle upon Tyne, UK
| | - Jurgen Fripp
- The Australian e-Health Research Centre, CSIRO Health and Biosecurity, Brisbane, Australia
| | | | - Michelle Hall
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Parkville, Australia
| | - Young Jo Kim
- Department of Orthopedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - James M Linklater
- Department of Musculoskeletal Imaging, Castlereagh Imaging, St Leonards, New South Wales, Australia
| | - Robert Molnar
- Sydney Orthopaedic Trauma & Reconstructive Surgery, Sydney, New South Wales, Australia
| | - Ales Neubert
- The Australian e-Health Research Centre, CSIRO Health and Biosecurity, Brisbane, Australia
| | - Rachel L O'Connell
- Institute of Bone and Joint Research, Kolling Institute of Medical Research, University of Sydney, Camperdown, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - John O'Donnell
- Hip Arthroscopy Australia, 21 Erin St, Richmond, Victoria, Australia.,St Vincent's Private Hospital, 159 Grey St, East Melbourne, Victoria, Australia
| | - Michael O'Sullivan
- North Sydney Orthopaedic and Sports Medicine Centre, North Sydney, New South Wales, Australia
| | - Sunny Randhawa
- Macquarie University Hospital, 3 Technology Pl, Macquarie University, Macquarie Park, NSW, 2109, Australia
| | - Stephan Reichenbach
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, Bern, Switzerland.,Department Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Parminder Singh
- Hip Arthroscopy Australia, 21 Erin St, Richmond, Victoria, Australia.,Maroondah Hospital, Eastern Health, Davey Drive, Ringwood East, Melbourne, Victoria, 3135, Australia
| | - Phong Tran
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC, Australia
| | - David Wilson
- Department of Orthopaedics, Center for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
| | - Honglin Zhang
- Department of Orthopaedics, Center for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
| | - Kim L Bennell
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Parkville, Australia
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Abstract
Preoperative evaluation of the pathomorphology is crucial for surgical planning, including radiographs as the basic modality and magnetic resonance imaging (MRI) and case-based additional imaging (e.g. 3D-CT, abduction views). Hip arthroscopy (HAS) has undergone tremendous technical advances, an immense increase in use and the indications are getting wider. The most common indications for revision arthroscopy are labral tears and residual femoroacetabular impingement (FAI). Treatment of borderline developmental dysplastic hip is currently a subject of controversy. It is paramount to understand the underlining problem of the individual hip and distinguish instability (dysplasia) from FAI, as the appropriate treatment for unstable hips is periacetabular osteotomy (PAO) and for FAI arthroscopic impingement surgery. PAO with a concomitant cam resection is associated with a higher survival rate compared to PAO alone for the treatment of hip dysplasia. Further, the challenge for the surgeon is the balance between over- and undercorrection. Femoral torsion abnormalities should be evaluated and evaluation of femoral rotational osteotomy for these patients should be incorporated to the treatment plan.
Cite this article: EFORT Open Rev 2021;6:472-486. DOI: 10.1302/2058-5241.6.210019
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Affiliation(s)
- Markus S Hanke
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Till D Lerch
- Department of Diagnostic, Interventional and Pediatric Radiology University Hospital of Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology University Hospital of Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Malin K Meier
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
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Lerch TD, Zwingelstein S, Schmaranzer F, Boschung A, Hanke MS, Todorski IAS, Steppacher SD, Gerber N, Zeng G, Siebenrock KA, Tannast M. Posterior Extra-articular Ischiofemoral Impingement Can Be Caused by the Lesser and Greater Trochanter in Patients With Increased Femoral Version: Dynamic 3D CT-Based Hip Impingement Simulation of a Modified FABER Test. Orthop J Sports Med 2021; 9:2325967121990629. [PMID: 34104657 PMCID: PMC8167016 DOI: 10.1177/2325967121990629] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/02/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Posterior extra-articular hip impingement has been described for valgus hips
with increased femoral version (FV). These patients can present clinically
with lack of external rotation (ER) and extension and with a positive
posterior impingement test. But we do not know the effect of the combination
of deformities, and the impingement location in early flexion is
unknown. Purpose: To evaluate patient-specific 3-dimensional computed tomography (3D CT) scans
of hips with increased FV and control hips for differences in range of
motion, location and prevalence of osseous posterior intra- and
extra-articular hip impingement. Study Design: Case series; Level of evidence, 4. Methods: Osseous 3D models based on segmentation of 3D CT scans were analyzed for 52
hips (38 symptomatic patients) with positive posterior impingement test and
increased FV (>35°). There were 26 hips with an increased McKibbin
instability index >70 (unstable hips). Patients were mainly female (96%),
with an age range of 18 to 45 years. Of them, 21 hips had isolated increased
FV (>35°); 22 hips had increased FV and increased acetabular version (AV;
>25°); and 9 valgus hips (caput-collum-diaphyseal angle >139°) had
increased FV and increased AV. The control group consisted of 20 hips with
normal FV, normal AV, and no valgus (caput-collum-diaphyseal angle
<139°). Validated 3D CT–based collision detection software for
impingement simulation was used to calculate impingement-free range of
motion and location of hip impingement. Surgical treatment was performed
after the 3D CT–based impingement simulation in 27 hips (52%). Results: Hips with increased FV had significantly (P < .001)
decreased extension and ER at 90° of flexion as compared with the control
group. Posterior impingement was extra-articular (92%) in hips with
increased FV. Valgus hips with increased FV and AV had combined intra- and
extra-articular impingement. Posterior hip impingement occurred between the
ischium and the lesser trochanter at 20° of extension and 20° of ER.
Impingement was located between the ischium and the greater trochanter or
intertrochanteric area at 20° of flexion and 40° of ER, with a modification
of the flexion-abduction-ER (FABER) test. Conclusion: Posterior extra-articular ischiofemoral hip impingement can be caused by the
lesser and greater trochanter or the intertrochanteric region. We recommend
performing the modified FABER test during clinical examination in addition
to the posterior impingement test for female patients with high FV. In
addition, 3D CT can help for surgical planning, such as femoral derotation
osteotomy and/or hip arthroscopy or resection of the lesser trochanter.
