1
|
Kamaşak Arpaçay B, Karapinar BO, Güler H, İpekten F, Nisari M. Is the golden ratio present in the coxal bone? An anatomical pilot study. Anat Sci Int 2024:10.1007/s12565-024-00800-7. [PMID: 39256284 DOI: 10.1007/s12565-024-00800-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Accepted: 09/03/2024] [Indexed: 09/12/2024]
Abstract
The coxal bone is crucial for movement, stability, and childbirth. Although most morphometric studies estimate gender and age, ratio, correlation and index calculations, there are no studies on the golden ratios in the coxal bone. Inspired by this idea, we investigated the presence of the golden ratio in the coxal bones. In this study, 95 adult dry coxal bones were measured using a digital caliper. Morphometric measurements were conducted based on 18 identified parameters. 12 of these parameters were related to the distances between two points in various parts of the bone. New ratios were determined with those measurements. In our study, we detected a constant coefficient between the following lengths: anterior superior iliac spine (ASIS)- posterior superior iliac spine (PSIS) and anterior inferior iliac spine (AIIS)- posterior inferior iliac spine (PIIS), vertical and transverse diameters of the acetabulum (AC), ASIS-AC and AIIS-AC, PSIS-AC and PIIS-AC, ASIS-auricular surface and AIIS-auricular surface, ASIS-symphyseal surface and AIIS-symphyseal surface (respectively, 1.29, 1.05, 1.18, 2.32, 1.26, 1.32). In order to check the accuracy of this hypothesis, length of between AIIS-PIIS, transverse diameter of the acetabulum, length of between PIIS-AC, length of between AIIS-AC, shortest distance between AIIS-auricular surface, length of between AIIS-symphyseal surface were estimated with the help of new equations. We detected constant ratios between some lengths in the coxal bone. Estimated distances should be taken into account during surgical procedures to prevent complications. In this context, the constant ratios identified in our study will serve as a guide for surgeons.
Collapse
Affiliation(s)
- Burcu Kamaşak Arpaçay
- Department of Anatomy, Faculty of Medicine, Kırşehir Ahi Evran University, Kırşehir, Turkey.
| | - Burak Oğuzhan Karapinar
- Department of Medical Services and Techniques, Vocational School of Health Services, Ondokuz Mayıs University, Samsun, Turkey
| | - Hatice Güler
- Department of Anatomy, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Funda İpekten
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Adıyaman University, Adiyaman, Turkey
| | - Mehtap Nisari
- Department of Anatomy, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| |
Collapse
|
2
|
Bisciotti GN, Zini R, Aluigi M, Aprato A, Auci A, Bellinzona E, Benelli P, Bigoni M, Bisciotti A, Bisciotti A, Bona S, Brustia M, Bruzzone M, Canata GL, Carulli C, Cassaghi G, Coli M, Corsini A, Costantini A, Dallari D, Danelli G, Danesi G, Della Rocca F, DE Nardo P, DI Benedetto P, DI Marzo F, DI Pietto F, Eirale C, Ferretti A, Fogli M, Foglia A, Guardoli A, Guglielmi A, Lama D, Maffulli N, Manunta AF, Massari L, Mazzoni G, Moretti B, Moretti L, Nanni G, Niccolai R, Occhialini M, Panascì M, Parra MF, Pigalarga G, Randelli F, Sacchini M, Salini V, Santori N, Tenconi P, Tognini G, Vegnuti M, Zanini A, Volpi P. Groin Pain Syndrome Italian Consensus Conference update 2023. J Sports Med Phys Fitness 2024; 64:402-414. [PMID: 38126972 DOI: 10.23736/s0022-4707.23.15517-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Groin pain syndrome (GPS) is a controversial topic in Sports Medicine. The GPS Italian Consensus Conference on terminology, clinical evaluation and imaging assessment of groin pain in athletes was organized by the Italian Society of Arthroscopy in Milan, on 5 February 2016. In this Consensus Conference (CC) GPS etiology was divided into 11 different categories for a total of 63 pathologies. The GPS Italian Consensus Conference update 2023 is an update of the 2016 CC. The CC was based on a sequential, two-round online Delphi survey, followed by a final CC in the presence of all panelists. The panel was composed of 55 experts from different scientific and clinical backgrounds. Each expert discussed 6 different documents, one of which regarded the clinical and imaging definition of sports hernias, and the other 5 dealt with 5 new clinical situations thought to result in GPS. The panelists came to an agreement on the definition of a sports hernia. Furthermore, an agreement was reached, recognizing 4 of the 5 possible proposed pathologies as causes to GPS. On the contrary, the sixth pathology discussed did not find consensus given the insufficient evidence in the available scientific literature. The final document includes a new clinical and imaging definition of sports hernia. Furthermore, the etiology of GPS was updated compared to the previous CC of 2016. The new taxonomic classification includes 12 categories (versus 11 in the previous CC) and 67 pathologies (versus 63 in the previous CC).
