nach oben

Skeletal Radiology

Erschienen in:

07.12.2022 | Scientific Article

The posterior crescent sign on MRI and MR arthrography: is it a marker of hip dysplasia and instability?

verfasst von: Andrew A. MacDonald, Donna G. Blankenbaker, Matthew J. Brick, Chris M. Hanna, Rebecca M. Woodward

Erschienen in: Skeletal Radiology | Ausgabe 6/2023

Einloggen, um Zugang zu erhalten

Abstract

Objective

To evaluate the prevalence of the ‘posterior crescent sign’ in symptomatic patients referred for MRI/MR arthrogram of the hip and identify any correlation with imaging features of joint pathology.

Materials and methods

Retrospective imaging assessment of a cohort of 1462 hips, from 1380 included MR examinations (82 bilateral) retrieved from a search of all examinations in patients 16–50 years old from June 2018 to June 2021, with median age 45.8 years (range 17.8–50.0) and 936 hips (64%) in women. Radiographic and MR findings related to hip dysplasia, femoroacetabular impingement and osteoarthritis were assessed.

Results

Fifty-one hips (3.5%) were positive for the posterior crescent sign, median age of 45.8 years (range 17.8–50.0) and 29 (58%) in women. Radiographic findings included the following: mean lateral centre edge angle (LCEA) 22.2° (± 7.8°) with LCEA < 20° in 15 (31%) and LCEA 20–25° in 17 (35%) and mean acetabular index (AI) of 13.1° (± 5.8°) with AI > 13° in 22 (45%). MR findings included the following: mean anterior acetabular sector angle (AASA) 54.3° (± 9.8°), mean posterior acetabular sector angle (PASA) 92.7° (± 7.0°), labral tear at 3–4 o’clock in 20 (39%), high-grade acetabular chondral loss in 42 (83%) and ligamentum teres abnormality in 20 (39%).

Conclusion

The posterior crescent sign occurs in 3.5% of symptomatic young and middle-aged adults on MR. It is associated with overt and borderline hip dysplasia and other findings of hip instability. It is also associated with osteoarthritis in some cases and should be interpreted with caution in these patients.

Bolia I, Chahla J, Locks R, Briggs K, Philippon MJ. Microinstability of the hip: a previously unrecognized pathology. Muscles Ligaments Tendons J. 2016;6:354–60.CrossRefPubMedPubMedCentral

Safran MR, Lopomo N, Zaffagnini S, Signorelli C, Vaughn ZD, Lindsey DP, et al. In vitro analysis of peri-articular soft tissues passive constraining effect on hip kinematics and joint stability. Knee Surg Sports Traumatol Arthrosc. 2013;21:1655–63.CrossRefPubMed

Charbonnier C, Kolo FC, Duthon VB, Magnenat-Thalmann N, Menetrey J. Assessment of congruence and impingement of the hip joint in professional ballet dancers: a motion capture study. Am J Sports Med. 2011;39:557–66.CrossRefPubMed

Wyatt MC, Beck M. The management of the painful borderline dysplastic hip. J Hip Preserv Surg. 2018;5:105–12.CrossRefPubMedPubMedCentral

Safran MR. Microinstability of the hip – gaining acceptance. J Am Acad Orthop Surg. 2019;27:12–22.CrossRefPubMed

Kalisvaart MM, Safran MR. Microinstability of the hip – it does exist: etiology, diagnosis and treatment. J Hip Preserv Surg. 2015;2:123–35.CrossRefPubMedPubMedCentral

Dangin A, Tardy N, Wettstein M, May O, Bonin N. Microinstability of the hip: a review. Orthop Traumatol Surg Res. 2016;102:S301–9.CrossRefPubMed

Woodward RM, Philippon MJ. Persistent or recurrent symptoms after arthroscopic surgery for femoroacetabular impingement: a review of imaging findings. J Med Imaging Radiat Oncol. 2019;63:15–24.CrossRefPubMed

Shibata KR, Matsuda S, Safran MR. Is there a distinct pattern to the acetabular labrum and articular cartilage damage in the non-dysplastic hip with instability? Knee Surg Sports Traumatol Arthrosc. 2017;25:84–93.CrossRefPubMed

10.

Safran MR, Murray IR, Andrade AJ, Aoki SK, Ayeni OR, Balakumar J, et al. Criteria for the operating room confirmation of the diagnosis of hip instability: the results of an international expert consensus conference. Arthrosc J Arthrosc Relat Surg. 2022;38:2837–49.CrossRef

11.

Cohen D, Jean P-O, Patel M, Aravinthan N, Simunovic N, Duong A, et al. Hip microinstability diagnosis and management: a systematic review. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-022-06976-7.

12.

Akiyama K, Sakai T, Koyhanagi J, Yoshikawa H, Sugamoto K. Evaluation of translation in the normal and dysplastic hip using three-dimensional magnetic resonance imaging and voxel-based registration. Osteoarthritis Cartilage. 2011;19:700–10.CrossRefPubMed

13.

Burke CJ, Walter WR, Gyftopoulos S, Pham H, Baron S, Gonzalez-Lomas G, et al. Real-time assessment of femoroacetabular motion using radial gradient echo magnetic resonance arthrography at 3 Tesla in routine clinical practice: a pilot study. Arthrosc J Arthrosc Relat Surg. 2019;35:2366–74.CrossRef

14.

Beltran LS, Rosenberg ZS, Mayo JD, Diaz de Tuesta M, Martin O, Neto LP, et al. Imaging evaluation of developmental hip dysplasia in the young adult. Am J Roentgenol. 2013;200:1077–88.CrossRef

15.

