Skip to main content
Erschienen in: Clinical Orthopaedics and Related Research® 8/2013

01.08.2013 | Symposium: Advanced Hip Arthroscopy

The Crossover Sign Overestimates Acetabular Retroversion

verfasst von: Ira Zaltz, MD, Bryan T. Kelly, MD, Iftach Hetsroni, MD, Asheesh Bedi, MD

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 8/2013

Einloggen, um Zugang zu erhalten

Abstract

Background

The crossover sign is a radiographic finding associated with cranial acetabular retroversion and has been associated with pincer-type femoroacetabular impingement (FAI) in patients with hip pain. Variable morphology, location, and size of the anterior inferior iliac spine (AIIS) may contribute to the crossover sign even in the absence of retroversion. Thus, the sign may overestimate the incidence of acetabular retroversion.

Questions/purposes

We asked: Can the crossover sign appear on standardized, well-positioned AP pelvis radiographs despite the absence of acetabular retroversion? And what is the contribution of variable size and morphology of the AIIS to a crossover sign?

Methods

We evaluated radiographs of 53 patients with symptomatic FAI in the absence of substantial chondral degenerative changes (< Tönnis Grade 2). Forty-one radiographs met the appropriate criteria of neutral tilt and obliquity. Three independent reviewers determined presence and location of the crossover sign. Acetabular version was defined using high-resolution three-dimensional CT. CT reconstructions were used to define three AIIS types addressing AIIS morphology.

Results

Nineteen of 38 radiographs with a crossover sign on AP radiographs had focal or global acetabular retroversion on three-dimensional CT (positive and negative predictive values = 50%). In contrast, the AIIS extended to or below the level of the anterior superior acetabular rim and was partially or completely responsible for the appearance of a radiographic crossover sign in all 19 hips with an anteverted acetabulum. High interobserver reliability (kappa > 0.8) was found for AIIS types.

Conclusions

A crossover sign is frequently present on well-positioned AP pelvis radiographs in the absence of acetabular retroversion. Variable AIIS morphology may explain the appearance of this sign in the presence or absence of acetabular retroversion.

