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01-06-2010 | Scientific Article

MRI morphometry, cartilage damage and impaired function in the follow-up after slipped capital femoral epiphysis

Authors: Falk R. Miese, Christoph Zilkens, Arne Holstein, Bernd Bittersohl, Patric Kröpil, Marcus Jäger, Tallal C. Mamisch, Rüdiger Krauspe, Ulrich Mödder, Günther Fürst

Published in: Skeletal Radiology | Issue 6/2010

Abstract

Objective

To assess rotation deficits, asphericity of the femoral head and localisation of cartilage damage in the follow-up after slipped capital femoral epiphysis (SCFE).

Materials and Methods

Magnetic resonance imaging studies were obtained in adult patients with a history of SCFE. A total of 35 hips after SCFE in 26 patients (mean age 24.1 ± 6.5, mean follow-up 11.9 ± 6.1 years) were evaluated. The control group comprised 20 healthy hips from 10 young adults with an average age of 23.9 ± 3.7 years. The MR protocol included a T1-weighted sequence with a 3D volumetric interpolated breath-hold sequence and a radial 2D proton density-weighted sequence around the femoral neck. Images were evaluated for alpha angle and cartilage damage in five positions around the femoral head. Hip function was evaluated at the time of MRI and correlated with MRI results. Mann–Whitney U test and Spearman’s correlation coefficient were used for statistical analysis.

Results

In the hips after SCFE alpha angles were significantly increased in the anterosuperior (74.1° ± 18.8°) and superior (72.5° ± 21.5°) positions and decreased in the posterior position (25.0° ± 7.2°). Cartilage damage was dominant in the anterosuperior and superior positions. Impaired rotation significantly correlated with increased anterosuperior, superior and posterosuperior alpha angles.

Conclusion

The data support an anterosuperior and superior cam-type deformity of the femoral head–neck junction in the follow-up after SCFE. MRI after SCFE can be used to assess anterosuperior and superior alpha angles, since the anterior alpha angle by itself may underestimate asphericity and is not associated with rotation deficits.

Leunig M, Casillas MM, Hamlet M, et al. Slipped capital femoral epiphysis: early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis. Acta Orthop Scand. 2000;71(4):370–5.CrossRefPubMed

Goodman DA, Feighan JE, Smith AD, Latimer B, Buly RL, Cooperman DR. Subclinical slipped capital femoral epiphysis. Relationship to osteoarthrosis of the hip. J Bone Jt Surg Am. 1997;79(10):1489–97.

Rab GT. The geometry of slipped capital femoral epiphysis: implications for movement, impingement, and corrective osteotomy. J Pediatr Orthop. 1999;19(4):419–24.CrossRefPubMed

Leunig M, Fraitzl CR, Ganz R. Early damage to the acetabular cartilage in slipped capital femoral epiphysis. Therapeutic consequences. Orthopade. 2002;31(9):894–9.CrossRefPubMed

Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;(417):112–20.

Ito K, Leunig M, Ganz R. Histopathologic features of the acetabular labrum in femoroacetabular impingement. Clin Orthop Relat Res. 2004;(429):262–71.

Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Jt Surg Br. 2005;87(7):1012–8.CrossRef

Leunig M, Beck M, Dora C, Ganz R. Femoroacetabular impingement: trigger for the development of coxarthrosis. Orthopade. 2006;35(1):77–84.CrossRefPubMed

Boyer DW, Mickelson MR, Ponseti IV. Slipped capital femoral epiphysis. Long-term follow-up study of one hundred and twenty-one patients. J Bone Jt Surg Am. 1981;63(1):85–95.

10.

Carney BT, Weinstein SL, Noble J. Long-term follow-up of slipped capital femoral epiphysis. J Bone Jt Surg Am. 1991;73(5):667–74.

11.

Seller K, Wild A, Westhoff B, Raab P, Krauspe R. Radiological evaluation of unstable (acute) slipped capital femoral epiphysis treated by pinning with Kirschner wires. J Pediatr Orthop B. 2006;15(5):328–34.PubMed

12.

Tins B, Cassar-Pullicino V, McCall I. The role of pre-treatment MRI in established cases of slipped capital femoral epiphysis. Eur J Radiol. 2009;70(3):570–8.CrossRefPubMed

13.

