Skip to main content
SpringerLink
Log in

CT Reveals a High Incidence of Osseous Abnormalities in Hips with Labral Tears

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Acetabular labral tears are being diagnosed with increasing frequency and there is a growing consensus that these tears rarely occur in the absence of osseous abnormalities.

Questions/purposes

We therefore determined the presence of structural abnormalities in patients with acetabular labral tears using a standardized CT protocol.

Methods

We evaluated 135 consecutive patients with labral tears diagnosed by MRI with CT scans of the symptomatic hip. The CT scans were evaluated in a standardized fashion to determine acetabular and femoral pathomorphologic features. Acetabular evaluation included version measurements and anterior and lateral center-edge angles. Femoral parameters evaluated included version, alpha angle, and neck-shaft angle.

Results

One hundred twenty-two (90%) of the 135 hips had structural abnormalities. One hundred two (76%) had an alpha angle greater than 50°, 18 (13%) had femoral version less than 5°, 22 (16%) had femoral version greater than 25º, and five (4%) had coxa valga. Fifty-eight (43%) patients had acetabular retroversion and five (4%) had a lateral center-edge angle less than 20º. Of the 58 patients with acetabular retroversion, 23 had isolated cranial retroversion, 12 had isolated central retroversion, and 23 had combined cranial and central retroversion. Sixty-seven of the 121 hips (55%) with bony abnormalities had a combination of abnormalities.

Conclusions

Ninety percent of patients with labral tears had structural abnormalities seen on CT scans. These structural abnormalities frequently occur in combination, and understanding these underlying morphologic features of the hip can help guide treatment.

Level of Evidence

Level IV, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–B
Fig. 2A–D
Fig. 3
Fig. 4
Fig. 5A–B
Fig. 6

Similar content being viewed by others

References

  1. Abel MF, 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.

    CAS  PubMed  Google Scholar 

  2. Allen D, Beaule PE, Ramadan O, Doucette S. Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement. J Bone Joint Surg Br. 2009;91:589–594.

    Article  CAS  PubMed  Google Scholar 

  3. Bedi A, Chen N, Robertson W, Kelly BT. The management of labral tears and femoroacetabular impingement of the hip in the young, active patient. Arthroscopy. 2008;24:1135–1145.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  PubMed  Google Scholar 

  5. 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.

    Article  PubMed  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. 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.

    CAS  PubMed  Google Scholar 

  8. Eijer H, Myers SR, Ganz R. Anterior femoroacetabular impingement after femoral neck fractures. J Orthop Trauma. 2001;15:475–481.

    Article  CAS  PubMed  Google Scholar 

  9. Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.

    PubMed  Google Scholar 

  10. Giunti A, Moroni A, Olmi R, Rimondi E, Soldati D, Vicenzi G. The importance of the angle of anteversion in the development of arthritis of the hip. Ital J Orthop Traumatol. 1985;11:23–27.

    CAS  PubMed  Google Scholar 

  11. Guevara CJ, Pietrobon R, Carothers JT, Olson SA, Vail TP. Comprehensive morphologic evaluation of the hip in patients with symptomatic labral tear. Clin Orthop Relat Res. 2006;453:277–285.

    Article  PubMed  Google Scholar 

  12. Heyworth BE, Shindle MK, Voos JE, Rudzki JR, Kelly BT. Radiologic and intraoperative findings in revision hip arthroscopy. Arthroscopy. 2007;23:1295–1302.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. Lequesne M, de Seze S. [False profile of the pelvis: a new radiographic incidence for the study of the hip. Its use in dysplasias and different coxopathies] [in French]. Rev Rhum Mal Osteoartic. 1961;28:643–652.

    CAS  PubMed  Google Scholar 

  17. Leunig M, Beaule PE, Ganz R. The concept of femoroacetabular impingement: current status and future perspectives. Clin Orthop Relat Res. 2009;467:616–622.

    Article  PubMed  Google Scholar 

  18. Leunig M, Casillas MM, Hamlet M, Hersche O, Notzli H, Slongo T, Ganz R. Slipped capital femoral epiphysis: early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis. Acta Orthop Scand. 2000;71:370–375.

    Article  CAS  PubMed  Google Scholar 

  19. Maruyama M, Feinberg JR, Capello WN, D’Antonio JA. The Frank Stinchfield Award: Morphologic features of the acetabulum and femur: anteversion angle and implant positioning. Clin Orthop Relat Res. 2001;393:52–65.

    Article  PubMed  Google Scholar 

  20. 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 non-contrast imaging. Arthroscopy. 2005;21:385–393.

