Radiographic and MR Imaging of the Athletic

Derek R. Armfield, MDa'b'*, Jeffrey D. Towers, MDab, Douglas D. Robertson, MD, PhDa'b'c

"Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA

b'Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA

cDepartment of Bioengineering, School of Engineering, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA

Magnetic resonance imaging (MRI) and radiography are the imaging essentials needed to evaluate intra-articular pathology and extra-articular sources of hip pain. Over the past decade MR imaging has highlighted the detection of labral tears as a source of hip pain, but it is also critical for detecting cartilage defects, capsular/iliofemoral ligament injury, liga-mentum teres tears, and bony findings associated with femoroacetabular impingement (FAI). Despite the central role of MR arthrography for evaluating intra-articular abnormalities, radiography remains essential for the radiologic work up of the athlete with hip pain. A normal hip radiograph has been redefined over the past several years, as relatively normal appearing radiographs may have evidence of subtle acetabular dysplasia (ie, retroversion) or a femoral neck bump that may provide a clue to the presence of intra-articular labral or cartilage injury. One recent study showed that 87% of patients that underwent surgery for labral tears had a structural hip abnormality identified on conventional radiographs [1]. In addition, periacetabular ossicles and synovial hernia-tion pits were once considered normal variants, but we now view them as markers for underlying FAI or labral pathology. A generalized MR of the entire pelvis may be useful for the evaluation of surrounding muscle, tendon, and bone marrow abnormalities; but it is insufficient for evaluating internal derangements of the hips. This article first describes the general approach for the radiologic work up for the athletic hip, followed by MR appearances of labral and nonlabral abnormalities.

* Corresponding author. Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213. E-mail address: [email protected] (D.R. Armfield).

0278-5919/06/$ - see front matter © 2006 Elsevier Inc. All rights reserved.

doi:10.1016/j.csm.2005.12.009 sportsmed.theclinics.com

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