Fish JB. Cuneiform osteotomy of the femoral neck in the treatment of slipped capital femoral epiphysis. A follow-up note. J Bone Jt Surg Am. 1994;76(1):46–59.

14.

Fron D, Forgues D, Mayrargue E, Halimi P, Herbaux B. Follow-up study of severe slipped capital femoral epiphysis treated with Dunn's osteotomy. J Pediatr Orthop. 2000;20(3):320–5.CrossRefPubMed

15.

Kartenbender K, Cordier W, Katthagen BD. Long-term follow-up study after corrective Imhauser osteotomy for severe slipped capital femoral epiphysis. J Pediatr Orthop. 2000;20(6):749–56.PubMed

16.

Rao JP, Francis AM, Siwek CW. The treatment of chronic slipped capital femoral epiphysis by biplane osteotomy. J Bone Jt Surg Am. 1984;66(8):1169–75.

17.

Beaulé PE, Le Duff MJ, Zaragoza E. Quality of life following femoral head-neck osteochondroplasty for femoroacetabular impingement. J Bone Jt Surg Am. 2007;89(4):773–9.CrossRef

18.

Murray RO. The aetiology of primary osteoarthritis of the hip. Br J Radiol. 1965;38(455):810–24.CrossRefPubMed

19.

Harris WH. Etiology of osteoarthritis of the hip. Clin Orthop Relat Res. 1986;(213):20–33.

20.

Dudda M, Albers C, Mamisch TC, Werlen S, Beck M. Do normal radiographs exclude asphericity of the femoral head-neck junction? Clin Orthop Relat Res. 2009;467(3):651–9.CrossRefPubMed

21.

Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Jt Surg Br. 2002;84(4):556–60.CrossRef

22.

Lohan DG, Seeger LL, Motamedi K, Hame S, Sayre J. Cam-type femoral-acetabular impingement: is the alpha angle the best MR arthrography has to offer? Skeletal Radiol. 2009;38(9):855–62.CrossRefPubMed

23.

Pfirrmann CW, Mengiardi B, Dora C, Kalberer F, Zanetti M, Hodler J. Cam and pincer femoroacetabular impingement: characteristic MR arthrographic findings in 50 patients. Radiology. 2006;240(3):778–85.CrossRefPubMed

24.

Abraham E, Gonzalez MH, Pratap S, Amirouche F, Atluri P, Simon P. Clinical implications of anatomical wear characteristics in slipped capital femoral epiphysis and primary osteoarthritis. J Pediatr Orthop. 2007;27(7):788–95.PubMed

25.

Clohisy JC, Knaus ER, Hunt DM, Lesher JM, Harris-Hayes M, Prather H. Clinical presentation of patients with symptomatic anterior hip impingement. Clin Orthop Relat Res. 2009;467(3):638–44.CrossRefPubMed

26.

Outerbridge RE. The etiology of chondromalacia patellae. J Bone Jt Surg Br. 1961;43:752–7.

27.

Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG. Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy. 1997;13(4):456–60.CrossRefPubMed

28.

Suh JS, Lee SH, Jeong EK, Kim DJ. Magnetic resonance imaging of articular cartilage. Eur Radiol. 2001;11(10):2015–25.CrossRefPubMed

29.

Spencer S, Millis MB, Kim YJ. Early results of treatment of hip impingement syndrome in slipped capital femoral epiphysis and pistol grip deformity of the femoral head-neck junction using the surgical dislocation technique. J Pediatr Orthop. 2006;26(3):281–5.PubMed

30.

Siebenrock KA, Wahab KH, Werlen S, Kalhor M, Leunig M, Ganz R. Abnormal extension of the femoral head epiphysis as a cause of cam impingement. Clin Orthop Relat Res. 2004;(418):54–60.

31.

Leunig M, Slongo T, Kleinschmidt M, Ganz R. Subcapital correction osteotomy in slipped capital femoral epiphysis by means of surgical hip dislocation. Oper Orthop Traumatol. 2007;19(4):389–410.CrossRefPubMed

32.

Loder RT. The demographics of slipped capital femoral epiphysis. An international multicenter study. Clin Orthop Relat Res. 1996;(322):8–27.

33.