    Article  PubMed  Google Scholar 

  21. Murphy SB, Simon SR, Kijewski PK, Wilkinson RH, Griscom NT. Femoral anteversion. J Bone Joint Surg Am. 1987;69:1169–1176.

    CAS  PubMed  Google Scholar 

  22. 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 impingement. J Bone Joint Surg Br. 2002;84:556–560.

    Article  CAS  PubMed  Google Scholar 

  23. Peelle MW, Della Rocca GJ, Maloney WJ, Curry MC, Clohisy JC. Acetabular and femoral radiographic abnormalities associated with labral tears. Clin Orthop Relat Res. 2005;441:327–333.

    Article  PubMed  Google Scholar 

  24. Peters CL, Erickson JA. Treatment of femoro-acetabular impingement with surgical dislocation and debridement in young adults. J Bone Joint Surg Am. 2006;88:1735–1741.

    Article  PubMed  Google Scholar 

  25. Philippon MJ, Schenker ML, Briggs KK, Kuppersmith DA, Maxwell RB, Stubbs AJ. Revision hip arthroscopy. Am J Sports Med. 2007;35:1918–1921.

    Article  PubMed  Google Scholar 

  26. Reikeras O, Bjerkreim I, Kolbenstvedt A. Anteversion of the acetabulum and femoral neck in normals and in patients with osteoarthritis of the hip. Acta Orthop Scand. 1983;54:18–23.

    Article  CAS  PubMed  Google Scholar 

  27. Reikeras O, Hoiseth A. Femoral neck angles in osteoarthritis of the hip. Acta Orthop Scand. 1982;53:781–784.

    Article  CAS  PubMed  Google Scholar 

  28. Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum: a cause of hip pain. J Bone Joint Surg Br. 1999;81:281–288.

    Article  CAS  PubMed  Google Scholar 

  29. Siebenrock KA, Kalbermatten DF, Ganz R. Effect of pelvic tilt on acetabular retroversion: a study of pelves from cadavers. Clin Orthop Relat Res. 2003;407:241–248.

    Article  PubMed  Google Scholar 

  30. Siebenrock KA, Schoeniger R, Ganz R. Anterior femoro-acetabular impingement due to acetabular retroversion: treatment with periacetabular osteotomy. J Bone Joint Surg Am. 2003;85:278–286.

    PubMed  Google Scholar 

  31. Terjesen T, Benum P, Anda S, Svenningsen S. Increased femoral anteversion and osteoarthritis of the hip joint. Acta Orthop Scand. 1982;53:571–575.

    Article  CAS  PubMed  Google Scholar 

  32. Tonnis D, Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am. 1999;81:1747–1770.

    CAS  PubMed  Google Scholar 

  33. 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.

    Article  PubMed  Google Scholar 

  34. Wiberg G. The anatomy and roentgenographic appearance of a normal hip joint. Acta Chir Scand. 1939;83(suppl 58):7–38.

    Google Scholar 

Download references

Acknowledgments

We thank Steven Albert MD, Douglas Decorato MD, and Robert Ludwig MD for assistance in evaluating CT scans for this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago , IL, USA

    Mark M. Dolan MD

  2. Northwestern Orthopaedic Institute, 680 North Lake Shore Drive Suite 924, Chicago, IL, 60611, USA

    Mark M. Dolan MD

  3. Department of Sports Medicine, Massachusetts General Hospital, Boston, MA, USA

    Benton E. Heyworth MD

  4. Sports Medicine & Shoulder Surgery, University of Michigan, Ann Arbor, MI, USA

    Asheesh Bedi MD

  5. Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA

    Asheesh Bedi MD

  6. New York Presbyterian Hospital, East River Imaging, New York, NY, USA

    Gavin Duke MD

  7. Center for Hip Pain & Preservation, Hospital for Special Surgery, New York, NY, USA

    Bryan T. Kelly MD

Authors
  1. Mark M. Dolan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Benton E. Heyworth MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Asheesh Bedi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gavin Duke MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bryan T. Kelly MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark M. Dolan MD.

Additional information

One or more of the authors (BTK) is a paid consultant for Pivot Medical, Inc, Smith & Nephew, and Shriners Hospitals for Children Clinical Outcomes Studies Advisory Board and holds stock or stock options in Pivot Medical, Inc and Smith & Nephew. One or more of the authors (AB) is a paid consultant for Smith & Nephew.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at the Hospital for Special Surgery, New York, NY, USA.

About this article

Cite this article

Dolan, M.M., Heyworth, B.E., Bedi, A. et al. CT Reveals a High Incidence of Osseous Abnormalities in Hips with Labral Tears. Clin Orthop Relat Res 469, 831–838 (2011). https://doi.org/10.1007/s11999-010-1539-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-010-1539-6

Keywords

Search

Navigation