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Plain radiographs, including anteroposterior pelvis, Dunn lateral, and false-profile view, are key in initial assessment of patients suspected of femoroacetabular impingement.
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Computed tomography scans rely less patient positioning and allow for accurate definition of the exact location and size of pincer-type and cam-type deformities, and can be particularly helpful in revision hip arthroscopy.
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Studies have shown high incidence of labral tears in asymptomatic patients, thus correlation between
Imaging in Hip Arthroscopy for Femoroacetabular Impingement: A Comprehensive Approach
Section snippets
Key points
Plain radiography
Plain radiographs play a key role in initial management of patients presenting with hip pain when FAI is suspected. Several options exist regarding views and these should be fully understood to optimize information obtained. From these radiographs, several parameters can be obtained to help evaluate patients before hip preservation surgery. These same radiographs can be helpful when considering revision hip arthroscopy and postoperative correction of deformity.
Anteroposterior (AP) pelvis
Computed tomography
3D imaging allows for advanced characterization of the patient’s bony morphology. Computed tomography (CT) can be profoundly helpful in surgical planning for FAI.3, 19 Advances in preoperative planning software and motion analysis technology based on advanced imaging represent a growing area of hip preservation surgery.19, 20 CT is helpful in further delineation of a bony pathologic state noted on plain radiographs, though routine use is controversial given the degree of radiation exposure.21
Magnetic resonance imaging
MRI is a common diagnostic option to evaluate soft tissue hip injuries in patients undergoing workup for FAI. Imaging techniques include but are not limited to conventional noncontrast MRI, indirect magnetic resonance arthrography (MRA) and direct MRA. The latter techniques differ by route of contrast injection. Indirect MRA is intravenously injected; direct MRA is intra-articularly injected.2 Routine imaging sequences include coronal fat-saturated T2 fast spin echo (FSE), coronal T1 FSE,
Role of imaging in preoperative planning
Following an appropriate and thorough history and physical examination, diagnostic imaging plays an important role in determining the correct diagnosis for the young patient with hip pain.50 Recognition and correlation of physical examination findings with bony and soft tissue abnormalities identified on diagnostic imaging allows the surgeon to appreciate the unique fingerprint of disease in each patient. Preoperatively identifying the individualized pathologic condition helps to devise a
Imaging parameters of successful femoroacetabular impingement correction
Incomplete resection of underlying FAI deformity is a major reason for residual hip pain following surgery and a leading cause of revision hip arthroscopy.24, 25, 61, 62, 63, 64 Over-resection of offending osseous disease may lead to iatrogenic instability and poor outcomes.61, 65, 66 In addition to careful attention to preoperative imaging, recent research has suggested that systematic implementation of intraoperative fluoroscopy can assist in providing adequate acetabular and femoral
Future directions
Cartilage disease may be predictive of poorer outcomes after hip preservation surgery. Despite the limitations of conventional MRI, recent advances in biochemical imaging techniques have shown promise for detecting cartilage disease earlier and on a microscopic level.76, 77, 78, 79 These techniques include quantitative T2 and T2* relaxation mapping to assess cartilage water content and collagen organization,77, 80 as well as T1rho (T1ρ)78 and delayed gadolinium-enhanced MRI of cartilage
Summary
Hip arthroscopy continues to experience incredible growth and advances in imaging have progressed concomitantly. Plain radiographs play a key role in initial management of patients presenting with hip pain when FAI is suspected. 3D imaging with CT and MRI allows for advanced characterization of the patient’s bony morphology and soft tissue injury. Incomplete resection of underlying FAI deformity is a major reason for residual hip pain following surgery and a leading cause of revision hip
References (87)
- et al.
Prevalence of femoroacetabular impingement imaging findings in asymptomatic volunteers: a systematic review
Arthroscopy
(2015) - et al.
Arthroscopic management of femoroacetabular impingement: minimum 2-year follow-up
Arthroscopy
(2011) - et al.
Arthroscopic treatment of cam-type femoroacetabular impingement: preliminary report at 2 years minimum follow-up
J Arthroplasty
(2008) - et al.
Cam-type deformities: Concepts, criteria, and multidetector CT features
Radiologia
(2015) - et al.
The false-profile view may be used to identify cam morphology
Arthroscopy
(2015) - et al.
Femoroacetabular impingement
Magn Reson Imaging Clin N Am
(2013) - et al.
Prognostic value of magnetic resonance arthrography for Czerny stage II and III acetabular labral tears
Arthroscopy
(2006) - et al.
Greater trochanter pain syndrome: a descriptive MR imaging study
Eur J Radiol
(2014) - et al.
Femoroacetabular impingement
Radiol Clin North Am
(2013) - et al.
