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Scientific Articles   |    
Acetabular Cartilage Delamination in Femoroacetabular ImpingementRisk Factors and Magnetic Resonance Imaging Diagnosis
Lucas A. Anderson, PA-C1; Christopher L. Peters, MD1; Brandon B. Park, MD1; Gregory J. Stoddard, MPH1; Jill A. Erickson, PA-C1; Julia R. Crim, MD1
1 Department of Orthopaedic Surgery, University of Utah School of Medicine, 590 Wakara Way, Salt Lake City, UT 84108. E-mail address for C.L. Peters: chris.peters@hsc.utah.edu
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Feb 01;91(2):305-313. doi: 10.2106/JBJS.G.01198
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Abstract

Background: Delamination of acetabular articular cartilage is a common abnormality in hips with femoroacetabular impingement. The purpose of the present study was to identify clinical and radiographic factors predisposing to delamination and to assess the diagnostic accuracy of magnetic resonance arthrography for the detection of these lesions.

Methods: Following a retrospective review of records, we determined that acetabular cartilage delamination had been present in twenty-eight of sixty-four hips that had undergone a surgical dislocation procedure for the treatment of femoroacetabular impingement. Multivariable logistic regression was performed to assess the correlation of radiographic findings (i.e., magnetic resonance imaging and computerized tomography findings) with the status of delamination. The preoperative interpretations of the magnetic resonance arthrograms for twenty-seven hips that underwent surgical dislocation were reviewed to assess the accuracy of detecting delamination. At the time of surgery, nine of these twenty-seven hips were found to have delamination. Magnetic resonance arthrography interpretations that did not correlate with operative findings were subjected to conspicuity assessment and error analysis.

Results: The rate of delamination of the acetabular cartilage as noted at the time of surgical dislocation was 44% (twenty-eight of sixty-four). Delamination was strongly associated with male sex and femoral sided signs of impingement; however, it was not associated with acetabular overcoverage (center-edge angle, >40°) (odds ratio = 0.16; p < 0.05). While there was no significant difference in the prevalence of labral lesions between groups, whenever labral and delamination lesions were found in the same hip, they were directly adjacent to one another. Preoperative magnetic resonance arthrography had a low sensitivity for delamination (22%) but had a high specificity (100%). Two-thirds of the delamination lesions were visible on retrospective review of these images when the reader was unblinded to the surgical findings. Delamination could most often be identified on the sagittal T1-weighted image and on the proton-density sequences with fat saturation.

Discussion: There should be a high level of suspicion for articular cartilage delamination in men and in patients with primarily cam-type femoroacetabular impingement. Acetabular overcoverage may be protective against delamination. Preoperative high-quality magnetic resonance arthrograms should be carefully analyzed for evidence of delamination in this patient population.

Level of Evidence: Diagnostic Level III. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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