Haefeli PC, Steppacher SD, Babst D, Siebenrock KA, Tannast M. An increased iliocapsularis-to-rectus-femoris ratio is suggestive for instability in borderline hips. Clin Orthop. 2015;473:3725–34.CrossRefPubMedPubMedCentral

16.

Mascarenhas VV, Ayeni OR, Egund N, Jurik AG, Caetano A, Castro M, et al. Imaging methodology for hip preservation: techniques, parameters, and thresholds. Semin Musculoskelet Radiol. 2019;23:197–226.CrossRefPubMed

17.

Anda S, Terjesen T, Kvistad KA, Svenningsen S. Acetabular angles and femoral anteversion in dysplastic hips in adults: CT investigation. J Comput Assist Tomogr. 1991;15:115–20.CrossRefPubMed

18.

Chadayammuri V, Garabekyan T, Bedi A, Pascual-Garrido C, Rhodes J, O’Hara J, et al. Passive hip range of motion predicts femoral torsion and acetabular version. J Bone Joint Surg Am. 2016;98:127–34.CrossRefPubMed

19.

Baker KB, Vesey RM, Clark B, Billington K, Woodward RM. Assessment of the iliocapsularis muscle on magnetic resonance imaging. J Med Imaging Radiat Oncol. 2022;66:920–6.CrossRefPubMed

20.

Zurmühle CA, Kuner V, McInnes J, Pfluger DH, Beck M. The crescent sign – a predictor of hip instability in magnetic resonance arthrography. J Hip Preserv Surg. 2021;8:164–71.CrossRefPubMedPubMedCentral

21.

Sonoda K, Hara T. “Anterior-shift sign”: a novel MRI finding of adult hip dysplasia. Arch Orthop Trauma Surg. 2022;142:1763–8.CrossRefPubMed

22.

Wilkin GP, Ibrahim MM, Smit KM, Beaulé PE. A contemporary definition of hip dysplasia and structural instability: toward a comprehensive classification for acetabular dysplasia. J Arthroplasty. 2017;32:S20–7.CrossRefPubMed

23.

Nepple JJ, Wells J, Ross JR, Bedi A, Schoenecker PL, Clohisy JC. Three patterns of acetabular deficiency are common in young adult patients with acetabular dysplasia. Clin Orthop. 2017;475:1037–44.CrossRefPubMed

24.

Tannast M, Fritsch S, Zheng G, Sibenrock KA, Steppacher SD. Which radiographic hip parameters do not have to be corrected for pelvic rotation and tilt? Clin Orthop. 2015;473:1255–66.CrossRefPubMed

25.

Blankenbaker DG, De Smet AA, Keene JS, Fine JP. Classification and localization of acetabular labral tears. Skeletal Radiol. 2007;36:391–7.CrossRefPubMed

26.

Suter A, Dietrich TJ, Maier M, Dora C, Pfirrmann CW. MR findings associated with positive distraction of the hip joint achieved by axial traction. Skeletal Radiol. 2015;44:787–95.CrossRefPubMed

27.

Harris JD. Hypermobile hip syndrome. Oper Tech Sports Med. 2019;27:101–18.CrossRef

28.

Barlow B. Iliopsoas fractional lengthening: treating a disease or a symptom? Arthrosc J Arthrosc Relat Surg. 2019;35:1441–4.CrossRef

29.

Cerezal L, Kassarjian A, Canga A, Dobado MC, Montero JA, Llopis E, et al. Anatomy, biomechanics, imaging, and management of ligamentum teres injuries. Radiographics. 2010;30:1637–51.CrossRefPubMed

30.

Perumal V, Woodley SJ, Nicholson HD, Brick MJ, Bacon CJ. Ligamentum teres lesions are associated with poorer patient outcomes in a large primary hip arthroscopy cohort of 1,935 patients. Arthrosc Sports Med Rehabil. 2022;4:e1363–72.CrossRefPubMedPubMedCentral

31.

Woodward RM, Vesey RM, Bacon CJ, White SG, Brick MJ, Blankenbaker DG. Microinstability of the hip: a systemic review of the imaging findings. Skeletal Radiol. 2020;49:1903–19.CrossRefPubMed

32.

Mayes S, Ferris A-R, Smith P, Garnham A, Cook J. Atraumatic tears of the ligamentum teres are more frequent in professional ballet dancers than a sporting population. Skeletal Radiol. 2016;45:959–67.CrossRefPubMed

33.

Blankenbaker DG, De Smet AA, Keene JS, Munoz del Rio A. Imaging appearance of the normal and partially torn ligamentum teres on hip MR athrography. Am J Roentgenol. 2012;199:1093–8.CrossRef

34.

Shakoor D, Farahani SJ, Hafezi-Nejad N, Johnson A, Vaidya D, Khanuja HS, et al. Lesions of ligamentum teres: diagnostic performance of MRI and MR arthrography – a systematic review and meta-analysis. Am J Roentgenol. 2018;211:W52-63.CrossRef

35.

Field RE, Rajakulendran K. The labro-acetabular complex. J Bone Joint Surg Am. 2011;93:22–7.CrossRefPubMed

Titel: The posterior crescent sign on MRI and MR arthrography: is it a marker of hip dysplasia and instability?
verfasst von: Andrew A. MacDonald
Donna G. Blankenbaker
Matthew J. Brick
Chris M. Hanna
Rebecca M. Woodward
Publikationsdatum: 07.12.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: Skeletal Radiology / Ausgabe 6/2023
Print ISSN: 0364-2348
Elektronische ISSN: 1432-2161
DOI: https://doi.org/10.1007/s00256-022-04248-6

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

The posterior crescent sign on MRI and MR arthrography: is it a marker of hip dysplasia and instability?