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Acetabular anteversion is associated with gluteal tendinopathy at MRI

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Abstract

Objective

Gluteal tendinopathy and greater trochanteric pain syndrome (GTPS) remain incompletely understood despite their pervasiveness in clinical practice. To date, no study has analyzed the morphometric characteristics of the hip on magnetic resonance imaging (MRI) that may predispose to gluteal tendinopathy. This study aimed to evaluate whether acetabular anteversion (AA), femoral neck anteversion (FNA), and femoral neck-shaft angle (FNSA) are associated with MRI features of gluteal tendinopathy.

Materials and methods

A total of 203 MRI examinations of the hip met our inclusion and exclusion criteria. A single blinded investigator measured AA, FNA, and FNSA according to validated MRI techniques. Two blinded subspecialty-trained musculoskeletal radiologists then independently evaluated the presence of gluteal tendinosis, trochanteric bursitis, and subgluteal bursitis. Statistical analysis was performed using a one-way analysis of variance (ANOVA; post-hoc Tukey’s range test).

Results

At MRI, 57 patients had gluteal tendinosis with or without bursitis, 26 had isolated trochanteric bursitis, and 11 had isolated subgluteal bursitis. AA was significantly (p = 0.01) increased in patients with MRI evidence of gluteal tendinosis with or without bursitis [mean: 18.4°, 95 % confidence interval (CI): 17.2°-19.6°] compared with normal controls (mean: 15.7°, 95 % CI: 14.7°-16.8°). Similarly, AA was significantly (p = 0.04) increased in patients with isolated trochanteric bursitis (mean: 18.8°, 95 % CI: 16.2°-21.6°). No association was found between FNA or FNSA and the presence of gluteal tendinopathy. Interobserver agreement for the presence and categorization of gluteal tendinopathy was very good (kappa = 0.859, 95 % CI: 0.815-0.903).

Conclusion

Our MRI study suggests that there is an association between increased AA and gluteal tendinopathy, which supports a growing body of evidence implicating abnormal biomechanics in the development of this condition.

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Disclosures

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Medical Imaging, University of Saskatchewan, Saskatoon, SK, Canada

    Kyle M. Moulton, Michael Shepel & Haron Obaid

  2. Department of Physical Medicine and Rehabilitation, University of Saskatchewan, Saskatoon, SK, Canada

    Abdel-Rahman Aly

  3. Health Pointe – Pain, Spine & Sport Medicine, Edmonton, AB, Canada

    Sathish Rajasekaran

  4. Department of Medical Imaging, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK, Canada, S7N 0W8

    Kyle M. Moulton

Authors
  1. Kyle M. Moulton
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  2. Abdel-Rahman Aly
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  3. Sathish Rajasekaran
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  4. Michael Shepel
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  5. Haron Obaid
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Correspondence to Kyle M. Moulton.

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Moulton, K.M., Aly, AR., Rajasekaran, S. et al. Acetabular anteversion is associated with gluteal tendinopathy at MRI. Skeletal Radiol 44, 47–54 (2015). https://doi.org/10.1007/s00256-014-1991-6

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  • DOI: https://doi.org/10.1007/s00256-014-1991-6

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