Capsulolabroligamentous
Structures of the Hip:
Anatomy and Pathology
Michelle M. Nguyen, MD
VA Palo Alto Medical Center
Dept of Radiology, MSK DivisionLecture Outline
Normal Articular Anatomy of the Hip
Pathology of Joint Capsule and Ligaments
Labrum:

I.
II.
III.
I.
II.
III.

Normal Anatomy
Pathology
Pitfalls

MiscellaneousIV.
I.

Supraacetabular fossa/Stellate lesionHip Joint: Articular Anatomy

Hip Jointl Synovial ball-and-socket

jointl Rotate around 3 planesl Transverse axis: flexionand extensionl Longitudinal axis: medial
and lateral rotationl Sagittal axis: abduction
and adduction
http//: wikipedia.org

Hip Joint: Osseous Anatomyl Femoral Headl Half a spherel Directed upward, mediallyand slightly anteriorlyl Smooth surface xc forroughened pit, the foveal Femoral Neckl Entire anterior surface

intracapsularl Medial third of posterior
surface intracapsularHip Joint: Osseous Anatomy
Acetabuluml Cup-shaped socket

Iliuml Elevated bony rim withlunate cartilaginous
surfacel Bony rim/cartilage
absent inferiorly at theacetabular notchl Acetabular fossal Devoid of cartilagel Filled with fatl Covered by synovium

LunateSurface

Acetabular
Fossa

Pubis
Ischium
Acetabular
Notch
my.statdx.com

Hip Joint: Articular Anatomyl

LabrumFibrocartilaginous rim
attached to edge of theacetabuluml Deepens the acetabularside of the jointl Ends and merges
inferiorly with thetransverse ligamentllTransverse Ligament
Spans the acetabular
notch, coverting notch toforamenl A non-cartilaginous
extension of the labruml

LabrumCartilage
Acetabular
Fossa Fat

Transverse
Ligament

Ligamentum
Teres cutmy.statdx.com

Ligamentum Teres Femoris
l
l
l
l

l
l
l

Pyramidal ligament
Covered by synovium
Extends from femoral fovea
as round band
Inserts distally as 2 flattened
bands on either side ofacetabular notch, blending
with fibers of transverse
ligament
Sometimes only synovial
covering is present
Contributes to stability infetal and neonatal hips9
Debated function in adulthips

Ito et al. J of Ortho Res 2009 on-line issue7

Ligamentum Teres Femoris
l
l
l
l

l
l
l

Pyramidal ligament
Covered by synovium
Extends from femoral fovea
as round band
Inserts distally as 2 flattened
bands on either side ofacetabular notch, blending
with fibers of transverse
ligament
Sometimes only synovial
covering is present
Contributes to stability infetal and neonatal hips9
Debated function in adult Ligamentum
Teres: 2 Bands
hips

Transverse
Ligament

Ligamentum Teres Femoris

Bardakos N et al. The Ligamentum Teres of the Adult Hip. JBJS 2009;91- B:8-15.

Hip Joint: Synovial Cavity
Synovial Membrane
Covers portion offemoral neck, femoral
head articular surface,ligamentum teresl Intimate with deep fibersof capsular ligamentsl Covers acetabular
labrum and fossalHip Joint: Capsule
Fibrous capsulel Circular and longitudinal
fibersl Strongest anteriorly andsuperiorlyl Attachments:
Proximal: acetabular margin(5-6mm above labrum), labrum,transverse ligamentl Anterior/distal: surrounds
femoral neck to trochanteric linel Posterior/distal: femoral neck to
1cm above trochanteric crestl

Chatha DS et al. Mag Res Imag Clin N Am
2005;13: 605-15.

