Generic placeholder image

Current Medical Imaging

Author(s): Heba Ibrahim*, Muhammad Ali Raffat and Thomas Nau

DOI: 10.2174/1573405619666230306095522

DownloadDownload PDF Flyer Cite As
Reliability of Conventional Hip MRI in Detecting Labral Tear and Labrocartilagenous Lesions in cases of Femoroacetabular Impingement, A Comparative Study with Hip Arthroscopy

Article ID: e060323214358 Pages: 7

  • * (Excluding Mailing and Handling)

Abstract

Background: Imaging studies play a crucial role in diagnosing femoroacetabular impingement (FAI), including plain radiography and Magnetic Resonance Imaging (MRI). FAI is a combined pathology of bony abnormality, labral and labrocartilagenous erosions. Surgical treatment for such cases has become more established and preoperative imaging is the roadmap that includes the assessment of labrum and articular cartilage.

Methods: During a period of 2 years, thirty-seven patients with a clinical diagnosis of FAI were retrospectively enrolled in this study, including 17 men and 20 women, aged 27–62 years. There were 22 right hips and 15 left hips. MRI was done for all patients to identify bony details, labral and chondral abnormalities and to exclude coexisting disorders. The imaging findings were compared with the arthroscopic data.

Results: 15 patients had Pincer FAI, 11 patients had CAM, and 11 patients had combined Cam/Pincer FAI. Labral tear was detected in 100% of patients, 97% had an anterosuperior labral tear. 82% of patients had partial thickness cartilage lesions and 8% had full thickness cartilage lesions. MRI had a sensitivity of 100% compared to hip arthroscopy in detecting labral tear, 60% in detecting cartilage erosion.

Conclusion: Conventional hip MRI detects bony changes in FAI, type of impingement and associated labral tear and cartilage erosions in comparison to the hip arthroscopy.

