A Geographic Zone Method to Describe Intra-articular Pathology in Hip Arthroscopy: Cadaveric Study and Preliminary Report

Ilizaliturri, Víctor M.; Byrd, J. W. Thomas; Sampson, Thomas; Guanche, Carlos A.; Philippon, Marc J.; Kelly, Bryan T.; Dienst, Michael; Mardones, Rodrigo; Shonnard, Paul; Larson, Christopher M.

doi:10.1016/j.arthro.2007.11.019

Cited by 177 publications

(114 citation statements)

References 6 publications

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“…The assessment consisted of a description of the labral tear type based on a four-type classification system modified from the two-type system originally described by Seldes et al [38] ( Table 2). The location of the tear was described using clock-face geometry, as used by others [4,26,35,40] and supported by reliability studies [7,15]. The presence or absence, size, and location of cam and pincer lesions also were recorded, based on arthroscopic inspection and probing of the acetabular rim and femoral head-neck junction, with hip flexion and internal and external rotation performed within the limits of a hip arthroscopy traction table.…”

Section: Methodsmentioning

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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Section: Methodsmentioning

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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“…SHOMRI uses a sagittal and coronal sequence to divide the femoral head and the acetabular articular surface into six and four subregions, respectively. Arthroscopic measurement of hip joint abnormalities relies on a similar zone-based system, recently published by Ilizaliturri et al [16]. To define the areas of agreement between the arthroscopic zone-based system and SHOMRI subregions, five training cases were retrospectively reviewed by an experienced orthopedic surgeon (ALZ) and an experienced musculoskeletal radiologist (TML).…”

Section: Evaluation Of Combined Geographic Zones Of Shomri and Arthromentioning

confidence: 99%

Validation of scoring hip osteoarthritis with MRI (SHOMRI) scores using hip arthroscopy as a standard of reference

et al. 2018

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Purpose To validate SHOMRI gradings in preoperative hip magnetic resonance imaging (MRI) with intra-arthroscopic evaluation of intraarticular hip abnormalities. Methods Preoperative non-arthrographic 3.0-T MRIs of 40 hips in 39 patients (1 patient with bilateral hip surgery) with femoroacetabular impingement (FAI) syndrome (mean age, 34.7 years ± 9.0; n = 16 females), refractory to conservative measures, that underwent hip arthroscopy were retrospectively assessed by two radiologists for chondrolabral abnormalities and compared with intra-arthroscopic findings as the standard of reference. Arthroscopically accessible regions were compared with the corresponding SHOMRI subregions and assessed for the presence and grade of cartilaginous pathologies in the acetabulum and femoral head. The acetabular labrum was assessed for the presence or absence of labral tears. For the statistical analysis sensitivity and specificity as well as intraclass correlation (ICC) for interobserver agreement were calculated. Results Regarding chondral abnormalities, 58.8% of the surgical cases showed chondral defects. SHOMRI scoring showed a sensitivity of 95.7% and specificity of 84.8% in detecting cartilage lesions. Moreover, all cases with fullthickness defects (n = 9) were identified correctly, and in n = 6 cases (out of n = 36 with partial-thickness defects) the defective cartilage was identified but the actual depth overestimated. Labral tears were present in all cases and the MR readers identified 92.5% correctly. ICC showed a good interobserver agreement with 86.3% (95% CI 80.0, 90.6%) Conclusion Using arthroscopic correlation, SHOMRI grading of the hip proves to be a reliable and precise method to assess chondrolabral hip joint abnormalities. Key Points • Assessment of hip abnormalities using MRI with surgical correlation.• Comparing surgery and MRI by creating a hybrid anatomic map that covers both modalities.• Non-arthrographic use of 3.0-T MRI provides detailed information on cartilage and labral abnormalities in hip joints.

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“…1). The modified zoning method described by Ilizaliturri et al [5] is applied to the data (Fig. 2), with Zones 1 to 6 being contained in the acetabulum and Zones 7 to 9 being lateral to the acetabular rim.…”

Section: Proposed Programmentioning

confidence: 99%

“…Furthermore, we can subcategorize lesions into zones based on a modification of the grid described by Ilizaliturri et al [5] for cartilage lesions, along with the classic clock face description.…”

Section: Introductionmentioning

confidence: 99%

Emerging Ideas: Novel 3-D Quantification and Classification of Cam Lesions in Patients With Femoroacetabular Impingement

Kang¹,

Yanke²,

Orias³

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Femoroacetabular impingement (FAI) can lead to labral injury, osseous changes, and even osteoarthritis. The literature contains inconsistent definitions of the alpha angle and other nonthree-dimensional (3-D) radiographic measures. We present a novel approach to quantifying cam lesions in 3-D terms. Our method also can be used to develop a classification system that describes the exact location and size of cam lesions. Questions/Hypotheses We asked whether automated quantification of CAM lesions based on CT data is a reasonable way to detect CAM lesions and whether they may be classified based on location. Method of Study We developed a method to quantify femoral head cam lesions using 3-D modeling of CT scans. By segmenting raw DICOM data, we can determine the distance from the cam lesion's surface points to the centroid of the femoral head to quantify the mean bump height, volume, and location. The resulting 3-D femoral and acetabular models will be analyzed with custom software. We then will quantify the cam lesion with 3-D parameters using a modified zoning method. The mean bump height, volume, and location on the clock face, and relative zoning will be calculated. Zonal differences will be statistically analyzed. To assess the ability of this method to predict arthroscopic findings, we will obtain preoperative CT scans for 25 patients who undergo hip arthroscopy for FAI. We will compare measurements with the method with our measurements from arthroscopy. The clinical implications of our method's measurements then will be reviewed and refined for future prospective studies. Significance We present a novel approach that can quantify a cam lesion's location and size. This method will be used to provide guidelines for the exact amount of bony resection needed from a specific location of the proximal femur. There is also potential to develop software for ease of use so this method can be more widely applied. HypothesisQuantifying femoral head cam lesions that are analyzed three-dimensionally using the distance from the cam lesion's surface points to the centroid of the femoral head to quantify the mean bump height, volume, and location will effectively define cam lesions and predict arthroscopic measurements.

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A Geographic Zone Method to Describe Intra-articular Pathology in Hip Arthroscopy: Cadaveric Study and Preliminary Report

Cited by 177 publications

References 6 publications

Preoperative Three-dimensional CT Predicts Intraoperative Findings in Hip Arthroscopy

Preoperative Three-dimensional CT Predicts Intraoperative Findings in Hip Arthroscopy

Validation of scoring hip osteoarthritis with MRI (SHOMRI) scores using hip arthroscopy as a standard of reference

Emerging Ideas: Novel 3-D Quantification and Classification of Cam Lesions in Patients With Femoroacetabular Impingement

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