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Cleft Sign and Bone Marrow Edema of the Pubic Synthesis are Associated with Sports Activity and Bony Morphology Related to Femoroacetabular Impingement in Symptomatic Patients with Labral Tears: A Cohort Study

Keisuke Nakayama, MD, PhD
JAPAN

Cleft Sign and Bone Marrow Edema of the Pubic Synthesis are Associated with Sports Activity and Bony Morphology Related to Femoroacetabular Impingement in Symptomatic Patients with Labral Tears: A Cohort Study

Keisuke Nakayama, MD, PhD, JAPAN Hajime Utsunomiya, MD, PhD, JAPAN Soshi Uchida, MD, PhD, JAPAN

Wakamatsu Hospital of the University of Occupational and Environmental Health, Kitakyushu, Fukuoka, JAPAN

2021 Congress Abstract Presentation 5 minutes Not yet rated

Anatomic Location

Hip / Groin / Thigh

Anatomic Structure

Bones Labrum Cartilage

Diagnosis / Condition

Impingement

Treatment / Technique

Arthroscopy Repair / Reconstruction

Patient Populations

Pediatric / Adolescent Female Athletes Professional Athletes / Olympians Sport Specific Population

Diagnosis Method

X-ray MRI

Sports Medicine

Sport Specific Injuries

Labrum

Labrum Treatment

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Summary: Cleft sign and bone marrow edema of the pubis are significantly associated with sports activity. A FAI-related bony abnormality could contribute to increase the risk of cleft sign and bone marrow edema in athletes, especially in the contact-sport players.

Background

The cleft sign (CS) of the pubic synthesis comprises superior cleft sign (SCS) and inferior cleft sign (ICS). SCS indicates a tear at the attachment of rectus abdominis/adductor longus, and ICS indicates a tear at the attachment of the short adductors to the inferior margin of the inferior pubic ramus. The CS and bone marrow edema (BME) of the pubis are associated with hip and groin pain in athletes; however, it remains elusive regarding the relationship between the CS/BME and bone morphology including femoroacetabular impingement (FAI), and the CS/BME and specific sports activities. A recent study reported that the arthroscopic FAI correction surgery for soccer players resulted in significant improvement of BME of pubis.

Purpose

To clarify whether the presence of the CS/BME is associated with FAI-related bone morphology and sports specific activities.

Hypothesis

The CS/BME is more frequently observed in soccer players with FAI-related bony morphology.

Methods

From 2015 to 2018, 631 hips undergoing hip arthroscopic surgery for acetabular labral injury were enrolled in this study. Hips with osteoarthritis (Tönnis grade > 1, 50 patients, 51 hips) were excluded, and 580 hips of 506 patients were investigated. All patients (100%) were examined by single 3-tesla magnetic resonance imaging preoperatively, and SCS, ICS, and BME of ipsilateral side of the pubis were screened. Lateral center edge (LCE) angle, Sharp angle, Tönnis angle, vertical center anterior (VCA) angle, and alpha angle were measured using plain radiographs. All radiographic measurements were manually performed by 2 authors using a picture archiving and communication system. The relationship between the presence of the CS or BME and patient characteristics including sports activity and radiographic measurements were analyzed by Student t-test, chi-square test, or Fisher’s exact test.

Results

580 hips (292 males 288 females, mean age 35.8±15.7 years, mean LCEA28.4±8.7° [<18°: 12.7%, 18°-25°: 21.6%, 25°<: 64.5%]) were included. SCS, ICS, and bone marrow edema of the pubis were seen in 18 hips (3.1%), 13 hips (2.2%), and 36 hips (6.2%), respectively. SCS was not seen in the patients with LCEA less than 18° (0%). Patients with positive SCS had significantly higher VCA angle (positive v negative, 37.1±8.7° vs 30.2±12.5°, p = 0.03). The rate of soccer players among positive SCS, ICS and BME were 56%, 54%, and 53%, respectively (p < 0.001). Among soccer players, SCS, ICS, and BME were more frequently seen (16.4%, 11.5%, 31.1%, respectively) compared to the other kind of athletic activities / non-athletes (1.5%, 1.2%, 3.3%, p < 0.001, respectively).