Collapse
Affiliation(s)
| | - Raul Zini
- Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | | | | | | | | | | | | | | | - Andrea Bisciotti
- Kinemove Rehabilitation Centers, Pontremoli, La Spezia, Italy
- Humanitas Research Hospital, Milan, Italy
| | | | | | - Marco Bruzzone
- University of Brescia, Brescia, Italy
- University of Modena and Reggio Emilia, Modena, Italy
- Unione Sportiva Sassuolo Calcio, Sassuolo, Modena, Italy
| | - Gian L Canata
- Center of Sports Traumatology, Koelliker Hospital, Turin, Italy
| | | | | | | | | | | | - Dante Dallari
- Reconstructive Orthopedic Surgery and Innovative Techniques Musculoskeletal Tissue Bank, Rizzoli IRCCS Orthopedic Institute, Bologna, Italy
| | | | | | | | | | | | | | | | | | - Andrea Ferretti
- Istituto Medicina e Scienza dello Sport Comitato Olimpico Nazionale Italiano, Rome, Italy
| | | | - Andrea Foglia
- Centers of Rehabilitative Phisiotherapy, Civitanova Marche, Macerata, Italy
| | | | | | | | - Nicola Maffulli
- La Sapienza University, Rome, Italy
- Centre for Sport and Exercise Medicine, Queen Mary University of London, London, UK
- Barts and the London School of Medicine, Surgery and Dentistry, London, UK
- Keele University School of Medicine, Stoke on Trent, UK
| | - Andrea F Manunta
- Orthopedic Clinic Sassari, Fondo Ateneo Ricerca 2020, Sassari, Italy
| | | | | | - Biagio Moretti
- Unit of Orthopedics and Traumatology, Polyclinic University Hospital, Bari, Italy
| | - Lorenzo Moretti
- Unit of Orthopedics and Traumatology, Polyclinic University Hospital, Bari, Italy
| | | | | | | | - Manlio Panascì
- Nancy Gvm Care and Research, S. Carlo Hospital, Rome, Italy
| | - Maria F Parra
- Kinemove Rehabilitation Centers, Pontremoli, La Spezia, Italy
| | | | - Filippo Randelli
- Hip Department (CAD), Gaetano Pini-CTO Orthopaedic Institute, University of Milan, Milan, Italy
| | | | | | | | | | | | - Marco Vegnuti
- Kinemove Rehabilitation Centers, Pontremoli, La Spezia, Italy
| | - Antonio Zanini
- San Clemente Nursing Home, S. Anna Clinica Institute, Brescia, Italy
| | - Piero Volpi
- Humanitas Research Hospital, Milan, Italy
- FC Internazionale Milano, Milan, Italy
| |
Collapse
|
3
|
Efrima B, Amar E, Ovadia JE, Levy O, Ben Yehuda O, Rath E. Magnetic Resonance Imaging Is Not Reliable in Classifying Anterior Inferior Iliac Spine Morphology Compared to 3-Dimensional Computerized Tomography. Arthroscopy 2022; 38:793-798. [PMID: 34246520 DOI: 10.1016/j.arthro.2021.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/30/2021] [Accepted: 06/06/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study is to determine the reliability of standard magnetic resonance imaging (MRI) evaluation of AIIS morphology compared with three-dimensional (3D) computerized tomography (CT) (reference standard). METHODS Sixty hips in 30 patients met the inclusion criteria. The images were reviewed and classified by two fellowship-trained orthopedic surgeons. A second imaging viewing session was conducted in the same manner for validation of AIIS evaluation. The agreement and accuracy indices between the two raters were calculated for each imaging modality (inter-rater agreement) as well the agreement across the imaging modality for each rater (intermethod agreement). RESULTS The inter-rater agreement for the morphological evaluation of the AIIS for the first session according to 3D CT was .553 (P < .05) and by means of MRI was .0163 (P < .05). The inter-rater agreement for the second session by means of 3D CT was .449 (P < .05) and according to MRI was 0 (P < .05). The inter-method agreement for rater 1 for the first session was .04 (P < 0.05), while the agreement for rater 2 was .016 (P < .05). The intermethod agreement for rater 1 on the second session was .35 (P < 0.05), while that of rater 2 was .297(P < .05). The overall accuracy of MRI compared to 3D CT for rater 1 for the first session was .531, .490, and .959 for types I, II, III respectively and .551, .531, and .980 for the second session for types I, II, and III respectively. The overall accuracy of MRI compared to 3D CT for rater 2 for the first session was .551, .469, and .918 for types I, II, III respectively and .633, .592, and .918 for the second session for types I, II, and III, respectively. CONCLUSION MRI evaluations and subsequent classifications of AIIS morphology demonstrated a poor to slight correlation compared with that of the reference standard of 3D CT. LEVEL OF EVIDENCE Level II, retrospective diagnostic study.
Collapse
Affiliation(s)
- Ben Efrima
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Amar
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joshua Ezekiel Ovadia
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital, Reading, Unite Kingdom
| | - Omer Ben Yehuda
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Rath
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
4
|
Amar E, Rosenthal R, Guanche CA, Palmanovich E, Ankory R, Levy O, Rath E. Sonographic evaluation of anterior inferior iliac spine morphology demonstrates excellent accuracy when compared to false profile view. Knee Surg Sports Traumatol Arthrosc 2021; 29:1413-1419. [PMID: 33030609 DOI: 10.1007/s00167-020-06304-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare ultrasound examination to false profile radiographs in identification and classification of AIIS morphology. The study hypothesis stated that sonographic imaging of the AIIS correlates well to AIIS morphology seen on false profile radiographs. METHODS Fifty-three hips in 30 consecutive patients met the inclusion criteria. A single, fellowship trained, orthopedic surgeon performed an ultrasound on all of the patients to evaluate the AIIS morphology. The patients underwent standing false profile radiographs. The US and radiographic images were independently reviewed and classified according to Hetsroni classification of AIIS morphology by two senior, fellowship trained, orthopedic surgeons. Agreement between the two raters was calculated for each imaging modality (inter-rater agreement) as well as the agreement between the rating in each modality by the same rater ("inter-method" agreement). RESULTS The agreement between the raters (inter-rater agreement) for morphologic evaluation of the AIIS by means of FP view was 88.8% (p < 0.001) and that by means of US was 81.5%(p < 0.001). The overall accuracy of the US compared to the FP view was 92.3% (48/52) for both rater 1 and 2. CONCLUSION This study showed near-perfect agreement in analyzing the morphology of the AIIS in a group of patients with hip pathology. Office sonographic evaluation of the AIIS is reliable and, therefore, may be routinely utilized in the clinic setting avoiding unnecessary radiation exposure to the patient. LEVEL OF EVIDENCE Level II.