Hip Joint: Capsule
Zona orbicularis
Deep circular fibers of
capsulel Collar about femoral neckl No connection to bonel Blends with the more
superficial capsularligamentsl Abundant at inferior andposterior capsulel Tension at extreme flexion
or extensionl Hip stability in distraction7l “femoral arcuate
ligament8,10”l

www.prohealthsys.com

Capsular Ligamentsl Hip joint capsule isintimate with andreinforced by
caspular ligamentsl Strongest anteriorlyl Anterior
Ligaments:l Pubofemoral
Ligamentl Iliofemoral
Ligament

www.prohealthsys.com

Anterior Capsular Ligamentsl Iliofemoral Ligamentl Ligament of Bigelowl Strongest capsularligamentl “Y” shapedl Apex attached to or nearlower portion of anterior
inferior iliac spine (AIIS)l Base attached along
trochanteric line

LMl Two bands (majority)l Lateral band (L)l Medial band (M)l Possible 3 bands8

www.prohealthsys.com

Iliofemoral Ligamentl Main restrictor of externalrotation and extensionl Medial Band (A)Martin H et al. Arthroscopy
2008; 24(2): 188-195l AnatomyØ Origin: btwn AIIS andacetabular rimØ Insertion: more distaltrochanteric line of femoralneckØ Almost vertical orientation● FunctionØ Inhibitor of externalrotation, especially inextension

Cadaveric analysis of anatomy and function:
Internal and external rotation thru ROM fr 30˚flexion to 10˚ extension along neutral swing pathIliofemoral Ligament
Lateral Band (B)l AnatomyØ Origin: AIISØ Insertion: superior portion oftrochanteric lineØ More horizontal obliqueorientation along femoral neck

● FunctionØ Main inhibitor of externalrotation, along neutral swingØ Also inhibitor of internalrotation, esp in extension

Martin H et al. Arthroscopy
2008; 24(2): 188-195

Iliofemoral Ligament

Moorman CT et al. J Bone Joint Surg Am. 2003;85:1190-1196.

Anterior Capsular Ligaments:
Pubofemoral Ligamentl Resembles a slingl Anatomy12Ø Origin: Wide attachment toiliopectineal eminence,superior ramus andobturator crestØ Insertion: Blends with
capsule and deep surface ofmedial band of iliofemoral
ligament. Attaches tofemoral neck

● Function12Ø Inhibitor of external rotationin extension and abduction

Anterior Capsule:
Inherent Weak Areal Inherent weak areaof anterior capsulebetween the medialband of theiliofemoral ligament
and the pubofemoral
ligamentl Potential
communication
between hip joint andiliopsoas bursa

Posterior Capsular
Ischiofemoral Ligament
Anatomy12
Origin: Ischial portion of
acetabular rim and extends
superolaterally as 2 bandsl Superior Bandl

Spirals across posterior femoral
neck, blends with zona orbicularisØ Inserts medial to anterosuperiorbase of greater trochanterØ● Inferior Band
Crosses posterior femoral neckØ Inserts medial to base of greater
trochanter along posterior
trochanteric crestØFunction12: Inhibitor of externalrotation in extension

Capsule: Normal Arthrogram
Anterior Joint
CapsuleBlue arrowsl Extends totrochanteric linel

Posterior Joint
CapsuleBlack arrowheadsl More medial andproximal thananterior joint capsulel

my.statdx.com

Hip Joint: Normal MR Anatomy

Chatha DS et al. MR Imaging of Normal Hip. MRIClin N Am 2005;13: 605-15.

Coronal T1FS Anterior to Posterior

Iliofemoral
ligament

Iliopsoas T.

Iliofemoral
ligament(lateral)

Iliopsoas t.

