Acetabular Cartilage Lesions Research Articles

Acetabular Labral Tears and Cartilage Lesions of the Hip: Indirect MR Arthrographic Correlation With Arthroscopy—A Preliminary Study

The purpose of this study was to assess the diagnostic correlation between indirect MR arthrography, conventional MRI, and arthroscopy in acetabular labral and cartilage lesions of the hip. Fourteen patients who underwent conventional and indirect MR arthrography with arthroscopic correlation were studied over the course of 18 months. MR studies were performed on a 1.5-T magnet. Sequences consisted of unilateral sagittal turbo spin-echo proton density fat-suppressed, axial turbo spin-echo T2 fat-saturated, and coronal turbo spin-echo proton density fat-saturated images. Whole-pelvis coronal T1 and STIR sequences were also performed. Patients received IV gadolinium contrast material and exercised for 15 minutes. Gadolinium-enhanced fat-saturated T1 sequences were obtained in three planes. Arthroscopy was performed by two orthopedic surgeons who specialize in treating hip disorders. Cases were then retrospectively reviewed by two experienced musculoskeletal radiologists who were blinded to the arthroscopic findings. Cases were examined for acetabular labral tears and chondral lesions. Extraarticular findings of femoral acetabular impingement were recorded. Unenhanced and gadolinium-enhanced images of the labrum were compared for differences and changes in diagnosis. Comparison was made between the arthroscopic and MR findings for analysis of the results. Of the 13 labral tears found at arthroscopy, 85% were detected by conventional MRI, whereas 100% were identified via indirect MR arthrography. Seventy percent of the labral tears identified on conventional MRI were better delineated by indirect MR arthrography. Identification of chondral abnormalities was not improved via indirect MR arthrography over conventional MRI. IV contrast-enhanced indirect MR arthrography appears to be an effective means of hip evaluation for labral tears. It does not appear to improve detection of cartilage abnormalities when compared with conventional MRI.

Open Treatment of Femoroacetabular Impingement is Associated with Clinical Improvement and Low Complication Rate at Short-term Followup

Since the modern description of femoroacetabular impingement (FAI) a decade ago, surgical treatment has become increasingly common. Although the ability of open treatment of FAI to relieve pain and improve function has been demonstrated in a number of retrospective studies, questions remain regarding predictability of clinical outcome, the factors associated with clinical failure, and the complications associated with treatment. We therefore described the change in clinical pain and function after open treatment, determined whether failure of treatment and progression of osteoarthritis was associated with Outerbridge Grade IV hyaline cartilage injury, and described the associated complications. We retrospectively reviewed all 94 patients (96 hips) (55 males and 39 females; mean age, 28 years) who underwent surgical dislocation for femoroacetabular impingement between 2000 and 2008. Seventy-two of the 96 hips had acetabular articular cartilage lesions treated with a variety of methods, most commonly resection of damaged hyaline cartilage and labral advancement. Patients were followed for a minimum of 18 months (mean, 26 months; range, 18-96 months). Mean Harris hip scores improved from 67 to 91 at final followup. Six of the 96 hips (6%) were converted to arthroplasty or had worse Harris hip score after surgical recovery. Four of these six had Outerbridge Grade IV acetabular cartilage lesions and two had Legg-Calvé-Perthes disease or slipped capital epiphysis deformities. Two hips (2%) had refixation of the greater trochanter. At short-term followup, open treatment for femoroacetabular impingement in hips without substantial acetabular hyaline cartilage damage reduced pain and improved function with a low complication rate. Treatment of Outerbridge Grade IV acetabular cartilage delamination remains the major challenge. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Arthroscopically assisted anterior decompression for femoroacetabular impingement: technique and early clinical results

In patients with symptomatic femoroacetabular impingement resection osteochondroplasty of the femoral head-neck junction may improve hip pain and range of motion. We evaluated the short-term treatment results of an arthroscopically assisted mini-open anterior approach to compare it with the results after surgical dislocation for FAI. The clinical and radiographic results of 33 patients were reviewed retrospectively 15 months after the surgery. Harris hip scores and plain radiographs were obtained preoperatively and at follow-up. Patient satisfaction with the treatment result was quantified with a Visual Analogous scale (VAS) ranging from 0 (very dissatisfied) to 10 (very satisfied). The mean Harris hip score improved from 64 points preoperatively to 85 points at the time of follow-up (P < 0.001). Mean patient satisfaction on the VAS was seven points (range: 2-10 points). In two of our first patients we observed a transient femoral nerve palsy (completely resolved at follow-up) and 15 patients reported numbness in the area of the lateral cutaneous femoral nerve. Treatment of anterior femoroacetabular impingement through an arthroscopically assisted mini-open anterior approach can reduce pain and improve function in a short-term observation period. Femoral osteochondroplasty as well as surgical treatment of acetabular cartilage and labrum lesions are possible, but the access is limited to the anterior and anterolateral part of the hip joint.

