Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association · 2026
Plain Radiographic Signs of Acetabular Retroversion Can Accurately Detect Global Retroversion With High Sensitivity and Specificity Without a Computed Tomography Scan.
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Ro Jimmy, Rocha Alexandra, Ng K C Geoffrey, Degen Ryan M
Аннотация
PURPOSE: To examine the relationship between radiographic signs of acetabular retroversion (AR) in symptomatic femoroacetabular impingement syndrome (FAIS) patients and global AR (GAR) measured on 3-dimensional imaging.
METHODS: A retrospective cohort study was conducted to identify patients between 2017 and 2024, with radiographic and clinical FAIS. Standardized pelvic radiographs were analyzed for crossover sign (COS; including crossover percentage), ischial spine sign (ISS), and posterior wall sign (PWS). Alpha angle, femoral torsion, lateral center-edge angle (LCEA), and acetabular version at 1, 2, and 3 o'clock were collected from computed tomography (CT) scans. Patients with AR, defined as >/=5° of retroversion relative to normal values at the 1, 2, and 3 o'clock positions were identified. The sensitivity and specificity of each sign were calculated using CT scans to establish groups of focal and GAR. Continuous variables were compared using one-way analysis of variance and linear regression analyses.
RESULTS: Of the 273 cases, 209 were included. Patients were categorized into the following groups: globally retroverted (n = 56), focally retroverted (n = 74), and normal version (n = 79). The GAR minimal clinically important difference (MCID) is .086°, focal AR MCID is .062°, and normal range acetabular version is .063°. COS and PWS were most sensitive at detecting CT-confirmed AR at 91.6%. Combined crossover percentage greater than 30%, with all positive plain X-ray signs of AR, was most specific at 94.6%. A significant association between crossover percentage and extent of AR at the 3 o'clock position was observed (R2 = .1008, P = .0003). Gender-based sensitivity and specific analyses show COS and PWS are most sensitive, and an isolated COS% greater than 30% is most specific at detecting GAR in male patients. A positive ISS was more prevalent among females, whereas a positive PWS was more prevalent among males.
CONCLUSIONS: This retrospective review of patients with symptomatic FAIS and radiographic signs of FAI accurately detects GAR with high sensitivity and specificity without a CT scan. Crossover percentage was associated with the extent of AR and may be valuable as a predictive tool. This may help identify patients with more complex deformities that may benefit from CT imaging.
LEVEL OF EVIDENCE: Level III, retrospective diagnostic case series.
METHODS: A retrospective cohort study was conducted to identify patients between 2017 and 2024, with radiographic and clinical FAIS. Standardized pelvic radiographs were analyzed for crossover sign (COS; including crossover percentage), ischial spine sign (ISS), and posterior wall sign (PWS). Alpha angle, femoral torsion, lateral center-edge angle (LCEA), and acetabular version at 1, 2, and 3 o'clock were collected from computed tomography (CT) scans. Patients with AR, defined as >/=5° of retroversion relative to normal values at the 1, 2, and 3 o'clock positions were identified. The sensitivity and specificity of each sign were calculated using CT scans to establish groups of focal and GAR. Continuous variables were compared using one-way analysis of variance and linear regression analyses.
RESULTS: Of the 273 cases, 209 were included. Patients were categorized into the following groups: globally retroverted (n = 56), focally retroverted (n = 74), and normal version (n = 79). The GAR minimal clinically important difference (MCID) is .086°, focal AR MCID is .062°, and normal range acetabular version is .063°. COS and PWS were most sensitive at detecting CT-confirmed AR at 91.6%. Combined crossover percentage greater than 30%, with all positive plain X-ray signs of AR, was most specific at 94.6%. A significant association between crossover percentage and extent of AR at the 3 o'clock position was observed (R2 = .1008, P = .0003). Gender-based sensitivity and specific analyses show COS and PWS are most sensitive, and an isolated COS% greater than 30% is most specific at detecting GAR in male patients. A positive ISS was more prevalent among females, whereas a positive PWS was more prevalent among males.
CONCLUSIONS: This retrospective review of patients with symptomatic FAIS and radiographic signs of FAI accurately detects GAR with high sensitivity and specificity without a CT scan. Crossover percentage was associated with the extent of AR and may be valuable as a predictive tool. This may help identify patients with more complex deformities that may benefit from CT imaging.
LEVEL OF EVIDENCE: Level III, retrospective diagnostic case series.