Anterior
LabrumIliofemoral
ligament(medial)Iliofemoral
ligament
Transverse
ligament

Iliofemoral
ligament(medial)Labrum
Iliofemoral
ligament

Fovea

Transverse
ligament
Region of
pubofemoral
ligament

Labrum
Ligamentum
Teres

Iliofemoral
ligament
ZO

Transverse
ligament
ZO

Labrum
Acetabular
fossa

Iliofemoral
ligament
ZO

Ligamentum
Teres
Transverse
ligament

ZO

Synovial
longitudinal fibers/
retinacularvessels

Labrum
Ischiofemoral
ligament

Ligamentum
Teres

ZO
Transverse
ligament
ZO

Labrum
Ischiofemoral
ligament

LabrumZO

ZO

Posterior
LabrumObturator
Externus
TendonSagittal T1FS Medial to Lateral

Transverse
ligamentTransverse
ligamentIliopsoas t.

LabrumLabrumLabrum
Iliopsoas t.

LabrumLabrum
Iliofemoral
ligament

LabrumIschiofemoral
ligamentIliofemoral
ligament

Ischiofemoral
ligamentIliofemoral
ligament

Ischiofemoral
ligament
ZOIschiofemoral
ligament
Iliofemoral
ligament

ZO
Obturator
Externus
TendonZO
Iliofemoral
ligament

Obturator
Externus
TendonAxial T1FS Superior to Inferior
LabrumIliofemoral
ligament

Labrum

Iliofemoral
ligamentIliofemoral
ligament

LabrumAcetabular
Fossa
Fovea
Ischiofemoral
ligament
LabrumIliofemoral
ligament

Acetabular
Fossa
Ligamentum
Teres
Ischiofemoral
ligament
LabrumIliofemoral
ligament

LabrumAcetabular
Fossa
Ligamentum
Teres

Ischiofemoral
ligament
LabrumIliofemoral
ligament

Ligamentum
Teres
ZO
Ischiofemoral
ligament

LabrumIliofemoral
ligament

Transverse
ligament

ZO

Ligamentum
Teres
ZO
Ischiofemoral
ligamentIliofemoral
ligament
ZO

Transverse
ligament

ZO
Ischiofemoral
ligamentIliofemoral
ligament

Ischiofemoral
ligament

Pathology of Capsule andLigaments

Capsular Laxity and Hip Instabilityl Traumatic (acute): Dislocation or subluxationl Atraumatic (non-acute):l Overuse (chronic repetitive microtrauma)l Connective tissue disorders (Marfan,Ehlers-Danlos)l Capsular ligaments (iliofemoral ligament) andlabrum are static stabilizers of hipl Once injured, the psoas major muscle (dynamic

stabilizer) constantly contracts to provide hip stabilityl Leads to stiffness, flexion contractures of hip, backpainl Treatment: Thermal capsulorrhaphy +/- plicationand labral repair

Shindle M et al. Clin of Sport Med 2006(25)-309-326

Traumatic Posterior Subluxation
Seen in athletes (American
football)l Fall on flexed adducted hipl Low-energy traumal Difficult clinical diagnosisl Avulsion fracture of posterior
acetabuluml Disruption of iliofemoral
ligament and anterior
capsulel Hemarthrosisl Risks: AVN, chondrolysisl

Moorman CT et al. JBJS 2003;
85A(7):1190-6.

Traumatic Posterior Subluxation

Traumatic Posterior Subluxation

Hip Dislocation
Posterior >> anterior
dislocationl Joint capsule is stronger
anteriorlyl High-force impactl

Posterior Dislocation

Flexed adducted internallyrotated hip à Posterior
dislocationl Abducted externally rotatedhip à Anterior dislocationll

Risks: AVN, posttraumatic osteoarthrosis
Philippon M et al. Arthroscopy
2009;25(2):169-174

Hip Dislocation
Imaging Findingsl Iliofemoral ligament disruptionl 16 of 18 pts with traumatic dislocation14l Labral and chondral injuries +/- entrapmentl Capsular/Ischiofemoral ligament disruptionl Ligamentum teres disruption15l Femoral head or acetabular fracturel Marrow and muscle edemal Sciatic nerve injury

Ligamentous Injuries in Dislocation
Ischiofemoral
Ligament Tear:contrast extends
outside posterior
capsuleIliofemoral Ligament
Disruption: contrast
extends outside capsulemy.statdx.com

