Upsloping lateral sourcil: a radiographic finding of hip instability

Wong, Thomas Y.; Jesse, Mary K.; Jensen, Alexandria; Kraeutler, Matthew J.; Coleman, Christopher; Mei-Dan, Omer

doi:10.1093/jhps/hny042

Cited by 29 publications

(20 citation statements)

References 45 publications

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“…37 Thus, additional radiographic parameters should be used to assist in the diagnosis of borderline or frank hip dysplasia, in particular the ACEA, 37 anterior wall index, 37 Tönnis angle, 37,49 iliofemoral line, 28 a broken Shenton line, 23 and the presence of an upsloping lateral sourcil. 57…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the LCEA, supplementary radiographic parameters from plain radiographs used to assess for acetabular dysplasia include the Tönnis angle, ACEA, anterior and posterior wall index, acetabular index, iliofemoral line, 28 and an upsloping lateral sourcil 54,57 (Figure 1). In a retrospective review of 98 patients with hip pain and an LCEA between 18° and 25°, McClincy et al 37 identified the ACEA and anterior wall index as independent factors predicting which patients underwent hip arthroscopy versus PAO.…”

Section: Defining Frank Hip Dysplasia and Bhd With Radiographic Parammentioning

confidence: 99%

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A Contemporary Look at the Evaluation and Treatment of Adult Borderline and Frank Hip Dysplasia

et al. 2019

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Background: Adult hip dysplasia is often diagnosed according to the lateral center-edge angle (LCEA). Patients with frank hip dysplasia (LCEA <20°) traditionally require treatment with bony realignment through a periacetabular osteotomy (PAO) and/or derotational femoral osteotomy, while patients with borderline hip dysplasia (BHD) present a challenging treatment dilemma, as it remains unknown when they should be treated with hip arthroscopy and/or a PAO. Purpose: To perform a narrative review to report the differences in hip morphology and clinical outcomes between adult patients with frank hip dysplasia and BHD. Study Design: Narrative review. Methods: A systematic search of the literature was conducted through the Medline, EMBASE, and Cochrane databases with the search phrase borderline hip dysplasia. Results: The search identified 305 articles, of which 48 were considered relevant to this study after screening of titles and abstracts. Four articles discussed new radiographic means of evaluating adult hip dysplasia, 16 articles analyzed morphology of dysplastic hips, and 28 articles described the clinical outcomes of patients with frank hip dysplasia or BHD treated with hip arthroscopy and/or PAO. Because the level of evidence obtained from this search was not adequate for systematic review or meta-analysis, a current concepts review on the diagnosis, hip morphology, and clinical outcomes of patients with frank hip dysplasia or BHD is presented. Conclusion: Adult hip dysplasia is most commonly diagnosed based on the LCEA; however, the LCEA is an unreliable sole marker for dysplasia, and additional radiographic parameters should be utilized. Furthermore, specific pathology identified on imaging and/or during hip arthroscopy can provide clues to a surgeon when the diagnosis is inconclusive according to history and physical examination alone. While the data support that patients with frank dysplasia are best treated with PAO, there is no such preferred treatment for patients with BHD, who have a wide spectrum of instability. Selective use of arthroscopic labral and capsular treatment alone may provide good results in carefully chosen patients with BHD, while some may end up requiring a bony realignment procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Defining Frank Hip Dysplasia and Bhd With Radiographic Parammentioning

confidence: 99%

A Contemporary Look at the Evaluation and Treatment of Adult Borderline and Frank Hip Dysplasia

et al. 2019

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“…Our method of grouping, based on accepted current literature, utilizes LCEA ≤20 as a marker for instability and LCEA >20 to indicate the absence of instability. However, the true assessment of hip instability goes far beyond the measured LCEA and includes acetabular version, femoral torsion, congruency of articulation, percentage medialization of the iliofemoral line, 16 presence of an upsloping lateral sourcil, 37 Beighton ligamentous laxity score, and clinical range of motion. In actual surgical practice, the senior author implements all of these important parameters in arriving at a treatment plan that is tailored to each patient.…”

Section: Discussionmentioning

confidence: 99%

The “Outside-In” Lesion of Hip Impingement and the “Inside-Out” Lesion of Hip Dysplasia: Two Distinct Patterns of Acetabular Chondral Injury

