Carina crossover sign

Background: Radiographic findings related to the cam and pincer variants of femoroacetabular impingement (FAI) include measurements of the alpha angle and lateral center-edge angle (LCEA). The function of these radiographic findings has been put into question because of high heterogeneity in reported studies. Purpose: The aim of this study was 3-fold: (1) to determine the prevalence of cam and pincer variants according to sex and age on anteroposterior (AP) pelvic radiographs from an asymptomatic nonathletic population, (2) to identify the most common radiographic signs of cam- and pincer-type variants, and (3) to determine if there are variations in the prevalence of these radiographic signs according to sex and age. Study Design: Cross-sectional study; Level of evidence, 3. Methods: There were 3 independent observers who retrospectively analyzed the 939 AP pelvic radiographs (1878 hips) of patients aged 18 to 50 years who did not have hip symptoms and who were not professional athletes. The prevalence of the cam and pincer variants according to the alpha angle and LCEA, respectively, and the presence of other radiographic signs commonly associated with these variables were determined in the overall population and by subgroup according to sex and age group (18-30, 31-40, and 41-50 years). Descriptive and inferential statistics were used to analyze the study sample. Results: The mean age of the included population was 31.0 ± 9.2 years, and 68.2% were male. The prevalence of the cam-type variant was 29.7% (558/1878), and that of the pincer-type variant was 24.3% (456/1878). The radiographic signs that were most associated with the cam and pincer variants were a pistol-grip deformity and the crossover sign, respectively. Significant differences ( P < .001) in the prevalence of these variants were identified between men and women in both variants. No differences were observed in the alpha angle or LCEA according to sex or age. Conclusion: Radiographic findings suggestive of FAI had significant variations with respect to sex and age in this study sample. This study provides information to determine the prevalence of these anatomic variants in the general population.

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Clinical and Radiographic Predictors of Acetabular Cartilage Lesions in Adolescents Undergoing Hip Arthroscopy

The American Journal of Sports Medicine ◽

10.1177/0363546518801848 ◽

2018 ◽

Vol 46 (13) ◽

pp. 3082-3089 ◽

Cited By ~ 7

Author(s):

Michael P. McClincy ◽

Drake G. Lebrun ◽

Frances A. Tepolt ◽

Young-Jo Kim ◽

Yi-Meng Yen ◽

...

Keyword(s):

Hip Arthroscopy ◽

Alpha Angle ◽

Cartilage Lesion ◽

Control Analysis ◽

Acetabular Cartilage ◽

Crossover Sign ◽

Cartilage Lesions ◽

Matched Case ◽

Male Sex ◽

Case Control Analysis

Background: Acetabular cartilage lesions are a known cause of poor outcomes after hip arthroscopy and are seen regularly among adolescents. However, studies identifying preoperative factors predictive of acetabular cartilage lesions have been limited to adult populations. Purpose: To assess clinical and radiographic predictors of acetabular cartilage lesions in a large cohort of adolescents undergoing hip arthroscopy. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: Patients undergoing hip arthroscopy for idiopathic femoroacetabular impingement or acetabular labral tears at a children’s hospital were reviewed. Demographic predictors were analyzed by use of univariate logistic regression with generalized estimating equations. A matched case-control analysis was subsequently performed to identify radiographic predictors of acetabular cartilage lesions through use of univariate and multivariable conditional logistic regression. Results: Four hundred two patients (446 hips) undergoing hip arthroscopy between 2010 and 2015 were analyzed. Median age was 16.7 years (range, 13.6-19.0) and 72% of patients were female. Ninety-five hips (21%) were found to have an acetabular cartilage lesion at the time of arthroscopic surgery. Age (odds ratio [OR], 1.7; 95% CI, 1.4-2.1), male sex (OR, 2.5; 95% CI, 1.7-5.0), and body mass index (OR, 1.07; 95% CI, 1.01-1.14) were found to be predictive of intraoperative acetabular cartilage lesions. In the matched case-control analysis, femoral alpha angle as calculated on a Dunn lateral radiograph was independently predictive of an intraoperative acetabular cartilage lesion (OR, 1.8; 95% CI, 1.2-2.6). Additionally, the presence of a crossover sign was independently associated with a decreased odds of an acetabular cartilage lesion (OR, 0.3; 95% CI, 0.1-0.7). On multivariate analysis, alpha angle (Dunn lateral) (OR, 2.0; 95% CI, 1.3-3.1) and crossover sign (OR, 0.2; 95% CI, 0.1-0.7) remained independently associated with the presence of an acetabular cartilage lesion. The presence of an acetabular labral tear was not predictive of an associated cartilage lesion (OR, 1.17; 95% CI, 0.39-3.47; P = .78). Conclusion: In an adolescent population undergoing hip arthroscopy, older age, male sex, and higher body mass index were predictive of acetabular cartilage lesions. From an imaging standpoint, increased alpha angle increased the likelihood of an acetabular cartilage lesion whereas the presence of a crossover sign decreased this likelihood. Predicting the presence of an acetabular cartilage lesion is important when considering a hip arthroscopy procedure to facilitate preoperative planning and to more accurately set patient expectations.

