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Sublabral Sulcus at the Posteroinferior Acetabulum: A Potential Pitfall in MR Arthrography Diagnosis of Acetabular Labral Tears

Philip A. Dinauer1,2, Kevin P. Murphy3 and John F. Carroll4

1 Department of Radiology, Walter Reed Army Medical Center, 6900 Georgia Ave., NW, Washington, DC 20307-5001.
2 Department of Radiology and Nuclear Medicine, Uniformed Services, University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814.
3 Department of Orthopedic Surgery, Walter Reed Army Medical Center, Washington, DC 20307-5001.
4 Department of Radiologic Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000.



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  		Fig. 1A. —36-year-old male runner with right hip pain and popping sensation. Sagittal T1-weighted (TR/TE, 733/13) MR arthrography image shows labral avulsion from anterior acetabular rim (arrow).

 


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  		Fig. 1B. —36-year-old male runner with right hip pain and popping sensation. Corresponding arthroscopy photograph shows unstable, detached labrum (L). Probe easily retracts labral base (arrow) from acetabulum (A). Patient was treated with labral débridement and arthroscopic suture repair.

 


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  		Fig. 2A. —23-year-old man with posteroinferior sublabral sulcus, preoperatively misinterpreted as labral tear. Axial fat-suppressed T1-weighted MR image (TR/TE, 750/15) shows partial detachment of posterior labrum from underlying acetabulum (arrow).

 


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  		Fig. 2B. —23-year-old man with posteroinferior sublabral sulcus, preoperatively misinterpreted as labral tear. Arthroscopic view from anterolateral portal shows tip of probe on normal posterior labrum. Sublabral groove (arrows) with smooth contour separates acetabular articular cartilage (A) from labrum (L). Femoral head (F) is on right and posterior joint capsule (C) is on left. On surgical inspection, posterior labrum was stable with no evidence of tissue trauma.

 


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  		Fig. 3A. —28-year-old female runner with chronic hip pain associated with anterior labral tear. Axial fat-saturated fast spin-echo T2-weighted image (TR/TE, 3,000/40) from saline arthrogram shows posterior labral detachment from underlying acetabulum (arrow). Radiologist preoperatively offered differential of either traumatic avulsion or normal sublabral sulcus. Anterior labral tear produces intermediate signal intensity (arrowhead).

 


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  		Fig. 3B. —28-year-old female runner with chronic hip pain associated with anterior labral tear. Arthroscopic view of posterior acetabulum (A) from lateral portal shows normal sulcus (arrow) at base of labrum (L). Femoral head (F) is anterior.

 


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  		Fig. 4. —35-year-old man with apparent absence of portion of anterior labrum on sagittal fat-saturated T1-weighted (TR/TE, 500/14) hard-copy image from gadolinium arthrography. At arthroscopy, degenerative labral fraying and displaced labral flap were observed at anterior to anterosuperior acetabulum. Posterior labrum (arrowhead) was normal. Arrow indicates absent segment of anterior labrum.

 


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  		Fig. 5A. —36-year-old man with anterosuperior labral tear (not shown) and normal anatomic variation anteroinferiorly. Sagittal fat-saturated T1-weighted image (TR/TE, 733/13) from gadolinium arthrography obtained at level of transverse ligament and anterior labral junction shows normal cleft (arrow) that may be mistaken for labral tear by inexperienced observers.

 


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  		Fig. 5B. —36-year-old man with anterosuperior labral tear (not shown) and normal anatomic variation anteroinferiorly. Coronal fat-saturated T1-weighted image (733/13) obtained posterior to junctional cleft and anterior to ligamentum teres shows normal joint recess (arrow) interposed between anterior portion of transverse ligament and adjacent acetabulum.

 


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  		Fig. 6A. —Fat-suppressed gadolinium-enhanced images of 40-year-old woman with anterosuperior labral tear (not shown). Axial image (TR/TE, 467/14) shows normal triangular configuration and low signal intensity of anterior and posterior labrum (arrows).

 


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  		Fig. 6B. —Fat-suppressed gadolinium-enhanced images of 40-year-old woman with anterosuperior labral tear (not shown). Sagittal image (800/14) obtained at level of acetabular notch shows normal transverse ligament (arrow) and absence of cleft in region where ligament and anterior labrum join.

 


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  		Fig. 6C. —Fat-suppressed gadolinium-enhanced images of 40-year-old woman with anterosuperior labral tear (not shown). Coronal image (733/14) shows absence of periligamentous recess between ligamentum teres and transverse ligament. Contrast material fills small superior perilabral recess (arrowhead) adjacent to normal superior labrum. Arrow indicates junction of transverse ligament with ligamentum teres.

 


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  		Fig. 7A. —38-year-old man with avulsion of anterior to anterosuperior labrum at arthroscopy. Coronal fat-suppressed T1-weighted image (TR/TE, 733/13) shows partial detachment of anterosuperior labrum that, if viewed in isolation, may be falsely interpreted as normal sublabral sulcus. Arrow indicates contrast undermining base of anterosuperior labrum.

 


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  		Fig. 7B. —38-year-old man with avulsion of anterior to anterosuperior labrum at arthroscopy. Sagittal fat-saturated T1-weighted image (750/13) shows complete detachment of anterior labrum (arrow), and normal posterior labrum (arrowhead).

 


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  		Fig. 7C. —38-year-old man with avulsion of anterior to anterosuperior labrum at arthroscopy. Corresponding arthroscopic view from lateral portal with femoral head (F) on right. Arrow shows separation of anterior labrum (L) from acetabulum (A). With probing, labral fraying and unstable labral detachment occurred and were treated with arthroscopic suture repair.

 

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