Assessment of Femoral Torsion on Magnetic Resonance Imaging is More Reliable Using Axial-Oblique Sequences Compared With Standard Axial Slices in Patients With Femoroacetabular Impingement Syndrome

Evaluating the Need for Preoperative MRI Before Primary Hip Arthroscopy in Patients 40 Years and Younger With Femoroacetabular Impingement Syndrome: A Multicenter Comparative Analysis

“…A computed tomography scan may be useful, but this report should not be applied to computed tomography scan necessity. 1 , 3 While the multiple institutions and surgeons serve variable geographic populations, there may be inherent biases among patients who are evaluated at academic versus nonacademic centers. Additionally, only practices within the United States were studied, and the time to see a physician, acquire an MRI, and undergo surgery may not be generalizable to health systems in other countries.…”

Editorial Commentary: Differences in Femoral Torsion Measurements Based on Axial Versus Axial–Oblique Magnetic Resonance Imaging Sequences—Let’s Begin to Standardize Hip-Preservation Techniques to Improve Research and Clinical Outcomes

“…The study reported in this issue by Alter, Kunze, Newhouse, Bessa, DeFroda, Williams, and Nho, 9 entitled "Assessment of Femoral Torsion on Magnetic Resonance Imaging is More Reliable Using AxialeOblique Sequences Compared With Standard Axial Slices in Patients With Femoroacetabular Impingement Syndrome," provides a comparison of the agreeability of femoral torsion measurements on axial and axialeoblique magnetic resonance imaging sequences in patients with FAI. The authors should be praised for their work on this topic and for demonstrating more reliable measurements with the use of axialeoblique slices.…”

“…However, as Alter et al 9 point out, there is heterogeneity across studies regarding femoral torsion measurement methodology, the imaging modalities used for measurement, and which measurements constitute normal femoral torsion versus ante-/retrotorsion. Thus, it is important to begin to establish standardized guidelines regarding appropriate imaging modalities, imaging sequences, and femoral torsion measurements which warrant treatment with DFO.…”

“…Although the difference in axial and axialeoblique measurements of femoral torsion is clinically insignificant for the majority of patients, this difference does become relevant in patients with extreme abnormalities. 9 In select cases, this difference may lead a surgeon to recommend a DFO based on the magnetic resonance imaging sequence used to measure femoral torsion. This is an example of how minute details are important not only in appropriately assessing and treating patients but also in reporting methods such that comparisons can be made across studies.…”

Editorial Commentary: Successful Revision Hip Arthroscopy Requires Accurate Diagnosis of the Cause of Failure: “One-Size-Fits-All Surgery Is Not Appropriate”

“…3,4 It could be subtle alterations of acetabular and femoral version that resulted in previously undiagnosed causes for impingement or effective dysplasia. 5 The more effort we put into identifying the specific cause of patient symptoms, the better…”