Hip Imaging in Athletes - Part 2

Overview

• Continuation from Part 1 (link provided in the lecture).
• Focus on various deformities and conditions affecting the hip in athletes.

Cam Deformity Secondary to Slipped Capital Femoral Epiphysis

• Description: Epiphysis tilted medially and downward, flattening of femoral head-neck junction.
• Relevance: Understanding etiology is nice to know but not crucial for adult treatment.
• Treatment: Surgery.

Ischiofemoral Impingement

• Type: Extra-articular hip impingement.
• Observation: Edema in the quadratus femoris muscle due to chronic contact between femoral and ischial bones.
• Measurement:
  • Sensitivity at 77% if space is less than 15mm.
  • Usually not necessary to measure; rely on edema or fatty atrophy appearance.
  • Variability due to leg position.

Subspine Impingement

• Description: Prominent anterior inferior iliac spine impinges on femoral head-neck junction during hip flexion.
• Treatment: Resecting the anterior inferior iliac spine.

Labral Tears

• Common Location: Anterior superior position of the hip.
• **Characteristics: **
  • Tears often near supraglenoid recesses.
  • Labrum shows signal intensity changes.
• Possible Cause: Chronic friction from iliopsoas tendon.

Imaging Insights

• Cam Deformity: Abnormal head-neck junction, labral tear, and chondral defects.
• Cartilage Defects: Look specifically near fovea; traction MRI or arthrography aids detection.

Example Case Study

• **Initial Observation: ** Supra acetabular fossa filled with contrast.
• Follow-Up (8 months later): Fossa filled with cartilage; distinction between fluid-filled (type 1) and cartilage-filled (type 2) fossa.
• Conclusion: Continuum from type 1 to type 2; not to be mistaken as osteo contribution.

Next Steps

• Part 3 of the series coming next week.