Lateral Acetabular Coverage Predicts the Size of the Hip Labrum

Garabekyan, Tigran; Ashwell, Zachary R.; Chadayammuri, Vivek; Jesse, Mary K.; Pascual‐Garrido, Cecilia; Petersen, Brian; Mei-Dan, Omer

doi:10.1177/0363546516634058

Cited by 68 publications

(64 citation statements)

References 23 publications

(22 reference statements)

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“…Realizing the limitations of the LCEA, there have been attempts to use other parameters in borderline hips as surrogate markers for hip instability, such as the size of the labrum or the volume of the iliocapsularis, both structures known often to be hypertrophic in hip dysplasia [1,8,11]. Introducing the FEAR index is a new attempt to assess functional stability of the hip, based on the biomechanical concept that the growth plate orients itself perpendicularly to the joint reacting forces during growth [5,6,8,9]. In the control group and the stable borderline group, the FEAR index had a medially open angle, that is, a medially directed vector, indicating medial-directed joint-reaction forces and stability.…”

Section: Discussionmentioning

confidence: 99%

The Femoro-Epiphyseal Acetabular Roof (FEAR) Index: A New Measurement Associated With Instability in Borderline Hip Dysplasia?

Wyatt

Weidner

Pflüger

et al. 2017

Clinical Orthopaedics &Amp; Related Research

139

161

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Background The definition of osseous instability in radiographic borderline dysplastic hips is difficult. A reliable radiographic tool that aids decision-makingspecifically, a tool that might be associated with instability-therefore would be very helpful for this group of patients. Questions/purposes (1) To compare a new radiographic measurement, which we call the Femoro-Epiphyseal Acetabular Roof (FEAR) index, with the lateral centeredge angle (LCEA) and acetabular index (AI), with respect to intra-and interobserver reliability; (2) to correlate AI, neck-shaft angle, LCEA, iliocapsularis volume, femoral antetorsion, and FEAR index with the surgical treatment received in stable and unstable borderline dysplastic hips; and (3) to assess whether the FEAR index is associated clinical instability in borderline dysplastic hips. Methods We defined and validated the FEAR index in 10 standardized radiographs of asymptomatic controls using two blinded independent observers. Interrater and intrarater coefficients were calculated, supplemented by Bland-Altman plots. We compared its reliability with LCEA and AI. We performed a case-control study using standardized radiographs of 39 surgically treated symptomatic borderline radiographically dysplastic hips and 20 age-matched controls with asymptomatic hips (a 2:1 ratio), the latter were patients attending our institution for trauma unrelated to their hips but who had standardized pelvic radiographs between January 1, 2016 and March 1, 2016. Patient demographics were assessed using univariate Wilcoxon two-sample tests. There was no difference in mean age (overall: 31.5 ± 11.8 years [95% CI, 27.7-35.4 years]; stable borderline group: mean, 32.1± 13.3 years [95% CI, 25.5-38.7 years]; unstable borderline group: mean, 31.1 ± 10.7 years [95% CI, 26.2-35.9 years]; p = 0.96) among study groups. Treatment received was either a periacetabular osteotomy (if the hip was unstable) or, for patients with femoroacetabular impingement, either an open or arthroscopic femoroacetabular impingement procedure. The association of received treatment categories with the variables AI, neck-shaft angle, LCEA, iliocapsularis volume, femoral antetorsion, and FEAR index were evaluated first using Wilcoxon two-sample tests (two-sided) followed by stepwise multiple logistic regression analysis to identify the potential associated variables in a combined setting. Sensitivity, specificity, and receiver operator curves were calculated. The primary endpoint was the association between the FEAR index and instability, which we defined as migration of the femoral head either already visible on conventional radiographs or recentering of the Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Results The FEAR index showed excellent intra-and interobserver reliability, ...

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Section: Discussionmentioning

confidence: 99%

The Femoro-Epiphyseal Acetabular Roof (FEAR) Index: A New Measurement Associated With Instability in Borderline Hip Dysplasia?