et al. 2019

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Background: Femoroacetabular impingement (FAI) and acetabular dysplasia lead to acetabular cartilage damage that commonly results in the chondral flaps seen during hip arthroscopy. Purpose: To compare the acetabular chondral flap morphology seen during hip arthroscopy (“outside-in” vs “inside-out”) with clinical and radiographic parameters underlying FAI and hip dysplasia. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent hip arthroscopy by the senior author between 2013 and 2017 with a finding of Outerbridge grade IV acetabular chondral flap were included. Each procedure was retrospectively reviewed on video and chondral flaps were categorized as inside-out or outside-in. An inside-out designation was made for flaps exhibiting an intact chondrolabral junction with a detached sleeve of chondrolabral tissue from the central acetabulum, and an outside-in designation was made for centrally anchored flaps exhibiting a break in the chondrolabral junction. Radiographic markers of hip impingement/dysplasia were noted for each patient during assignment into 1 of 2 radiographic groups: group 1, lateral center edge angle (LCEA) >20 with FAI, and group 2, LCEA ≤20 with or without cam FAI. Associations between chondral flap morphology and clinical diagnosis were tested using a chi-square test. Results: Overall, 95 patients (103 hips) were included (group 1, 78 hips; group 2, 25 hips). Among hips in group 2, 24 had concurrent cam FAI. There was a significant relationship between chondral flap type and radiographic diagnosis ( P < .001). Among group 1 hips, 78% exhibited outside-in type chondral flaps, 12% exhibited combined outside-in and inside-out flaps, and 10% exhibited inside-out flaps. Group 2 hips showed 72% inside-out type chondral flaps, 16% combined, and 12% outside-in. Hips exhibiting outside-in type flaps were significantly more likely to be in group 1 (positive predictive value [PPV], 91%; negative predictive value [NPV], 69%). Similarly, hips exhibiting inside-out type flaps were significantly more likely to be in group 2 (PPV, 56%; NPV, 95%). Altogether, 90% of group 1 hips exhibited an outside-in lesion and 88% of group 2 hips exhibited an inside-out lesion. Conclusion: Acetabular chondral flap type visualized during hip arthroscopy correlates with radiographic markers of hip impingement and hip instability. Outside-in flaps are highly predictive of FAI, whereas inside-out flaps are highly predictive of acetabular dysplasia.

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“…Unexpectedly, there was no correlation relationship between the supra‐peripheral or supra‐central regional topographic‐acetabular curvature and LCEA or ARO. Meanwhile, it has been reported that the upsloping lateral sourcil of the acetabular rim is often observed in AP radiographs of the borderline and the frank dysplastic hips 38 . In our study, we evaluated the zonal‐acetabular curvature, assuming that the lunate surfaces in the zone are spherical surfaces.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the acetabular rim morphology can affect the measurements of topographic‐acetabular radius of curvatures. Furthermore, it has been pointed out that the upsloping lateral sourcil may be associated with the enlarged attachment of the labrum in the dysplastic hips 38–40 . Since the purpose of this study was to evaluate the difference of the topographic‐acetabular curvatures in the acetabulum, we focused on the measurement range on the lunate surface.…”

Section: Discussionmentioning

confidence: 99%

Three‐dimensional hip joint congruity evaluation of the borderline dysplasia: Zonal‐acetabular radius of curvature

Irie

Orías

Nho

et al. 2020

Journal Orthopaedic Research

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In theory, a hemispherical acetabulum provides the ideal hip congruity in any hip position. However, it remains unknown how the three‐dimensional acetabular morphology of borderline dysplastic and frank dysplastic hips compare to normal hips. This study inquires if borderline dysplastic zonal‐acetabular curvatures in the anterior, superior, and posterior zones are different from normal or dysplastic hips three‐dimensionally. One‐hundred and fifteen hips, grouped as control (25°≤ LCEA <40°), 36 hips; borderline (20°≤ LCEA <25°), 32 hips; dysplasia (LCEA ≤20°), 47 hips were analyzed. The radii of acetabular curvature for the anterior, superior, and posterior zones were calculated as the zonal‐acetabular radius of curvature (ZARC). The mean acetabular roof obliquity of the borderline (10.6 ± 4.3 [SD]°) was significantly larger than the control (3.0° ± 5.4°; P < .001) and smaller than the dysplasia (19.3° ± 5.7°; P < .001). Although the mean acetabular anteversion angle of the borderline (21.3° ± 3.7°) was significantly larger than control (17.9 ± 3.5°; P = .001), that of the borderline was not different from the dysplasia (23.3° ± 4.0°; P = .053). The mean anterior ZARC in the borderline (29.8 ± 2.6 mm) was significantly larger than the control (28.0 ± 2.2 mm; P = .011) and smaller than the dysplasia (31.5 ± 2.7 mm; P = .009). The mean superior ZARC in the borderline (25.7 ± 3.0 mm) was not different from the control (25.9 ± 2.2 mm; P = .934) or the dysplasia (25.8 ± 2.5 mm; P = .991). Although the mean posterior ZARC in the borderline (27.2 ± 2.5 mm) was not different from the control (26.4 ± 1.9 mm; P = .455), that of the borderline group was significantly smaller than the dysplasia (30.4 ± 3.3 mm; P < .001); that is, the severity of lateral under‐coverage affects the anterior and/or posterior zonal‐acetabular curvature.

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Upsloping lateral sourcil: a radiographic finding of hip instability

Cited by 29 publications

References 45 publications

A Contemporary Look at the Evaluation and Treatment of Adult Borderline and Frank Hip Dysplasia

A Contemporary Look at the Evaluation and Treatment of Adult Borderline and Frank Hip Dysplasia

The “Outside-In” Lesion of Hip Impingement and the “Inside-Out” Lesion of Hip Dysplasia: Two Distinct Patterns of Acetabular Chondral Injury

Three‐dimensional hip joint congruity evaluation of the borderline dysplasia: Zonal‐acetabular radius of curvature

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