Acetabular overcoverage mri

Pincer morphology refers to an abnormality of the acetabulum or rather an acetabular overcoverage of the femoral head, which may be focal or global, and is one of the causes of femoroacetabular impingement. Pincer morphology as an isolated finding does is not a very frequent cause of impingement and if symptomatic, it is usually found with coexisting cam morphology 3. It is most often found in middle-aged women.

Pincer morphology can be asymptomatic or if coupled with femoroacetabular impingement present with symptoms, for example, movement-related hip pain or groin pain and is then referred to as femoroacetabular impingement Patients can also complain of decreased and painful range of motion. Thus the anterior or anterosuperior acetabular rim usually builds up contact to the femoral neck, with possible associated symptoms and further development of a chondral contrecoup lesion typically found posteroinferiorly 3.

AP view of the pelvis and a lateral femoral neck view is recommended for the initial evaluation 1. Cross-sectional imaging is recommended for the detection of chondral and labral lesions and preoperative planning 1,3.

The following morphological abnormalities can be assessed in addition 3D reconstructions enable surgical planning e. Symptomatic femoroacetabular-impingement with pincer morphology can be treated conservatively or surgically.

Surgical treatment includes acetabular rim reconstruction or resection of the acetabular ossicle 5. Global acetabular over coverage, if symptomatic, should be approached more cautiously with arthroscopy and might be better treated with osteotomy 7. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys.

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MR arthrography was performed bilaterally. What are the findings? What is your diagnosis? Laterally prominent femoral head margins yellow arrowheads create femoral head asphericity bilaterally. The superior portions of the acetabular labra are partially detached bilaterally blue arrows. A convex bump yellow arrowheads is present at the anterior femoral head-neck junction.

An area of chondral loss red arrows is present on the acetabular side of the joint. Subtle subchondral degenerative changes red arrowhead are located on the corresponding femoral side of the joint. The anterosuperior portion of the right acetabular labrum exhibits a complete tear blue arrowheadwith a tiny associated paralabral cyst green arrowhead.

The opposite hip exhibits localized high grade chondral loss red arrows in the upper anterior portion of the acetabulum.

Femoroacetabular impingement FAI is not a disease, but a common pathomechanical process which occurs when the proximal femur comes into contact with the acetabular rim. This can occur in normal hips in extreme flexion and internal rotation or may be from morphologic changes that cause premature contact between the structures.

Chronic microtrauma from recurrent impingement can lead to acetabular labral tears and breakdown of the articular cartilage, subsequently resulting in osteoarthritis. FAI from radiographically subtle morphologic abnormalities has been suggested to be the underlying cause of most cases of idiopathic or primary osteoarthritis 9. Timely diagnosis is therefore important. Surgical intervention can give immediate pain relief and, if it is performed before cartilage breakdown has begun, it may prevent later cartilage loss and development of osteoarthritis.

FAI can occur from abnormal morphology on either the femoral or acetabular side of the joint. In order for the hip to flex normally without impingement, the femoral head needs to be round and there must be a suitable space at the femoral head-neck junction aka the femoral waist. If instead the femoral head is aspherical or there is not a suitable femoral head-neck offset, then this area of the proximal femur will abnormally pressurize the cartilage at the acetabular rim during hip flexion, causing chondral and subsequent labral damage.

acetabular overcoverage mri

Cam-type FAI. The normal hip above has enough space at the femoral waist to accommodate the acetabular rim throughout the normal range of motion. The hip below has localized osseous protuberance asterisk and an aspherical humeral head blue arrow that impinge on the superolateral portion of the acetabulum during flexion and internal rotation, injuring the hyaline cartilage and adjacent labrum, resulting in labral detachment red arrow.

In a hip with a cam lesion, rotation of the femoral head brings a broader radius into the acetabular margin, typically anterosuperiorly, compressing the hyaline cartilage at this site and pushing it medially. With labral injury and further progression of chondral damage, the hip may then later develop instability and femoral head cartilage damage.

We have long known that patients with a history of slipped capital femoral epiphysis or Perthes disease that have developed a pistol grip deformity are prone to developing secondary osteoarthritis, but it was not until more recently that FAI has been recognized as the underlying mechanism.