[1]
Leunig M, Beck M, Woo A, Dora C, Kerboull M, Ganz R. Acetabular rim degeneration: A constant finding in the aged hip. Clin Orthop Relat Res 2003; 413(413): 201-7.
[http://dx.doi.org/10.1097/01.blo.0000073341.50837.91] [PMID: 12897611]
[2]
Li AE, Jawetz ST, Greditzer HG IV, Burge AJ, Nawabi DH, Potter HG. MRI for the preoperative evaluation of femoroacetabular impingement. Insights Imaging 2016; 7(2): 187-98.
[http://dx.doi.org/10.1007/s13244-015-0459-0] [PMID: 26715128]
[3]
Ito K, Minka- MA II, Leunig M, Werlen S, Ganz R. Femoroacetabular impingement and the cam-effect. J Bone Joint Surg Br 2001; 83-B(2): 171-6.
[http://dx.doi.org/10.1302/0301-620X.83B2.0830171] [PMID: 11284559]
[4]
Kassarjian A, Yoon LS, Belzile E, Connolly SA, Millis MB, Palmer WE. Triad of MR arthrographic findings in patients with cam-type femoroacetabular impingement. Radiology 2005; 236(2): 588-92.
[http://dx.doi.org/10.1148/radiol.2362041987] [PMID: 15972331]
[5]
Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 2002; 84-B(4): 556-60.
[http://dx.doi.org/10.1302/0301-620X.84B4.0840556] [PMID: 12043778]
[6]
Siebenrock KA, Wahab KHA, Werlen S, Kalhor M, Leunig M, Ganz R. Abnormal extension of the femoral head epiphysis as a cause of cam impingement. Clin Orthop Relat Res 2004; 418(418): 54-60.
[http://dx.doi.org/10.1097/00003086-200401000-00010] [PMID: 15043093]
[7]
Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage. J Bone Joint Surg Br 2005; 87-B(7): 1012-8.
[http://dx.doi.org/10.1302/0301-620X.87B7.15203] [PMID: 15972923]
[8]
Johnston TL, Schenker ML, Briggs KK, Philippon MJ. Relationship between offset angle alpha and hip chondral injury in femoroacetabular impingement. Arthroscopy 2008; 24(6): 669-75.
[http://dx.doi.org/10.1016/j.arthro.2008.01.010] [PMID: 18514110]
[9]
Pfirrmann CWA, Duc SR, Zanetti M, Dora C, Hodler J. MR arthrography of acetabular cartilage delamination in femoroacetabular cam impingement. Radiology 2008; 249(1): 236-41.
[http://dx.doi.org/10.1148/radiol.2491080093] [PMID: 18682585]
[10]
Tannast M, Goricki D, Beck M, Murphy SB, Siebenrock KA. Hip damage occurs at the zone of femoroacetabular impingement. Clin Orthop Relat Res 2008; 466(2): 273-80.
[http://dx.doi.org/10.1007/s11999-007-0061-y] [PMID: 18196406]
[11]
Wagner S, Hofstetter W, Chiquet M, et al. Early osteoarthritic changes of human femoral head cartilage subsequent to femoro-acetabular impingement. Osteoarthritis Cartilage 2003; 11(7): 508-18.
[http://dx.doi.org/10.1016/S1063-4584(03)00075-X] [PMID: 12814614]
[12]
Siebenrock KA, Schoeniger R, Ganz R. Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy. J Bone Joint Surg Am 2003; 85(2): 278-86.
[http://dx.doi.org/10.2106/00004623-200302000-00015] [PMID: 12571306]
[13]
Martin SD, Katz JN. Labral Tears and Femoroacetabular Impingement: Clinical Features and Arthroscopic Management. Open Arthritis Journal 2012; 5: 1-13.
[http://dx.doi.org/10.2174/1876539401205010001]
[14]
Albers CE, Steppacher SD, Ganz R, Siebenrock KA, Tannast M. Joint-preserving surgery improves pain, range of motion, and abductor strength after Legg-Calvé-Perthes disease. Clin Orthop Relat Res 2012; 470(9): 2450-61.
[http://dx.doi.org/10.1007/s11999-012-2345-0] [PMID: 22528379]
[15]
Albers CE, Steppacher SD, Haefeli PC, et al. Twelve percent of hips with a primary cam deformity exhibit a slip-like morphology resembling sequelae of slipped capital femoral epiphysis. Clin Orthop Relat Res 2015; 473(4): 1212-23.
[http://dx.doi.org/10.1007/s11999-014-4068-x] [PMID: 25448326]
[16]
Wensaas A, Gunderson RB, Svenningsen S, Terjesen T. Femoroacetabular impingement after slipped upper femoral epiphysis. J Bone Joint Surg Br 2012; 94-B(11): 1487-93.
[http://dx.doi.org/10.1302/0301-620X.94B11.29569] [PMID: 23109627]
[17]
Eijer H, Myers SR, Ganz R. Anterior femoroacetabular impingement after femoral neck fractures. J Orthop Trauma 2001; 15(7): 475-81.
[http://dx.doi.org/10.1097/00005131-200109000-00003] [PMID: 11602829]
[18]
Leunig M, Podeszwa D, Beck M, Werlen S, Ganz R. Magnetic resonance arthrography of labral disorders in hips with dysplasia and impingement. Clin Orthop Relat Res 2004; 418(418): 74-80.
[http://dx.doi.org/10.1097/00003086-200401000-00013] [PMID: 15043096]
[19]
Corten K, Ganz R, Chosa E, Leunig M. Bone apposition of the acetabular rim in deep hips: a distinct finding of global pincer impingement. J Bone Joint Surg Am 2011; 93 (Suppl. 2): 10-6.
