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Fibrocystic Changes at Anterosuperior Femoral Neck: Prevalence in Hips with Femoroacetabular Impingement¹

¹ From the Department of Orthopedic Surgery, University of Berne, Inselspital, CH-3010 Berne, Switzerland (M.L., M.B., M.K., Y.J.K., R.G.); and Department of Radiology, Clinic Sonnenhof, Berne, Switzerland (S.W.). Received January 25, 2004; revision requested April 2; final revision received August 30; accepted September 29. M.K. supported by a grant from the University of Teheran. Y.J.K. supported by a fellowship from AO-International. Address correspondence to M.L. (e-mail: michael.leunig{at}balgrist.ch).

View larger version (120K): [in a new window]   Figure 1a. AP pelvic radiographs obtained in three patients show juxtaarticular fibrocystic changes at anterosuperior femoral neck without other major signs of OA. All patients were symptomatic, with groin pain and positive impingement test results. (a) Radiograph obtained in 32-year-old woman with hypermobility shows small (4-mm), scarcely visible fibrocystic changes (arrows) and an acetabular abnormality consisting of a deep socket (coxa profunda), with the acetabular fossa medial to the ilioischial line (dotted line). (b) Radiograph obtained in 26-year-old physically active man shows more inferior, medium-sized (7-mm) fibrocystic changes (arrows) and signs of acetabular and femoral abnormalities combined with a cranial acetabular retroversion (highlighted by lateral projection of the anterior acetabular rim [dotted line] relative to the posterior acetabular rim) and an aspherical femoral head (dashed line). (c) Radiograph obtained in 32-year-old man, a carpenter, with substantial femoral head asphericity (dashed line) shows large (15-mm) anterosuperior femoral neck fibrocystic changes (arrows).

View larger version (120K): [in a new window]   Figure 1b. AP pelvic radiographs obtained in three patients show juxtaarticular fibrocystic changes at anterosuperior femoral neck without other major signs of OA. All patients were symptomatic, with groin pain and positive impingement test results. (a) Radiograph obtained in 32-year-old woman with hypermobility shows small (4-mm), scarcely visible fibrocystic changes (arrows) and an acetabular abnormality consisting of a deep socket (coxa profunda), with the acetabular fossa medial to the ilioischial line (dotted line). (b) Radiograph obtained in 26-year-old physically active man shows more inferior, medium-sized (7-mm) fibrocystic changes (arrows) and signs of acetabular and femoral abnormalities combined with a cranial acetabular retroversion (highlighted by lateral projection of the anterior acetabular rim [dotted line] relative to the posterior acetabular rim) and an aspherical femoral head (dashed line). (c) Radiograph obtained in 32-year-old man, a carpenter, with substantial femoral head asphericity (dashed line) shows large (15-mm) anterosuperior femoral neck fibrocystic changes (arrows).

View larger version (127K): [in a new window]   Figure 1c. AP pelvic radiographs obtained in three patients show juxtaarticular fibrocystic changes at anterosuperior femoral neck without other major signs of OA. All patients were symptomatic, with groin pain and positive impingement test results. (a) Radiograph obtained in 32-year-old woman with hypermobility shows small (4-mm), scarcely visible fibrocystic changes (arrows) and an acetabular abnormality consisting of a deep socket (coxa profunda), with the acetabular fossa medial to the ilioischial line (dotted line). (b) Radiograph obtained in 26-year-old physically active man shows more inferior, medium-sized (7-mm) fibrocystic changes (arrows) and signs of acetabular and femoral abnormalities combined with a cranial acetabular retroversion (highlighted by lateral projection of the anterior acetabular rim [dotted line] relative to the posterior acetabular rim) and an aspherical femoral head (dashed line). (c) Radiograph obtained in 32-year-old man, a carpenter, with substantial femoral head asphericity (dashed line) shows large (15-mm) anterosuperior femoral neck fibrocystic changes (arrows).