Conclusion

The CS and BME of the pubis were significantly associated with sports activity. SCS was not seen in dysplastic patients, and was correlated to acetabular anterior over coverage. These results provide a significant hypothesis of the mechanism of the CS and BME of the pubic synthesis; high frequency of the impacts between the acetabulum and femoral head related to sports activities can be one of the most important mechanisms of the CS and BME of the pubic synthesis.

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Hip Labrum Reconstruction With A Polyurethane Scaffold: A Preliminary Report Of 3 Cases ePoster Presentation Bruno Capurro, MD, PhD., SPAIN Marc Tey, MD, PhD., SPAIN Raul Torres, MD, SPAIN Fernando Marques, MD, PhD., SPAIN Alfonso León, MD, PhD., SPAIN Oliver Marín-Peña, MD, SPAIN Joan Carles Monllau, MD, PhD, Prof., SPAIN
Predicting Dissatisfaction Following Total Hip Arthroplasty Using A Bayesian Model Averaging (Bma) Approach: Results From The Australian Arthroplasty Clinical Outcomes Registry (Acorn) ePoster Presentation Jan Peter Van Meirhaeghe, MD, BELGIUM Rob Molnar, MBBS, AUSTRALIA Sam Adie, BSc(Med) MBBS MSpMed MPH PhD FRACS, AUSTRALIA
Evaluation of endoscopically gluteus medius repair in patients with Femoro-acetabular impingement and labrum detachment ePoster Presentation George D. Tsikouris, MD, GREECE Nikolaos D. Gravvanis, MD, GREECE Georgia S. Dedousi, MD, GREECE Panagiota Vlaserou, BSc in Physiotherapy, MSc Biomedical Engineer, GREECE Fanis P. Papadakis, BSc, MSc(cand.), GREECE Ioannis K. Antonopoulos, GREECE Vassilis N. Psychoyios, MD, GREECE Theodoros G. Troupis, Prof, GREECE
Correlation Between Arthro-MRI Results And Intraoperative Hip Arthroscopy Findings In Fai Syndrome ePoster Presentation Christian Sobau, MD, GERMANY Konstantinos Tramountanis, MD, GERMANY Wolfgang Miehlke, MD, GERMANY Alexander Zimmerer, MD, GERMANY
Can Hip Microinstability Be Predicted By Hip Range Of Motion Abstract Presentation 5 minutes Marc R. Safran, MD, Prof., UNITED STATES Justin Hopkins, MD, UNITED STATES Katia Elisman, BS, UNITED STATES Andrea Finlay, PhD, UNITED STATES Nicole Segovia Pham, MPH, UNITED STATES
Midterm Outcomes After Arthroscopic Hip Capsular Reconstruction Using Iliotibial Band Allograft Abstract Presentation 4 minutes Joseph J. Ruzbarsky, MD, UNITED STATES Max Seiter, MD, UNITED STATES Rui Soares, BS, UNITED STATES Lauren Pierpoint, PhD, UNITED STATES Karen K. Briggs, MPH, MBS, UNITED STATES Marc J. Philippon, MD, UNITED STATES
Arthroscopy For Gunshot Wounds To The Hip ePoster Presentation Jorge Figueras, BS, UNITED STATES J P Ertl, MD, UNITED STATES Karchi Ertl, BS, UNITED STATES Brian Mullis, MD
Covid Mortality Among Neck Of Femur Fractures During The Pandemic 2019 Abstract Presentation 5 minutes Aashish Raghu, MBBS, MS, MRCS, FRCS (Tr & Orth), UNITED KINGDOM Anas Hassan, MBBS, MRCS, UNITED KINGDOM Nicholas Dr Roeck, MB ChB, FRCS (ENG), FRCS (Tr&Orth), UNITED KINGDOM Mohamed Antar, MBBS, Master of Orthopaedics, MRCS, UNITED KINGDOM
