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Direct MR Arthrography of the Hip with Leg Traction: Feasibility for Assessing Articular Cartilage

Centre Hospitalier Universitaire Vaudois Lausanne, Switzerland

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We read the article by Llopis et al. [1] with interest and congratulate the authors for their work. Because the imaging of cartilage defects remains a radiologic challenge that is of the utmost importance for the orthopedic surgeon planning conservative hip surgery, in October 2005 we developed a similar technique.

Our experience is slightly different because we use considerably more weight (15–20 kg), which more nearly approaches the weight used for distraction in hip arthroscopy (25–38 kg) [2]. Even with such a weight, the distraction of both cartilage surfaces to obtain adequate visualization of a cartilage defect is often more difficult to achieve than described by Llopis et al. [1]. Therefore, 6 kg of weight may be sufficient for lax patients but is not enough for all patients. This is especially significant because many hip abnormalities that require MR arthrography involve young men.

We therefore wonder how the authors achieved a distraction of up to 3.8 mm with such a small traction without counterpost to stabilize the pelvis and the opposite leg to avoid pelvic tilt, without adaptation to patient weight, and without relaxation.

Furthermore, the description by Llopis et al. [1] about distraction width is not precise enough to determine whether this measurement was done at the anterosuperior, polar superior, or tightest level of the joint. Indeed, knowledge of the state of the cartilage at the anterosuperior level of the acetabulum is essential for an indication for conservative hip surgery because the destruction of the joint most frequently begins at this level. We consider it a contraindication for this type of surgery if we see a significant anterosuperior cartilage lesion under traction or, without sufficient traction, an indirect sign of cartilage damage such as anterosuperior subluxation of the head visible as posteroinferior crescent sign.

We fully agree with Llopis et al. [1] that their technical and study principles may be a further step toward better imaging of cartilage defects of the hip.

References

1. Llopis E, Cerezal L, Kassarjian A, Higueras V, Fernandez E. Direct MR arthrography of the hip with leg traction: feasibility for assessing articular cartilage. AJR 2008;190 :1124 –1128[Abstract/Free Full Text]
2. Sampson TG. The lateral approach. In: Byrd JWT. Operative hip arthroscopy, 2nd ed. New York, NY: Springer Science, 2005:129 –144

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				E. LLopis, L. Cerezal, and A. Kassarjian Reply Am. J. Roentgenol., November 1, 2008; 191(5): W207 - W207. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wettstein, M. Articles by Theumann, N. Search for Related Content PubMed PubMed Citation Articles by Wettstein, M. Articles by Theumann, N. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?