Patient History
30-year-old male complaining of pain since falling down a slope while carrying a refrigerator, at which time he heard a pop.
Findings
SKELETAL: Mildly depressed osteochondral fracture representing avascular necrosis involving the superior to anterosuperior left femoral head weight-bearing surface measuring 1.6cm in depth, 3.3cm in anteroposterior dimension and 3.2cm in width. The lesion involves at least 75 percent of the weight-bearing surface of the femoral head.
Moderate to severe reactive confluent osteoedema extending down to the intertrochanteric region.
PELVIS: Left sacroiliac joint, iliac blade, iliopectineal and ilioischial lines are intact.
JOINTS: Loss of the normal femoral head sphericity of the bilateral femoral heads with widening of the femoral head-neck junction. The left hip alpha angle is of 71.7 degrees.
Synovial pitting seen at the lateral aspect of the femoral head-neck junction more conspicuous in the right.
Moderate left hip joint osteoarthrosis. Diffuse chondral plate delamination with moderate reactive stress osteoedema involving the superior to anterosuperior acetabulum.
Moderate reactive joint effusion without internal debris or free bodies. Reactive synovitis.
ACETABULUM/LABRUM: Chronic-appearing anterosuperior labral tear with a subcentimeter dystrophic ossification. No displacement. No paralabral cysts.
MUSCLES/TENDONS/LIGAMENTS: Adductor and abductor muscular compartments are intact.
Ligamentum teres, ischiofemoral and iliofemoral ligaments are intact.
OTHER/SOFT TISSUE: Unremarkable pelvic basin contents.
Normal neurovascular bundle.
Impressions
1. Mildly depressed avascular necrosis of the left femoral head measuring 1.6cm in depth, 3.3cm in AP and 3.2cm in width.
2. Background of combined femoroacetabular impingement (FAI) due to cam-type and secondary pincer-type deformity. These last findings are secondary to a chronic repetitive microtraumatic anterosuperior labral tear with a subcentimeter reactive dystrophic ossification.
3. Moderate left hip joint osteoarthrosis with diffuse chondral plate delamination and moderate reactive stress osteoedema involving the superior to anterosuperior acetabulum.
4. Moderate reactive joint effusion with capsulosynovitis.
