The ligamentum teres has traditionally been viewed as an embryonic remnant with no role in the biomechanics or vascularity of adult hips. However, the ligamentum teres is a strong intraarticular ligament that is anatomically and biochemically similar to the anterior cruciate ligament of the knee. It is composed of two bands that originate from the acetabular transverse ligament and the pubic and ischial margins of the acetabular notch. Among other functions, the ligamentum teres is an important stabilizer of the hip, particularly in adduction, flexion, and external rotation. Abnormalities of the ligamentum teres account for 4%-15% of sports-related injuries and should be considered in the differential diagnosis of patients with hip pain. Lesions of the ligamentum teres include partial or complete traumatic tears, degenerative tears, avulsion fractures of the ligament at its insertion into the fovea capitis femoris, and a congenital absence of the ligament. Magnetic resonance arthrography and computed tomographic arthrography are the preferred modalities for precise preoperative diagnosis of ligamentum teres injuries and may be used to rule out other associated intraarticular injuries. Treatment of these lesions is still evolving; at present, treatment of most injuries is limited to arthroscopic débridement.
The study of the wrist represents a major diagnostic challenge because of its complex anatomy and the small size of individual structures. Recent advances in imaging techniques have increased our diagnostic capabilities. However, 3T magnets, multichannel specific wrist coils, and new MRI sequences have not restricted the indications of arthrographic imaging techniques (CT arthrography and MR arthrography). Distension of the different wrist compartments at CT arthrography and MR arthrography significantly improves the diagnostic accuracy for triangular fibrocartilage (TFC) complex injuries and carpal instability. Dedicated multichannel wrist coils are essential for an adequate study of the wrist, but the placement of these coils and the positioning of the wrist are also important for proper diagnosis. The development of dynamic multislice CT studies allows a diagnostic approach that combines dynamic information and the accurate assessment of ligaments and the TFC complex. New advances in arthroscopy have changed the anatomical description of the TFC with a functional division in the proximal and distal TFC complex, and they have allowed a better characterization of lesions of the TFC complex with subclassification of Palmer 1B and 1D lesions and description of new lesions not included in the Palmer classification, such as capsular injuries.
Hip MR arthrography with leg traction is a technically feasible and safe procedure that improves visualization of the femoral and acetabular cartilage surfaces.
Objectives: Imaging assessment for the clinical management of femoroacetabular impingement syndrome (FAIS) remains controversial because of a paucity of evidencebased guidance and notable variability in clinical practice, ultimately requiring expert consensus. The purpose of this agreement is to establish expert-based statements on FAIS imaging, using formal techniques of consensus building driven by relevant literature review. Methods:The validated Delphi method and peer-reviewed literature were used to formally derive consensus among 30 panel members (21 musculoskeletal radiologists and 9 orthopedic surgeons) from 13 countries.Forty-two questions were agreed on, and recent relevant seminal literature was circulated and classified in five major topics ("General issues", "Parameters and reporting", "Radiographic assessment", "MRI evaluation" and "Ultrasound") in order to produce answering statements.The level of evidence was noted for all produced statements and panel members were asked to score their level of agreement with each statement (0 to 10) during iterative rounds. Either "group consensus", "group agreement" or "no agreement" was achieved.Items near consensus were further queried using 4 moderated group sessions and in 4 Delphi rounds.Results: Forty-five statements were generated and group consensus was reached for 43 (95.7%). Seventeen of these statements were selected as most important for dissemination in advance. There was no agreement for the two statements pertaining to "Ultrasound". Conclusion:The first international Delphi-based consensus for the imaging assessment of FAIS was developed. The resulting consensus can serve as a tool to reduce variability in clinical practices and guide further research for the clinical management of FAIS. Key Points• FAI imaging literature is extensive although often of low level of evidence.• Radiographic evaluation with a reproducible technique is the cornerstone of hip imaging assessment.• MRI with a dedicated protocol is the gold standard imaging technique for FAI assessment.
Lesions of the quadratus femoris have been implicated as a cause of hip pain. It therefore is important to be familiar with the anatomy of the quadratus muscle and to be able to diagnose the causes of abnormal signal intensity in the quadratus femoris, which include tears and impingement.
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