Most commonly, an aspherical femoral head or a bump at the femoral head-neck junction creates cam-type FAI. There are several underlying possible causes Table 1. An overly prominent acetabular rim is reflected by the presence of acetabular overcoverage of the femoral head. Pincer-type impingement. With a pincer lesion, the acetabular rim is prominent blue arrow often with os acetabuli asterisk and focally impacts the femur during flexion and internal rotation, resulting in labral degeneration and tearing.

Cartilage damage occurs after the labral injury, initially limited to a thin strip anterosuperiorly, later involving larger areas posteroinferiorly red arrow as a "contrecoup lesion. There are several possible underlying causes of pincer lesions, developmental and acquired, and the abnormality may be local e. Labral ossification and osseous proliferation are most frequently seen, which are likely chronic changes secondary to prior labral injury.

As with cam-type FAI, the initial injury site is typically anterosuperior in position from hip flexion and internal rotation. However, with pincer-type impingement, the initial injury is to the labrum, which develops myxoid degeneration and tearing.

To a lesser degree there may be damage to a thin adjacent strip of acetabular cartilage. Later in this process, when dystrophic ossification has developed in the injured labrum, the prominent acetabular rim acts as fulcrum, leveraging the femoral head posteroinferiorly and causing more significant chondral injury at that site. Most cases of FAI are a combination of both cam and pincer-type mechanisms, with cam-type usually predominating. It is possible that the femoral head-neck junction bump found in cam-type impingement may be initiated by microtrauma from pincer-type impingement at this site.FAI can lead to early degenerative disease.

Femoroacetabular impingement is common in active young and middle-aged adult individuals, with pincer morphology being more common in middle-aged women and cam morphology more common in young men 1,2. Sometimes the pain is also described in the buttock, back or thigh and in addition, there may be symptoms of stiffness, clicking, locking, catching 2. A common clinical test for femoroacetabular impingement is the FADIR test, which is sensitive but not specific 2.

Femoroacetabular impingement is an intra-articular or internal form of impingement, where structural changes combined with dynamic factors as repetitive abnormal contact of the acetabulum and the femoral head-neck junction lead to mechanical stress and shear forces on the labrum and chondral surfaces and subsequent damage The etiology of cam and pincer morphology comprises primary idiopathic and secondary developmental, traumatic and iatrogenic causes 3.

Two basic structural factors or subtypes of the femoroacetabular morphology have been identified, which can lead to femoroacetabular impingement either alone or in combination:.

The morphological change in cam morphology is situated at the femoral head-neck junction, most often in the anterosuperior position lateral to the physeal scar with decreased femoral head-neck offset 1,3. Acetabular over-coverage in pincer morphology can be global or focal and concerns the acetabular rim, focal acetabular overcoverage can be anywhere but most often is also located anterosuperior due to acetabular retroversion, posterior wall prominence and os acetabuli being other forms of focal overcoverage 1.

Chondral contrecoup lesions in case of pincer morphology are often found posteroinferiorly 1. For initial evaluation of the acetabulum plain radiographs of the pelvis are recommended and an additional view of the femoral neck such as Dunn viewscross-table lateral, frog-leg lateral or Meyer lateral for the assessment of the femoral head-neck junction 2.

[Pincer FAI_01] Femoroacetabular impingement, coxa profunda, acetabular protrusio

It is important that it is acquired with neutral tilt, centered on the pubic symphysis since some of those signs will be falsely positive or negative depending with increasing tilt and rotation 1, :. In addition, 3D reconstructions enable surgical planning e. Typical findings on CT are an osseous bump in the anterosuperior position of the femoral head-neck junction with cysts and herniation pit as indirect signs for cam morphology.

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Increased acetabular depth, acetabular ossicle and acetabular retroversion indicate pincer morphology 4, A 3D sequence of the hip in question can be considered, for easy and fast radial double oblique reformations along the femoral neck and proper evaluation of the acetabulum. Direct MR arthrography can improve the detection of chondral injuries as carpet lesions and can add sensitivity for the detection of labral injury e.