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Affiliation(s)
- Till D Lerch
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sébastien Zwingelstein
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adam Boschung
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus S Hanke
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Inga A S Todorski
- Department of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Gerber
- sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
| | - Guodong Zeng
- sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
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Hanke MS, Schmaranzer F, Steppacher SD, Reichenbach S, Werlen SF, Siebenrock KA. A Cam Morphology Develops in the Early Phase of the Final Growth Spurt in Adolescent Ice Hockey Players: Results of a Prospective MRI-based Study. Clin Orthop Relat Res 2021; 479:906-918. [PMID: 33417423 PMCID: PMC8052031 DOI: 10.1097/corr.0000000000001603] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/18/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cam morphologies seem to develop with an increased prevalence in adolescent boys performing high-impact sports. The crucial question is at what age the cam morphology actually develops and whether there is an association with an aberration of the shape of the growth plate at the cam morphology site. QUESTIONS/PURPOSES (1) What is the frequency of cam morphologies in adolescent ice hockey players, and when do they appear? (2) Is there an association between an extension of the physeal growth plate and the development of a cam morphology? (3) How often do these players demonstrate clinical findings like pain and lack of internal rotation? METHODS A prospective, longitudinal MRI study was done to monitor the proximal femoral development and to define the appearance of cam morphologies in adolescent ice hockey players during the final growth spurt. Young ice hockey players from the local boys' league up to the age of 13 years (mean age 12 ± 0.5 years) were invited to participate. From 35 players performing on the highest national level, 25 boys and their parents consented to participate. None of these 25 players had to be excluded for known disease or previous surgery or hip trauma. At baseline examination as well as 1.5 and 3 years later, we performed a prospective noncontrast MRI scan and a clinical examination. The three-dimensional morphology of the proximal femur was assessed by one of the authors using radial images of the hip in a clockwise manner. The two validated parameters were: (1) the alpha angle for head asphericity (abnormal > 60°) and (2) the epiphyseal extension for detecting an abnormality in the shape of the capital physis and a potential correlation at the site of the cam morphology. The clinical examination was performed by one of the authors evaluating (1) internal rotation in 90° of hip and knee flexion and (2) hip pain during the anterior impingement test. RESULTS Cam morphologies were most apparent at the 1.5-year follow-up interval (10 of 25; baseline versus 1.5-year follow-up: p = 0.007) and a few more occurred between 1.5 and 3 years (12 of 23; 1.5-year versus 3-year follow-up: p = 0.14). At 3-year follow-up, there was a positive correlation between increased epiphyseal extension and a high alpha angle at the anterosuperior quadrant (1 o'clock to 3 o'clock) (Spearman correlation coefficient = 0.341; p < 0.003). The prevalence of pain on the impingement test and/or restricted internal rotation less than 20° increased most between 1.5-year (1 of 25) and the 3-year follow-up (6 of 22; 1.5-year versus 3-year follow-up: p = 0.02). CONCLUSION Our data suggest that a cam morphology develops early during the final growth spurt of the femoral head in adolescent ice hockey players predominantly between 13 to 16 years of age. A correlation between an increased extension of the growth plate and an increased alpha angle at the site of the cam morphology suggests a potential underlying growth disturbance. This should be further followed by high-resolution or biochemical MRI methods. Considering the high number of cam morphologies that correlated with abnormal clinical findings, we propose that adolescents performing high-impact sports should be screened for signs of cam impingement, such as by asking about hip pain and/or examining the patient for limited internal hip rotation. LEVEL OF EVIDENCE Level I, prognostic study.
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Affiliation(s)
- Markus S. Hanke
- M. S. Hanke, S. D. Steppacher, K. A. Siebenrock, Department of Orthopedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- S. F. Werlen, Department of Radiology, Sonnenhof Clinic, Lindenhof Group, Bern, Switzerland
| | - Florian Schmaranzer
- M. S. Hanke, S. D. Steppacher, K. A. Siebenrock, Department of Orthopedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- S. F. Werlen, Department of Radiology, Sonnenhof Clinic, Lindenhof Group, Bern, Switzerland
| | - Simon D. Steppacher
- M. S. Hanke, S. D. Steppacher, K. A. Siebenrock, Department of Orthopedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- S. F. Werlen, Department of Radiology, Sonnenhof Clinic, Lindenhof Group, Bern, Switzerland
| | - Stephan Reichenbach
- M. S. Hanke, S. D. Steppacher, K. A. Siebenrock, Department of Orthopedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- S. F. Werlen, Department of Radiology, Sonnenhof Clinic, Lindenhof Group, Bern, Switzerland
| | - Stefan F. Werlen
- M. S. Hanke, S. D. Steppacher, K. A. Siebenrock, Department of Orthopedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- S. F. Werlen, Department of Radiology, Sonnenhof Clinic, Lindenhof Group, Bern, Switzerland
| | - Klaus A. Siebenrock
- M. S. Hanke, S. D. Steppacher, K. A. Siebenrock, Department of Orthopedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Department of Rheumatology, Immunology and Allergology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- S. Reichenbach, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- S. F. Werlen, Department of Radiology, Sonnenhof Clinic, Lindenhof Group, Bern, Switzerland