Wyatt

Weidner

Pflüger

et al. 2017

Clinical Orthopaedics &Amp; Related Research

139

161

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“…The hypertrophic labrum may be an adaptive response of the hip to undercoverage such as dysplasia, and its identification before embarking on hip surgery is paramount. [129][130][131] The identification of a hypertrophic labrum may delineate the need for adjunct procedures, such as a periacetabular osteotomy, in the setting of hip dysplasia. Furthermore, a hypertrophic labrum can provide a technical challenge in atraumatic access to the joint because it may obscure arthroscopic portal placement.…”

Section: Size Of the Labrummentioning

confidence: 99%

Femoroacetabular Impingement: What the Surgeon Wants to Know

Rego

Beaulé

Ayeni

et al. 2019

Semin Musculoskelet Radiol

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Femoroacetabular impingement (FAI) is increasingly recognized as a risk factor for early hip degeneration in young active patients. The diagnosis depends on clinical examination and proper imaging that should be able to identify abnormal and sometimes subtle morphological changes. Labral tears and cartilage lesions rarely occur without underlying bone abnormalities. Surgical approaches to treat FAI are increasing significantly worldwide, even without a clearly defined consensus of what should be accepted as the standard imaging diagnosis for FAI morphology.Hip abnormalities encompass many variations related to the shape, size, and spatial orientation of both sides of the joint and can be difficult to characterize if adequate imaging is not available.This article presents a comprehensive review about the information orthopaedic surgeons need to know from radiologists to plan the most rational approach to a painful hip resulting from a mechanical abnormality.

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“…In addition to the above-mentioned causative factors, hip instability is associated with several characteristic intra-and extra-articular abnormalities typically due to chronic overload of secondary soft tissue stabilizers (Table I). With regard to intra-articular abnormalities, both labral length (measured with magnetic resonance imaging) 11 as well as labral width (measured during arthroscopy) 12 are larger in patients with reduced lateral acetabular coverage. Labral enlargement is thought to represent adaptive hypertrophy in the setting of increased shear forces within the unstable hip joint, though it may also be due to incomplete ossification of the cartilaginous acetabulum during hip development.…”

Section: Hip Instability: a Review Of Hip Dysplasia And Other Contribmentioning

confidence: 99%

Hip instability: a review of hip dysplasia and other contributing factors

Kraeutler

Garabekyan

Pascual-Garrido

et al. 2019

Muscle Ligaments and Tendons J

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Background: Hip instability has classically been associated with developmental dysplasia of the hip (DDH) in newborns and children. However, numerous factors may contribute to hip instability in children, adolescents, and adults. Purpose: This review aims to concisely present the literature on hip instability in patients of all ages in order to guide health care professionals in the appropriate diagnosis and treatment of the various disorders which may contribute to an unstable hip. Methods: We reviewed the literature on the diagnosis and surgical management of hip dysplasia and other causes of hip instability. Conclusions: Multiple intra-and extra-articular variables may contribute to hip instability, including acetabular bony coverage, femoral torsion, femoroacetabular impingement, and soft tissue laxity. Physical examination and advanced imaging studies are essential to accurately diagnose the pathology contributing to a patient's unstable hip. Conservative management, including activity modification and physical therapy, may be used as a first-line treatment in patients with intra-articular hip pathology. Patients who continue to experience symptoms of pain or instability should proceed with arthroscopic or open surgical treatment aimed at correcting the underlying pathology. Level of evidence: V. KEY WORDS: developmental dysplasia of the hip, femoral anteversion, femoroacetabular impingement, hip instability, periacetabular osteotomy.

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Lateral Acetabular Coverage Predicts the Size of the Hip Labrum

Cited by 68 publications

References 23 publications

The Femoro-Epiphyseal Acetabular Roof (FEAR) Index: A New Measurement Associated With Instability in Borderline Hip Dysplasia?

The Femoro-Epiphyseal Acetabular Roof (FEAR) Index: A New Measurement Associated With Instability in Borderline Hip Dysplasia?

Femoroacetabular Impingement: What the Surgeon Wants to Know

Hip instability: a review of hip dysplasia and other contributing factors

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