MR Arthrography of the Hip: Differentiation between an Anterior Sublabral Recess as a Normal Variant and a Labral Tear

To retrospectively evaluate imaging characteristics of surgically proved sublabral recesses and labral tears in the anterior portion of the acetabulum at magnetic resonance (MR) arthrography. Institutional review board approval was obtained; informed consent was waived. The study included 57 patients (36 women [mean age, 37 years], 21 men [mean age, 32 years]) who underwent MR arthrography and either surgery or arthroscopy as reference standard. On MR images, location of sublabral contrast material interposition and depth, shape, and extension into the labral substance of contrast material interpositions were described. Abnormal labral signal intensity (areas of high signal intensity), acetabular cartilage lesions, osseous abnormalities, and perilabral cysts were noted. Mann-Whitney U and Fisher exact tests were performed; interobserver agreement was calculated (kappa statistic and intraclass correlation coefficient). Surgical procedures revealed that 10 (18%) of 57 patients had recesses and 44 (77%) of 57 had tears. Locations of recesses and tears, respectively, were as follows: seven and none, in the 8-o'clock position; two of each, in the 9-o'clock position; one and 22, in the 10-o'clock position; and none and 20, in the 11-o'clock position. None of the recesses extended into the substance of the labrum or through the full thickness of the labral base; 51% (22 of 43) of tears extended into the substance and 49% (21 of 43) of tears extended along the entire labral base. Shape of sublabral contrast material interposition was linear in five (83%) of six recesses and 21 (49%) of 43 tears. Recesses were not associated with abnormal signal intensity of the labrum, cartilage lesions, osseous abnormalities, or perilabral cysts. Of 43 tears, 32 (74%) were associated with abnormal signal of the labrum; 23 (53%), with cartilage damage; 11 (26%), with osseous abnormalities; and eight (19%), with perilabral cysts. Recesses occur as normal variants in the anteroinferior part of the acetabulum. Location in the 8-o'clock position, linear shape of contrast material interposition, partial separation of the labrum, and absence of perilabral abnormalities are characteristics of a recess.

MRI Findings of Femoroacetabular Impingement

The purpose of our study was to evaluate MRI in the identification of labral and articular cartilage lesions in patients with a clinical suspicion of femoroacetabular impingement. Preoperative MRI was performed in 46 consecutive patients (26 men, 20 women; age range, 21-45 years; mean age, 32.3 years) for whom femoroacetabular impingement was clinically suspected. Two musculoskeletal radiologists independently assessed the MR images for the presence and anatomic site of labral disorders, labral-chondral transitional zone disorders, femoral cartilage lesions, and acetabular cartilage lesions. Surgical correlation was obtained in all cases by two surgeons who were experienced in hip arthroscopy. Seven patients showed labral tears on MRI that were confirmed surgically in all cases. Thirty-seven patients (97%) of the 38 surgically confirmed cases had lesions of the labral-chondral transitional zone on MRI. The sites of labral-chondral transitional zone abnormalities at arthroscopy were 50% anterosuperior, 36% anterosuperior and superolateral, 11% superolateral, and 3% superolateral and posterosuperior. The site was identified correctly in 92% (reviewer 1) and 95% (reviewer 2) of cases on MRI. Separate acetabular cartilage abnormality was surgically identified in 39% of cases, and femoral cartilage lesions were found in 20%. The acetabular chondral lesions were correctly identified in 89-94% of cases. MRI provides a useful assessment of patients in whom a femoroacetabular impingement is clinically suspected. A high-resolution, nonarthrographic technique can provide preoperative information regarding the presence and anatomic site of labral and cartilage abnormalities.

Evaluation and treatment of young adults with femoro-acetabular impingement secondary to Perthes disease

Hip pain and loss of motion in young adults with previous Legg-Calve-Perthes-Disease may be caused by anterior femoro-acetabular impingement. Eleven patients (12 hips) with the chief complaint of groin pain and significant proximal femoral deformity were treated. Gadolinium-enhanced magnetic resonance arthrography in ten patients indicated labral injury and adjacent acetabular cartilage lesions in nine hips. A surgical dislocation of each hip confirmed that there was impingement induced intra-articular injury consistent with the pathology indicated on the MRI. Reshaping of the femoral head, with correction of the femoral head/neck offset, and treatment of the acetabular rim pathology was performed for each hip in conjunction with other procedures for the proximal femur. Correction of the impingement and increased range of motion could be visualized intra-operatively. At a mean follow-up of 33 months, half of all patients were pain-free and all had improvement in pain compared with preoperatively. Ten patients had an improved range of motion and two a slight decrease. No additional necrosis following the dislocation of the femoral head was seen.;