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Schmaranzer F, Kallini JR, Ferrer MG, Miller PE, Wylie JD, Kim YJ, Novais EN. How Common Is Femoral Retroversion and How Is it Affected by Different Measurement Methods in Unilateral Slipped Capital Femoral Epiphysis? Clin Orthop Relat Res 2021; 479:947-959. [PMID: 33377759 PMCID: PMC8052062 DOI: 10.1097/corr.0000000000001611] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/24/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although femoral retroversion has been linked to the onset of slipped capital femoral epiphysis (SCFE), and may result from a rotation of the femoral epiphysis around the epiphyseal tubercle leading to femoral retroversion, femoral version has rarely been described in patients with SCFE. Furthermore, the prevalence of actual femoral retroversion and the effect of different measurement methods on femoral version angles has yet to be studied in SCFE. QUESTIONS/PURPOSES (1) Do femoral version and the prevalence of femoral retroversion differ between hips with SCFE and the asymptomatic contralateral side? (2) How do the mean femoral version angles and the prevalence of femoral retroversion change depending on the measurement method used? (3) What is the interobserver reliability and intraobserver reproducibility of these measurement methods? METHODS For this retrospective, controlled, single-center study, we reviewed our institutional database for patients who were treated for unilateral SCFE and who had undergone a pelvic CT scan. During the period in question, the general indication for obtaining a CT scan was to define the surgical strategy based on the assessment of deformity severity in patients with newly diagnosed SCFE or with previous in situ fixation. After applying prespecified inclusion and exclusion criteria, we included 79 patients. The mean age was 15 ± 4 years, 48% (38 of 79) of the patients were male, and 56% (44 of 79) were obese (defined as a BMI > 95th percentile (mean BMI 34 ± 9 kg/m2). One radiology resident (6 years of experience) measured femoral version of the entire study group using five different methods. Femoral neck version was measured as the orientation of the femoral neck. Further measurement methods included the femoral head's center and differed regarding the level of landmarks for the proximal femoral reference axis. From proximal to distal, this included the most-proximal methods (Lee et al. and Reikerås et al.) and most-distal methods (Tomczak et al. and Murphy et al.). Most proximally (Lee et al. method), we used the most cephalic junction of the greater trochanter as the landmark and, most distally, we used the center base of the femoral neck superior to the lesser trochanter (Murphy et al.). The orientation of the distal femoral condyles served as the distal reference axis for all five measurement methods. All five methods were compared side-by-side (involved versus uninvolved hip), and comparisons among all five methods were performed using paired t-tests. The prevalence of femoral retroversion (< 0°) was compared using a chi-square test. A subset of patients was measured twice by the first observer and by a second orthopaedic resident (2 years of experience) to assess intraobserver reproducibility and interobserver reliability; for this assessment, we used intraclass correlation coefficients. RESULTS The mean femoral neck version was lower in hips with SCFE than in the contralateral side (-2° ± 13° versus 7° ± 11°; p < 0.001). This yielded a mean side-by side difference of -8° ± 11° (95% CI -11° to -6°; p < 0.001) and a higher prevalence of femoral retroversion in hips with SCFE (58% [95% CI 47% to 69%]; p < 0.001) than on the contralateral side (29% [95% CI 19% to 39%]). These differences between hips with SCFE and the contralateral side were higher and ranged from -17° ± 11° (95% CI -20° to -15°; p < 0.001) based on the method of Tomczak et al. to -22° ± 13° (95% CI -25° to -19°; p < 0.001) according to the method of Murphy et al. The mean overall femoral version angles increased for hips with SCFE using more-distal landmarks compared with more-proximal landmarks. The prevalence of femoral retroversion was higher in hips with SCFE for the proximal methods of Lee et al. and Reikerås et al. (91% [95% CI 85% to 97%] and 84% [95% CI 76% to 92%], respectively) than for the distal measurement methods of Tomczak et al. and Murphy et al. (47% [95% CI 36% to 58%] and 60% [95% CI 49% to 71%], respectively [all p < 0.001]). We detected mean differences ranging from -19° to 4° (all p < 0.005) for 8 of 10 pairwise comparisons in hips with SCFE. Among these, the greatest differences were between the most-proximal methods and the more-distal methods, with a mean difference of -19° ± 7° (95% CI -21° to -18°; p < 0.001), comparing the methods of Lee et al. and Tomczak et al. In hips with SCFE, we found excellent agreement (intraclass correlation coefficient [ICC] > 0.80) for intraobserver reproducibility (reader 1, ICC 0.93 to 0.96) and interobserver reliability (ICC 0.95 to 0.98) for all five measurement methods. Analogously, we found excellent agreement (ICC > 0.80) for intraobserver reproducibility (reader 1, range 0.91 to 0.96) and interobserver reliability (range 0.89 to 0.98) for all five measurement methods in healthy contralateral hips. CONCLUSION We showed that femoral neck version is asymmetrically decreased in unilateral SCFE, and that differences increase when including the femoral head's center. Thus, to assess the full extent of an SCFE deformity, femoral version measurements should consider the position of the displaced epiphysis. The prevalence of femoral retroversion was high in patients with SCFE and increased when using proximal anatomic landmarks. Since the range of femoral version angles was wide, femoral version cannot be predicted in a given hip and must be assessed individually. Based on these findings, we believe it is worthwhile to add evaluation of femoral version to the diagnostic workup of children with SCFE. Doing so may better inform surgeons as they contemplate when to use isolated offset correction or to perform an additional femoral osteotomy for SCFE correction based on the severity of the slip and the rotational deformity. To facilitate communication among physicians and for the design of future studies, we recommend consistently reporting the applied measurement technique. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Florian Schmaranzer
- F. Schmaranzer, J. R. Kallini, M. G. Ferrer, P. E. Miller, J. D. Wylie, Y-J. Kim, E. N. Novais, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- J. D. Wylie, The Orthopedic Specialty Hospital, Intermountain Healthcare, Murray, UT, USA
| | - Jennifer R Kallini
- F. Schmaranzer, J. R. Kallini, M. G. Ferrer, P. E. Miller, J. D. Wylie, Y-J. Kim, E. N. Novais, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- J. D. Wylie, The Orthopedic Specialty Hospital, Intermountain Healthcare, Murray, UT, USA
| | - Mariana G Ferrer
- F. Schmaranzer, J. R. Kallini, M. G. Ferrer, P. E. Miller, J. D. Wylie, Y-J. Kim, E. N. Novais, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- J. D. Wylie, The Orthopedic Specialty Hospital, Intermountain Healthcare, Murray, UT, USA
| | - Patricia E Miller
- F. Schmaranzer, J. R. Kallini, M. G. Ferrer, P. E. Miller, J. D. Wylie, Y-J. Kim, E. N. Novais, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- J. D. Wylie, The Orthopedic Specialty Hospital, Intermountain Healthcare, Murray, UT, USA
| | - James D Wylie
- F. Schmaranzer, J. R. Kallini, M. G. Ferrer, P. E. Miller, J. D. Wylie, Y-J. Kim, E. N. Novais, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- J. D. Wylie, The Orthopedic Specialty Hospital, Intermountain Healthcare, Murray, UT, USA
| | - Young-Jo Kim