Traumatic Hip Dislocation in
Professional Athletes15

Philippon M et al. Arthroscopy 2009;Feb 25(2):169-174

Ligamentum Teres Injuries
Gray and Villar Classification17l Type I Complete Rupture:
Usually acute and associated with major trauma/surgeryl Often associated with other significant abnormalities (labral orchondral injuries)ll Type II Partial Rupture:l Usually associated with chronic hip painl Often seen in athletes (ballet dancers, martial arts or high impact
sports).
l Third most common finding at arthroscopy in young athletesl Type III Degenerative:l Usually associated with osteoarthritis in older patientsTraumatic Ligamentum Teres Tear:
A source of Hip Pain16l

Mechanism9:
Fall on flexed adducted hipl Twisting injury, ext rotationl Hyperabductionll

Clinical Symptoms:
Deep anterior groin painl Locking, clicking, popping
l

l
l
l
l
l

23 cases of traumatic tears ofLT (15 major trauma, 8 twisting)2 detected by preop MRA (7MRA, 20 MRI done)
Young pts (avg age=28)
8 cases were isolated findings.
Treatment:
Debridement of torn fibersl Improved sx after treatmtl

Byrd T et al. Athroscopy 2004;20(4): 385-391

MR Imaging of Ligamentum Teres
MR Arthrogram18,19:l Axial oblique planes may be optimall Normal: Homogeneous low SI on both T1 and T2Wl Partial Tear: Intermed/high T2 signal and abnormal

morphologyl Hypertrophied ligament: 2 mm medial extension
beyond foveal insertion on axial oblique images.

l If ligament is hypertrophied, either abnormal T2 signal ormorphology determines partial tear.

l Occasionally will see bony intra-articular fragmentsfrom avulsion injuries of LT (more common withcomplete/type I injuries
Armfield DR et al. Clin of Sport Med 2006(25):211-239

Ligamentum Teres Tears
NormalHypertrophied

Partial Tear
Armfield DR et al. Clin of Sport Med 2006(25):211-239

24 yo professional soccer player
with left hip pain
Coronal T2FS

Courtesy of Drs Craig Stewart and Tudor Hughes24 yo professional soccer player
with left hip pain
Axial T2 FS

24 yo professional soccer player
with left hip pain
Axial T2 FS
Arthroscopic Findings:
Type 2 partial tear of left
ligamentum teres at its
foveal attachment

Labrum: Normal Anatomy
and Pathology

Labruml Fibrocartilaginous

Labrumstructure:

Attached to acetabular perimeterl Inferiorly, attached to transverse
acetabular ligamentl Collagen fibers contiguous withthose in transverse ligamentll Morphology:
Anterior labrum: Wider andthinnerl Posterior labrum: Less wide andthickerlResnick D. IDJ Advanced Intensive MR
Imaging Course Feb 2009

Transverse
Ligament
my.statdx.com

LabrumlFunction:
Provides seal, keeping fluid
btwn femoral head andacetabulum during mildcompressionl Helps contain femoral head
during extreme ROM, esp hip
flexionllHistology2:Dense connective tissuel Fibrocartilagel Collagen fibers (longitudinal
circumferential bundles)l Neuroreceptors within labrum
provide proprioception of hip4lLabrum: Vascularityll

Most vascular at peripheral 1/3 oflabrum2
Kelly et al3 divided labrum into
capsular zone IA/IB and articularzone IIA/IIB
Capsular zone most vascular d/t
abundant blood suppy from joint
capsulel Some blood supply from adj bonel Least blood supply in central andarticular labruml

Peripheral labral tears nearcapsulolabral junction may
heal better.

Kelly et al. Arthroscopy 2005;21(1):3-11
Shindle et al. JBJS 2008;90 Suppl 4:2-19

Labrum: MR Evaluationl MR arthrography is sensitive and specificin detecting labral pathologyl Debate that noncontrast MRI just as

accurate33l Radial imaging has been suggested as

better way to evaluate labrum.