“X-Square” Technique For Radial Meniscal Root Tear ePoster Presentation Winyou Ratanachai, MD.M Ch(Orth)., THAILAND Keerati Klinchanhom, MD, THAILAND
A Prospective Comparison Of Groin-Related Complications Following Hip Arthroscopy With Versus Without A Perineal Post ePoster Presentation Iciar M Davila Castrodad, MD, UNITED STATES Matthew J. Kraeutler, MD, UNITED STATES Omer Mei-Dan, MD, UNITED STATES Anthony Scillia, UNITED STATES
Defining Sex-Based Outcomes Following Hip Arthroscopy In Patients With Borderline Hip Dysplasia. ePoster Presentation Benjamin Saks, MD, UNITED STATES James Fox, BBA, UNITED STATES Jade S Owens, BS, UNITED STATES Andrew Jimenez, MD, UNITED STATES Hari Krishna Ankem, MD, UNITED STATES Payam William Sabetian, MD, GUATEMALA Ajay C. Lall, MD, MS, FAAOS, UNITED STATES Benjamin G. Domb, MD, UNITED STATES
Long Term Outcomes After Arthroscopic Treatment Of Femoroacetabular Impingement For Patients With Borderline Dysplasia Abstract Presentation 4 minutes Ryan S. Selley, MD, UNITED STATES Molly A Day, MD, UNITED STATES Reena Olsen, BS, UNITED STATES Stephanie S Buza, MD, UNITED STATES Bryan T. Kelly, MD, UNITED STATES Anil S. Ranawat, MD, UNITED STATES Danyal H. Nawabi, MD, FRCS(Orth), UNITED STATES
Risk Factors For Early Conversion To Hip Arthroplasty Following Hip Arthroscopy: A Matched Cohort Analysis Abstract Presentation 4 minutes Joseph J. Ruzbarsky, MD, UNITED STATES Max Seiter, MD, UNITED STATES Rui Soares, BS, UNITED STATES Lauren Pierpoint, PhD, UNITED STATES Karen K. Briggs, MPH, MBS, UNITED STATES Marc J. Philippon, MD, UNITED STATES
Hip Arthroscopic Portals:A New Approach Through Accessory Portals Established Within 3Cm Around Anterolateral Portal ePoster Presentation Kiran Kumar Shah, MD, NEPAL
Can Intra-Articular Gadolinium Confound The Results Of A Diagnostic Anesthetic Injection In Young Patients With Hip Pain? Abstract Presentation 5 minutes Daniel Curtis, MD, UNITED STATES William Michael Pullen, MD, UNITED STATES Christopher Jamero, MA, ATC, UNITED STATES Marc R. Safran, MD, Prof., UNITED STATES
Psychologically Distressed Patients Can Obtain Meaningful Clinical Benefit from Arthroscopic Hip Surgery ePoster Presentation Benjamin Saks, MD, UNITED STATES Rachel Glein, BS, UNITED STATES Hari Krishna Ankem, MD, UNITED STATES Andrew Jimenez, MD, UNITED STATES Payam William Sabetian, MD, GUATEMALA Ajay C. Lall, MD, MS, FAAOS, UNITED STATES Benjamin G. Domb, MD, UNITED STATES
Superior Outcomes With Routine Capsular Repair In Hip Arthroscopy Abstract Presentation 5 minutes Austin M Looney, MD, UNITED STATES Spencer M Comfort, BS, UNITED STATES Patrick T Connolly, BS, UNITED STATES Julia E McCann, MD, UNITED STATES Andrew Curley, MD, UNITED STATES William F. Postma, MD, UNITED STATES
Utilizing Laser Doppler Flowmetry To Measure Labral Blood Flow During Arthroscopic Acetabular Labral Repair Abstract Presentation 5 minutes Paul F Abraham, BS, UNITED STATES Mark R. Nazal, MPH, UNITED STATES Nathan Varady, MD, MBA, UNITED STATES Michael Peter Kucharik, BS, UNITED STATES Christopher T Eberlin, BS, UNITED STATES Stephen M Gillinov, AB, UNITED STATES Wendy Madeline Meek, BBA, UNITED STATES Scott D Martin, MD, UNITED STATES