- F. Schmaranzer, J. R. Kallini, M. G. Ferrer, P. E. Miller, J. D. Wylie, Y-J. Kim, E. N. Novais, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- J. D. Wylie, The Orthopedic Specialty Hospital, Intermountain Healthcare, Murray, UT, USA
| | - Eduardo N Novais
- F. Schmaranzer, J. R. Kallini, M. G. Ferrer, P. E. Miller, J. D. Wylie, Y-J. Kim, E. N. Novais, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- F. Schmaranzer, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- J. D. Wylie, The Orthopedic Specialty Hospital, Intermountain Healthcare, Murray, UT, USA
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Lerch TD, Ambühl D, Schmaranzer F, Todorski IAS, Steppacher SD, Hanke MS, Haefeli PC, Liechti EF, Siebenrock KA, Tannast M. Biochemical MRI With dGEMRIC Corresponds to 3D-CT Based Impingement Location for Detection of Acetabular Cartilage Damage in FAI Patients. Orthop J Sports Med 2021; 9:2325967120988175. [PMID: 33816640 PMCID: PMC7988263 DOI: 10.1177/2325967120988175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/30/2020] [Indexed: 01/20/2023] Open
Abstract
Background Anterior femoroacetabular impingement (FAI) is associated with labral tears and acetabular cartilage damage in athletic and young patients. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is an imaging method for detecting early damage to cartilage. Purpose We evaluated the following questions: (1) What is the sensitivity and specificity of morphological magnetic resonance imaging (MRI) and dGEMRIC for detecting cartilage damage? Do the mean acetabular and femoral dGEMRIC indices differ between (2) superior acetabular clock positions with and without impingement and (3) between cam- and pincer-type FAI? Study Design Cohort study (diagnosis); Level of evidence, 2. Methods This was a retrospective comparative study of 21 hips (20 patients with symptomatic anterior FAI) without osteoarthritis on anteroposterior radiographs. Morphological MRI and dGEMRIC (3.0-T, 3-dimensional [3D] T1 maps, dual-flip angle technique) of the same hip joint were compared. Intraoperative acetabular cartilage damage was assessed in patients who underwent surgical treatment. Computed tomography (CT)-based 3D bone models of the same hip joint were used as the gold standard for the detection of impingement, and dGEMRIC indices and zones of morphologic damage were compared with the CT-based impingement zones. Results Of the 21 hips, 10 had cam-type FAI and 8 had pincer-type FAI according to radiographs. The mean age was 30 ± 9 years (range, 17-48 years), 71% were female, and surgical treatment was performed in 52%. We found a significantly higher sensitivity (69%) for dGEMRIC compared with morphological MRI (42%) in the detection of cartilage damage (P < .001). The specificity of dGEMRIC was 83% and accuracy was 78%. The mean peripheral acetabular and femoral dGEMRIC indices for clock positions with impingement (485 ± 141 and 440 ± 121 ms) were significantly lower compared with clock positions without impingement (596 ± 183 and 534 ± 129 ms) (P < .001). Hips with cam-type FAI had significantly lower acetabular dGEMRIC indices compared with hips with pincer-type FAI on the anterosuperior clock positions (1 to 3 o'clock) (P = .018). Conclusion MRI with dGEMRIC was more sensitive than morphological MRI, and lower dGEMRIC values were found for clock positions with impingement as detected on 3D-CT. This could aid in patient-specific diagnosis of FAI, preoperative patient selection, and surgical decision making to identify patients with cartilage damage who are at risk for inferior outcomes after hip arthroscopy.
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Affiliation(s)
- Till D Lerch
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dimitri Ambühl
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Inga A S Todorski
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus S Hanke
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pascal C Haefeli
- Department of Orthopaedic Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Emanuel F Liechti
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Orthopaedic Surgery, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Castro MO, Mascarenhas VV, Afonso PD, Rego P, Schmaranzer F, Sutter R, Kassarjian A, Sconfienza L, Dienst M, Ayeni OR, Beaulé PE, Dantas P, Lalam R, Weber MA, Vanhoenacker FM, Dietrich TJ, Jans L, Robinson P, Karantanas AH, Sudoł-Szopińska I, Anderson S, Noebauer-Huhmann I, Marin-Peña O, Collado D, Tey-Pons M, Schmaranzer E, Padron M, Kramer J, Zingg PO, De Maeseneer M, Llopis E. The Lisbon Agreement on Femoroacetabular Impingement Imaging-part 3: imaging techniques. Eur Radiol 2021; 31:4652-4668. [PMID: 33411053 DOI: 10.1007/s00330-020-07501-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/19/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Imaging diagnosis of femoroacetabular impingement (FAI) remains controversial due to a lack of high-level evidence, leading to significant variability in patient management. Optimizing protocols and technical details is essential in FAI imaging, although challenging in clinical practice. The purpose of this agreement is to establish expert-based statements on FAI imaging, using formal consensus techniques driven by relevant literature review. Recommendations on the selection and use of imaging techniques for FAI assessment, as well as guidance on relevant radiographic and MRI classifications, are provided. METHODS The Delphi method was used to assess agreement and derive consensus among 30 panel members (musculoskeletal radiologists and orthopedic surgeons). Forty-four questions were agreed on and classified into five major topics and recent relevant literature was circulated, in order to produce answering statements. The level of evidence was assessed for all statements and panel members scored their level of agreement with each statement during 4 Delphi rounds. Either "group consensus," "group agreement," or "no agreement" was achieved. RESULTS Forty-seven statements were generated and group consensus was reached for 45. Twenty-two statements pertaining to "Imaging techniques" were generated. Eight statements on "Radiographic assessment" and 12 statements on "MRI evaluation" gained consensus. No agreement was reached for the 2 "Ultrasound" related statements. CONCLUSION The first international consensus on FAI imaging was developed. Researchers and clinicians working with FAI and hip-related pain may use these recommendations to guide, develop, and implement comprehensive, evidence-based imaging protocols and classifications. KEY POINTS • Radiographic evaluation is recommended for the initial assessment of FAI, while MRI with a dedicated protocol is the gold standard imaging technique for the comprehensive evaluation of this condition. • The MRI protocol for FAI evaluation should include unilateral small FOV with radial imaging, femoral torsion assessment, and a fluid sensitive sequence covering the whole pelvis. • The definite role of other imaging methods in FAI, such as ultrasound or CT, is still not well defined.