21,26
Labrum Types: MR Imagingl Triangular 69-80%l Round 13-16%l Irregular/Flat 7-13%l “Absent” 1-2.5%l May not have been

seen d/t techniquel Degenerative or torn,
not truly absent22,23

Aydingoz U et al. Eur Radiol 2001;11:567-574.

Normal Labrum: MR Imaging
MR Findings:
Triangular (mostcommon)l Homogeneous dark
signal intensity on all
sequencesl Closely attached to
articular cartilagel Clock face: sagittal
plane25l

12:00 superiorl 3:00 anteriorl 6:00 inferiorl 9:00 posteriorl

Steinbach L et al. RadioGraphics
2002; 22:1223–1246

Normal Labrum: MR Imaging
MR Findings:
Triangular (mostcommon)l Homogeneous dark
signal intensity on all
sequencesl Closely attached to
articular cartilagel Clock face: sagittal
plane25l

12:00 superiorl 3:00 anteriorl 6:00 inferiorl 9:00 posterior

Ref #25l

Steinbach L et al. RadioGraphics
2002; 22:1223–1246

Labral Abnormalities/Tears
Causes1.

Degenerationl

2.

Femoroacetabular
Impingement
l
l
l
l
l

3.
4.

Intrasubstance abnl signal

Cam type: femoral head/neckoffsetPincer type: abnormal
acetabular morphology
Mixed type: most common
Developmental hip dysplasia
Coxa magna

TraumaRepetitive activity in athletes

Clinical Findings:• Asymptomatic: >70 yo•Hip/Groin Pain
•ClickingResnick D. IDJ Advanced Intensive
MR Imaging Course Feb 2009

Femoroacetabular Impingement:
Cam type
Pain w/flexion and internalrotation and limited ROM w/
internal rotationl Offset at femoral head/neckjunction causes
impingement on labrum withflexionl “Pistol grip” deformityl Young athletic personsl Labral and chondral
abnormalitiesl Alpha angle > 55˚l Herniation pits may be early
osteoarthrosis29lNormal (a/b): Labrum clears with flexion
Cam type (c/d): Femoral head/neck offset
impinges on acetabular labrum

Hong R, Hughes T, Gentili A, Chung C. J
of Mag Res Imag 2008;27:435

Femoroacetabular Impingement:
Pincer-typel

Abnormal acetabularmorphology

Acetabular protrusionl Acetabular retroversionl Os acetabulil Traumal

Older female patientsl Over-coverage of femoral
headàlinear contact on
acetabular labruml Mostly labral abnormalitiesl Contrecoup chondral injury
in posteroinferior
acetabulum and femoral
headl

Normal (a/b): Labrum clears with flexion
Pincer type (e/f): Over-acetabular coverageof femoral head. Abnormal linear contact on
acetabular labrum on flexion

Hong R, Hughes T, Gentili A, Chung C.
J of Mag Res Imag 2008;27:435

Acetabular Protrusio

Measure fr medial acetabularwall to ilioischial line
Acetabular Protrusio > 3mmin men; > 6mm in women

MR measurement B is the distance between the medial
most point of the acetabular fossa and a line
perpendicular to the horizontal axis that passes throughthe lateral most point of the posterior inner pelvic wall
(curved arrow) at the level of the ischial spine.

Chen L, Boonthathip M et al. Skel Rad 2009(38):123

Acetabular Retroversion

Anterior acetabular rim is more lateral and crosses overposterior acetabular rim. “Figure of 8” or crossoversign
Tannast M et al. AJR 2007;188(6):1540-52.