Both 3D gradient-echo and spin-echo sequences have been described with good diagnostic accuracy It seems as if CT-arthrography is most accurate in detecting labral tears Untreated femoroacetabular impingement can lead to damage to the labrum and acetabular cartilage, manifesting as hip and groin pain if left untreated and will later progress to early osteoarthritis of the hip. Surgical options aim at restoring hip morphology and repair or reconstruction of chondral and labral damage with arthroscopic and open surgical approaches, the latter including femoral or acetabular osteotomy or osteochondroplasty ,18, The indication for surgery warrants not only morphological changes but also typical clinical signs and symptoms indicative of femoroacetabular impingement 2.

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Log In. Sign Up. Become a Gold Supporter and see no ads. Log in Sign up. Articles Cases Courses Quiz. About Blog Go ad-free. On this page:. The etiology of osteoarthritis of the hip: an integrated mechanical concept.

Promoted articles advertising. Edit article Share article View revision history Report problem with Article. URL of Article.Current assessment techniques for focal acetabular overcoverage are neither consistent nor quantitatively accurate. We developed a method to assess focal acetabular overcoverage using points selected from CT scans along the acetabular rim after realigning the pelvis into a neutral position.

Our algorithm assessed the amount of focal acetabular overcoverage using CT data and projected data from reconstructed radiographs. The proposed method represents a new avenue in consistently quantifying focal acetabular overcoverage using CT models while correcting for pelvic tilt and rotation.

Our analysis confirms AP hip radiograph simulations overestimate the amount of overhanging acetabular rim in a pincer deformity. This technique has potential to improve preoperative diagnostic accuracy and enhance surgical planning for correction of a pincer deformity resulting from focal acetabular overcoverage.

A subtype of FAI, pincer impingement, is an acetabular abnormality in which there is abnormal contact of the femoral head-neck junction with the acetabular rim. This work focuses on assessing focal acetabular overcoverage, which causes anterior FAI.

Dandachli et al. However, for patients with deficient posterior coverage, an acetabular reorientation procedure can help to correct both abnormalities [ 18 ]. The amount of bone requiring resection of an overhanging acetabular rim is difficult to quantify on radiographic projections.

Inadequate resection will allow impingement to persist, whereas excessive resection can lead to biomechanical instability and even subluxation of the hip.

Orthopaedic surgeons currently rely on their experience and subjective observations made from radiographs, clinical evaluation, and MRI to preoperatively estimate the amount of bone to resect.

Siebenrock et al. However, such measurements on plain radiographs are subject to projectional distortions and positioning variability. As a result of the difficulties in defining pelvic tilt and acetabular overcoverage, little is known about the natural history or overdiagnosis of pincer impingement. Consistent quantitative representation of overcoverage is missing, affecting treatment and patient comparison.

The objectives of this study are to 1 introduce an approach that uses 3-D CT data to accurately assess the amount of focal acetabular overcoverage in a pincer deformity by quantifying the length and width of the overhanging region; 2 preliminarily evaluate the interobserver consistency of the approach; and 3 compare the method with conventional radiographic assessments.

From the scans, we segmented the acetabular lunate to define the anterior and posterior rims of the acetabular wall.

acetabular overcoverage mri

We used the segmented acetabular wall and digitally reconstructed radiographs DRRs of the CT scans to place the pelvis in a neutral position and identify the amount of focal acetabular overcoverage. To define the acetabulum lunate, we used the method of Armiger et al.

The lateral and medial edges of the acetabular rim were selected sequentially on each oblique slice; these points then were connected using a third-order polynomial spline to define a continuous outline of the acetabulum lunate. Interpolation over fixed intervals of the radius of curvature of the hip between the medial and lateral rims generated a triangular mesh representation of the acetabulum Fig. The midacetabular axis is the cyan line connecting the superolateral point to the midpoint of the most inferior points on the anterior and posterior rims.

The acetabular lunate is outlined in blue. The red crosses indicate the position of the superolateral point, crossover point, and the point of greatest width. The simulated projections are centered through the center of the femoral head and have been translated and magnified for improved observation.

We defined the inclination of the pelvis according to the method of Tannast et al. This is a simple computation because we used the volumetric model of the pelvis to simulate radiographs from the lateral view, thereby observing the symphysis and promontory.

