Use of Intraoperative Computed Tomography Scanning in Determining the Magnitude of Arthroscopic Osteochondroplasty

Mofidi, A.; Shields, John S.; Tan, Josh S.; Poehling, Gary G.; Stubbs, Allston J.

doi:10.1016/j.arthro.2010.11.009

Cited by 14 publications

(10 citation statements)

References 21 publications

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“…Several authors have questioned the use of plain radiographs [8,13], whereas others have even advocated the routine intraoperative use of CT [18]. Although CT provides excellent visualization of the bony deformity, limitations of its use include additional radiation exposure, cost, and routine availability of complex reconstructive sequences.…”

Section: Discussionmentioning

confidence: 99%

Do Plain Radiographs Correlate With CT for Imaging of Cam-type Femoroacetabular Impingement?

Nepple

Martel

Kim

et al. 2012

Clinical Orthopaedics &Amp; Related Research

109

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Section: Discussionmentioning

confidence: 99%

Do Plain Radiographs Correlate With CT for Imaging of Cam-type Femoroacetabular Impingement?

Nepple

Martel

Kim

et al. 2012

Clinical Orthopaedics &Amp; Related Research

109

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“…Despite its value in assessing the status of intraarticular and periarticular soft tissue structures about the hip, there are clear limitations in the ability of MRI to evaluate bony morphologic features. Although the value of three-dimensional (3D) CT imaging for hip pain is less well-studied [12,18,20,30], CT has long been the best imaging modality for assessment of bony abnormalities, and its inherent advantages over MRI have been further advanced with the introduction of 3D reformatting of CT images. Thus, with expanding appreciation of FAI as a causative factor in labral and cartilaginous hip disorders, CT may have an underappreciated role as a preoperative imaging modality before arthroscopic hip procedures.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Three-dimensional CT Predicts Intraoperative Findings in Hip Arthroscopy

Heyworth

Dolan²,

Nguyen

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Currently, plain radiographs and MRI are the standard imaging modalities used for diagnosing femoroacetabular impingement (FAI) and preoperative planning for arthroscopic treatment of FAI. The value of three-dimensional (3D) CT for these purposes is unclear. Questions/purposes We therefore determined the reliability of CT assessment of FAI and whether CT findings of hip disease predict arthroscopic findings. Methods We retrospectively assessed the preoperative CT scans of 118 patients who underwent primary hip arthroscopy. Intraoperative findings, including size of the cam lesion, presence of an acetabular labral articular disruption lesion, and one of four types of labral tear were recorded and compared with the retrospectively read CT findings. Results Agreement analysis between CT and intraoperative detection of FAI yielded kappa values of 0.48 for cam lesions and 0.16 for pincer lesions. Increasing values for the CT-based alpha angle correlated with increasing severity of arthroscopically assessed acetabular labral articular disruption grade. Each pattern of FAI predicted a specific labral tear type. Conclusions Our data suggest CT has moderate value in predicting mechanically based labral tear patterns, although better parameters for assessment of pincer lesions are needed. Diagnostic assessment of patients with suspected FAI may be improved with use of 3D CT. Level of Evidence Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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“…30 This is also the explanation for the characteristic bony abnormalities in cam-type FAIS (anterolateral femoral neck) and pincer-type FAIS (anterosuperior acetabulum). The nature of bone to increase apposition in response to mechanical load 19,31 is likely a critical factor in the development and progression of FAIS and pincer hypertrophy . [32][33][34][35] Prior FAIS studies have correlated alpha angle or severity of disease with training intensity, which suggests a mechanobiological etiology to FAI.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11][12] Templating of rim resection has been investigated with a number of different preoperative and intraoperative techniques, including anterior and lateral center edge angle (LCEA) resection formulas. 8,[13][14][15][16][17][18][19] However, in unilaterally symptomatic patients, the best template for restoring normal anatomy and preventing the complications of over-or underresection may be the unaffected hip. As such, the purpose of this study was to use mirror imaging to identify the location and magnitude of difference in acetabular rim morphology between the symptomatic and unaffected acetabula in patients with symptomatic unilateral pincer-type or mixed FAIS using 1D models created with CT. Our hypothesis was that the acetabular rim would be more prominent on the affected side compared with the healthy, unaffected side.…”

mentioning

confidence: 99%

Mirror Image Modeling of Acetabular Rim Thickness Differences in Patients With Unilateral Femoroacetabular Impingement Syndrome

Riff

Weber

Keating

et al. 2019

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To use mirror imaging to identify the location and magnitude of difference in acetabular rim morphology between the symptomatic and unaffected acetabula in patients with symptomatic unilateral pincer-type or mixed femoroacetabular impingement syndrome (FAIS) using 1-dimensional models created with computed tomography (CT). Methods: CT scans of bilateral hips in 33 patients diagnosed with unilateral pincer-type or mixed FAIS were obtained. Three-dimensional bilateral hip models were constructed, and the unaffected hemipelvis was superimposed onto the symptomatic side to compare acetabular thickness. Protrusion of the symptomatic side was recorded, and rim morphology was divided into clock face quadrants to analyze the location of greatest magnitude of difference between affected and unaffected acetabula. Analysis of the quadrants was performed using analysis of variance with post hoc Bonferroni correction. Results: The study group consisted of more females (51.6%) than males, with an average age of 35.72 AE 7.8 years and an average body mass index of 24.3 AE 4.1 kg/m 2 . Of the 33 hips included, 14 were isolated pincer-type FAIS and 19 were mixed. The average preoperative symptomatic side lateral center edge angle was 37.5 AE 7.2 compared with 29 AE 5.1 on the asymptomatic side (P ¼ .001). The symptomatic acetabular rim was on average 0.43 AE 0.18 mm thicker than the corresponding location on the unaffected rim. When the acetabulum was divided into clock face quadrants, the 12 to 3 o'clock position showed the greatest difference between symptomatic and unaffected sides (0.55 AE 0.18 mm) compared with the 3 to 6 o'clock position (0.4 AE 0.28 mm; P ¼ .006), 6 to 9 o'clock (0.34 AE 0.07 mm; P < .001), and 9 to 12 o'clock (0.38 AE 0.03; P ¼ .001). Conclusions: Patients with unilateral, symptomatic pincer-type or mixed FAIS show statistical differences in rim thickness between the affected and unaffected acetabula. Small changes in acetabular rim morphology on the order of 0.5 mm may be the difference between symptomatic FAIS and the unaffected hip. Level of Evidence: IV, case series.

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Use of Intraoperative Computed Tomography Scanning in Determining the Magnitude of Arthroscopic Osteochondroplasty

Cited by 14 publications

References 21 publications

Do Plain Radiographs Correlate With CT for Imaging of Cam-type Femoroacetabular Impingement?

Do Plain Radiographs Correlate With CT for Imaging of Cam-type Femoroacetabular Impingement?

Preoperative Three-dimensional CT Predicts Intraoperative Findings in Hip Arthroscopy

Mirror Image Modeling of Acetabular Rim Thickness Differences in Patients With Unilateral Femoroacetabular Impingement Syndrome

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