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Does hip morphology correlate with proximal femoral fracture type?

Hip International ◽

10.1177/1120700019859275 ◽

2019 ◽

Vol 30 (5) ◽

pp. 629-634

Author(s):

Gilad Rotem ◽

Zachary T Sharfman ◽

Ehud Rath ◽

Aviram Gold ◽

Gil Rachevsky ◽

...

Keyword(s):

Hip Fractures ◽

Alpha Angle ◽

Fracture Type ◽

Crossover Sign ◽

Hip Axis Length ◽

Neck Shaft Angle ◽

Hip Morphology ◽

Shaft Angle ◽

Axis Length ◽

Neck Diameter

Purpose: To determine if boney morphology influences the anatomic location of hip fractures in elderly patients. Methods: All patients with hip fractures between 2008 and 2012 who had hip radiographs taken prior to the fracture were reviewed. Fractures were classified as intracapsular or extracapsular and hip morphology was measured on the pre-fracture x-rays. Hip morphology was determined by alpha angle, lateral central edge angle, acetabular index, neck-shaft angle, hip axis length, femoral neck diameter, Tönnis classification for hip osteoarthritis (OA) and the presence of a crossover sign. Results: 148 subjects (78.4% female, age 83.5 years) with proximal femur fractures were included. 44 patients (29.7%) had intracapsular fractures and 104 (70.3%) had extracapsular fractures. 48% of patients had previous hip fractures on the contralateral side and 74.6% had the same type of fracture bilaterally. The rates of bilateral intracapsular and extracapsular fractures were similar (33.7% vs. 40.9% respectively, p = 0.39). Extracapsular fractures had a statically significant higher neck-shaft angle, a shorter hip axis length, a narrower femoral neck diameter and a higher grade of Tönnis classification of OA ( p = 0.04, 0.046, 0.03, 0.02 respectively). Acetabular coverage and the proximal femoral head-neck junction, which were evaluated by lateral centre-edge angle (LCEA), acetabular index and the presence of a crossover sign, did not correlate with fracture type. The alpha angle > 40° had a statistically significant higher likelihood for extracapsular fractures ( p = 0.013). Conclusions: Acetabular coverage and proximal femoral head-neck junction morphology, were found to partially correlate with the location of hip fractures and do not fully elucidate fracture type susceptibility.

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The Ischial Spine in Developmental Hip Dysplasia: Unraveling the Role of Acetabular Retroversion in Periacetabular Osteotomy

Advances in Orthopedics ◽

10.1155/2020/1826952 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Gerard El-Hajj ◽

Hicham Abdel-Nour ◽

Rami Ayoubi ◽

Joseph Maalouly ◽

Fouad Jabbour ◽

...