Collapse
Affiliation(s)
- Eyal Amar
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel.
| | - Ron Rosenthal
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel
| | - Carlos A Guanche
- Southern California Orthopedic Institute, Thousand Oaks, CA, USA
| | - Ezequiel Palmanovich
- Department of Orthopedic Surgery, Meir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Kfar Sava, Israel
| | - Ran Ankory
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel
| | - Ofer Levy
- Reading Shoulder Unit, Royal Berkshire Hospital, Reading, UK
| | - Ehud Rath
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel
| |
Collapse
|
5
|
Kobayashi N, Choe H, Ike H, Higashihira S, Kobayashi D, Watanabe S, Kubota S, Inaba Y. Evaluation of anterior inferior iliac spine impingement after hip arthroscopic osteochondroplasty using computer simulation analysis. J Orthop Surg (Hong Kong) 2021; 28:2309499020935533. [PMID: 32627667 DOI: 10.1177/2309499020935533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Anterior inferior iliac spine (AIIS) impingement is an important risk factor for revision hip arthroscopy. Although a morphological classification system is available, evaluating AIIS impingement with respect to joint kinematics remains a challenge. PURPOSE To use computer simulation analysis to ascertain the prevalence of AIIS impingement before and after osteochondroplasty. METHODS A total of 35 joints from 30 cases (20 males and 10 females; average age: 43.3 ± 13.7 years) were analyzed. All joints had cam morphology and underwent hip arthroscopic osteochondroplasty. A three-dimensional model of each joint was constructed pre- and postoperatively. Joint kinematic simulation software (ZedHip®, Lexi, Tokyo) was used to identify the impingement point on the acetabular side and the incidence (expressed as a percentage) of AIIS impingement calculated. Radiographic and clinical evaluation was performed pre- and postoperatively. RESULTS AIIS impingement was observed postoperatively in six joints but preoperatively in only one joint. The rate of AIIS postoperative impingement was significantly higher than that of preoperative impingement. All impingement points were located on the inferior aspect of the AIIS apex. However, there were no significant differences between the AIIS impingement and non-impingement groups in terms of clinical outcome. CONCLUSION The incidence of AIIS impingement after osteochondroplasty was 17% by computer simulation analysis. Osteochondroplasty may result in subsequent AIIS impingement.
Collapse
Affiliation(s)
- Naomi Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Hyonmin Choe
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Hiroyuki Ike
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Shota Higashihira
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Daigo Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Shintaro Watanabe
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
| | - So Kubota
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
| |
Collapse
|
6
|
Michal F, Amar E, Atzmon R, Sharfman Z, Haviv B, Eisenberg G, Rath E. Subspinal impingement: clinical outcomes of arthroscopic decompression with one year minimum follow up. Knee Surg Sports Traumatol Arthrosc 2020; 28:2756-2762. [PMID: 29610973 DOI: 10.1007/s00167-018-4923-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 03/28/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE This study was designed to (1) evaluate the clinical outcomes after arthroscopic subspinal decompression in patients with hip impingement symptoms and low AIIS, and to (2) assess the presence of low anterior inferior iliac spine on the pre-operative radiographs of patients with established subspinal impingement diagnosed intra-operatively. METHODS Retrospective analysis of patients who underwent arthroscopic subspinal decompression has been performed. The indications for surgery were femoroacetabular impingement (FAI), or subspinal impingement. Pre-operative radiographs were assessed for anterior inferior iliac spine type. Intra-operative diagnosis of low anterior inferior iliac spine was based on the level of anterior inferior iliac spine extension relative to the acetabulum and the presence of reciprocal labral and chondral lesions. In patients where low anterior inferior iliac spine was not diagnosed on pre-operative radiographs, the pre-operative radiographs were re-read retrospectively to assess missed signs of low anterior inferior iliac spine. RESULTS Thirty-four patients underwent arthroscopic subspinal decompression between 2012 and 2015. The patients were followed for a median of 25 months (13-37 months). Intra-operatively, grade 2 anterior inferior iliac spine was found in 27 patients and grade 3 anterior inferior iliac spine was found in 7 patients. MHHS, HOS, and HOSS scores increased from median (range) pre-operative scores of 55 (11-90), 48 (20-91) and 20 (0-80) to 95 (27-100), 94 (30-100) and 91 (5-100), respectively (p < 0.0001, p = 0.001, p < 0.0001, respectively). Pre-operative diagnosis of low AIIS was made in 6/34 patients via AP radiographs. On retrospective analysis of pre-operative radiographs, signs of low AIIS were still not observed in 21/34 (61.8%) patients. CONCLUSIONS Arthroscopic subspinal decompression of low AIIS yielded significantly improved outcome measures and high patient satisfaction at a minimum of 13 months follow-up. Low AIIS is often under-diagnosed on AP pelvis and lateral frog radiographs and if left untreated, may result in unresolved symptoms and failed procedure. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Frankl Michal
- Assaf HaRofe Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Zriffin, Israel.
