The Effect of Acetabular Rim Recession on Anterior Acetabular Coverage

Kling, Scott; Karns, Michael R.; Gebhart, Jeremy J.; Kosmas, Christos; Robbin, Mark; Nho, Shane J.; Bedi, Asheesh; Salata, Michael J.

doi:10.1177/0363546515571918

Cited by 10 publications

(9 citation statements)

References 30 publications

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“…It is suggested through in vivo and cadaveric studies that each 1 mm of rim resection results in 1°to 2°d ecreases in lateral and anterior center-edge angles [6,14,22]. However, cadaveric studies also show that rim resection of 4 mm increases the contact pressure within the hip [4] and that rim resection of as little as 3 mm can cause instability and subluxation of the hip [6].…”

Section: Discussionmentioning

confidence: 99%

Is Increased Acetabular Cartilage or Fossa Size Associated With Pincer Femoroacetabular Impingement?

Pun

Hingsammer

Millis

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Surgical treatment for pincer femoroacetabular impingement (FAI) of the hip remains controversial, between trimming the prominent acetabular rim and reverse periacetabular osteotomy (PAO) that reorients the acetabulum. However, rim trimming may decrease articular surface size to a critical threshold where increased joint contact forces lead to joint degeneration. Therefore, knowledge of how much acetabular articular cartilage is available for resection is important when evaluating between the two surgical options. In addition, it remains unclear whether the acetabulum rim in pincer FAI is a prominent rim because of increased cartilage size or increased fossa size. Questions/purposes We used reformatted MR and CT data to establish linear length dimensions of the lunate cartilage and cotyloid fossa in normal, dysplastic, and deep acetabula. Methods We reviewed the last 200 hips undergoing PAO, reverse PAO, and surgical dislocation for acetabular rim trimming at one institution. We compared MR images of symptomatic hips with acetabular dysplasia (20 hips), pincer FAI (29 hips), and CT scans of asymptomatic hips from patients who underwent CT scans for reasons other than hip pain (20 hips). These hips were chosen sequentially from the underlying pool of 200 potential subjects to identify the first 10 male and the first 10 female hips in each group that met inclusion criteria. As a result of low numbers, we included all hips that had undergone reverse PAO and met inclusion criteria. Cartilage width was measured medially from the cotyloid fossa to the lateral labrochondral junction. Cotyloid fossa linear height was measured from superior to inferior and cotyloid fossa width was measured from anterior to posterior. Superior lunate cartilage width (SLCW) and cotyloid fossa height (CFH) were measured on MR and CT oblique coronal reformats; anterior lunate cartilage width (ALCW), posterior lunate cartilage width (PLCW), and cotyloid fossa width (CFW) were measured on MR and CT oblique axial reformats. Cohorts were compared using multivariate analysis of variance with Bonferroni's adjustment for multiple comparisons.Results Compared with control acetabula, dysplastic acetabula had smaller SLCW (2.08 ± 0.29 mm versus 2.63 Clinical Orthopaedics and Related Research ®A Publication of The Association of Bone and Joint Surgeons® ± 0.42 mm, mean difference = À0.55 mm; 95% confidence interval [CI] = À0.83 to À0.27; p \ 0.01), ALCW (1.20 ± 0.34 mm versus 1.64 ± 0.21 mm, mean difference = À0.44 mm; 95% CI = À0.70 to À0.18; p = 0.00), CFH (2.84 ± 0.37 mm versus 3.42 ± 0.57 mm, mean difference = À0.59 mm; 95% CI = À0.96 to À0.21; p \ 0.01), and CFW (1.98 ± 0.50 mm versus 2.77 ± 0.33 mm, mean difference = À0.80 mm; 95% CI = À1.16 to À0.42; p \ 0.0001). Based on the results, we identified two subtypes of deep acetabula. Compared with controls, deep subtype 1 had normal CFH and CFW but increased ALCW (2.09 ± 0.42 mm versus 1.64 ± 0.21 mm; p \ 0.001) and PLCW (2.32 ± 0.36 mm versus 2.00 ± 0.32 mm; p = 0.04). Compared ...

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Section: Discussionmentioning

confidence: 99%

Is Increased Acetabular Cartilage or Fossa Size Associated With Pincer Femoroacetabular Impingement?

Pun

Hingsammer

Millis

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…A resection of 7.5 mm caused 50% of the specimens to become unstable and require an externally applied force to maintain hip joint reduction. 16 Philippon et al 8 found that 1 and 2 mm of rim resection correlated with a change in LCEA of 2.4 and 3.1 , respectively. In the current study, we found that the average difference in preoperative LCEA between symptomatic and unaffected acetabula was 8.5 , whereas the difference in anterosuperior rim thickness was 0.5 mm.…”

Section: Discussionmentioning

confidence: 99%

“…There is currently controversy about normal and abnormal acetabular rim morphology and what radiographic or advanced imaging parameter or parameters are used to measure "normal." 7,16 Radiographic parameters alone have been shown to be poor predictors of pincer-type FAI. [3][4][5] CTbased studies and 3D studies have attempted to qualify and quantify normal and abnormal parameters for acetabular volume and morphology.…”

Section: Discussionmentioning

confidence: 99%

“…This point is further illustrated by the many studies that have identified radiographically positive FAIS in asymptomatic volunteers. [38][39][40] Surgical correction of pincer-type FAIS must balance between underresection, resulting in potential continued FAIS symptoms, and overresection, resulting 8,14,16 A prior study by Kling et al 16 showed that small rim resections in a cadaver model caused large changes in ACEAs or LCEAs. In their study, a cadaveric rim resection of 5 mm caused 2 of 12 specimens to become dysplastic as measured by ACEAs and LCEAs.…”

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.…”

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confidence: 99%

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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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Improved Functional Outcome Scores Associated with Greater Reduction in Cam Height Using the Femoroacetabular Impingement Resection Arc During Hip Arthroscopy

Kaplan

Matache

Fried

et al. 2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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The Effect of Acetabular Rim Recession on Anterior Acetabular Coverage

Abstract: The false-profile view is recommended in the perioperative workup for all patients undergoing arthroscopic treatment of pincer impingement.

Cited by 10 publications

References 30 publications

Is Increased Acetabular Cartilage or Fossa Size Associated With Pincer Femoroacetabular Impingement?

Is Increased Acetabular Cartilage or Fossa Size Associated With Pincer Femoroacetabular Impingement?

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

Improved Functional Outcome Scores Associated with Greater Reduction in Cam Height Using the Femoroacetabular Impingement Resection Arc During Hip Arthroscopy

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