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. 2022 Dec 12;23(1):1082.
doi: 10.1186/s12891-022-06045-7.

A comparison between ultrasound-guided AIIS injection and radiography in the diagnosis of subspine impingement in patients with FAI

Zi-Yi He #  1   2 , Zi-Ming Liu #  1 , Gui-Juan Bi  1 , Xiao-Le Zhang  1 , Jian-Quan Wang  1 , Ling Jiang #  3 , Xiao-Dong Ju #  4
Affiliations

A comparison between ultrasound-guided AIIS injection and radiography in the diagnosis of subspine impingement in patients with FAI

Zi-Yi He et al. BMC Musculoskelet Disord. .

Abstract

Background: Subspine impingement (SSI) does not have effective diagnostic criteria, especially in patients who also have femoroacetabular impingement (FAI). The classification of anterior inferior iliac spine (AIIS) morphology via three-dimensional CT is controversial.

Purpose: To propose a method for ultrasound-guided AIIS injection as a way to diagnose SSI and evaluate the accuracy of radiography methods, including 3-D CT and MRI, as well as intraoperative findings.

Methods: Patients diagnosed with FAI between September 2020 and December 2021 were evaluated in this prospective study. Those who met the criteria were included in the ultrasound-guided AIIS injection test. Whether the pain was relieved after injection was recorded in the radiology report. Patients who experienced significant relief of the anterior groin pain (more than 50%) after the AIIS injection were considered positive responders. Among these patients, radiography materials, including AIIS morphology as measured by 3-D CT as well as superior capsular oedema on MRI, were compared. The presence of congestion or bruising on the capsule side of the labrum corresponding to the AIIS during hip arthroscopy was recorded.

Results: A total of 73 patients with FAI underwent the ultrasound-guided AIIS injection test. Prevalence rates of 13.70% (10/73), 58.90% (43/73), 23.29% (17/73) and 4.11% (3/73) were recorded for Type I, Type IIA, Type IIB and Type III AIISs, respectively. Thirty-six patients had positive responses to injection, and 37 patients had negative responses to injection. None of the patients with Type I, 23 (53.49%) patients with Type IIA, 11 (64.71%) patients with Type IIB and 2 (66.7%) patients with Type III AIISs had positive responses to the injection. A total of 57.14% of patients with Type II or Type III AIIS had positive responses to the injection. The proportions of patients with superior capsular oedema on MRI in the Type I, Type IIA, Type IIB, and Type III AIIS groups was 0, 30.23, 29.41 and 0%, respectively. Among non-Type I AIIS patients, those who reported positive responses to the injection had a higher incidence of superior capsular oedema (38.89% vs. 14.81%, P = 0.036), but they had no significant differences in the proportion of congestion or bruising of the labrum (47.22% vs. 37.04%, P = 0.419). The results showed that no pairs of methods-ultrasound-guided injection, MRI, and intraoperative findings-achieved good consistency (κ = 0.222, κ = 0.098 and κ = - 0.116).

Conclusions: Radiographic methods including 3-D CT and MRI as well as the intraoperative findings of the labrum cannot be considered an accurate and reliable basis for the diagnosis and treatment of SSI in FAI patients. It is suggested that ultrasound-guided AIIS injections be combined with radiography to better diagnose SSI.

Level of evidence: IV, case series.

Keywords: AIIS morphology; Subspine impingement; Superior capsular oedema; Ultrasound-guided AIIS injection.

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Conflict of interest statement

All authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Imaging of Ultrasound Guided AIIS Injection
Fig. 2
Fig. 2
Type I (A), Type IIA (B), Type IIB (C) and Type III (D) AIISs Imaged by 3-D CT
Fig. 3
Fig. 3
Normal Anterior Inferior Iliac Spine (A) and Superior Capsular Oedema in an AIIS on MRI (B-C)
Fig. 4
Fig. 4
Intraoperative Findings of Congestion or Bruising on the Capsule Side of the Labrum in a Patient
See this image and copyright information in PMC

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References

    1. Pan H, Kawanabe K, Akiyama H, et al. Operative treatment of hip impingement caused by hypertrophy of the anterior inferior iliac spine. J Bone Joint Surg Br. 2008;90(5):677–679. doi: 10.1302/0301-620X.90B5.20005. - DOI - PubMed
    1. Sa DD, Alradwan H, Cargnelli S, et al. Extra-articular hip impingement: A systematic review examining operative treatment of psoas, subspine, ischiofemoral, and greater trochanteric/pelvic impingement. Arthroscopy. 2014;30(8):1026–1041. doi: 10.1016/j.arthro.2014.02.042. - DOI - PubMed
    1. Carton P, Filan D. Anterior inferior iliac spine (aiis) and subspine hip impingement. Muscles Ligaments Tendons J. 2016;6(3):324–336. doi: 10.32098/mltj.03.2016.08. - DOI - PMC - PubMed
    1. Larson C, Kelly B, Stone R. Making a case for anterior inferior iliac spine/subspine hip impingement: Three representative case reports and proposed concept. Arthroscopy. 2011;27(12):1732–1737. doi: 10.1016/j.arthro.2011.10.004. - DOI - PubMed
    1. Aguilera-Bohorquez B, Brugiatti M, Coaquira R, et al. Frequency of subspine impingement in patients with femoroacetabular impingement evaluated with a 3-dimensional dynamic study. Arthroscopy. 2019;35(1):91–96. doi: 10.1016/j.arthro.2018.08.035. - DOI - PubMed