Abstract
Background
Currently, plain radiographs and MRI are the standard imaging modalities used for diagnosing femoroacetabular im**ement (FAI) and preoperative planning for arthroscopic treatment of FAI. The value of three-dimensional (3D) CT for these purposes is unclear.
Questions/purposes
We therefore determined the reliability of CT assessment of FAI and whether CT findings of hip disease predict arthroscopic findings.
Methods
We retrospectively assessed the preoperative CT scans of 118 patients who underwent primary hip arthroscopy. Intraoperative findings, including size of the cam lesion, presence of an acetabular labral articular disruption lesion, and one of four types of labral tear were recorded and compared with the retrospectively read CT findings.
Results
Agreement analysis between CT and intraoperative detection of FAI yielded kappa values of 0.48 for cam lesions and 0.16 for pincer lesions. Increasing values for the CT-based alpha angle correlated with increasing severity of arthroscopically assessed acetabular labral articular disruption grade. Each pattern of FAI predicted a specific labral tear type.
Conclusions
Our data suggest CT has moderate value in predicting mechanically based labral tear patterns, although better parameters for assessment of pincer lesions are needed. Diagnostic assessment of patients with suspected FAI may be improved with use of 3D CT.
Level of Evidence
Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Similar content being viewed by others
References
Abel M, Sutherland DH, Wenger DR, Mubarak SJ. Evaluation of CT scans and 3-D reformatted images for quantitative assessment of the hip. J Pediatr Orthop. 1994;14:48–53.
Anderson LA, Gililland J, Pelt C, Linford S, Stoddard GJ, Peters CL. Center edge angle measurement for hip preservation surgery: technique and caveats. Orthopedics. 2011;34:86.
Beaule PE, Zaragoza E, Motamedi K, Copelan N, Dorey FJ. Three-dimensional computed tomography of the hip in the assessment of femoroacetabular im**ement. J Orthop Res. 2005;23:1286–1292.
Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular im**ement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87:1012–1018.
Bedi A, Dolan M, Hetsroni I, Magennis E, Lipman J, Buly R, Kelly BT. Surgical treatment of femoroacetabular im**ement improves hip kinematics: a computer-assisted model. Am J Sports Med. 2011;39(suppl):43S–49S.
Biswas D, Bible JE, Bohan M, Simpson AK, Whang PG, Grauer JN. Radiation exposure from musculoskeletal computerized tomographic scans. J Bone Joint Surg Am. 2009;91:1882–1889.
Blankenbaker DG, De Smet AA, Keene JS, Fine JP. Classification and localization of acetabular labral tears. Skeletal Radiol. 2007;36:391–397.
Clohisy JC, Carlisle JC, Beaule PE, Kim YJ, Trousdale RT, Sierra RJ, Leunig M, Schoenecker PL, Millis MB. A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am. 2008;90(suppl 4):47–66.
Clohisy JC, Carlisle JC, Trousdale R, Kim YJ, Beaule PE, Morgan P, Steger-May K, Schoenecker PL, Millis M. Radiographic evaluation of the hip has limited reliability. Clin Orthop Relat Res. 2009;467:666–675.
Cohen MS, Gelberman RH, Griffin PP, Kasser JR, Emans JB, Millis MB. Slipped capital femoral epiphysis: assessment of epiphyseal displacement and angulation. J Pediatr Orthop. 1986;6:259–264.
Dandachli W, Ul Islam S, Tippett R, Hall-Craggs MA, Witt JD. Analysis of acetabular version in the native hip: comparison between 2D axial CT and 3D CT measurements. Skeletal Radiol. 2011;40:877–883.
Dolan MM, Heyworth BE, Bedi A, Duke G, Kelly BT. CT reveals a high incidence of osseous abnormalities in hips with labral tears. Clin Orthop Relat Res. 2011;469:831–838.
Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular im**ement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.
Heyworth BE, Shindle MK, Voos JE, Rudzki JR, Kelly BT. Radiologic and intraoperative findings in revision hip arthroscopy. Arthroscopy. 2007;23:1295–1302.
Ilizaliturri VM Jr, Byrd JW, Sampson TG, Guanche CA, Philippon MJ, Kelly BT, Dienst M, Mardones R, Shonnard P, Larson CM. A geographic zone method to describe intra-articular pathology in hip arthroscopy: cadaveric study and preliminary report. Arthroscopy. 2008;24:534–539.
Ito K, Minka MA 2nd, Leunig M, Werlen S, Ganz R. Femoroacetabular im**ement and the cam-effect: a MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br. 2001;83:171–176.
Jamali AA, Mladenov K, Meyer DC, Martinez A, Beck M, Ganz R, Leunig M. Anteroposterior pelvic radiographs to assess acetabular retroversion: high validity of the “cross-over-sign”. J Orthop Res. 2007;25:758–765.
Jung KA, Restrepo C, Hellman M, AbdelSalam H, Parvizi J, Morrison W. The prevalence of cam-type femoroacetabular deformity in asymptomatic adults. J Bone Joint Surg Br. 2011;93:1303–1307.
Kalberer F, Sierra RJ, Madan SS, Ganz R, Leunig M. Ischial spine projection into the pelvis: a new sign for acetabular retroversion. Clin Orthop Relat Res. 2008;466:677–683.
