Radiographic and MR Imaging of the Athletic Hip

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Radiography

Plain film radiography remains the primary screening tool because it is widely available, simple, and relatively inexpensive; but it must be done properly. In the past, a typical screening radiographic series for hip pain often included a nonweight-bearing anteroposterior (AP) and frogleg lateral view of the affected hip with or without a supine AP view of the pelvis. The goal of the screening test was to detect obvious sources of pathology such as advanced arthrosis, tumor, fracture, and

Radiographic evaluation and measurements of the hip

To identify more recently described findings of FAI, our radiographic hip protocol deviates from common past screening hip radiographs. The AP weight-bearing view of the pelvis and AP view of the hip provides multiple measurements to assess acetabular coverage and orientation [1], [20], [21]. Radiographic measurements should be performed after a thorough assessment for subtle fractures or tumors, soft tissue, and intrapelvic anomalies, as well as sacroiliac, pubic symphyseal, and lower lumbar

Labrum

Acetabular labral tears have become a commonly recognized source of intra-articular hip pain that affects athletes and nonathletes alike. Although strongly associated with athletes performing twisting pelvic motions and rotations of the hip that occur in sports like soccer, golf, football, ballet, and hockey; athletes in all major sports (and even minor ones such as skateboarding and Olympic yachting) have been affected [38]. Many tour-level professional golfers have undergone successful hip

Postoperative evaluation of the hip

Initial radiographs should assess for overall anatomic alignment, bony contours, and mineralization with comparison to preoperative studies. Postoperative changes involving arthroscopic osteochondroplasty, open resection osteoplasty, or acetabular realignment should assess for any residual FAI. Plain films may detect postoperative myositis ossificans, which can be a rare postoperative complication. However, when clinically indicated, symptomatic postoperative evaluation primarily involves

Future directions

Future evaluation of intra-articular hip pathology will be largely influence by stronger MR magnetic fields (3T and greater), improved coil technology, and expanding knowledge base. The ultimate goal will be to create an easily reproducible noninvasive test with conspicuity of abnormal findings. We are currently evaluating the role of stress positioning and kinematic imaging to assess for biomechanical soft tissue dysfunction of the capsule, labrum, and ligamentum teres. We are evaluating

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