“Crevasse” Lesions

Abstract

Objective:The purpose of this article is to report on a distinctive pattern of linear femoral head chondral lesions that were observed in 7 patients who underwent hip arthroscopy for the treatment of mixed-type femoroacetabular impingement (FAI).Design:Between 2010 and 2012, 702 patients were treated with hip arthroscopy at our institution for symptomatic FAI. Among those patients, 7 were found to have a unique vertical chondral fissure located on the posterior femoral head. A retrospective review of the preoperative history, physical examination, and radiographic findings in addition to the intraoperative findings and surgical procedures performed was carried out for each patient.Results:All patients were diagnosed with mixed-type FAI by dynamic examination intraoperatively. The femoral head cartilage lesions were noted to be both linear and deep and resembled the appearance of a crevasse. Three of the 7 patients in whom these lesions were identified reported an acute event preceding their pain. Of the other 4 patients, 3 were involved in sports that involved vigorous rotational hip movements: golf, tennis, and wrestling. Notably, none of these lesions were identifiable on preoperative 3-T MRI scans.Conclusions:This series reports on a previously undefined femoral head cartilage lesion. It is hypothesized that increased pathologic translational movements and perching of the femoral head on the posterior rim of the acetabulum create this pattern of chondral damage. Recognition of this pattern of damage on the femoral head is important in the setting of mixed-type FAI.

Evaluating the Morphology of Unique Superficial Fissured Cartilage Lesions at the Femoral Head-Neck Junction in Patients with Femoroacetabular Impingement Syndrome

“…We previously reported a unique crevasse lesion, a vertical cartilage injury of the posterior aspect of the femoral head. 22 The crevasse lesions involving the deeper layers of cartilage are presumed to be caused by adverse concomitant motion related to FAI. In addition, Zaltz and Leunig 31 reported a rare cartilage defect within the posterior superior quadrant of the femoral head associated with FAI and assumed that the injury was shear stress induced.…”

“…We previously reported unique vertical chondral fissure, the ''crevasse lesion,'' located on the posterior femoral head that was not detectable on magnetic resonance imaging (MRI) in 7 patients with mixed-type FAI out of 702 patients with FAIS. 22 The crevasse lesions involving the deeper layers of cartilage are presumed to be caused by adverse concomitant motion related to FAI. In this report, we further identified a dimpled golf-balllike cartilage surface fissures on the femoral head-neck junction in FAIS patients, which exhibited cartilage surface irregularities.…”