The position of the pelvis also was corrected for rotation by minimizing the distances of the sacrococcygeal joint and pubic symphysis to the midsagittal plane. The DRR paradigm uses line integrals of the intensity values through the volumetric data to construct an xray projection. This can be achieved through ray casting eg, [ 6 ]projecting tetrahedra eg, [ 13 ]or several other means.

We used the method developed by Sadowsky et al. In this method, tetrahedra from the segmented pelvis volume acquired from CT data were projected onto the image plane, divided into fragments, and interpolated.

Line integrals of the fragments are computed and summed, generating a geometrically correct perspective xray projection view. Given the acetabulum lunate points as segmented from the CT data, the most superolateral point at the edge of the weightbearing zone was determined. Combining this point with the midpoint of the most inferior points on the anterior and posterior acetabular rims creates a line we termed the midacetabular axis the cyan line in Fig. Extending the midacetabular axis anteriorly and posteriorly creates a plane the midacetabular plane.

We defined crossover to occur when the anterior rim crossed the midacetabular plane. This does not exactly correspond with the previous definition of crossover, the point where the anterior wall crosses the posterior wall in a 2-D AP view, but this method was used to facilitate computational analysis and define crossover in 3-D from the CT scans.Acetabular dysplasia is referred to as a shallow acetabulumnot being able to provide sufficient coverage for the femoral head and thus leading to instability of the hip joint.

Acetabular dysplasia is a form of developmental dysplasia of the hip DDH often referred to in the adolescent and adult population 5. Adult hip dysplasia has an estimated prevalence of 0.

Male sex is apparently associated with posterosuperior deficiency 2. Patients usually present with hip pain or groin pain especially with extreme positions e. In addition, there may be limping or signs and symptoms of hip instability ref. Acetabular dysplasia is characterized by a smaller weight-bearing surface than the normal acetabulum, which ultimately leads to increased contact stress and static overload due to under-coverage of the femoral head and to structural instability.

Acetabular dysplasia might be the result of abnormal growth after treatment or missed developmental dysplasia of the hip during childhood, the etiology of which is multi-factorial in nature.

It may be also due to other hip pathologies that have occurred during childhood as septic arthritistrauma or Legg-Calve-Perthes disease ref. Acetabular dysplasia can be divided into different patterns with respect to the 3-D morphology. One grading scheme subdivides the acetabular dysplasia into the following patterns with lateral acetabular deficiency being constantly present 2 :.

The most common measurement in acetabular dysplasia is the lateral center-edge angle on a plain anterior-posterior radiograph of the pelvis 1,3. Further measurements to confirm insufficient acetabular coverage are the following 1,3,4 :. The main role of CT is improved characterization of the three-dimensional acetabular morphology in a setting of preoperative planning. It should also comprise the assessment for excessive acetabular anteversion or acetabular retroversion.

Other than the crossover sign on the anterior-posterior view of the pelvisCT can also differentiate posterior under-coverage in the setting of acetabular dysplasia from anterior overcoverage in the setting of pincer morphology or plain acetabular retroversion and it can better assess the grade of posterior deficiency than the posterior wall sign 2.

CT measurements for the assessment of acetabular dysplasia include the following and are conducted one cut above the greater trochanters 1 :. In addition to the three-dimensional assessment of the acetabular and femoral morphology, which highly benefits from 3D imaging in this situation, MRI allows for assessment of concomitant labral, chondral or ligamentum teres injury as well as the evaluation of the joint capsule 1.

Treatment options of acetabular dysplasia include in particular periacetabular osteotomy 1,6 and other acetabular osteotomies e.

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Salter which reorient the acetabulum in a fashion that it provides better coverage for the femoral head. Other surgical options are acetabuloplasties, that alter the morphology of the acetabulum e. Pemberton 6,8. Periacetabular osteotomy is in particular indicated in patients with a preserved range of motion. Salvage osteotomies e. Chiari or shelf osteotomy do not preserve articular cartilage and can be considered if the hip needs to be stabilized in incongruous joints 8.