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Affiliation(s)
- Miguel O Castro
- Department of Radiology, Centro Hospitalar Universitário do Algarve, Sítio do Poço Seco, Portimão, 8500-338, Portugal.
| | - Vasco V Mascarenhas
- Musculoskeletal Imaging Unit, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Lisbon, Portugal
| | - P Diana Afonso
- Musculoskeletal Imaging Unit, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Lisbon, Portugal
| | - Paulo Rego
- Department of Orthopaedic Surgery, Hospital da Luz, Lisbon, Portugal
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern, University of Bern, Bern, Switzerland
| | - Reto Sutter
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | | | - Luca Sconfienza
- RCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | | | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Radhesh Lalam
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry, UK
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center, Rostock, Germany
| | - Filip M Vanhoenacker
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
- Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | | | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Philip Robinson
- Radiology Department, Leeds Teaching Hospitals, Chapel Allerton Hospital, Leeds, UK
- University of Leeds and NHIR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Apostolos H Karantanas
- Medical School-University of Crete and Computational BioMedicine Laboratory-ICS/FORTH, Heraklion, Greece
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation (NIGRiR), Warsaw, Poland
| | - Suzanne Anderson
- Institute of Radiology, Kantonsspital Baden, Baden, Switzerland
- The University of Notre Dame Australia, Sydney School of Medicine, Sydney, Australia
| | - Iris Noebauer-Huhmann
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Oliver Marin-Peña
- Orthopedic and Traumatology Department, Hip Unit, University Hospital Infanta Leonor, Madrid, Spain
| | - Diego Collado
- Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Barcelona, Spain
| | - Marc Tey-Pons
- Orthopedic Surgery and Traumatology, University Hospital del Mar, Barcelona, Spain
| | | | - Mario Padron
- Department of Radiology, Clínica Cemtro, Madrid, Spain
| | - Josef Kramer
- Röntgeninstitut am Schillerpark, Rainerstrasse, Linz, Austria
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | | | - Eva Llopis
- Department of Radiology, Hospital de la Ribera, Valencia, Spain
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Mascarenhas VV, Castro MO, Afonso PD, Rego P, Dienst M, Sutter R, Schmaranzer F, Sconfienza L, Kassarjian A, Ayeni OR, Beaulé PE, Dantas P, Lalam R, Weber MA, Vanhoenacker FM, Dietrich TJ, Jans L, Robinson P, Karantanas AH, Sudoł-Szopińska I, Anderson S, Noebauer-Huhmann I, Marin-Peña O, Collado D, Tey-Pons M, Schmaranzer E, Padron M, Kramer J, Zingg PO, De Maeseneer M, Llopis E. The Lisbon Agreement on femoroacetabular impingement imaging-part 2: general issues, parameters, and reporting. Eur Radiol 2021; 31:4634-4651. [PMID: 33411052 DOI: 10.1007/s00330-020-07432-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/13/2020] [Accepted: 10/15/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Imaging assessment for the clinical management of femoroacetabular impingement (FAI) is controversial because of a paucity of evidence-based guidance and notable variability among practitioners. Hence, expert consensus is needed because standardised imaging assessment is critical for clinical practice and research. We aimed to establish expert-based statements on FAI imaging by using formal methods of consensus building. METHODS The Delphi method was used to formally derive consensus among 30 panel members from 13 countries. Forty-four questions were agreed upon, and relevant seminal literature was circulated and classified in major topics to produce answering statements. The level of evidence was noted for all statements, and panel members were asked to score their level of agreement (0-10). This is the second part of a three-part consensus series and focuses on 'General issues' and 'Parameters and reporting'. RESULTS Forty-seven statements were generated and group consensus was reached for 45. Twenty-five statements pertaining to 'General issues' (9 addressing diagnosis, differential diagnosis, and postoperative imaging) and 'Parameters and reporting' (16 addressing femoral/acetabular parameters) were produced. CONCLUSIONS The available evidence was reviewed critically, recommended criteria for diagnostic imaging highlighted, and the roles/values of different imaging parameters assessed. Radiographic evaluation (AP pelvis and a Dunn 45° view) is the cornerstone of hip-imaging assessment and the minimum imaging study that should be performed when evaluating adult patients for FAI. In most cases, cross-sectional imaging is warranted because MRI is the 'gold standard' imaging modality for the comprehensive evaluation, differential diagnosis assessment, and FAI surgical planning. KEY POINTS • Diagnostic imaging for FAI is not standardised due to scarce evidence-based guidance on which imaging modalities and diagnostic criteria/parameters should be used. • Radiographic evaluation is the cornerstone of hip assessment and the minimum study that should be performed when assessing suspected FAI. Cross-sectional imaging is justified in most cases because MRI is the 'gold standard' modality for comprehensive FAI evaluation. • For acetabular morphology, coverage (Wiberg's angle and acetabular index) and version (crossover, posterior wall, and ischial spine signs) should be assessed routinely. On the femoral side, the head-neck junction morphology (α° and offset), neck morphology (NSA), and torsion should be assessed.
