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Plain Radiographic Signs of Acetabular Retroversion Can Accurately Detect Global Retroversion With High Sensitivity

Jimmy Ro1, Alexandra Rocha1, K C Geoffrey Ng2,3

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PubMed
Summary

Radiographic signs like the crossover sign and posterior wall sign can accurately detect global acetabular retroversion (GAR) in femoroacetabular impingement syndrome (FAIS) patients without CT scans. Crossover percentage shows promise as a predictive tool for the extent of retroversion.

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Area of Science:

  • Orthopedic surgery
  • Radiology
  • Biomedical engineering

Background:

  • Symptomatic femoroacetabular impingement syndrome (FAIS) is often associated with acetabular retroversion (AR).
  • Accurate detection of AR is crucial for diagnosis and treatment planning.
  • Distinguishing between focal and global AR is important for understanding disease severity.

Purpose of the Study:

  • To evaluate the relationship between standard radiographic signs of AR and global acetabular retroversion (GAR) measured via 3D imaging.
  • To determine the sensitivity and specificity of radiographic signs in detecting GAR in FAIS patients.

Main Methods:

  • Retrospective analysis of 209 FAIS patients (2017-2024) with pelvic radiographs and CT scans.
  • Radiographs assessed for crossover sign (COS), ischial spine sign (ISS), and posterior wall sign (PWS).
  • CT scans used to define and measure global acetabular retroversion (GAR) and focal AR.

Main Results:

  • Crossover sign (COS) and posterior wall sign (PWS) demonstrated high sensitivity (91.6%) for detecting CT-confirmed AR.
  • A combined analysis of crossover percentage (>30%) and other signs showed high specificity (94.6%) for GAR.
  • Crossover percentage correlated significantly with the extent of AR at the 3 o'clock position (R²=0.1008, P=0.0003).

Conclusions:

  • Standard pelvic radiographs can accurately identify global acetabular retroversion (GAR) in symptomatic FAIS patients, obviating the need for CT scans in many cases.
  • Crossover percentage is a valuable predictive tool for the extent of AR, aiding in the identification of complex deformities.
  • These findings can help clinicians identify patients who may benefit from further CT imaging for detailed assessment.