0:00

Let's show you some axial projections.

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Without and with intra-articular contrast.

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On your left, we see the without straight,

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orthogonal axial with the triangular

0:11

shaped normal appearance of the labrum

0:15

transitioning into the capsular ligament.

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Which is strong and secures the anterior hip.

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The structure in front is the iliopsoas tendon.

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The higher signal intensity represents

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the two opposed surfaces of the femoral

0:30

and acetabular hyaline cartilage, and

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we're in the upper quadrant of the hip.

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Look at how strong the ligamentous anatomy

0:37

is as it crosses over from medial to lateral.

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In the back, the labrum is also a large,

0:45

triangular, hypo intense structure with the

0:47

ischiofemoral ligament emanating from it.

0:50

These small areas of irregularity

0:52

represent the normal embryologic fusion

0:55

sites of the triradiate cartilage.

0:58

On the right is the contrast

1:01

enhanced arthrographic image.

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This small, ill-defined, hyper intense

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area anterior to the labrum, which

1:08

is here. This brighter area here

1:11

represents a recess and nothing more.

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The posterior labrum is highlighted with

1:17

the ischiofemoral ligament and capsule

1:20

lifted off and coming straight into the

1:22

screen, coming right at you, are the pubic

1:25

and ischial heads of the ligamentum teres.

1:28

Now let me scroll down one.

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More level in this patient.

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This is scrolling up.

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There's the upper portion of

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The ischiofemoral ligament.

1:36

Acetabulolabral complex, and let me go down one.

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And as we go down, there is

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A small defect in the labrum.

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A very common, difficult problem for all imagers

1:51

And surgeons when they look at their images.

1:54

So what do we do with this little cleft?

1:57

If it's round and smooth, it is said that

2:00

This is non problematic and a variation.

2:02

But such clefts are really

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Uncommon in younger individuals.

2:08

And when a cleft is truly a cleft,

2:10

It will maximize in its depth

2:13

In the anteroinferior quadrant.

2:15

So let's go down and see if it gets bigger.

2:17

It doesn't get bigger.

2:18

In fact, it disappears.

2:20

It is not behaving like the normal

2:21

Cleft, which has its greater depth at

2:24

The 7 or 8 o'clock position, again, in

2:26

The anteroinferior quadrant of the hip.

2:28

That is problematic.

2:31

Now let's look at our arthrographic image.

2:33

In which our cleft, which is greater than 25

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Percent depth, maybe not a cleft, on the second

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Cut, we see an oblique orientation of it.

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I'll blow it up a little

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Bit more so you can see it.

2:45

There it is.

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What we thought was a cleft, not a cleft.

2:51

So we have some beautiful normal anatomy,

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But we also have some extremely subtle

2:56

Abnormal anatomy that many people

2:57

Would have deemed normal anatomy.

2:59

A couple of other pearls before we step away.

3:01

The posterior labrum and the axial projection.

3:06

Right smack dab in the middle of

3:08

The fibrous labrum should line up

3:10

With the center of the femoral head.

3:13

The anterior labrum should be medial, or towards

3:17

The midline, relative to the posterior labrum.

3:20

For if the anterior labrum is sitting out

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Here, I'll draw it with a little arrow,

3:26

If it's sitting over here, relative

3:28

To the posterior labrum. There it is.

3:30

Then you have the condition of

3:32

Retroversion, and this is just too long.

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That is problematic, and

3:37

Either acquired or a dysplasia.

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Finally, let's go over to our contrast

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Enhanced image, and scroll it a little bit,

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And look at some of the capsular recesses.

3:50

They can be quite large in the

3:52

Inferior aspect of the hip.

3:53

Here we are down low.

3:55

Maybe I won't make it so large.

3:57

So you can see where you are, and you can

3:59

See how floppy and distensible the capsule

4:02

Is as we come up with the anterior boundary

4:06

Of the capsule, seen relative to the labrum,

4:08

And the recess, seen anterior to the labral

4:11

Complex, and posterior to the labral complex.

4:16

Let's move on to another projection, shall we?