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Affiliation(s)
- Vasco V Mascarenhas
- Musculoskeletal Imaging Unit, Radiology Department, Imaging Center, Hospital da Luz, Grupo Luz Saúde, Av Lusiada 100, 1500-650, Lisbon, Portugal.
| | - Miguel O Castro
- Department of Radiology, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - P Diana Afonso
- Musculoskeletal Imaging Unit, Radiology Department, Imaging Center, Hospital da Luz, Grupo Luz Saúde, Av Lusiada 100, 1500-650, Lisbon, Portugal
| | - Paulo Rego
- Department of Orthopaedic Surgery, Hospital da Luz, Lisbon, Portugal
| | | | - Reto Sutter
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern, University of Bern, Bern, Switzerland
| | - Luca Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | | | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Radhesh Lalam
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry, UK
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center, Rostock, Germany
| | - Filip M Vanhoenacker
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
- Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | | | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Philip Robinson
- Radiology Department, Leeds Teaching Hospitals, Chapel Allerton Hospital, Leeds, UK
- University of Leeds and NHIR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Apostolos H Karantanas
- Medical School-University of Crete and Computational BioMedicine Laboratory-ICS/FORTH, Heraklion, Greece
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation (NIGRiR), Warsaw, Poland
| | - Suzanne Anderson
- Institute of Radiology, Kantonsspital Baden, Baden, Switzerland
- The University of Notre Dame Australia, Sydney School of Medicine, Sydney, Australia
| | - Iris Noebauer-Huhmann
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Oliver Marin-Peña
- Orthopedic and Traumatology Department, Hip Unit, University Hospital Infanta Leonor, Madrid, Spain
| | - Diego Collado
- Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Barcelona, Spain
| | - Marc Tey-Pons
- Orthopedic Surgery and Traumatology, University Hospital del Mar, Barcelona, Spain
| | | | - Mario Padron
- Department of Radiology, Clínica Cemtro, Madrid, Spain
| | - Josef Kramer
- Röntgeninstitut am Schillerpark, Rainerstrasse, Linz, Austria
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | | | - Eva Llopis
- Department of Radiology, Hospital de la Ribera, Valencia, Spain
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Zeng G, Schmaranzer F, Degonda C, Gerber N, Gerber K, Tannast M, Burger J, Siebenrock KA, Zheng G, Lerch TD. MRI-based 3D models of the hip joint enables radiation-free computer-assisted planning of periacetabular osteotomy for treatment of hip dysplasia using deep learning for automatic segmentation. Eur J Radiol Open 2020; 8:100303. [PMID: 33364259 PMCID: PMC7753932 DOI: 10.1016/j.ejro.2020.100303] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/27/2020] [Accepted: 11/28/2020] [Indexed: 11/02/2022] Open
Abstract
Introduction Both Hip Dysplasia(DDH) and Femoro-acetabular-Impingement(FAI) are complex three-dimensional hip pathologies causing hip pain and osteoarthritis in young patients. 3D-MRI-based models were used for radiation-free computer-assisted surgical planning. Automatic segmentation of MRI-based 3D-models are preferred because manual segmentation is time-consuming.To investigate(1) the difference and(2) the correlation for femoral head coverage(FHC) between automatic MR-based and manual CT-based 3D-models and (3) feasibility of preoperative planning in symptomatic patients with hip diseases. Methods We performed an IRB-approved comparative, retrospective study of 31 hips(26 symptomatic patients with hip dysplasia or FAI). 3D MRI sequences and CT scans of the hip were acquired. Preoperative MRI included axial-oblique T1 VIBE sequence(0.8 mm3 isovoxel) of the hip joint. Manual segmentation of MRI and CT scans were performed. Automatic segmentation of MRI-based 3D-models was performed using deep learning. Results (1)The difference between automatic and manual segmentation of MRI-based 3D hip joint models was below 1 mm(proximal femur 0.2 ± 0.1 mm and acetabulum 0.3 ± 0.5 mm). Dice coefficients of the proximal femur and the acetabulum were 98 % and 97 %, respectively. (2)The correlation for total FHC was excellent and significant(r = 0.975, p < 0.001) between automatic MRI-based and manual CT-based 3D-models. Correlation for total FHC (r = 0.979, p < 0.001) between automatic and manual MR-based 3D models was excellent.(3)Preoperative planning and simulation of periacetabular osteotomy was feasible in all patients(100 %) with hip dysplasia or acetabular retroversion. Conclusions Automatic segmentation of MRI-based 3D-models using deep learning is as accurate as CT-based 3D-models for patients with hip diseases of childbearing age. This allows radiation-free and patient-specific preoperative simulation and surgical planning of periacetabular osteotomy for patients with DDH.