View larger version (95K): [in a new window]   Figure 2a. (a) Contrast material–enhanced coronal oblique intermediate-weighted radial (left, 2000/15) and sagittal 3D two-echo steady-state (right, 26.8/9.0) MR arthrograms obtained in 32-year-old woman described in Fig 1. (b) Contrast-enhanced coronal oblique intermediate-weighted radial (left, 2000/15) and coronally reformatted 3D two-echo steady-state (right, 26.8/9.0) MR arthrograms obtained in 26-year-old man described in Fig 1. (c) Contrast-enhanced coronal oblique intermediate-weighted radial (left, 2000/15) and sagittal 3D two-echo steady-state (right, 26.8/9.0) MR arthrograms obtained in 32-year-old man described in Fig 1. All three intermediate-weighted images (a–c, left) show labral alterations (arrow). The 3D two-echo steady-state images (a–c, right) of fibrocystic changes (arrow) show high fluid content in two cases (a and b); however, in one case (c), the fibrocyst is filled with a dense fibrous tissue (arrow).

View larger version (87K): [in a new window]   Figure 2b. (a) Contrast material–enhanced coronal oblique intermediate-weighted radial (left, 2000/15) and sagittal 3D two-echo steady-state (right, 26.8/9.0) MR arthrograms obtained in 32-year-old woman described in Fig 1. (b) Contrast-enhanced coronal oblique intermediate-weighted radial (left, 2000/15) and coronally reformatted 3D two-echo steady-state (right, 26.8/9.0) MR arthrograms obtained in 26-year-old man described in Fig 1. (c) Contrast-enhanced coronal oblique intermediate-weighted radial (left, 2000/15) and sagittal 3D two-echo steady-state (right, 26.8/9.0) MR arthrograms obtained in 32-year-old man described in Fig 1. All three intermediate-weighted images (a–c, left) show labral alterations (arrow). The 3D two-echo steady-state images (a–c, right) of fibrocystic changes (arrow) show high fluid content in two cases (a and b); however, in one case (c), the fibrocyst is filled with a dense fibrous tissue (arrow).

View larger version (89K): [in a new window]   Figure 2c. (a) Contrast material–enhanced coronal oblique intermediate-weighted radial (left, 2000/15) and sagittal 3D two-echo steady-state (right, 26.8/9.0) MR arthrograms obtained in 32-year-old woman described in Fig 1. (b) Contrast-enhanced coronal oblique intermediate-weighted radial (left, 2000/15) and coronally reformatted 3D two-echo steady-state (right, 26.8/9.0) MR arthrograms obtained in 26-year-old man described in Fig 1. (c) Contrast-enhanced coronal oblique intermediate-weighted radial (left, 2000/15) and sagittal 3D two-echo steady-state (right, 26.8/9.0) MR arthrograms obtained in 32-year-old man described in Fig 1. All three intermediate-weighted images (a–c, left) show labral alterations (arrow). The 3D two-echo steady-state images (a–c, right) of fibrocystic changes (arrow) show high fluid content in two cases (a and b); however, in one case (c), the fibrocyst is filled with a dense fibrous tissue (arrow).

View larger version (17K): [in a new window]   Figure 3. Histogram illustrating frequency (bars) and normal (line) distributions of fibrocyst diameters measured on MR arthrograms shows a higher frequency of smaller cyst diameters. The mean fibrocyst diameter is 5 mm. According to findings at 3D two-echo steady-state MR arthrography, the fibrocystic changes had high water content (white bars) more frequently than they consisted of dense fibrous material (gray bars).

View larger version (181K): [in a new window]   Figure 4a. (a–c) Intraoperative photographs of two small fibrocysts (arrows in a), one medium-size fibrocyst (arrows in b), and one large fibrocyst (arrows in c). All fibrocysts are located at the femoral neck and distal to the physis. The fibrocysts became visible during osteochondroplasty to optimize the femoral head-neck offset.

View larger version (169K): [in a new window]   Figure 4b. (a–c) Intraoperative photographs of two small fibrocysts (arrows in a), one medium-size fibrocyst (arrows in b), and one large fibrocyst (arrows in c). All fibrocysts are located at the femoral neck and distal to the physis. The fibrocysts became visible during osteochondroplasty to optimize the femoral head-neck offset.