Cooperman DR, Charles LM, Pathria M, Latimer B, Thompson GH. Post-mortem description of slipped capital femoral epiphysis. J Bone Jt Surg Br. 1992;74(4):595–9.

34.

Lehmann CL, Arons RR, Loder RT, Vitale MG. The epidemiology of slipped capital femoral epiphysis: an update. J Pediatr Orthop. 2006;26(3):286–90.PubMed

35.

Moed BR. Hip pain in the young adult. Mo Med. 2005;102(3):221–4.PubMed

36.

Gosvig KK, Jacobsen S, Sonne-Holm S, Gebuhr P. The prevalence of cam-type deformity of the hip joint: a survey of 4151 subjects of the Copenhagen Osteoarthritis Study. Acta Radiol. 2008;49(4):436–41.CrossRefPubMed

37.

Bittersohl B, Hosalkar HS, Hughes T, et al. Feasibility of T(2) (*) mapping for the evaluation of hip joint cartilage at 1.5 T using a three-dimensional (3D), gradient-echo (GRE) sequence: a prospective study. Magn Reson Med. 2009;62(4):896–901.CrossRefPubMed

38.

Siebenrock KA, Schoeniger R, Ganz R. Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy. J Bone Jt Surg Am. 2003;85-A(2):278–86.

39.

Tanzer M, Noiseux N. Osseous abnormalities and early osteoarthritis: the role of hip impingement. Clin Orthop Relat Res. 2004;(429):170–7.

40.

Beaulé PE, Zaragoza E, Motamedi K, Copelan N, Dorey FJ. Three-dimensional computed tomography of the hip in the assessment of femoroacetabular impingement. J Orthop Res. 2005;23(6):1286–92.PubMed

41.

Rakhra KS, Sheikh AM, Allen D, Beaulé PE. Comparison of MRI alpha angle measurement planes in femoroacetabular impingement. Clin Orthop Relat Res. 2009;467(3):660–5.CrossRefPubMed

42.

Bellemans J, Fabry G, Molenaers G, Lammens J, Moens P. Slipped capital femoral epiphysis: a long-term follow-up, with special emphasis on the capacities for remodeling. J Pediatr Orthop B. 1996;5(3):151–7.PubMed

43.

Kallio PE, Foster BK, LeQuesne GW, Paterson DC. Remodeling in slipped capital femoral epiphysis: sonographic assessment after pinning. J Pediatr Orthop. 1992;12(4):438–43.PubMed

44.

Loder RT. Slipped capital femoral epiphysis. Am Fam Phys. 1998;57(9):2135–42; 2148–50.

45.

Loder RT, Aronsson DD, Dobbs MB, Weinstein SL. Slipped capital femoral epiphysis. Instr Course Lect. 2001;50:555–70.PubMed

46.

Lavigne M, Parvizi J, Beck M, Siebenrock KA, Ganz R, Leunig M. Anterior femoroacetabular impingement. I. Techniques of joint preserving surgery. Clin Orthop Relat Res. 2004;(418):61–6.

47.

Zaragoza E, Lattanzio PJ, Beaulé PE. Magnetic resonance imaging with gadolinium arthrography to assess acetabular cartilage delamination. Hip Int. 2009;19(1):18–23.PubMed

48.

Mintz DN, Hooper T, Connell D, Buly R, Padgett DE, Potter HG. Magnetic resonance imaging of the hip: detection of labral and chondral abnormalities using noncontrast imaging. Arthroscopy. 2005;21(4):385–93.CrossRefPubMed

Title: MRI morphometry, cartilage damage and impaired function in the follow-up after slipped capital femoral epiphysis
Authors: Falk R. Miese
Christoph Zilkens
Arne Holstein
Bernd Bittersohl
Patric Kröpil
Marcus Jäger
Tallal C. Mamisch
Rüdiger Krauspe
Ulrich Mödder
Günther Fürst
Publication date: 01-06-2010
Publisher: Springer-Verlag
Published in: Skeletal Radiology / Issue 6/2010
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI: https://doi.org/10.1007/s00256-010-0903-7

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Springer Medicine

MRI morphometry, cartilage damage and impaired function in the follow-up after slipped capital femoral epiphysis

Abstract

Objective

Materials and Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Materials and Methods

Results

Conclusion

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