3.0 T conventional hip MR and hip MR arthrography for the acetabular labral tears confirmed by arthroscopy
Eur J Radiol
(2014)
The acetabular labral tear: an arthroscopic classification
Arthroscopy
MR imaging of the hip: normal anatomic variants and imaging pitfalls
Magn Reson Imaging Clin N Am
Making a case for anterior inferior iliac spine/subspine hip impingement: three representative case reports and proposed concept
Arthroscopy
Magnetic resonance imaging of the hip: detection of labral and chondral abnormalities using noncontrast imaging
Arthroscopy
Radiologic and intraoperative findings in revision hip arthroscopy
Arthroscopy
Hip subluxation as a complication of arthroscopic debridement
Arthroscopy
Acute iatrogenic dislocation following hip impingement arthroscopic surgery
Arthroscopy
Acetabular rim reduction for the treatment of femoroacetabular impingement correlates with preoperative and postoperative center-edge angle
Arthroscopy
Fluoroscopic templating technique for precision arthroscopic rim trimming
Arthroscopy
A geographic zone method to describe intra-articular pathology in hip arthroscopy: cadaveric study and preliminary report
Arthroscopy
Complications and reoperations during and after hip arthroscopy: a systematic review of 92 studies and more than 6,000 patients
Arthroscopy
A new method to analyze dGEMRIC measurements in femoroacetabular impingement: preliminary validation against arthroscopic findings
Osteoarthritis Cartilage
Cartilage damage in femoroacetabular impingement (FAI): preliminary results on comparison of standard diagnostic vs delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC)
Osteoarthritis Cartilage
Regional variations in MR relaxation of hip joint cartilage in subjects with and without femoralacetabular impingement
Magn Reson Imaging
Prevalence of abnormal hip findings in asymptomatic participants: a prospective, blinded study
Am J Sports Med
Diagnostic imaging of femoroacetabular impingement
J Am Acad Orthop Surg
A systematic approach to the plain radiographic evaluation of the young adult hip
J Bone Joint Surg Am
The crossover sign overestimates acetabular retroversion
Clin Orthop Relat Res
Femoroacetabular impingement
J Bone Joint Surg Am
Coxa profunda in the diagnosis of pincer-type femoroacetabular impingement and its prevalence in asymptomatic subjects
Bone Joint J
Radiographic Prevalence of Dysplasia, Cam, and Pincer Deformities in Elite Ballet
Am J Sports Med
Femoroacetabular impingement: a cause for osteoarthritis of the hip
Clin Orthop Relat Res
Imaging of femoroacetabular impingement
J Bone Joint Surg Am
Correlation of pelvic incidence with cam and pincer lesions
Am J Sports Med
Cam morphology in the human hip
Orthopedics
The alpha angle in cam-type femoroacetabular impingement: new reference intervals based on 2038 healthy young adults
Bone Joint J
The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement
J Bone Joint Surg Br
Preoperative three-dimensional CT predicts intraoperative findings in hip arthroscopy
Clin Orthop Relat Res
Pros, cons, and future possibilities for use of computer navigation in hip arthroscopy
Sports Med Arthrosc
Do plain radiographs correlate with CT for imaging of cam-type femoroacetabular impingement?
Clin Orthop Relat Res
Inter- and intra-observer agreement of femoroacetabular impingement (FAI) parameters comparing plain radiographs and advanced, 3D computed tomographic (CT)-generated hip models in a surgical patient cohort
Knee Surg Sports Traumatol Arthrosc
Intraoperative fluoroscopic imaging to treat cam deformities: correlation with 3-dimensional computed tomography
Am J Sports Med
Arthroscopic Hip Revision Surgery for Residual Femoroacetabular Impingement (FAI): Surgical Outcomes Compared With a Matched Cohort After Primary Arthroscopic FAI Correction
Am J Sports Med
Cited by (16)
Assessment of Femoral Torsion on Magnetic Resonance Imaging is More Reliable Using Axial-Oblique Sequences Compared With Standard Axial Slices in Patients With Femoroacetabular Impingement Syndrome
2022, Arthroscopy - Journal of Arthroscopic and Related SurgeryHip Pathology Evaluation and Imaging
2019, Operative Techniques in OrthopaedicsCitation Excerpt :Multiplanar imaging and 3-dimensional (3D) reconstruction models can assist in characterization of atypical cam deformity, AIIS morphology or extent of acetabular dysplasia. The use of CT scan in FAI can allow for more accurate and complete measurement of key radiographic parameters.15-17 For example, the alpha angle can be measured in multiple planes and at multiple positions along the head-neck junction.
Hip arthroscopy-MRI correlation and differences for hip anatomy and pathology: What radiologists need to know
2018, Clinical ImagingCitation Excerpt :Both MRI and arthroscopy can depict different types of cartilage injuries such as focal cartilage signal abnormality/edematous change, cartilage flap, attached or loose cartilage fragment, focal subchondral fracture associated with cartilage damage; and, osteochondral defects [70]. MRI has the advantage of showing subchondral marrow edema and cysts; findings that can be inconspicuous at arthroscopy and indicative of osteoarthrosis which can influence the surgical planning [71,72] (Fig. 4). Quantitative MRI assessment of cartilage, such as delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), T1rho (T1ρ), and T2 mapping can detect degenerative changes in earlier stages before they become morphologically apparent and therefore provide additional information for preoperative consideration and longitudinal assessment of changes following arthroscopy [51].
Three-Dimensional Quantification of Cam Resection Using MRI Bone Models: A Comparison of 2 Techniques
2022, Orthopaedic Journal of Sports MedicineInstrumental Diagnosis and Preoperative Planning of Hip Arthroscopy in Femoroacetabular Impingement Syndrome: Lecture
2021, Travmatologiya i Ortopediya Rossii