Three-Dimensional Computed Tomography Reconstructions May Detect Pincer Lesions With Higher Sensitivity Than Radiographs in Patients With Femoroacetabular Impingement Syndrome

Abstract

Purpose: To assess the diagnostic capability of radiographs (XRs) to detect pincer lesions compared with 3-dimensional (3D) computed tomography scans in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Methods: We performed a retrospective review of all patients who underwent hip arthroscopy for FAIS between September 1, 2020, and October 2, 2022. Preoperative imaging was reviewed. Pincer lesions were defined as a lateral center-edge angle greater than 40°; a Tönnis angle greater than 0°; the presence of the ischial spine, crossover, or posterior wall sign; and the presence of overcoverage greater than 80%. Under “select criteria,” patients were classified as having a pincer lesion on XRs and 3D computed tomography reconstructions (CTRs) based on the lateral center-edge angle or Tönnis angle alone, whereas “all criteria” added the presence of the crossover sign and coverage percentage. Statistical analysis was performed to determine the diagnostic accuracy of XRs compared with 3D CTRs. Results: A total of 69 patients met the inclusion criteria. There were 21 male patients (30.4%) and 48 female patients (69.6%). The mean age was 33 ± 13.5 years. χ2 Analysis for select criteria found that 3D CTR was more likely than XRs to detect a pincer lesion. χ2 Analysis for all criteria found that 3D CTR was more likely than XRs to detect a pincer lesion. χ2 Analysis further showed that when using XRs, a pincer lesion was more likely to be detected under all criteria than under select criteria. Likewise, when using 3D CTR, a pincer lesion was more likely to be detected under all criteria than under select criteria. Conclusions: In this study, we found that 3D CTR detected pincer lesions in patients undergoing hip arthroscopy for FAIS with significantly higher sensitivity than XRs alone. Level of Evidence: Level III, retrospective cohort study.