| | - Eyal Amar
- Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ran Atzmon
- Assaf HaRofe Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Zriffin, Israel
| | - Zachary Sharfman
- Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Barak Haviv
- Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Rabin Medical Center, Hasharon Hospital, Petach-Tikva, Israel
| | - Gilad Eisenberg
- Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ehud Rath
- Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
7
|
Klasan A, Neri T, Putnis SE, Dworschak P, Schüttler KF, Fuchs-Winkelmann S, Schofer MD, Heyse TJ. The prevalence of a prominent anterior inferior iliac spine. Arch Orthop Trauma Surg 2019; 139:1045-1049. [PMID: 30770995 DOI: 10.1007/s00402-019-03146-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Impingement of the prominent anterior inferior iliac spine (AIIS) against the femoral neck has recently been described as another type of impingement. The purpose of this study is to provide a distribution of AIIS types using the classification proposed by Hetsroni and thus report on the prevalence of prominent types. MATERIALS AND METHODS A total of 400 patients were included in the study with an average age 27.3 ± 6.9 years (range 18-40). All patients received a whole-body polytrauma computer tomography (CT) scan in the emergency room (ER) upon arrival. The classification of AIIS proposed by Hetsroni et al., which describes three morphological types, was used. Type II and III were grouped as prominent types. The measurements were performed in all three planes by two examiners. RESULTS Male to female ratio was 71:29. Type I was observed in 367 (91.7%) patients. Type II was observed in 31 (7.8%) patients and type III was observed in 2 (0.5%) patients, unilaterally. Prominent types were much more prevalent in men (10.5%) than in women (2.6%). The CT assessment demonstrated excellent intra- and interreliability (overall: 0.926, I/II: 0.906, III: 1.000). CONCLUSION A young population demonstrates a prevalence of a prominent AIIS of 11.5%. Prominent AIIS is more common in men than in women.
Collapse
Affiliation(s)
- Antonio Klasan
- Center for Orthopedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany.