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Affiliation(s)
- Guodong Zeng
- Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Switzerland
| | - Florian Schmaranzer
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern, Switzerland
| | - Celia Degonda
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Nicolas Gerber
- Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Switzerland
| | - Kate Gerber
- Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital, University of Fribourg, Switzerland
| | - Jürgen Burger
- Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Guoyan Zheng
- Institute for Medical Robotics, School of Biomedical Engineering, Shanghai Jiao Tong University, China
| | - Till D Lerch
- Department of Orthopedic Surgery, Inselspital, University of Bern, Bern, Switzerland.,Department of Diagnostic, Interventional and Paediatric Radiology, University of Bern, Inselspital, Bern, Switzerland
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Lerch TD, Liechti EF, Todorski IAS, Schmaranzer F, Steppacher SD, Siebenrock KA, Tannast M, Klenke FM. Prevalence of combined abnormalities of tibial and femoral torsion in patients with symptomatic hip dysplasia and femoroacetabular impingement. Bone Joint J 2020; 102-B:1636-1645. [PMID: 33249913 DOI: 10.1302/0301-620x.102b12.bjj-2020-0460.r1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIMS The prevalence of combined abnormalities of femoral torsion (FT) and tibial torsion (TT) is unknown in patients with femoroacetabular impingement (FAI) and hip dysplasia. This study aimed to determine the prevalence of combined abnormalities of FT and TT, and which subgroups are associated with combined abnormalities of FT and TT. METHODS We retrospectively evaluated symptomatic patients with FAI or hip dysplasia with CT scans performed between September 2011 and September 2016. A total of 261 hips (174 patients) had a measurement of FT and TT. Their mean age was 31 years (SD 9), and 63% were female (165 hips). Patients were compared to an asymptomatic control group (48 hips, 27 patients) who had CT scans including femur and tibia available for analysis, which had been acquired for nonorthopaedic reasons. Comparisons were conducted using analysis of variance with Bonferroni correction. RESULTS In the overall study group, abnormal FT was present in 62% (163 hips). Abnormal TT was present in 42% (109 hips). Normal FT combined with normal TT was present in 21% (55 hips). The most frequent abnormal combination was increased FT combined with normal TT of 32% (84 hips). In the hip dysplasia group, 21% (11 hips) had increased FT combined with increased TT. The prevalence of abnormal FT varied significantly among the subgroups (p < 0.001). We found a significantly higher mean FT for hip dysplasia (31°; SD 15)° and valgus hips (42° (SD 12°)) compared with the control group (22° (SD 8°)). We found a significantly higher mean TT for hips with cam-type-FAI (34° (SD 6°)) and hip dysplasia (35° (SD 9°)) compared with the control group (28° (SD 8°)) (p < 0.001). CONCLUSION Patients with FAI had a high prevalence of combined abnormalities of FT and TT. For hip dysplasia, we found a significantly higher mean FT and TT, while 21% of patients (11 hips) had combined increased TT and increased FT (combined torsional malalignment). This is important when planning hip preserving surgery such as periacetabular osteomy and femoral derotation osteotomy. Cite this article: Bone Joint J 2020;102-B(12):1636-1645.
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Affiliation(s)
- Till D Lerch
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,University Institute of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Emanuel F Liechti
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Inga A S Todorski
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,University Institute of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,University Institute of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Moritz Tannast
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Frank M Klenke
- Department of Orthopaedic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Abstract
Classical indications for hip preserving surgery are: femoro-acetabular impingement (FAI) (intra- and extra-articular), hip dysplasia, slipped capital femoral epiphysis, residual deformities after Perthes disease, avascular necrosis of the femoral head. Pre-operative evaluation of the pathomorphology is crucial for surgical planning including radiographs as the basic modality and magnetic resonance imaging (MRI) and/or computed tomography (CT) to evaluate further intra-articular lesions and osseous deformities. Two main mechanisms of intra-articular impingement have been described:
(1) Inclusion type FAI (‘cam type’). (2) Impaction type FAI (‘pincer type’).
Either arthroscopic or open treatment can be performed depending on the severity of deformity. Slipped capital femoral epiphysis often results in a cam-like deformity of the hip. In acute cases a subcapital re-alignment (modified Dunn procedure) of the femoral epiphysis is an effective therapy. Perthes disease can lead to complex femoro-acetabular deformity which predisposes to impingement with/without joint incongruency and requires a comprehensive diagnostic workup for surgical planning. Developmental dysplasia of the hip results in a static overload of the acetabular rim and early osteoarthritis. Surgical correction by means of periacetabular osteotomy offers good long-term results.
Cite this article: EFORT Open Rev 2020;5:630-640. DOI: 10.1302/2058-5241.5.190074
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Affiliation(s)
- Markus S Hanke
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology, University Hospital of Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Till D Lerch
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
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Mascarenhas VV, Castro MO, Rego PA, Sutter R, Sconfienza LM, Kassarjian A, Schmaranzer F, Ayeni OR, Dietrich TJ, Robinson P, Weber MA, Beaulé PE, Dienst M, Jans L, Lalam R, Karantanas AH, Sudoł-Szopińska I, Anderson S, Noebauer-Huhmann I, Vanhoenacker FM, Dantas P, Marin-Peña O, Collado D, Tey-Pons M, Schmaranzer E, Llopis E, Padron M, Kramer J, Zingg PO, De Maeseneer M, Afonso PD. Correction to: The Lisbon Agreement on Femoroacetabular Impingement Imaging-part 1: overview. Eur Radiol 2020; 30:6966-6967. [PMID: 32681363 DOI: 10.1007/s00330-020-07009-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The original version of this article, published on 14 May 2020, unfortunately contained a mistake.
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Affiliation(s)
- Vasco V Mascarenhas
- Musculoskeletal Imaging Unit, Imaging Center, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, 1500-650, Lisbon, Portugal.