Labral Tears Classificationl

Arthroscopic classification by
Lage27
Radial flapl Radial fibrillatedl Longitudinal peripherall Unstablell

Initial MR Imaging
classification by Czerny et al28
I. Intralabral signal
II. Contrast extends into labrum
III. Labral detachmentl

BUT, these 2 systems do notcorrelate well with ea other25

Resnick’s MR Classification ofLabral Tears
l
l

l

Use sagittal plane forlocation of tearCoronal plane (crossreference to other planes) for
type of tear
Types:
1.
2.
3.
4.
5.

Longitudinal verticalLongitudinal horizontal
RadialComplexLabral detachmentl

6.

From bone or articularcartilage

Acetabulolabral articular
destruction (ALAD)

Resnick D. IDJ Advanced Intensive MR
Imaging Course Feb 2009

1.

2.

3.

4.

Bone

5.

Cartilage

Bone
Cartilage

6.

Labral Tears: Location isEverythingl Most tears are anterior or anterosuperiorl Theories: poorer vascular supply,

mechanically weaker and subject to greater
stressl Marginal attachment to cartilage, parallel
collagen fibers to cartilage32l Posterosuperior tears can occur inyounger pts and more common in Japanl Normal labral variants are more likely inthe lower quadrant14 yo female ballerina with “snapping”
sensation of right hip
MR Arthrogram: Coronal T1 FS

Axial T1 FS

Anterosuperior Labral Tear
Courtesy of Dr Tudor Hughes68 yo woman with anterosuperior labral tearStudler U et al. Radiology 2008;249(3):947-954.

38 yo male with avulsion ofanterosuperior labrum

Dinauer et al. AJR 2004;183:1745-53

Labral Tears: Paralabral Cyst

38 yo female with right hip pain for 7 yrs, no trauma
Courtesy of Dr Tudor HughesLabral Tears: Paralabral Cyst

38 yo female with right hip pain for 7 yrs, no trauma
Courtesy of Dr Tudor HughesAcetabulolabral articular
destruction (ALAD)

40 yo male with right hip pain
Courtesy of Dr Tudor HughesLabral Imaging Pitfalls
Terminology:l Perilabral recess or
sulcus: btwn labrum
and capsulel NORMALl Sublabral recess or

sulcus: btwn labrum
and articular cartilage
or subchondral bonel Normal or not??

Normal Perilabral Recess5

Sublabral Sulcus: Confusing Topicl

Breakdown of literature
1981 Walker34: anterosuperior labral cleft in fetal labrum seen w/ lightmicroscopy but not macroscopically, possible prep artifact?
l 1994 Keene38: 100 pts arthroscopy. 2 posteroinferior sublabral sulci.
l 1996 Petersilge35: 10 MRA. No sublabral sulcus.
l 1999 Czerny36: 40 MRA; 6 cadavers. No sublabral sulcus.
l 2004 Dinauer37: 54 MRA, 4 MRI. 13 Posteroinferior sublabral sulci.
l 2006 Saddik39: 24 noncon MRI, 3 MRA. 12 anterosuperior,
14 posteroinferior, 2 anteroinferior, 2 posterosuperior sulcil 2008 Studler40: 57 MRA. 7 anteroinferior, 1 anterosuperior, 2 anterior
sulci.
lll

Definition per above: Partial separation of labrum fr articular cartilage
with normal underlying labrum. Gold standard was arthroscopy.
BUT, there were some examples of sublabral sulcus on MR provento be tear on arthroscopyPosteroinferior Sublabral Sulcus37

Posteroinferior Sublabral Sulcus39

Posterosuperior Sublabral Sulcus39

Anterosuperior Sublabral Sulcus39

Anteroinferior Sublabral Sulcus40

39
Tear or Sublabral Sulcus ?

39Tear or Sublabral Sulcus ?

Anterosuperior
labral tear on
arthroscopy

37
Tear or Sublabral Sulcus ?

37Tear or Sublabral Sulcus ?