| | - Thomas Neri
- Department of Orthopaedic Surgery, University Hospital St Etienne, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France
| | - Sven Edward Putnis
- The Gallery, Sydney Orthopaedic Research Institute, Level 1, 445 Victoria Avenue, Chatswood, NSW, 2067, Australia
| | - Philipp Dworschak
- Center for Orthopedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Karl Friedrich Schüttler
- Center for Orthopedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Susanne Fuchs-Winkelmann
- Center for Orthopedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Markus D Schofer
- Orthomedic Frankfurt Offenbach, Herrnstraße 57, 63065, Offenbach, Germany
| | - Thomas J Heyse
- Orthomedic Frankfurt Offenbach, Herrnstraße 57, 63065, Offenbach, Germany
| |
Collapse
|
8
|
Aguilera-Bohorquez B, Brugiatti M, Coaquira R, Cantor E. Frequency of Subspine Impingement in Patients With Femoroacetabular Impingement Evaluated With a 3-Dimensional Dynamic Study. Arthroscopy 2019; 35:91-96. [PMID: 30611374 DOI: 10.1016/j.arthro.2018.08.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 08/08/2018] [Accepted: 08/08/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE (1) To estimate the frequency of subspine impingement (SSI) morphology in patients with a diagnosis of femoroacetabular impingement (FAI) and (2) to describe the performance of the alpha angle, range of motion, and femoral and acetabular anteversion for the identification of cases with and without SSI morphology. METHODS We performed a retrospective observational study of patients with symptomatic FAI evaluated by computed tomography between February 2015 and June 2017. SSI morphology was identified using a 3-dimensional dynamic study with Move Forward software. A case was considered positive if a contact area of the anterior inferior iliac spine with the femoral neck was evidenced. Measurements of acetabular anteversion, femoral anteversion, the lateral center-edge angle, the alpha angle, and the neck-shaft angle, as well as range-of-mobility data, were collected. RESULTS The study included 135 patients (194 hips), with a mean age of 39.1 ± 13.9 years; 65.2% were women. SSI morphology was found in 23.7% of hips (46 hips) (95% confidence interval, 18.3%-30.2%). Of the hips identified with SSI, 52.2% had a type I anterior inferior iliac spine, 41.3% had type II, and 6.5% had type III. In hips with SSI, median femoral anteversion was 5.6° (interquartile range, 2.1°-7.5°) and values of less than 8° would increase the suspected SSI morphology (81.8% sensitivity, 70.5% specificity). CONCLUSIONS SSI morphology is a frequent finding in patients with symptomatic FAI through a 3-dimensional dynamic study. A decrease in femoral anteversion could be considered a useful criterion to suspect SSI morphology. LEVEL OF EVIDENCE Level IV, case series.
Collapse
Affiliation(s)
- Bernardo Aguilera-Bohorquez
- Orthopedics and Traumatology-Hip Preservation Unit, Institute of Osteoarticular Diseases, Centro Médico Imbanaco, Cali, Colombia.
| | - Miguel Brugiatti
- Pontificia Universidad Javeriana de Cali, Centro Médico Imbanaco, Cali, Colombia
| | - Ruddy Coaquira
- Pontificia Universidad Javeriana de Cali, Centro Médico Imbanaco, Cali, Colombia
| | - Erika Cantor
- Research Institute, Centro Médico Imbanaco, Cali, Colombia
| |
Collapse
|
9
|
Karns MR, Adeyemi TF, Stephens AR, Aoki SK, Beese ME, Salata MJ, Maak TG. Revisiting the Anteroinferior Iliac Spine: Is the Subspine Pathologic? A Clinical and Radiographic Evaluation. Clin Orthop Relat Res 2018; 476:1494-1502. [PMID: 29794857 PMCID: PMC6437578 DOI: 10.1097/01.blo.0000533626.25502.e1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Subspine impingement is a recognized source of extraarticular hip impingement. Although CT-based classification systems have been described, to our knowledge, no study has evaluated the morphology of the anteroinferior iliac spine (AIIS) with plain radiographs nor to our knowledge has any study compared its appearance between plain radiographs and CT scan and correlated AIIS morphology with physical findings. Previous work has suggested a correlation of AIIS morphology and hip ROM but this has not been clinically validated. Furthermore, if plain radiographs can be found to adequately screen for AIIS morphology, CT could be selectively used, limiting radiation exposure. QUESTIONS/PURPOSES The purposes of this study were (1) to determine the prevalence of