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Usefulness of MR arthrography of the hip with leg traction in the evaluation of ligamentum teres injuries

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Abstract

Purpose

To retrospectively evaluate the diagnostic accuracy of magnetic resonance (MR) arthrography of the hip with leg traction in the evaluation of ligamentum teres lesions and to evaluate whether there is increased articular distraction, possibly indicating secondary instability, in hips with ligamentum teres injuries.

Materials and methods

Institutional review board approval and informed consent were obtained for this retrospective study. MR arthrograms of the hip with leg traction of 184 consecutive patients, including 108 men (mean age, 32.6 years; range, 19–53 years) and 76 women (mean age, 38.5 years; range, 18–56 years), who underwent hip arthroscopy were assessed for the presence of ligamentum teres lesions. The MR arthrographic findings were independently assessed by two radiologists who were blinded to the arthroscopic results. The inclusion criteria stipulated no previous surgery, arthroscopy within 1 month after MR arthrography, and availability of a detailed surgical report with ligamentum teres findings. The arthroscopy findings served as the reference standard. Sensitivity, specificity, accuracy, and K statistics for interobserver and intraobserver agreement were calculated.

Results

At arthroscopy, 32 ligamentum teres injuries were found. The ligamentum teres was normal in 152 (82.6 %) patients and had suffered low-grade partial tears in 15 (8.1 %) patients, high-grade partial tears in 10 (5.4 %) patients, and complete ruptures in 7 (3.8 %) patients.

MR arthrography with axial traction demonstrated moderate sensitivity and high specificity for both low-grade (62/93 %) and high-grade (66/96 %) partial tears. Grouping low- and high-grade partial tears increased the diagnostic performance of MR arthrography, yielding a sensitivity of 87 % and a specificity of 95 %. For complete ligamentum teres tears, MR arthrography with leg traction demonstrated high sensitivity (92 %) and specificity (98 %). Articular distraction was significantly increased in patients with complete ruptures of the ligamentum teres (p = 0.001).

Conclusion

MR arthrography with leg traction offers accurate diagnosis of ligamentum teres injuries. Patients with complete tears of the ligamentum teres exhibit increased articular distraction that may indicate secondary hip instability.

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Abbreviations

LT:

ligamentum teres

FAI:

femoroacetabular impingement

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Conflict of interest

No conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Diagnóstico Médico Cantabria, Calle Castilla 6 Bajo, 39002, Santander, Cantabria, Spain

    Luis Cerezal & Moisés Fernández-Hernando

  2. Learnig Trauma Med. Centro de Consultas Médicas CCM, Orthopedic Surgery department, Santander, Spain

    Luis Pérez Carro

  3. University of Cantabria - IDIVAL, Santander, Spain

    Javier Llorca

  4. CIBER Epidemiology and Public Health, Santander, Spain

    Javier Llorca

  5. Anatomy and Cell Biology, Cantabria University, Santander, Spain

    Juan Antonio Montero & Ana Canga

  6. Department of Radiology, Alzira Hospital, Valencia, Spain

    Eva Llopis

  7. Department of Radiology Marqués de Valdecilla University Hospital, Santander, Cantabria, Spain

    Ana Canga

Authors
  1. Luis Cerezal
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  2. Luis Pérez Carro
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  3. Javier Llorca
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  4. Moisés Fernández-Hernando
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  5. Eva Llopis
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  6. Juan Antonio Montero
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  7. Ana Canga
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Correspondence to Luis Cerezal.

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Cerezal, L., Carro, L.P., Llorca, J. et al. Usefulness of MR arthrography of the hip with leg traction in the evaluation of ligamentum teres injuries. Skeletal Radiol 44, 1585–1595 (2015). https://doi.org/10.1007/s00256-015-2210-9

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  • DOI: https://doi.org/10.1007/s00256-015-2210-9

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