| | - Miguel O Castro
- Department of Radiology, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - Paulo A Rego
- Department of Orthopaedic Surgery, Hospital da Luz, Lisbon, Portugal
| | - Reto Sutter
- Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | | | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern, University of Bern, Bern, Switzerland
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | - Philip Robinson
- Radiology Department, Leeds Teaching Hospitals, Chapel Allerton Hospital, Leeds, UK.,University of Leeds, Leeds, UK.,NHIR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center, Rostock, Germany
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Radhesh Lalam
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry, UK
| | - Apostolos H Karantanas
- Medical School, University of Crete, Heraklion, Greece.,Computational BioMedicine Laboratory, ICS/FORTH, Heraklion, Greece
| | - Iwona Sudoł-Szopińska
- Department of Radiology, Rheumatology and Rehabilitation, National Institute of Geriatrics, Warsaw, Poland
| | - Suzanne Anderson
- Institute of Radiology, Kantonsspital Baden, Baden, Switzerland.,Sydney School of Medicine, The University of Notre Dame Australia, Sydney, Australia
| | - Iris Noebauer-Huhmann
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Filip M Vanhoenacker
- Department of Radiology, Ghent University Hospital, Ghent, Belgium.,Department of Radiology, Antwerp University Hospital, Edegem, Belgium.,Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium
| | | | - Oliver Marin-Peña
- Orthopedic and Traumatology Department, Hip Unit, University Hospital Infanta Leonor, Madrid, Spain
| | - Diego Collado
- Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Barcelona, Spain
| | - Marc Tey-Pons
- Department of Orthopedic Surgery and Traumatology, University Hospital del Mar, Barcelona, Spain
| | | | - Eva Llopis
- Department of Radiology, Hospital de la Ribera, Valencia, Spain
| | - Mario Padron
- Department of Radiology, Clínica Cemtro, Madrid, Spain
| | - Josef Kramer
- Röntgeninstitut am Schillerpark, Rainerstrasse, Linz, Austria
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | | | - P Diana Afonso
- Musculoskeletal Imaging Unit, Imaging Center, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, 1500-650, Lisbon, Portugal
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50
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Mascarenhas VV, Castro MO, Rego PA, Sutter R, Sconfienza LM, Kassarjian A, Schmaranzer F, Ayeni OR, Dietrich TJ, Robinson P, Weber MA, Beaulé PE, Dienst M, Jans L, Lalam R, Karantanas AH, Sudoł-Szopińska I, Anderson S, Noebauer-Huhmann I, Vanhoenacker FM, Dantas P, Marin-Peña O, Collado D, Tey-Pons M, Schmaranzer E, Llopis E, Padron M, Kramer J, Zingg PO, De Maeseneer M, Afonso PD. The Lisbon Agreement on Femoroacetabular Impingement Imaging-part 1: overview. Eur Radiol 2020; 30:5281-5297. [PMID: 32405754 DOI: 10.1007/s00330-020-06822-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/28/2020] [Accepted: 03/18/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Imaging assessment for the clinical management of femoroacetabular impingement (FAI) syndrome remains controversial because of a paucity of evidence-based guidance and notable variability in clinical practice, ultimately requiring expert consensus. The purpose of this agreement is to establish expert-based statements on FAI imaging, using formal techniques of consensus building. METHODS A validated Delphi method and peer-reviewed literature were used to formally derive consensus among 30 panel members (21 musculoskeletal radiologists and 9 orthopaedic surgeons) from 13 countries. Forty-four questions were agreed on, and recent relevant seminal literature was circulated and classified in five major topics ('General issues', 'Parameters and reporting', 'Radiographic assessment', 'MRI' and 'Ultrasound') in order to produce answering statements. The level of evidence was noted for all statements, and panel members were asked to score their level of agreement with each statement (0 to 10) during iterative rounds. Either 'consensus', 'agreement' or 'no agreement' was achieved. RESULTS Forty-seven statements were generated, and group consensus was reached for 45 (95.7%). Seventeen of these statements were selected as most important for dissemination in advance. There was no agreement for the two statements pertaining to 'Ultrasound'. CONCLUSION Radiographic evaluation is the cornerstone of hip evaluation. An anteroposterior pelvis radiograph and a Dunn 45° view are recommended for the initial assessment of FAI although MRI with a dedicated protocol is the gold standard imaging technique in this setting. The resulting consensus can serve as a tool to reduce variability in clinical practices and guide further research for the clinical management of FAI. KEY POINTS • FAI imaging literature is extensive although often of low level of evidence. • Radiographic evaluation with a reproducible technique is the cornerstone of hip imaging assessment. • MRI with a dedicated protocol is the gold standard imaging technique for FAI assessment.
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Affiliation(s)
- Vasco V Mascarenhas
- Musculoskeletal Imaging Unit, Imaging Center, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, 1500-650, Lisbon, Portugal.
| | - Miguel O Castro
- Department of Radiology, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - Paulo A Rego
- Department of Orthopaedic Surgery, Hospital da Luz, Lisbon, Portugal
| | - Reto Sutter
- Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | | | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern, University of Bern, Bern, Switzerland
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | - Philip Robinson
- Radiology Department, Leeds Teaching Hospitals, Chapel Allerton Hospital, Leeds, UK.,University of Leeds, Leeds, UK.,NHIR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center, Rostock, Germany
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Radhesh Lalam
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry, UK
| | - Apostolos H Karantanas
- Medical School, University of Crete, Heraklion, Greece.,Computational BioMedicine Laboratory, ICS/FORTH, Heraklion, Greece
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Suzanne Anderson
- Institute of Radiology, Kantonsspital Baden, Baden, Switzerland.,Sydney School of Medicine, The University of Notre Dame Australia, Sydney, Australia
| | - Iris Noebauer-Huhmann
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Filip M Vanhoenacker
- Department of Radiology, Ghent University Hospital, Gent, Belgium.,Department of Radiology, Antwerp University Hospital, Edegem, Belgium.,Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium
| | | | - Oliver Marin-Peña
- Orthopedic and Traumatology Department, Hip Unit, University Hospital Infanta Leonor, Madrid, Spain
| | - Diego Collado
- Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Barcelona, Spain
| | - Marc Tey-Pons
- Department of Orthopedic Surgery and Traumatology, University Hospital del Mar, Barcelona, Spain
| | | | - Eva Llopis
- Department of Radiology, Hospital de la Ribera, Valencia, Spain
| | - Mario Padron
- Department of Radiology, Clínica Cemtro, Madrid, Spain
| | - Josef Kramer
- Röntgeninstitut am Schillerpark, Rainerstrasse, Linz, Austria
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | | | - P Diana Afonso
- Musculoskeletal Imaging Unit, Imaging Center, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, 1500-650, Lisbon, Portugal
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