Keyword(s):

Hip Dysplasia ◽

Periacetabular Osteotomy ◽

Posterior Wall ◽

Acetabular Retroversion ◽

Ischial Spine ◽

Acetabular Version ◽

Crossover Sign ◽

Developmental Hip Dysplasia ◽

Radiographic Sign ◽

Posterior Wall Sign

Purpose. Radiological diagnosis of acetabular retroversion (AR) is based on the presence of the crossover sign (COS), the posterior wall sign (PWS), and the prominence of the ischial spine sign (PRISS). The primary purpose of the study is to analyze the clinical significance of the PRISS in a sample of dysplastic hips requiring periacetabular osteotomy (PAO) and evaluate retroversion in symptomatic hip dysplasia. Methods. In a previous paper, we reported the classic coxometric measurements of 178 patients with symptomatic hip dysplasia undergoing PAO where retroversion was noted in 42% of the cases and was not found to be a major factor in the appearance of symptoms. In the current study, we have added the retroversion signs PRISS and PWS to our analysis. Among the retroverted dysplastic hips, we studied the association of the PRISS with the hips requiring PAO. We also defined the ischial spine index (ISI) and studied its relationship to the coxometric measurements and AR. Results. In hips with AR, the operated hips were significantly associated with the PRISS compared to the nonoperated ones (χ2 = 4.847). Additionally, the ISI was able to classify acetabular version (anteverted, neutral, and retroverted acetabula). A direct correlation between the ISI and the retroversion index (RI) was found, and the highest degree of retroversion was found when the 3 signs of acetabular retroversion were concomitantly present (RI = 33.6%). Conclusion. The PRISS, a radiographic sign reflecting AR, was found to be significantly associated with dysplastic hips requiring PAO where AR was previously not considered a factor in the manifestation of symptoms and subsequent requirement for surgery. Moreover, the PRISS can also serve as an adequate radiographic sign for estimating acetabular version on pelvic radiographs.

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Borderline Dysplasia with Acetabular Retroversion: Key Findings from a Large Hip Arthroscopy Study Group

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00432 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0043

Author(s):

Benjamin Kivlan ◽

Shane Nho ◽

Andrew Wolff ◽

John Salvo ◽

John Christoforetti ◽

...

Keyword(s):

Hip Arthroscopy ◽

Arthroscopic Surgery ◽

Acetabular Retroversion ◽

Control Groups ◽

Chi Square ◽

Crossover Sign ◽

Center Edge ◽

Significant Difference ◽

Chi Square Analysis ◽

And Control

Objectives: The radiographic crossover sign (COS) is an indicator of acetabular retroversion, classically representing anterosuperior overcoverage often treated with acetabuloplasty which could exacerbate acetabular hypovolemia in dysplasia. No prior study has investigated the prevalence of acetabular retroversion in patients with dysplasia undergoing hip arthroscopy, acetabuloplasty rates, and outcomes in this setting. Study objectives are to report the prevalence of acetabular retroversion in dysplasia, the influence of the COS on arthroscopic acetabuloplasty rates, and relative outcomes compared with control groups. Methods: A retrospective cohort study was performed from a prospectively collected multi-center database. Patients undergoing isolated hip arthroscopic surgery were assigned to dysplasia (lateral center-edge angle (LCEA) ≤ 25°) or one of two control groups: normal(LCEA 26-38°), or pincer femoroacetabular impingement (FAI)(LCEA ≥ 39°). The prevalence of COS and acetabuloplasty rates between and within study and control groups were compared (Chi square analysis). Minimum 2 year outcomes utilizing iHOT-12 were compared (analysis of variance). Results: Of 401 study patients, 64 (16%) comprised the dysplasia group, 273 (68%) normal group, and 64 (16%) pincer group. Mean LCEAs were 22.3°, 31.5°, and 42.4°, respectively (p<0.001). COS prevalence was similar between groups at 31%, 26%, and 33%, respectively (p=0.873). Acetabuloplasty rates were dependent on the amount of acetabular coverage with lowered rate in the dysplasia group(40%) and increasing rates in the normal(52%) and the pincer(90%) groups (p=0.013). Post-operative iHOT-12 scores improved in all groups (68, 74, and 77, respectively, p=0.222). Patients with a COS plus rendered acetabuloplasty reported similar scores that improved to 77, 74, and 79, respectively,(p=0.949). Patients with dysplasia with COS averaged 73.1(SD 23.3) iHOT-12 score compared to 67.1(SD: 28.7) for the patients with dysplasia without COS (p=0.466). Within the dysplasia with COS subgroup, there was no significant difference in iHOT-12 scores between the group with acetabuloplasty (77.0;SD:17.1) and without acetabuloplasty (70.4;SD:27.4,p=0.580). Conclusion: Acetabular retroversion occurs with similar prevalence in borderline dysplasia compared with non-dysplastic hips undergoing hip arthroscopy but with lower acetabuloplasty rates not influenced by the COS. Arthroscopic outcomes of dysplasia with retroversion are similarly successful and comparable with those of dysplasia and non-dysplastic hips. Although infrequently performed, acetabuloplasty did not compromise outcomes in dysplasia with retroversion.