Kang AC, Gooding AJ, Coates MH, Goh TD, Armour P, Rietveld J. Computed tomography assessment of hip joints in asymptomatic individuals in relation to femoroacetabular im**ement. Am J Sports Med. 2010;38:1160–1165.
Kelly BT, Weiland DE, Schenker ML, Philippon MJ. Arthroscopic labral repair in the hip: surgical technique and review of the literature. Arthroscopy. 2005;21:1496–1504.
Kelly BT, Williams RJ 3rd, Philippon MJ. Hip arthroscopy: current indications, treatment options, and management issues. Am J Sports Med. 2003;31:1020–1037.
Kocher MS, Kim YJ, Millis MB, Mandiga R, Siparsky P, Micheli LJ, Kasser JR. Hip arthroscopy in children and adolescents. J Pediatr Orthop. 2005;25:680–686.
Kudrna J. Femoral version: definition, diagnosis, and intraoperative correction with modular femoral components. Orthopedics. 2005;28(9 suppl):s1045–s1047.
Lavigne M, Parvizi J, Beck M, Siebenrock KA, Ganz R, Leunig M. Anterior femoroacetabular im**ement: Part I. Techniques of joint preserving surgery. Clin Orthop Relat Res. 2004;418:61–66.
Leunig M, Podeszwa D, Beck M, Werlen S, Ganz R. Magnetic resonance arthrography of labral disorders in hips with dysplasia and im**ment. Clin Orthop Relat Res. 2004;418:74–80.
McCarthy JC. Hip arthroscopy: applications and technique. J Am Acad Orthop Surg. 1995;3:115–122.
Meyer DC, Beck M, Ellis T, Ganz R, Leunig M. Comparison of six radiographic projections to assess femoral head/neck asphericity. Clin Orthop Relat Res. 2006;445:181–185.
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;21:385–393.
Mofidi A, Shields JS, Tan JS, Poehling GG, Stubbs AJ. Use of intraoperative computed tomography scanning in determining the magnitude of arthroscopic osteochondroplasty. Arthroscopy. 2011;27:1005–1013.
Nepple JJ, Carlisle JC, Nunley RM, Clohisy JC. Clinical and radiographic predictors of intra-articular hip disease in arthroscopy. Am J Sports Med. 2011;39:296–303.
Notzli 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 im**ement. J Bone Joint Surg Br. 2002;84:556–560.
Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br. 1961;43:752–757.
Philippon MJ, Schenker ML, Briggs KK, Kuppersmith DA, Maxwell RB, Stubbs AJ. Revision hip arthroscopy. Am J Sports Med. 2007;35:1918–1921.
Philippon MJ, Stubbs AJ, Schenker ML, Maxwell RB, Ganz R, Leunig M. Arthroscopic management of femoroacetabular im**ement: osteoplasty technique and literature review. Am J Sports Med. 2007;35:1571–1580.
Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum: a cause of hip pain. J Bone Joint Surg Br. 1999;81:281–288.
Robertson WJ, Kadrmas WR, Kelly BT. Arthroscopic management of labral tears in the hip: a systematic review of the literature. Clin Orthop Relat Res. 2007;455:88–92.
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;382:232–240.
Shindle MK, Voos JE, Heyworth BE, Mintz DN, Moya LE, Buly RL, Kelly BT. Hip arthroscopy in the athletic patient: current techniques and spectrum of disease. J Bone Joint Surg Am. 2007;89(suppl 3):29–43.
Tannast M, Goricki D, Beck M, Murphy SB, Siebenrock KA. Hip damage occurs at the zone of femoroacetabular im**ement. Clin Orthop Relat Res. 2008;466:273–280.
Voos JE, Rudzki JR, Shindle MK, Martin H, Kelly BT. Arthroscopic anatomy and surgical techniques for peritrochanteric space disorders in the hip. Arthroscopy. 2007;23:e1–e5.
Wenger DE, Kendell KR, Miner MR, Trousdale RT. Acetabular labral tears rarely occur in the absence of bony abnormalities. Clin Orthop Relat Res. 2004;426:145–150.
Zumstein M, Hahn F, Sukthankar A, Sussmann PS, Dora C. How accurately can the acetabular rim be trimmed in hip arthroscopy for pincer-type femoral acetabular im**ement: a cadaveric investigation. Arthroscopy. 2009;25:164–168.
Acknowledgments
We thank Steven Albert MD, Douglas Decorato MD, Robert Ludwig MD, and Gavin L. Duke MD for assistance in evaluating CT scans for this study.
Author information
Authors and Affiliations
Corresponding author
Additional information
One author (BTK) has consultancies (Pivot Medical – Sunnyvale, CA; A2 Medical – Dallas, TX; Smith and Nephew Endoscopy – Andover, MA) and stock ownership (Pivot Medical – Sunnyvale, CA) that may pose a conflict of interest. All other authors certify that neither he, nor a member of their immediate family, has consultancies, stock ownership, equity interest, or patent/licensing arrangements in any companies that may pose a conflict of interest.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
This work was performed at the Hospital for Special Surgery, New York, NY, USA.
About this article
Cite this article
Heyworth, B.E., Dolan, M.M., Nguyen, J.T. et al. Preoperative Three-dimensional CT Predicts Intraoperative Findings in Hip Arthroscopy. Clin Orthop Relat Res 470, 1950–1957 (2012). https://doi.org/10.1007/s11999-012-2331-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11999-012-2331-6