[http://dx.doi.org/10.2106/JBJS.J.01799] [PMID: 21543682]
[20]
Pfirrmann CWA, Mengiardi B, Dora C, Kalberer F, Zanetti M, Hodler J. Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. Radiology 2006; 240(3): 778-85.
[http://dx.doi.org/10.1148/radiol.2403050767] [PMID: 16857978]
[21]
Keeney JA, Peelle MW, Jackson J, Rubin D, Maloney WJ, Clohisy JC. Magnetic resonance arthrography versus arthroscopy in the evaluation of articular hip pathology. Clin Orthop Relat Res 2004; 429(429): 163-9.
[http://dx.doi.org/10.1097/01.blo.0000150125.34906.7d] [PMID: 15577482]
[22]
Mintz DN, Hooper T, Connell D, Buly R, Padgett DE, Potter HG. Magnetic resonance imaging of the hip: Detection of labral and chondral abnormalities using noncontrast imaging. Arthroscopy 2005; 21(4): 385-93.
[http://dx.doi.org/10.1016/j.arthro.2004.12.011] [PMID: 15800516]
[23]
Czerny C, Hofmann S, Neuhold A, et al. Lesions of the acetabular labrum: accuracy of MR imaging and MR arthrography in detection and staging. Radiology 1996; 200(1): 225-30.
[http://dx.doi.org/10.1148/radiology.200.1.8657916] [PMID: 8657916]
[24]
Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular Impingement. Clin Orthop Relat Res 2003; 417(417): 112-20.
[http://dx.doi.org/10.1097/01.blo.0000096804.78689.c2] [PMID: 14646708]
[25]
Frank JM, Harris JD, Erickson BJ. Prevalence of femoroacetabular impingement imaging findings in asymptomatic volunteers: A systematic review. Arthroscopy 2015; 31(6): 1199-204.
[http://dx.doi.org/10.1016/j.arthro.2014.11.042]
[26]
Domb BG, Philippon MJ, Giordano BD. Arthroscopic capsulotomy, capsular repair, and capsular plication of the hip: Relation to atraumatic instability. Arthroscopy 2013; 29(1): 162-73.
[http://dx.doi.org/10.1016/j.arthro.2012.04.057]
[27]
Anderson LA, Peters CL, Park BB, Stoddard GJ, Erickson JA, Crim JR. Acetabular cartilage delamination in femoroacetabular impingement. Risk factors and magnetic resonance imaging diagnosis. J Bone Joint Surg Am 2009; 91(2): 305-13.
[http://dx.doi.org/10.2106/JBJS.G.01198] [PMID: 19181974]
[28]
Clohisy JC, St John LC, Schutz AL. Surgical treatment of femoroacetabular impingement: a systematic review of the literature. Clin Orthop Relat Res 2010; 468(2): 555-64.
[http://dx.doi.org/10.1007/s11999-009-1138-6] [PMID: 19830504]
[29]
Schmaranzer F, Klauser A, Kogler M, et al. Diagnostic performance of direct traction MR arthrography of the hip: detection of chondral and labral lesions with arthroscopic comparison. Eur Radiol 2015; 25(6): 1721-30.
[http://dx.doi.org/10.1007/s00330-014-3534-x] [PMID: 25465714]
[30]
Safran MR, Hariri S. Hip arthroscopy assessment tools and outcomes. Oper Tech Orthop 2010; 20(4): 264-77.
[http://dx.doi.org/10.1053/j.oto.2010.09.014]
[31]
Griffin D, Karthikeyan S. Normal and Pathological Arthroscopic View in Hip Arthroscopy. Femoroacetabular Impingement. Berlin, Heidelberg: Springer 2012.
[http://dx.doi.org/10.1007/978-3-642-22769-1_12]
[32]
Seldes RM, Tan V, Hunt J, Katz M, Winiarsky R, Fitzgerald RH Jr. Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Relat Res 2001; 382(382): 232-40.
[http://dx.doi.org/10.1097/00003086-200101000-00031] [PMID: 11153993]
[33]
Blankenbaker DG, Tuite MJ. Acetabular labrum. Magn Reson Imaging Clin N Am 2013; 21(1): 21-33.
[http://dx.doi.org/10.1016/j.mric.2012.09.006]
[34]
James SLJ, Ali K, Malara F, Young D, O’Donnell J, Connell DA. MRI findings of femoroacetabular impingement. AJR Am J Roentgenol 2006; 187(6): 1412-9.
[http://dx.doi.org/10.2214/AJR.05.1415] [PMID: 17114529]
[35]
Monazzam S, Bomar JD, Dwek JR, Hosalkar HS, Pennock AT. Development and prevalence of femoroacetabular impingement-associated morphology in a paediatric and adolescent population. Bone Joint J 2013; 95-B(5): 598-604.
[http://dx.doi.org/10.1302/0301-620X.95B5.30118] [PMID: 23632667]
[36]
Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R. Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res 2004; 418(418): 67-73.
[http://dx.doi.org/10.1097/00003086-200401000-00012] [PMID: 15043095]
[37]
Schmid MR, Nötzli HP, Zanetti M, Wyss TF, Hodler J. Cartilage lesions in the hip: diagnostic effectiveness of MR arthrography. Radiology 2003; 226(2): 382-6.
[http://dx.doi.org/10.1148/radiol.2262020019] [PMID: 12563129]