Anterior labral
tear
Posteriorsublabral sulcus

Sublabral Sulcus: Bottom Linel Describe the labral finding.
l Location is key.
l If in anterosuperior labrum, consider a tear.
l If in posteroinferior labrum, likely a sulcus sincemost labral tears are anterosuperior in location.
l In other quadrants, be careful dismissing finding
as normal sulcus.

Miscellaneous:Supraacetabular Fossa
Stellate Crease/Lesion

Supraacetabular Fossa andthe Stellate Crease or Lesion
Supraacetabular Fossal Normal notch within theacetabulum deficient ofcartilagel Located above theacetabular fossa at 12:00
l Usually seen in young
peopleStellate Creasel Normal area of stellate
appearance of deficientcartilage at or nearsupraacetabular fossa,
seen on arthroscopy

Stellate Lesion
A subchondral
osseous fragment
within the stellatecreasel A plica attached tothe medial aspect of
the fragment,
extending mediallyand inferiorlyl May be symptomaticl Hip plica describedin arthroscopy
literature41l

Courtesy of Drs Resnick and Sampatchalit

Stoller D. MRI in Orthopaedics
and Sports Medicine 3rd Edit.

Summaryl Normal anatomy and pathology of thecapsule, ligaments and labrum of the hipl Pitfalls in imaging of the labruml Stellate lesionReferences
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.

Shindle M et al. Arthroscopic Management of Labral Tears in the Hip. J Bone Joint
Surg Am. 2008;90 Suppl 4:2-19
Petersen W et al. Structure and Vascularity of the Labrum. Arch Orthop Trauma
Surg 2003;123: 283–288
Kelly B et al. Vascularity of the Hip Labrum. Arthroscopy 2005; 21(1):3-11
Kim YT Azuma H. The nerve endings of the acetabular labrum. Clin Orthop Relat
Res. 1995;320:176-81.
Chatha DS et al. MR Imaging of Normal Hip. MRI Clin N Am 2005;13: 605-15.
Meislin R et al. Role of Hip MRI in Management of Sports-related Injuries. MRI Clin
N Am 2005;13: 635-40.
Ito et al. Proximal Hip Joint Capsule and Zona Orbicularis Contribute to Hip Joint
Stability. J of Ortho Res 2009 on-line paper.
Fuss FK, Bacher A. New aspects of the morphology and functionof the human hip joint ligaments. Am J Anat 1991;192:1-13.
Bardakos N et al. The Ligamentum Teres of the Adult Hip. J Bone Joint Surg
2009;91- B:8-15.
Hewitt J et al. Mech Properties of Human Hip Capsule Ligaments. J of Arthoplasty
2002;17(1): 82-9.
Moorman CT et al. Traumatic Posterior Hip Subluxation in American Football. J
Bone Joint Surg Am. 2003;85:1190-1196.
Martin H et al. Function of Hip Capsular Ligaments: Quantitative Report.
Arthroscopy 2008; 24(2): 188-195

References
13.
14.
15.
16.
17.
18.

19.
20.
21.
22.
23.

Hong R, Hughes T, Gentili A, Chung C. Magnetic Resonance of the Hip. J of Mag
Res Imag 2008;27:435-45.
Laorr A et al. Traumatic Hip Dislocation:Early MRI Findings. Skel Rad 1995;24:239
Philippon M et al. Arthroscopic Findings in Traumatic Hip Dislocation in 14
Professional Athletes. Arthroscopy 2009;25 (2):169-174.
Byrd T et al. Traumatic Rupture of Ligamentum Teres as a Source of Hip Pain.
Athroscopy 2004;20(4): 385-391.
Gray AJR, Villar RN. The Ligamentum Teres of the Hip: An Arthroscopic
Classification of Its Pathology. Arthroscopy 1997;13(5): 575-578.
Philippon MJ, Armfield DR, et al. Detection of Partial Tears of the Ligamentum
Teres of the Hip Using MR Arthrography. Paper #346. AAOS Meeting, Thursday
March 23, 2006
Armfield DR et al. Radiographic and MR Imaging of the Athletic Hip. Clin of Sport
Med 2006(25):211-239
Shindle M et al. Diagnosis and Management of Traumatic and Atraumatic Hip
Instability in the Athletic Patient. Clin of Sport Med 2006(25)-309-326
Aydingoz U, Ozturk MH. MR imaging of the acetabular labrum: a comparative studyof both hips in 180 asymptomatic volunteers. Eur Radiol 2001;11:567-574.
Blankerbaker D et al. The Painful Hip: New Concepts. Skeletal Radiol 2006;35:
352–370
Dinauer P et al. Sublabral Sulcus at the Posteroinferior Acetabulum. AJR
2004;183:1745–1753

