Wednesday, October 3, 2012

MRI #10

History: right hip pain. Clinical concern for instability. Status post multiple arthroscopic procedures including labral repair and debridements of the ligamentum teres.

Comparison is made to MRI of the right hip dated 5/8/12
MRI of the right hip was performed utilizing large field of view coronal fast inversion recovery and axial fast spin echo, as well as surface coil coronal, sagittal, and oblique axial fast spin echo techniques.
There is no acute fracture or osteonecrosis.
Surface coil images of the right hip demonstrates Osseous debridement of the anterior femoral neck junction, unchanged when compared to last MRI. There has been rim debridement of the labrum with superimposed labra repair. The labral remnant is blunted and degenerated. There is erosion around a fixation device located in the anterior superior acetabulum, which demonstrates slightly more prominent bony erosion when compared to the prior exam. The iliofemoral ligament is hyper intense and deficient, particularly at the anterior margin of the joint. The ligamentum teres is markedly attenuated. This constellation of findings is consistent with features of micro instability of the hip.

There is borderline coxa valga. There is moderate wear of cartilage over the subfoveal anterior margin of the head and anterior wall, unchanged since 5/8. There is also high signal within the cartilage overlying the posteromedial femoral head, with partial thickness chondral loss, and additional cartilage loss laterally in the area of debrident. There is no extensive bone on bone contact or bulky synovitis.

The short external rotators are preserved, as is the posterior footprint of the gluteus medius. There is degeneration of the anterolateral footprint of the gluteus minimums insertion, without tear. There is mild insertional tendinosis of the iliopsoas without tear. There is no iliopsoas or ischial bursitis. The previously noted fluid within the greater trochanteric bursa has resolved.

The hamstring origins are symmetric. The pubic symphysis is preserved a are the abductor origins. Fat planes surrounding the sciatic nerves are preserved. The femoral neuro vascular bundles are maintained.

MRI of the right hip status post Ossetia debridement of the anterior femoral head neck junction and labral repair demonstrates findings compatible with micro instability of the hip deficiency of both the anterior margin of the iliofemoral ligament as well as the ligamentum teres.
Ossetia resorption surrounding a fixation device in the anterior superior acetabulum has progressed since the prior exam.
There is moderate cartilage wear, preferentially affecting the femoral head.