AIIS subtypes in a cohort of patients with symptomatic femoroacetabular impingement; (2) to compare AP pelvis and false profile radiographs with three-dimensional (3-D) CT classification; and (3) to correlate the preoperative hip physical examination with AIIS subtypes. METHODS A retrospective study of patients undergoing primary hip arthroscopy for femoroacetabular impingement syndrome was performed. Between February 2013 and November 2016, 601 patients underwent hip arthroscopy. To be included here, each patient had to have undergone a primary hip arthroscopy for the diagnosis of femoroacetabular impingement syndrome. Each patient needed to have an interpretable set of plain radiographs consisting of weightbearing AP pelvis and false profile radiographs as well as full documentation of physical findings in the medical record. Patients who additionally had a CT scan with 3-D reconstructions were included as well. During the period in question, it was the preference of the treating surgeon whether a preoperative CT scan was obtained. A total of 145 of 601 (24%) patients were included in the analysis; of this cohort, 54% (78 of 145) had a CT scan and 63% (92 of 145) were women with a mean age of 31 ± 10 years. The AIIS was classified first on patients in whom the 3-D CT scan was available based on a previously published 3-D CT classification. The AIIS was then classified by two orthopaedic surgeons (TGM, MRK) on AP and false profile radiographs based on the position of its inferior margin to a line at the lateral aspect of the acetabular sourcil normal to vertical. Type I was above, Type II at the level, and Type III below this line. There was fair interrater agreement for AP pelvis (κ = 0.382; 95% confidence interval [CI], 0.239-0.525), false profile (κ = 0.372; 95% CI, 0.229-0.515), and 3-D CT (κ = 0.325; 95% CI, 0.156-0.494). There was moderate to almost perfect intraobserver repeatability for AP pelvis (κ = 0.516; 95% CI, 0.284-0.748), false profile (κ = 0.915; 95% CI, 0.766-1.000), and 3-D CT (κ = 0.915; 95% CI, 0.766-1.000). The plane radiographs were then compared with the 3-D CT scan classification and accuracy, defined as the proportion of correct classification out of total classifications. Preoperative hip flexion, internal rotation, external rotation, flexion adduction, internal rotation, subspine, and Stinchfield physical examination tests were compared with classification of the AIIS on 3-D CT. Finally, preoperative hip flexion, internal rotation, and external rotation were compared with preoperative lateral center-edge angle and alpha angle. RESULTS The prevalence of AIIS was 56% (44 of 78) Type I, 39% (30 of 78) Type II, and 5% (four of 78) Type III determined from the 3-D CT classification. For the plain radiographic classification, the distribution of AIIS morphology was 64% (93 of 145) Type I, 32% (46 of 145) Type II, and 4% (six of 145) Type III on AP pelvis and 49% (71 of 145) Type I, 48% (70 of 145) Type II, and 3% (four of 145) Type III on false profile radiographs. False profile radiographs were more accurate than AP pelvis radiographs for classification when compared against the gold standard of 3-D CT at 98% (95% CI, 96-100) versus 80% (95% CI, 75-85). The false profile radiograph had better sensitivity for Type II (97% versus 47%, p < 0.001) and specificity for Types I and II AIIS (97% versus 53%, p < 0.001; 98% versus 90%, p = 0.046) morphology compared with AP pelvis radiographs. There was no correlation between AIIS type as determined by 3-D CT scan and hip flexion (rs = -0.115, p = 0.377), internal rotation (rs = 0.070, p = 0.548), flexion adduction internal rotation (U = 72.00, p = 0.270), Stinchfield (U = 290.50, p = 0.755), or subspine tests (U = 319.00, p = 0.519). External rotation was weakly correlated (rs = 0.253, p = 0.028) with AIIS subtype. Alpha angle was negatively correlated with hip flexion (r = -0.387, p = 0.002) and external rotation (r = -0.238, p = 0.043) and not correlated with internal rotation (r = -0.068, p = 0.568). CONCLUSIONS The findings in this study suggest the false profile radiograph is superior to an AP radiograph of the pelvis in evaluating AIIS morphology. Neither preoperative hip internal rotation nor impingement tests correlate with AIIS type as previously suggested questioning the utility of the AIIS classification system in identifying pathologic AIIS anatomy. LEVEL OF EVIDENCE Level III, diagnostic study.
Collapse
|