Level of Evidence

Level III, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.
Literatur
1.
Zurück zum Zitat Beaule PE, Allen DJ, Clohisy JC, Schoenecker PL, Leunig M. The young adult with hip impingement: deciding on the optimal intervention. Instr Course Lect. 2009;58:213–222.PubMed Beaule PE, Allen DJ, Clohisy JC, Schoenecker PL, Leunig M. The young adult with hip impingement: deciding on the optimal intervention. Instr Course Lect. 2009;58:213–222.PubMed
2.
Zurück zum Zitat Dandachli W, Islam SU, Liu M, Richards R, Hall-Craggs M, Witt J. Three-dimensional CT analysis to determine acetabular retroversion and the implications for the management of femoro-acetabular impingement. J Bone Joint Surg Br. 2009;91:1031–1036.PubMed Dandachli W, Islam SU, Liu M, Richards R, Hall-Craggs M, Witt J. Three-dimensional CT analysis to determine acetabular retroversion and the implications for the management of femoro-acetabular impingement. J Bone Joint Surg Br. 2009;91:1031–1036.PubMed
3.
Zurück zum Zitat Dandachli W, Ul Islam S, Tippett R, Hall-Craggs MA, Witt JD. Analysis of acetabular version in the native hip: comparison between 2D axial CT and 3D CT measurements. Skeletal Radiol. 2011;40:877–883.PubMedCrossRef Dandachli W, Ul Islam S, Tippett R, Hall-Craggs MA, Witt JD. Analysis of acetabular version in the native hip: comparison between 2D axial CT and 3D CT measurements. Skeletal Radiol. 2011;40:877–883.PubMedCrossRef
4.
Zurück zum Zitat Dora C, Leunig M, Beck M, Simovitch R, Ganz R. Acetabular dome retroversion: radiological appearance, incidence and relevance. Hip Int. 2006;16:215–222.PubMed Dora C, Leunig M, Beck M, Simovitch R, Ganz R. Acetabular dome retroversion: radiological appearance, incidence and relevance. Hip Int. 2006;16:215–222.PubMed
5.
Zurück zum Zitat Eckman K, Hafez MA, Ed F, Jaramaz B, Levison TJ, Digioia AM 3rd. Accuracy of pelvic flexion measurements from lateral radiographs. Clin Orthop Relat Res. 2006;451:154–160.PubMedCrossRef Eckman K, Hafez MA, Ed F, Jaramaz B, Levison TJ, Digioia AM 3rd. Accuracy of pelvic flexion measurements from lateral radiographs. Clin Orthop Relat Res. 2006;451:154–160.PubMedCrossRef
6.
Zurück zum Zitat Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech. 2003;36:171–178.PubMedCrossRef Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech. 2003;36:171–178.PubMedCrossRef
7.
Zurück zum Zitat Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.PubMed Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.PubMed
8.
Zurück zum Zitat Jamali AA, Mladenov K, Meyer DC, Martinez A, Beck M, Ganz R, Leunig M. Anteroposterior pelvic radiographs to assess acetabular retroversion: high validity of the “cross-over-sign.” J Orthop Res. 2007;25:758–765.PubMedCrossRef Jamali AA, Mladenov K, Meyer DC, Martinez A, Beck M, Ganz R, Leunig M. Anteroposterior pelvic radiographs to assess acetabular retroversion: high validity of the “cross-over-sign.” J Orthop Res. 2007;25:758–765.PubMedCrossRef
9.
Zurück zum Zitat Kakaty DK, Fischer AF, Hosalkar HS, Siebenrock KA, Tannast M. The ischial spine sign: does pelvic tilt and rotation matter? Clin Orthop Relat Res. 2010;468:769–774.PubMedCrossRef Kakaty DK, Fischer AF, Hosalkar HS, Siebenrock KA, Tannast M. The ischial spine sign: does pelvic tilt and rotation matter? Clin Orthop Relat Res. 2010;468:769–774.PubMedCrossRef
10.
Zurück zum Zitat Kalberer F, Sierra RJ, Madan SS, Ganz R, Leunig M. Ischial spine projection into the pelvis: a new sign for acetabular retroversion. Clin Orthop Relat Res. 2008;466:677–683.PubMedCrossRef Kalberer F, Sierra RJ, Madan SS, Ganz R, Leunig M. Ischial spine projection into the pelvis: a new sign for acetabular retroversion. Clin Orthop Relat Res. 2008;466:677–683.PubMedCrossRef
11.
Zurück zum Zitat Larson CM, Kelly BT, Stone RM. Making a case for anterior inferior iliac spine/subspine hip impingement: three representative case reports and proposed concept. Arthroscopy. 2011;27:1732–1737.PubMedCrossRef Larson CM, Kelly BT, Stone RM. Making a case for anterior inferior iliac spine/subspine hip impingement: three representative case reports and proposed concept. Arthroscopy. 2011;27:1732–1737.PubMedCrossRef
12.
Zurück zum Zitat Pan HL, Kawanabe K, Akiyama H, Goto K, Onishi E, Nakamura T. Operative treatment of hip impingement caused by hypertrophy of the anterior inferior iliac spine. J Bone Joint Surg Br. 2008;90:677–679.PubMedCrossRef Pan HL, Kawanabe K, Akiyama H, Goto K, Onishi E, Nakamura T. Operative treatment of hip impingement caused by hypertrophy of the anterior inferior iliac spine. J Bone Joint Surg Br. 2008;90:677–679.PubMedCrossRef
13.
Zurück zum Zitat Siebenrock KA, Kalbermatten DF, Ganz R. Effect of pelvic tilt on acetabular retroversion: a study of pelves from cadavers. Clin Orthop Relat Res. 2003;407:241–248.PubMedCrossRef Siebenrock KA, Kalbermatten DF, Ganz R. Effect of pelvic tilt on acetabular retroversion: a study of pelves from cadavers. Clin Orthop Relat Res. 2003;407:241–248.PubMedCrossRef
14.
Zurück zum Zitat Tannast M, Kubiak-Langer M, Langlotz F, Puls M, Murphy SB, Siebenrock KA. Noninvasive three-dimensional assessment of femoroacetabular impingement. J Orthop Res. 2007;25:122–131.PubMedCrossRef Tannast M, Kubiak-Langer M, Langlotz F, Puls M, Murphy SB, Siebenrock KA. Noninvasive three-dimensional assessment of femoroacetabular impingement. J Orthop Res. 2007;25:122–131.PubMedCrossRef
15.
Zurück zum Zitat Tannast M, Siebenrock KA, Anderson SE. Femoroacetabular impingement: radiographic diagnosis—what the radiologist should know. AJR Am J Roentgenol. 2007;188:1540–1552.PubMedCrossRef Tannast M, Siebenrock KA, Anderson SE. Femoroacetabular impingement: radiographic diagnosis—what the radiologist should know. AJR Am J Roentgenol. 2007;188:1540–1552.PubMedCrossRef
16.
Zurück zum Zitat Tönnis D. [Letter: Congenital hip dysplasia: clinical and radiological diagnosis (author’s transl)] [in German]. Z Orthop Ihre Grenzgeb. 1976;114:98–99.PubMed Tönnis D. [Letter: Congenital hip dysplasia: clinical and radiological diagnosis (author’s transl)] [in German]. Z Orthop Ihre Grenzgeb. 1976;114:98–99.PubMed
Metadaten
Titel
The Crossover Sign Overestimates Acetabular Retroversion
verfasst von
Ira Zaltz, MD
Bryan T. Kelly, MD
Iftach Hetsroni, MD
Asheesh Bedi, MD
Publikationsdatum
01.08.2013
Verlag
Springer US
Erschienen in
Clinical Orthopaedics and Related Research® / Ausgabe 8/2013
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-012-2689-5

Weitere Artikel der Ausgabe 8/2013

Clinical Orthopaedics and Related Research® 8/2013 Zur Ausgabe

Symposium: Advanced Hip Arthroscopy

Labral Injuries of the Hip in Rowers

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

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