MRI and sonography in Legg-Calvé-Perthes disease: clinical relevance of containment and influence on treatment

TY - JOUR

T1 - MRI and sonography in Legg-Calvé-Perthes disease: clinical relevance of containment and influence on treatment

AU - Jandl, Nico Max

AU - Schmidt, T

AU - Schulz, M

AU - Rüther, W

AU - Stuecker, M H F

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Purpose: The containment orientated treatment of Legg-Calvé-Perthes disease (LCPD) affected hip joints is broadly accepted in the literature. The prerequisite is early recognition of loss of containment. An often-used quantitative MRI containment parameter is the cartilaginous acetabulum-head-index (CAHI). Based on ultrasound (US), we analyzed the newly created 'femoral head extrusion angle' (HA) as a containment parameter in comparison with the CAHI in severe LCPD.Methods: In a prospective study with 40 children (mean age 5.8 years sd 2.3) with unilateral LCPD classified as Catterall group III/IV, we measured the CAHI versus HA to assess the containment of the femoral head. HA in US was determined by the tangent from the bony acetabular rim to the cartilaginous cranio-lateral femoral head.Results: The HA was significantly higher in LCPD-affected hip joints (25° sd 7°) than in healthy ones (13° sd 5°; p < 0.001). Correlation analysis of all hip joints revealed a significant correlation between HA and CAHI (r = -0.69; p < 0.001). Hip joints with a low CAHI indicating loss of containment showed a higher HA in sonography.Conclusion: The results of our study suggest that the HA in US is a reliable containment parameter in severe LCPD with a HA > 22° defining a pathologic value. In comparison with the CAHI, HA measurement in ultrasound is easier than the assessment of various parameters to calculate an index. Frequent sonographical follow-up assessment in critical joints is an alternative if MRI is not available, helping to detect an impending loss of containment early enough.Level of Evidence: Level II.

AB - Purpose: The containment orientated treatment of Legg-Calvé-Perthes disease (LCPD) affected hip joints is broadly accepted in the literature. The prerequisite is early recognition of loss of containment. An often-used quantitative MRI containment parameter is the cartilaginous acetabulum-head-index (CAHI). Based on ultrasound (US), we analyzed the newly created 'femoral head extrusion angle' (HA) as a containment parameter in comparison with the CAHI in severe LCPD.Methods: In a prospective study with 40 children (mean age 5.8 years sd 2.3) with unilateral LCPD classified as Catterall group III/IV, we measured the CAHI versus HA to assess the containment of the femoral head. HA in US was determined by the tangent from the bony acetabular rim to the cartilaginous cranio-lateral femoral head.Results: The HA was significantly higher in LCPD-affected hip joints (25° sd 7°) than in healthy ones (13° sd 5°; p < 0.001). Correlation analysis of all hip joints revealed a significant correlation between HA and CAHI (r = -0.69; p < 0.001). Hip joints with a low CAHI indicating loss of containment showed a higher HA in sonography.Conclusion: The results of our study suggest that the HA in US is a reliable containment parameter in severe LCPD with a HA > 22° defining a pathologic value. In comparison with the CAHI, HA measurement in ultrasound is easier than the assessment of various parameters to calculate an index. Frequent sonographical follow-up assessment in critical joints is an alternative if MRI is not available, helping to detect an impending loss of containment early enough.Level of Evidence: Level II.

KW - Journal Article

U2 - 10.1302/1863-2548.12.180033

DO - 10.1302/1863-2548.12.180033

M3 - SCORING: Journal article

C2 - 30294371

VL - 12

SP - 472

EP - 479

JO - J CHILD ORTHOP

JF - J CHILD ORTHOP

SN - 1863-2521

IS - 5

ER -