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The posterior crescent sign on MRI and MR arthrography: is it a marker of hip dysplasia and instability?

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Abstract

Objective

To evaluate the prevalence of the ‘posterior crescent sign’ in symptomatic patients referred for MRI/MR arthrogram of the hip and identify any correlation with imaging features of joint pathology.

Materials and methods

Retrospective imaging assessment of a cohort of 1462 hips, from 1380 included MR examinations (82 bilateral) retrieved from a search of all examinations in patients 16–50 years old from June 2018 to June 2021, with median age 45.8 years (range 17.8–50.0) and 936 hips (64%) in women. Radiographic and MR findings related to hip dysplasia, femoroacetabular im**ement and osteoarthritis were assessed.

Results

Fifty-one hips (3.5%) were positive for the posterior crescent sign, median age of 45.8 years (range 17.8–50.0) and 29 (58%) in women. Radiographic findings included the following: mean lateral centre edge angle (LCEA) 22.2° (± 7.8°) with LCEA < 20° in 15 (31%) and LCEA 20–25° in 17 (35%) and mean acetabular index (AI) of 13.1° (± 5.8°) with AI > 13° in 22 (45%). MR findings included the following: mean anterior acetabular sector angle (AASA) 54.3° (± 9.8°), mean posterior acetabular sector angle (PASA) 92.7° (± 7.0°), labral tear at 3–4 o’clock in 20 (39%), high-grade acetabular chondral loss in 42 (83%) and ligamentum teres abnormality in 20 (39%).

Conclusion

The posterior crescent sign occurs in 3.5% of symptomatic young and middle-aged adults on MR. It is associated with overt and borderline hip dysplasia and other findings of hip instability. It is also associated with osteoarthritis in some cases and should be interpreted with caution in these patients.

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Author information

Authors and Affiliations

  1. Department of Radiology, Auckland City Hospital, Auckland, New Zealand

    Andrew A. MacDonald

  2. School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

    Donna G. Blankenbaker

  3. Orthosports North Harbour, Millenium Institute of Sport & Health, Auckland, New Zealand

    Matthew J. Brick

  4. Axis Sports Medicine Specialists, Auckland, New Zealand

    Chris M. Hanna

  5. Auckland Radiology Group (ARG), Auckland, New Zealand

    Rebecca M. Woodward

  6. Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand

    Rebecca M. Woodward

Authors
  1. Andrew A. MacDonald
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  5. Rebecca M. Woodward
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Correspondence to Andrew A. MacDonald.

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MacDonald, A.A., Blankenbaker, D.G., Brick, M.J. et al. The posterior crescent sign on MRI and MR arthrography: is it a marker of hip dysplasia and instability?. Skeletal Radiol 52, 1127–1135 (2023). https://doi.org/10.1007/s00256-022-04248-6

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