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Functional acetabular retroversion syndrome: description of a specific sub-type of FAI and results of treatment with minimally invasive PAO

Hip International ◽

10.1177/1120700019855240 ◽

2019 ◽

Vol 30 (6) ◽

pp. 779-786 ◽

Cited By ~ 1

Author(s):

Michael C Wyatt ◽

Christian Smith ◽

Ali Zavareh ◽

Dominik Pfluger ◽

Marcus JK Bankes

Keyword(s):

Minimally Invasive ◽

Smoking Status ◽

Periacetabular Osteotomy ◽

Clinical Results ◽

Acetabular Retroversion ◽

Crossover Sign ◽

Results Of Treatment ◽

Functional Scores ◽

The Mean

Introduction: Acetabular retroversion syndrome is associated with pincer-type femoroacetabular impingement (FAI) and results, theoretically, from an externally rotated hemipelvis. The purpose of this study was to examine our surgical experience and the clinical results of functional acetabular retroversion syndrome treated with minimally-invasive periacetabular osteotomy (PAO). Methods: We performed a retrospective cohort study of prospectively collected data in consecutive patients who had an anteverting PAO from 01 November 2010 to 31 December 2015. All patients were followed up clinically and radiologically. Functional scores were ascertained using pre- and postoperative iHOT-12 and EQ-5D. The effect of hypermobility, smoking status and body mass index (BMI) on outcome measures was evaluated. Results: 31 anteverting PAOs were performed on 27 consecutive patients. All patients were female. The mean age was 26.7 years (SD 6.7). The mean BMI was 25.8 kg/m2 (SD 5.1). 5 patients were smokers (16.1%) and 11 exhibited signs of generalised joint laxity. 23 hips had undergone prior hip arthroscopy and 1 patient had previous open FAI surgery. The minimum clinical follow-up was 2 years (mean 3.4 years; range 2–7 years). A crossover sign was present in all cases. The mean iHOT-12 score improved from 19.5 to 51 at 6 months, 64.5 at 1 year and 48 at 2 years following surgery ( p < 0.05) EQ-5D improved from 0.42 preoperatively to 0.76 at 6 months and 0.69 at 1 year following surgery ( p < 0.05). Conclusions: We have characterised functional acetabular retroversion syndrome (FARS) as a condition affecting young, active females which severe symptoms out of proportion to demonstrable radiographic pathology.

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Can the crossover sign be a reliable marker of global retroversion of the acetabulum?

Skeletal Radiology ◽

10.1007/s00256-016-2497-1 ◽

2016 ◽

Vol 46 (1) ◽

pp. 17-21 ◽

Cited By ~ 6

Author(s):

Seyed Ali Hashemi ◽

Javad Dehghani ◽

Amir Reza Vosoughi

Keyword(s):

Crossover Sign ◽

Reliable Marker

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Reliability and normative values of common adult radiographic parameters for hip preservation in the developing pelvis

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnz024 ◽

2019 ◽

Author(s):

Patrick W Whitlock ◽

Kamran F Salari ◽

Gideon Blumstein ◽

Bin Zhang ◽

Alexandre Arkader ◽

...

