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MRI Findings of Femoroacetabular Impingement

Steven L. J. James1,2, Kaline Ali1, Frank Malara3, David Young3, John O'Donnell3 and David A. Connell1

1 Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, Brockley Hill, Stanmore, Middlesex, United Kingdom HA7 4LP.
2 Present address: The Department of Radiology, The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, United Kingdom B31 2AP.
3 Department of Radiology, Victoria House Hospital, Prahran, Melbourne, Australia.


Figure 1
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  		Fig. 1 —Sagittal oblique proton density-weighted fast spin-echo sequence (TR/TE, 4,000/34) in 28-year-old woman shows normal appearance of labral-chondral transitional zone. Intermediate-signal acetabular hyaline articular cartilage can be seen blending with low-signal fibrocartilage of acetabular labrum (arrow).

 

Figure 2
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  		Fig. 2 —Sagittal oblique proton density-weighted fast spin-echo sequence (TR/TE, 4,000/34) in 29-year-old man shows grade 1 lesion of labral-chondral transitional zone. High-signal cleft (black arrow) is identified, and adjacent articular cartilage (white arrow) remains intact.

 

Figure 3
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  		Fig. 3 —Sagittal oblique proton density-weighted fast spin-echo sequence (TR/TE, 4,000/34) in 38-year-old man shows grade 2 lesion of labral-chondral transitional zone. Note thinning, hyperintensity, and fraying of cartilage at labral-chondral transitional zone and fissures extending to subchondral bone plate (arrow).

 

Figure 4
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  		Fig. 4A —32-year-old woman. Coronal proton density-weighted fast spin-echo sequence (TR/TE, 4,000/34) shows grade 3 lesion of labral-chondral transitional zone. Full-thickness loss of articular cartilage (white arrow) is shown at labral-chondral transitional zone. Bone prominence (black arrow) is shown at femoral head and neck junction.

 

Figure 5
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  		Fig. 4B —32-year-old woman. Sagittal oblique proton density-weighted fast spin-echo sequence (TR/TE, 4,000/34) shows grade 3 lesion of labral-chondral transitional zone. Full-thickness loss of articular cartilage (white arrow) is evident.

 

Figure 6
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  		Fig. 5 —Schematic drawing of hip joint. Labral-chondral transitional zone (gray) is divided into anterosuperior (AS), superolateral (SL), and posterosuperior (PS) areas. Acetabular articular cartilage is also divided using same divisions. Femoral articular cartilage is split into quadrants: anteromedial (AM), anterolateral (AL), posteromedial (PM), and posterolateral (PL).

 

Figure 7
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  		Fig. 6 —Sagittal oblique proton density-weighted fast spin-echo sequence (TR/TE, 4,000/34) in 35-year-old man shows full-thickness loss of articular cartilage over anterosuperior acetabulum (white arrow). Low-signal line of subchondral bone is visible, but no intermediate hyaline articular cartilage is present. Note associated subchondral cyst formation (black arrow) and bone marrow edema. Linear cleft of high signal at labral-chondral transitional zone (arrowhead) is again evident.

 

Figure 8
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  		Fig. 7 —Sagittal oblique proton density-weighted fast spin-echo sequence (TR/TE, 4,000/34) in 29-year-old man shows loss of articular cartilage (arrow) over femoral head. Note subchondral marrow edema (arrowhead) present in acetabulum.

 

Figure 9
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  		Fig. 8 —Sagittal oblique proton density-weighted fast spin-echo sequence (TR/TE, 4,000/34) in 23-year-old man shows radial tear of anterosuperior labrum and high-signal cleft (white arrow) extending into labral substance.

 

Figure 10
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  		Fig. 9 —Sagittal oblique proton density-weighted fast spin-echo sequence (TR/TE, 4,000/34) in 30-year-old woman shows flap tear (white arrow) of anterosuperior labrum. Note normal appearance of labral-chondral transitional zone (black arrow).

 

Figure 11
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  		Fig. 10 —Sagittal oblique proton density-weighted fast spin-echo sequence (TR/TE, 4,000/34) in 33-year-old woman shows small acetabular cyst (white arrow) beneath labral-chondral transitional zone. Note bone prominence (black arrow) at femoral head and neck junction.

 

Figure 12
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  		Fig. 11 —Coronal proton density-weighted fast spin-echo sequence (TR/TE, 4,000/34) in 32-year-old man shows MRI findings of cystic change (white arrow) at anterolateral femoral neck. High-signal cleft at labral-chondral transitional zone (black arrow) can again be identified.

 

Figure 13
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  		Fig. 12A —The labral chondral transitional zone in femoroacetabular impingement—schematic, MRI, and arthroscopic findings. Schematic diagram of labral-chondral transitional zone shows cleft (arrow) that is apparent at this site in patients with femoroacetabular impingement.

 

Figure 14
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  		Fig. 12B —The labral chondral transitional zone in femoroacetabular impingement—schematic, MRI, and arthroscopic findings. Coronal proton density-weighted fast spin-echo sequence (TR/TE, 4,000/34) in 32-year-old man shows MR appearances illustrated in A. High-signal cleft can be seen at labral-chondral transitional zone and extending to subchondral bone plate (black arrow). Note also cystic change at anterosuperior femoral neck (white arrow).

 

Figure 15
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  		Fig. 12C —The labral chondral transitional zone in femoroacetabular impingement—schematic, MRI, and arthroscopic findings. In 32-year-old man, arthroscopic view of labral-chondral transitional zone shows full-thickness loss of articular cartilage in adjacent acetabulum (grade 3) (black arrow) and separation of labrum (white arrow) at its attachment, which has been lifted by arthroscopic probe.

 

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