View larger version (171K): [in a new window]   Figure 4c. (a–c) Intraoperative photographs of two small fibrocysts (arrows in a), one medium-size fibrocyst (arrows in b), and one large fibrocyst (arrows in c). All fibrocysts are located at the femoral neck and distal to the physis. The fibrocysts became visible during osteochondroplasty to optimize the femoral head-neck offset.

View larger version (181K): [in a new window]   Figure 5a. (a, b) Sagittal intermediate-weighted dynamic MR images (3000/24) show a hip in extension (a) and flexion (b). In a, the fibrocystic alteration (bottom arrow) at the head-neck junction is some distance from the acetabular rim, where a labral tear (top arrow) is seen. In b, at 90° of flexion, the femoral neck, with an underlying fibrocystic alteration (arrow), abuts the acetabular rim.

View larger version (171K): [in a new window]   Figure 5b. (a, b) Sagittal intermediate-weighted dynamic MR images (3000/24) show a hip in extension (a) and flexion (b). In a, the fibrocystic alteration (bottom arrow) at the head-neck junction is some distance from the acetabular rim, where a labral tear (top arrow) is seen. In b, at 90° of flexion, the femoral neck, with an underlying fibrocystic alteration (arrow), abuts the acetabular rim.

View larger version (172K): [in a new window]   Figure 6a. (a, b) Intraoperative photographs of an aspherical femoral head (arrow in a) that leads to acetabular rim damage (b) only mildly involving the labrum (arrows in b) but causing a cleavage between the adjacent cartilage (clamp) and the subchondral bone.

View larger version (156K): [in a new window]   Figure 6b. (a, b) Intraoperative photographs of an aspherical femoral head (arrow in a) that leads to acetabular rim damage (b) only mildly involving the labrum (arrows in b) but causing a cleavage between the adjacent cartilage (clamp) and the subchondral bone.

View larger version (129K): [in a new window]   Figure 7a. Intraoperative photographs of a hip from a posterolateral approach. After capsulotomy, the femoral head in the acetabulum becomes visible, with prominent anterolateral extension (arrows) of the femoral head-neck junction. (a) The hip joint at full extension. (b–d) During flexion from 30° (b) to 60° (c), the nonspherical portion of the femur approaches the joint until it enters it at 90° (d).

View larger version (128K): [in a new window]   Figure 7b. Intraoperative photographs of a hip from a posterolateral approach. After capsulotomy, the femoral head in the acetabulum becomes visible, with prominent anterolateral extension (arrows) of the femoral head-neck junction. (a) The hip joint at full extension. (b–d) During flexion from 30° (b) to 60° (c), the nonspherical portion of the femur approaches the joint until it enters it at 90° (d).

View larger version (126K): [in a new window]   Figure 7c. Intraoperative photographs of a hip from a posterolateral approach. After capsulotomy, the femoral head in the acetabulum becomes visible, with prominent anterolateral extension (arrows) of the femoral head-neck junction. (a) The hip joint at full extension. (b–d) During flexion from 30° (b) to 60° (c), the nonspherical portion of the femur approaches the joint until it enters it at 90° (d).

View larger version (121K): [in a new window]   Figure 7d. Intraoperative photographs of a hip from a posterolateral approach. After capsulotomy, the femoral head in the acetabulum becomes visible, with prominent anterolateral extension (arrows) of the femoral head-neck junction. (a) The hip joint at full extension. (b–d) During flexion from 30° (b) to 60° (c), the nonspherical portion of the femur approaches the joint until it enters it at 90° (d).

View larger version (25K): [in a new window]   Figure 8a. (a, b) Graphs illustrate the spatial relation of acetabular rim disorders affecting the labrum (a) and/or the cartilage (b), as determined intraoperatively. Labral and cartilage lesions were located at anterosuperior sites that were almost identical to the sites where impingement with the femoral neck occurred.

View larger version (26K): [in a new window]   Figure 8b. (a, b) Graphs illustrate the spatial relation of acetabular rim disorders affecting the labrum (a) and/or the cartilage (b), as determined intraoperatively. Labral and cartilage lesions were located at anterosuperior sites that were almost identical to the sites where impingement with the femoral neck occurred.