Keyword(s):

Femoral Head ◽

Developmental Dysplasia ◽

Categorical Variables ◽

Normative Values ◽

Crossover Sign ◽

Good Reliability ◽

Rater Reliability ◽

Male And Female ◽

Female Patients ◽

Center Edge

AbstractAnterior–posterior (A/P) radiography of the pelvis is essential to the diagnosis and treatment of developmental dysplasia of the hip (DDH). Multiple well-defined parameters of adult hip morphology with good reliability are readily available. The purpose of this study was to determine normative values and observed reliability for 10 common adult hip parameters in the developing pelvis of male and female patients aged 6 months–16 years. One hundred and fifty-eight standardized A/P pelvic radiographs were randomly selected from an existing trauma patient database and stratified into five age groups. Mean values or presence of categorical values and the observed reliability of 10 adult hip parameters (acetabular index/angle, pelvic width index, lateral center edge angle, Tonnis angle, acetabular to femoral head distance, femoral head diameter, coxa profunda/protrusio, ischial spine sign, crossover sign and posterior wall sign) were determined. Minimal differences in all parameters were observed between male and female patients. The observed inter-rater reliability of continuous parameters was 0.77–0.99. The observed intra-rater reliability was 0.7–0.99 with a combined intra-rater reliability of 0.88–0.99. The observed inter-rater reliability of categorical variables was 0.64–1.0. The intra-rater reliability of categorical variables was 0.83–1.0. Normative values for 10 common adult hip parameters were determined for male and female patients in the developing pelvis. Reliable knowledge of these values and their relationship to the age of the patient and/or stage of pelvic development associated may provide additional information to aid the treatment of DDH.

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Radius Crossover Sign

Journal of Pediatric Orthopaedics ◽

10.1097/bpo.0b013e3182468cec ◽

2012 ◽

Vol 32 (4) ◽

pp. e15-e19 ◽

Cited By ~ 2

Author(s):

Patrick B. Wright ◽

Allison E. Crepeau ◽

José A. Herrera-Soto ◽

Charles T. Price

Keyword(s):

Crossover Sign

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Radiographic features of pelvis and hip joint development of English Bulldogs

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-09-02-0017 ◽

2010 ◽

Vol 23 (01) ◽

pp. 19-27 ◽

Cited By ~ 6

Author(s):

A. Volta ◽

J. P. Morgan ◽

M. Bonazzi ◽

S. Manfredi ◽

E. Bottarelli ◽

...

Keyword(s):

Hip Joint ◽

Normal Development ◽

External Rotation ◽

First Year ◽

Hip Joints ◽

Crossover Sign ◽

Distinctive Features ◽

Joint Development ◽

Torsional Deformity ◽

First Year Of Life

Summary Objectives: To evaluate distinctive features of pelvis and hip joint development of English Bulldogs throughout the first year of life. Methods: The pelves of 20 English Bulldogs were radiographed at three different ages (<4, 6–8, and 12–14 months). At each time point, the dogs were clinically evaluated and the abnormal hip joints were classified as mild, moderate, or severely deformed. The pelves were compared to a phantom study in which external rotation of a normal hemipelvis around its long axis was artificially created at different degrees, with different pelvic inclinations, and classified as either normal and without deformity, or as mild, moderate, or severely deformed. Hip joints and pelvic scores were statistically compared. Results: Although none of the dogs were considered lame at the end of the study, none of the hips showed normal development; 77.5% were moderately to severely deformed at 12–14 months of age. At this age, 75% of the hemipelves had moderate to severe torsional deformity (>5.2° of external rotation), with retroversion of the acetabulum confirmed by the presence of the crossover sign. An external rotation of the hemipelvis on its long axis >5° was likely associated with a moderate to severely altered hip joint conformation. Clinical Significance: Abnormal hip conformation was common in this series of English Bulldogs. Torsional deformity of the pelves with acetabular retroversion was a common and distinctive feature, which has not yet been thoroughly studied in dogs. These findings need further evaluation in English Bulldogs as well as in other breeds.

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