What is the Association Between Anterior Cruciate Ligament Reconstruction and Femoroacetabular Impingement Surgery? An Analysis of Over 18,000 Hip Arthroscopies Abstract Presentation 6 minutes Clare Wise, BS , UNITED STATES Marc R. Safran, MD, Prof., UNITED STATES Jeremy N. Truntzer, MD, UNITED STATES Robin Kamal, MD, MBA , UNITED STATES
Hip Osteochondroplasty May Benefit The Non-Ideal Patient With Femoroacetabular Impingement: Analysis From The Embedded Prospective Cohort Of The First Trial Abstract Presentation 6 minutes Mahmoud Almasri, MD, FRCSC, UNITED STATES Nicole Simunovic, MSc, CANADA Diane Heels-Ansdell, MSc, CANADA Olufemi R. Ayeni, MD, PhD, MSc, FRCSC, CANADA FIRST Investigators, MD, CANADA
Arthroscopic Tendon Release for Iliopsoas Impingement after Total Hip Arthroplasty ePoster Presentation Michael Andreas Finsterwald, MD, AUSTRALIA Georgina Waters, MD, AUSTRALIA Jay R. Ebert, PhD, AUSTRALIA Christopher W. Jones, FAOrthA FRACS PhD MBBS(Hons) BEng(Hons) BCom, AUSTRALIA Piers Yates, MBBS(Hons) BSc(Hons) MRCS(Eng) FRCS(Tr & Orth) FRA, AUSTRALIA Peter Alberto D'Alessandro, MBBS Hons. (UWA) FRACS FAOrthA, AUSTRALIA
A Systematic Review Of Terminology, Surgical Techniques, Preoperative Diagnostic Measures, And Geographic Differences In The Treatment Of Athletic Pubalgia/Sports Hernia/Core Muscle Injury/Inguinal Disruption ePoster Presentation Matthew J. Kraeutler, MD, UNITED STATES Omer Mei-Dan, MD, UNITED STATES John W. Belk, BA, UNITED STATES Christopher M. Larson, MD, UNITED STATES Toghrul Talishinskiy, MD, UNITED STATES Anthony Scillia, UNITED STATES
The Radiographical Influence Of Torsional Deformity Of The Acetabular And Femur In Dysplastic Hips ePoster Presentation Carsten Heimer, BA, GERMANY Carsten Perka, MD, PhD, GERMANY Henrik Baecker, MD, GERMANY

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Cleft Sign and Bone Marrow Edema of the Pubic Synthesis are Associated with Sports Activity and Bony Morphology Related to Femoroacetabular Impingement in Symptomatic Patients with Labral Tears: A Cohort Study

Cleft Sign and Bone Marrow Edema of the Pubic Synthesis are Associated with Sports Activity and Bony Morphology Related to Femoroacetabular Impingement in Symptomatic Patients with Labral Tears: A Cohort Study

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Purpose

Hypothesis

Methods

Results

Conclusion

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Cleft Sign and Bone Marrow Edema of the Pubic Synthesis are Associated with Sports Activity and Bony Morphology Related to Femoroacetabular Impingement in Symptomatic Patients with Labral Tears: A Cohort Study

Cleft Sign and Bone Marrow Edema of the Pubic Synthesis are Associated with Sports Activity and Bony Morphology Related to Femoroacetabular Impingement in Symptomatic Patients with Labral Tears: A Cohort Study

Background

Purpose

Hypothesis

Methods

Results

Conclusion

More ISAKOS 2021: Global Content