Ischial Spine Sign Reveals Acetabular Retroversion in Legg-Calvé-Perthes Disease

Larson, A. Noelle; Stans, Anthony A.; Sierra, Rafael J.

doi:10.1007/s11999-011-1793-2

Cited by 26 publications

(19 citation statements)

References 21 publications

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“…In 2008, Kalberer et al 20 proposed that acetabular retroversion can also be caused by hemipelvic retroversion and not only by the hypoplasia of the posterior wall or the overdevelopment of the anterior wall. Subsequently, some scholars have shown that a high proportion of patients with Perthes disease have a positive ischial spine sign 8 , 21 . This suggests that acetabular retroversion in Perthes disease may be caused by hemipelvic retroversion.…”

Section: Discussionmentioning

confidence: 99%

“…Hemipelvic retroversion may appear as the positive prominence of the ischial spine sign (PRIS). Larson et al 21 researched acetabular retroversion and PRIS in children with Perthes disease and found skeletally immature hips in 90% (37/41) of children with a positive PRIS sign but in only 32% (16/50) of children in the normal control group. Additionally, the positive PRIS sign rate was 90% (9/10) in the early stage of Perthes disease, which showed that acetabular retroversion was probably caused by hemipelvic retroversion in Perthes disease patients.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Retroversion of the hemipelvis rather than hypoplastic posterior wall decreases acetabular anteversion in hips affected by Perthes disease

Liao

Zhao

Wang

et al. 2021

Sci Rep

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The acetabular retroversion has a moderate incidence of 31–60% in all patients of the Perthes disease. It might be caused by posterior wall dysplasia based on recent animal researches. However, some studies support that hemipelvic retroversion is the main factor for the acetabular retroversion. The primary pathological factor of increasing retroversion angle is still controversial anatomically. This study aimed to identify whether there is acetabular retroversion in children with Perthes disease,and to find a method to distinguish version types. Forty children with unilateral Perthes disease who were admitted to our hospital from January 1, 2012 to December 31, 2018 were enrolled, and 40 controls were matched based on sex and age. The acetabular anteversion angle (AAA), internal wall anteversion angle (IWAA), anterior wall height of the acetabulum (A), acetabular posterior wall height (P), and acetabular width (W) were assessed on computed tomography (CT) at the level of the femoral head center. The acetabular wall difference index (AWDI; AWDI = P-A)/W*100) was calculated. The mean AAA was significantly lower in Perthes disease hips (10.59 (8.05–12.46)) than in contralateral hips (12.04 (9.02–13.33)) (p = 0.002) but did not differ from control hips (9.68 ± 3.76) (p = 0.465). The mean IWAA was significantly lower in Perthes hips (9.16 ± 3.89) than in contralateral hips (11.31 ± 4.04) (p = 0.000) but did not differ from control hips (9.43 ± 3.82) (p = 0.753). The mean AWDI did not differ between Perthes hips (0.41 ± 4.94) and contralateral hips (− 1.12 (− 4.50, 2.17)) (p = 0.06) or control hips (− 0.49 ± 5.46) (p = 0.437). The mean W was significantly higher in Perthes hips (44.61 ± 5.06) than in contralateral hips (43.36 ± 4.38) (p = 0.000) but did not differ from control hips (45.02 ± 5.01) (p = 0.719). The mean A and P did not differ between Perthes hips and contralateral hips or control hips. Correlation analysis of all hip joints revealed a significant correlation between AAAs and IWAAs (r = 0.772; r = 0.643; r = 0.608; and r = 0.540). Linear regression analysis revealed that AAAs increased with IWAAs. Multiple linear regression showed that IWAAs and AWDIs have good predictive value for AAAs in both Perthes and control hips (R2 = 0.842, R2 = 0.869). In patients with unilateral Perthes disease, the affected acetabulum is more retroverted than that on the contralateral side, which may be caused by hemipelvic retroversion. The measurements in this study could distinguish the form of acetabular retroversion. IWAAs and AWDIs can be used as new observations in future studies of acetabular version.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Retroversion of the hemipelvis rather than hypoplastic posterior wall decreases acetabular anteversion in hips affected by Perthes disease

Liao

Zhao

Wang

et al. 2021

Sci Rep

View full text Add to dashboard Cite

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“…Mechanical compression of the lateral ascending cervical arteries may contribute to the disorder (i.e., in hyperactive patients or activities with repeated abduction), as this region of the trochanteric-neck junction is smaller in children, specifically before the age of eight years. Larson et al described an ischial spine sign that could connote impingement on the vessels at the base of the femoral neck, but chronology of this deformity in the development of LCPD in their series could not be determined [ 6 ]. Furthermore, there is richer vascularity in the anterior femoral neck in black patients than in more susceptible Caucasians [ 20 ], which could explain the relative paucity of reported cases in blacks.…”