Evaluation and Treatment of Young Adults with Femoro-Acetabular Impingement Secondary to Perthes' Disease

Hip pain and loss of motion in young adults with previous Legg-Calve-Perthes-Disease may be caused by anterior femoro-acetabular impingement. Eleven patients (12 hips) with the chief complaint of groin pain and significant proximal femoral deformity were treated. Gadolinium-enhanced magnetic resonance arthrography in ten patients indicated labral injury and adjacent acetabular cartilage lesions in nine hips. A surgical dislocation of each hip confirmed that there was impingement induced intra-articular injury consistent with the pathology indicated on the MRI. Reshaping of the femoral head, with correction of the femoral head/neck offset, and treatment of the acetabular rim pathology was performed for each hip in conjunction with other procedures for the proximal femur. Correction of the impingement and increased range of motion could be visualized intra-operatively. At a mean follow-up of 33 months, half of all patients were pain-free and all had improvement in pain compared with preoperatively. Ten patients had an improved range of motion and two a slight decrease. No additional necrosis following the dislocation of the femoral head was seen.;

Contribution of helical computed tomography to the evaluation of early hip osteoarthritis: a study in 18 patients

Objectives. – To show that helical computed tomography arthrograms (HCTA) with multiplanar reformations can document cartilage lesions and their characteristics in patients with suspected hip osteoarthritis and normal or inconclusive hip radiographs. Methods. – We retrospectively reviewed abnormal HCTAs from patients with mechanical hip pain and normal findings on anteroposterior and oblique (“faux profil”) radiographs of the pelvis. HCTA in all patients consisted in acquiring 1 mm transverse slices and obtaining coronal and sagittal reformations. Radiographs and HCTAs were read separately by two experienced radiologists, who then worked together to reach a consensus. Results. – We identified 18 patients with abnormal HCTA findings and a full set of imaging studies. Mean age was 47.8 years, and there were 14 women and four men. Acetabular cartilage lesions were found consistently; they were often deep and predominated in the anterosuperior region. A labral fissure was noted in 12 patients. The sagittal and coronal reformations proved more informative than the acquired transverse slices. Interobserver reproducibility was excellent for the HCTA diagnosis of cartilage lesions. Conclusions. – In patients with hip pain and normal radiographs, HCTA can provide a diagnosis of hip osteoarthritis by showing cartilage lesions, which are usually located in the anterosuperior part of the acetabulum.

Anterior femoroacetabular impingement after femoral neck fractures.

To verify whether anterior femoroacetabular impingement can be a reason for hip pain and loss of motion in patients with a healed femoral neck fracture. Retrospective clinical, radiologic, and surgical evaluation. Third referral hospital. Nine patients who previously sustained a femoral neck fracture were treated between 1995 and 1999 for hip pain and loss of motion. All these mostly young patients (mean age 33.3 years) complained of groin pain. During the physical examination, acute pain could be elicited by passively forcing the femoral neck against the acetabular rim in flexion, adduction, and internal rotation, motions that were all limited. Conventional radiographs and, if possible, arthrographic magnetic resonance imaging scans were followed by a surgical subluxation or dislocation of the femoral head to analyze the sequelae of anterior femoroacetabular impingement. Treatment was based on improvement of the anterior offset (the difference between the anterior contour of the head and the femoral neck) or intertrochanteric osteotomy to ameliorate clearance of the joint. Intraoperatively in eight patients (one not operated), impingement was found to result from insufficient reduction of the fracture, already visible on the conventional radiographs. Retrotorsion (mean 20 degrees) of the head caused anterior impingement in all patients, additional varus position (mean caput collum diaphysis angle 115 degrees) of the head caused anterolateral impingement in two patients. In all patients, anterior labral and adjacent acetabular cartilage lesions were found during surgical subluxation or dislocation of the femoral head, comparable to those seen on the magnetic resonance imaging scan. They proved to result from repetitive abutment and compression between the head-neck junction and the acetabulum. Femoroacetabular impingement can be a cause for hip pain and loss of motion in patients who previously sustained a femoral neck fracture. The condition causes degenerative anterior labral and adjacent acetabular cartilage lesions. Early treatment is essential to prevent further degeneration and osteoarthrosis of the joint. Prevention is predicated by initial precise anatomic reduction of such fractures in all planes.