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Radiographic, Histologic, and Arthroscopic Findings in Amorphous Calcifications of the Hip Labrum

      Purpose

      The purpose of this study was to evaluate the clinical, radiographic, histologic, and intraoperative findings of an amorphous calcification involving the acetabular labrum.

      Methods

      From October 2008 to April 2013, all patients who underwent arthroscopic hip surgery for symptomatic intra-articular hip disorders and were found to have the characteristic calcific deposit involving the acetabular labrum were included. These patients were reviewed retrospectively on prospectively collected data. Radiographs were retrospectively evaluated for morphologic features of impingement and characteristics of labral calcification.

      Results

      Sixteen patients were identified as having amorphous calcification at the time of arthroscopy. There were 15 women and 1 man. Mean age was 37.3 years (range, 30 to 50 years). Symptoms were present for a mean of 9.3 months (range, 3 to 48 months). All patients reported anterior groin pain. Fifteen (94%) patients had positive anterior impingement and 9 (56%) had positive results for lateral impingement. Calcifications measured on average 3.2 mm (range, 1.9 mm to 5.6 mm), and 14 had a clear separation from the rim with increased opacity compared with neighboring trabecular bone. Intraoperatively, the characteristic amorphous calcium deposit was located in the anterosuperior labrum, with the deposit found to be accessible from the capsule-labral recess in all cases. All patients had labral tears and all patients had at least one component of femoroacetabular impingement (FAI).

      Conclusions

      Calcification in the anterosuperior acetabular labrum presents with a consistent patient demographic and distinct radiographic and arthroscopic presentation that is different from os acetabuli. As with os acetabuli, one should have a high suspicion for FAI when this lesion is encountered.

      Level of Evidence

      Level IV, therapeutic case series.
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      References

        • Ferguson S.J.
        • Bryant J.T.
        • Ganz R.
        • Ito K.
        The acetabular labrum seal: a poroelastic finite element model.
        Clin Biomech (Bristol, Avon). 2000; 15: 463-468
        • Greaves L.L.
        • Gilbart M.K.
        • Yung A.C.
        • Kozlowski P.
        • Wilson D.R.
        Effect of acetabular labral tears, repair and resection on hip cartilage strain: A 7T MR study.
        J Biomech. 2010; 43: 858-863
        • Kim Y.T.
        • Azuma H.
        The nerve endings of the acetabular labrum.
        Clin Orthop Relat Res. 1995; 320: 176-181
        • Seldes R.M.
        • Tan V.
        • Hunt J.
        • Katz M.
        • Winiarsky R.
        • Fitzgerald Jr., R.H.
        Anatomy, histologic features, and vascularity of the adult acetabular labrum.
        Clin Orthop Relat Res. 2001; 382: 232-240
        • Martinez A.E.
        • Li S.M.
        • Ganz R.
        • Beck M.
        Os acetabuli in femoro-acetabular impingement: stress fracture or unfused secondary ossification centre of the acetabular rim?.
        Hip Int. 2006; 16: 281-286
        • Larson C.M.
        • Stone R.M.
        The rarely encountered rim fracture that contributes to both femoroacetabular impingement and hip stability: a report of 2 cases of arthroscopic partial excision and internal fixation.
        Arthroscopy. 2011; 27: 1018-1022
        • Sarkar J.S.
        • Haddad F.S.
        • Crean S.V.
        • Brooks P.
        Acute calcific tendinitis of the rectus femoris.
        J Bone Joint Surg Br. 1996; 78: 814-816
        • Tsujii A.
        • Tanaka Y.
        • Yonetani Y.
        • Iuchi R.
        • Shiozaki Y.
        • Horibe S.
        Symptomatic calcification of the anterior cruciate ligament: A case report.
        Knee. 2012; 19: 223-225
        • Durr H.R.
        • Lienemann A.
        • Silbernagl H.
        • Nerlich A.
        • Refior H.J.
        Acute calcific tendinitis of the pectoralis major insertion associated with cortical bone erosion.
        Eur Radiol. 1997; 7: 1215-1217
        • Cox D.
        • Paterson F.W.
        Acute calcific tendinitis of peroneus longus.
        J Bone Joint Surg Br. 1991; 73: 342
        • Uhthoff H.K.
        • Loehr J.W.
        Calcific tendinopathy of the rotator cuff: Pathogenesis, diagnosis, and management.
        J Am Acad Orthop Surg. 1997; 5: 183-191
        • Kim Y.S.
        • Lee H.M.
        • Kim J.P.
        Acute calcific tendinitis of the rectus femoris associated with intraosseous involvement: a case report with serial CT and MRI findings.
        Eur J Orthop Surg Traumatol. 2013; 23: S233-S239