In case of a severely arthritic hip, joint replacement surgery might be considered and include total hip replacement and resurfacing arthroplasty 1. The role of conservative management is limited due to the early progression to osteoarthritis and should decrease pain and can be chosen in very mild dysplasia with mild symptoms. Non-operative treatment includes weight loss, activity and lifestyle modifications as well as nonsteroidal anti-inflammatory drugsspecialized physical therapy intra-articular injections ref.

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Log in Sign up.This means you cannot even bet on who will win awards such as the Most Valuable Player, Rookie of the Year, Cy Young and the like. Even so, "wacky" proposition bets can sometimes be found in Las Vegas sports books. They are often linked to the Super Bowl or another major sporting event. For instance, in Super Bowl XXXV gamblers could bet on whether the Ravens would score more touchdowns than the Chicago Blackhawks scored goals on Super Bowl Sunday -- and that was just one of countless "wacky" propositions.

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Example:Pitcher listed is starting pitcher Bet Num. On Today's Line we use a different format, the idea is the same. You will not find the odds for the Underdog. The Underdog's odds are based on what the casino has for its line. Most use a "Dime Line" or something close to that. You have just seen an example of a dime line.

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Basketball Teasers: A wager that improves the point spread, but at reduced odds. The following are approximate odds: Number of teams4 points4. A draw on a straight bet will refund your bet. A straight bet is the most common type of football bet. TeamLine101Jets 102Dolphins-6 Note: The bottom team is always listed as the home team unless otherwise noted.As you probably know, Anna was a mainstay of CASP from almost the beginning, first a predictor, then an assessor and then as an organizer.

Her contribution was massive. She had extraordinary scientific insight, and an amazing ability to turn that insight into effective action both in her own research and in CASP. She ran a series of CASP conferences in Italy, she organized and hosted CASP planning meetings, she acted as chief editor of many CASP special issues of Proteins, she provided her own grant funds for many of these activities.

She was always able to make wise and practical judgements on how to deal with problems and how to push CASP forward.

These formal acknowledgements fail to begin to convey what an extraordinary, marvelous, person she was, and what a privilege it was to know her and to work with her. She had an immensely strong personality that shone from her at all times - a world beating generosity of spirit that lit up a room.

She was always someone to turn to in times of stress, knowing one would receive frank, honest, and wise counsel and help. We do not know what we will do without her. John, Krzysztof, Andriy, and Torsten.

acetabular overcoverage mri

Post CASP12 at the Formia train station. On the train to Rome, with Michael Levitt and Torsten Schwede. Our goal is to help advance the methods of identifying protein structure from sequence. The Center has been organized to provide the means of objective testing of these methods via the process of blind prediction. The Critical Assessment of protein Structure Prediction (CASP) experiments aim at establishing the current state of the art in protein structure prediction, identifying what progress has been made, and highlighting where future effort may be most productively focused.

There have been eleven previous CASP experiments. The twelfth experiment is planned to start in May 2016. Welcome to the Protein Structure Prediction Center. In November 2011 we have opened a new rolling CASP experiment for all-year-round testing of ab initio modeling methods: CASP ROLL Details of the experiments have been published in a scientific journal Proteins: Structure, Function and Bioinformatics.

CASP proceedings include papers describing the structure and conduct of the experiments, the numerical evaluation measures, reports from the assessment teams highlighting state of the art in different prediction categories, methods from some of the most successful prediction teams, and progress in various aspects of the modeling.

Summary of numerical evaluation of the methods tested in the latest CASP experiment can be found on this web page. The latter paper also contains explanations of data handling procedures and guidelines for navigating the data presented on this website.

Some of the best performing methods are implemented as fully automated servers and therefore can be used by public for protein structure modeling. Conference in memory of Anna Tramontano, University of Rome, July 14, 2017Dear CASP Community: We are writing to share the announcement of the upcoming Conference dedicated to the memory of Anna Tramontano. The Conference will be hosted by the University of Rome on July 14.

Anna Tramontano Dear members of the CASP community, We write with the very very sad news that Anna Tramontano died last night. As you probably know, Anna was a mainstay of CASP from almost the beginning, first. The arrival of Donald Trump in the White House and elections in France and Germany will highlight the increasing power of new communication channels as traditional media continues to lose both influence and money.

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