Section: Discussionmentioning

confidence: 99%

“…The etiology of LCPD is unknown but is thought to result from vascular congestion and/or coagulation abnormalities in the circulation of the proximal femur [ 2 , 3 ]. The diagnosis has been associated with behavioral disorders [ 4 ], cigarette smoking [ 5 ], femoral and acetabular morphology [ 6 ], genitourinary anomalies [ 7 ], genetics [ 8 ], geography [ 1 ], childhood deprivation [ 9 , 10 ], and high-impact activities such as gymnastics [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

The presentation of Legg−Calvé−Perthes disease in females

Georgiadis

Seeley

Yellin

et al. 2015

Journal of Children's Orthopaedics

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PurposeLegg−Calvé−Perthes disease (LCPD) is uncommon in girls. The presentation of LCPD in female patients has been reported as later in onset and associated with certain high-impact activities. Our aim is to characterize the presentation of female LCPD at a large center, with particular attention to the clinical and radiographic features of late-onset disease (>ten years of age). We perceived an increasing burden of late-onset disease with adult-like radiographic features.MethodsAll patients presenting to a single large urban children’s hospital from 1990−2014 with a diagnosis of LCPD were reviewed. Demographic, clinical, and radiographic data for all female patients were examined and compared to historical norms.ResultsFour-hundred and fifty-one patients presented with LCPD in the study period, of which 82 (18.2 %) were female. The average age at presentation was 6.58 years in girls, which is similar to the classically reported mean age. Fourteen patients participated in high-impact repetitive activities or those with deep flexion and abduction, although few were late presenters. There were four female patients who presented for initial diagnosis >ten years of age.ConclusionsThere was a paucity of late-onset LCPD in girls in the study population, and the females with LCPD had a very similar age and character to their presentation as did males. Although their presentation is infrequent, three of four older females with LCPD were engaged in high-level physical activity, and their disease may be attributed to high-impact, repetitive athletics.Level of evidenceCase series, Level IV.

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“…This might be the reason for the high number of dropouts in our study population. Other authors who assessed acetabular retroversion in Perthes’ disease had a similar reduction of radiographs included ( Larson et al 2011 , Kawahara et al 2012 ). To our knowledge, only 1 study so far has assessed the inter-observer agreement of acetabular retroversion using ISS ( Kappe et al 2011 ).…”

Section: Discussionmentioning

confidence: 99%

The acetabulum in Perthes’ disease: Inter-observer agreement and reliability of radiographic measurements

et al. 2014

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Background and purpose Perthes’ disease leads to radiographic changes in both the femoral head and the acetabulum. We investigated the inter-observer agreement and reliability of 4 radiographic measurements assessing the acetabular changes.Patients and methods We included 123 children with unilateral involvement, femoral head necrosis of more than 50%, and age at diagnosis of 6 years or older. Radiographs were taken at onset, and 1 year and 5 years after diagnosis. Sharp’s angle, acetabular depth-width ratio (ADR), lateral acetabular inclination (LAI), and acetabular retroversion (ischial spine sign, ISS) were measured by 3 observers. Before measuring, 2 of the observers had a consensus meeting.Results We found good agreement and moderate to excellent reliability for Sharp’s angle for all observers (intra-class correlation coefficient (ICC) > 0.80 with consensus, ICC = 0.46–0.57 without consensus). There was good agreement and substantial reliability for ADR between the observers who had had a consensus meeting (ICC = 0.62–0.89). Low levels of agreement and poor reliability were found for observers who had not had a consensus meeting. LAI showed fair agreement throughout the course of the disease (kappa = 0.28–0.52). The agreement between observations for ISS ranged from fair to good (kappa = 0.20–0.76).Interpretation Sharp’s angle showed the highest reliability and agreement throughout the course of the disease. ADR was only reliable and showed good agreement between the observers when landmarks were clarified before measuring the radiographs. Thus, we recommend both parameters in clinical practice, provided a consensus is established for ADR. The observations for LAI had only fair agreement and ISS showed inconclusive agreement in our study. Thus, LAI and ISS can hardly be recommended in clinical practice.

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Ischial Spine Sign Reveals Acetabular Retroversion in Legg-Calvé-Perthes Disease

Abstract: Background Acetabular retroversion has

Cited by 26 publications

References 21 publications

Retroversion of the hemipelvis rather than hypoplastic posterior wall decreases acetabular anteversion in hips affected by Perthes disease

Retroversion of the hemipelvis rather than hypoplastic posterior wall decreases acetabular anteversion in hips affected by Perthes disease

The presentation of Legg−Calvé−Perthes disease in females

The acetabulum in Perthes’ disease: Inter-observer agreement and reliability of radiographic measurements

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