References
24.

Steinbach L et al. MR Arthography. RadioGraphics 2002; 22:1223–1246

25.

Blackenbaker D et al. Classification and localization of acetabular labral tears. SkelRad 2007; 36:391–397

26.

Abe I et al. Acetabular Labrum: Abnormal Findings at MR Imaging in Asymptomatic
Hips. Radiology 2000;216(2):576-81.

27.

Lage L et al. The Acetabular Labral Tear: An Arthroscopic Classification. Arthroscopy
1996;12:269-72.

28.

Czerny C et al. Lesions of Acetabular Labrum: Accuracy of MRI and MR Arthrography
in Detecting and Staging Radiology 1996;200:225-30.

29.

Leunig M et al. Fibrocystic changes at anterosuperior femoral neck: prevalence inhips with femoroacetabular impingement. Radiology 2005;236:237–246.

30.

Tannast M et al. Femoroacetabular Impingement Radiographic Diagnosis—What theRadiologist Should Know. AJR 2007;188(6):1540-52.

31.

Chen L et al. Acetabulum Protrusio and Center Edge Angle:New MR-Imaging
Measurement Criteria. Skel Rad 2009(38):123-129.

32.

Cashin M et al. Embryology of Acetabular Labral Chondral Complex. JBJS 2008 90B(8):1019-24.

33.

Mintz D et al. Magnetic Resonance Imaging of the Hip: Detection of Labral
and Chondral Abnormalities Using Noncontrast Imaging. Arthroscopy 2005;21(4):385

References
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.

Walker JM. Histological Study of the Fetal Development of the Human Acetabulum andLabrum: Significance in Congenital Hip Disease. Yale J Bio Med 1981;54(4):255.
Petersilge C et al. Acetabular Labral Tears: Evaluation with MR Arthrography.
Radiology 1996;200:231-35.
Czerny C et al. MR Arthrography of Adult Acetabular Capsular-Labral Complex. AJR
1999;173:345-49.
Dinauer P et al. Sublabral Sulcus at the Posteroinferior Acetabulum: A Potential Pitfall
in MR Arthrography Diagnosis of Acetabular Labral Tears. AJR 2004;183:1745-53.
Keene GS, Villar RN. Arthroscopic anatomy of the hip: an in vitro study. Arthroscopy
1994;10:392–399
Saddik D et al. Prevalence and Location of Acetabular Sublabral Sulci at Hip
Arthroscopy with Retrospective MRI Review. AJR 2006;187:W507-511.
Studler U et al. MR Arthrography of the Hip:Differentiation between an Anterior
Sublabral Recess as a Normal Variant and a Labral Tear. Radiology 2008;249(3):947
Byrd T. Hip Arthroscopy: The Supine Approach. Tech in Ortho 2005;20(1):17
Atlihan D et al. Arthroscopic Treatment of a Symptomatic Hip Plica. Clin Ortho Rel Res
2003;411:174-177.
Stoller D et al. Magnetic Resonance Imaging in Orthopaedics and Sports Medicine 3rdedtion. Lippincott Williams & Wilkins 2007
Resnick D et al. Internal Derangements of Joints 2nd edition. Elsevier 2007.
Resnick D. IDJ Advanced Intensive MR Imaging Course Feb 2009.