Characteristic imaging findings of tendinosis of the direct head of rectus femoris and their interpretation |
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| Institution: | 1. Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan;2. Adachi Surgery and Orthopedic Clinic, Sapporo, Japan;3. Department of Orthopedic Surgery, Kita-Akita Municipal Hospital, Akita, Japan;4. Department of Orthopedic Surgery, Omagari Kosei Medical Center, Akita, Japan;5. Akita Hip Research Group (AHRG), Akita, Japan;1. Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama, Japan;2. Department of Orthopaedic Surgery, Saiseika Hospital, Wakayama, Japan;3. Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan;1. Department of Rehabilitation Medicine, School of Medicine, International University of Health and Welfare, Chiba, Japan;2. Department of Orthopaedic and Orthopaedic Rehabilitation, Beijing Bo Ai Hospital, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China;3. Department of Spinal and Neural Function Reconstruction, Beijing Bo Ai Hospital, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China;4. Division of Rehabilitation Medicine, International University of Health and Welfare, Ichikawa Hospital, Chiba, Japan;5. Department of Physical Therapy, Beijing Bo Ai Hospital, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China;6. Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan;1. Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan;2. Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Tokyo, Japan;1. Department of Orthopaedic Surgery, Kansai Medical University Medical Center, Moriguchi, Osaka 570-8507, Japan;2. Department of Orthopaedic Surgery, Kansai Medical University Hospital, Hirakata, Osaka Japan;3. Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo Japan;1. Spine and Spinal Cord Center, International University of Health and Welfare (IUHW), Mita Hospital, Tokyo, Japan;2. Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan;3. Department of Orthopaedic Surgery, Kawasaki Municipal Kawasaki Hospital, Kanagawa, Japan;4. Department of Orthopaedic Surgery, Saiseikai Yokohamashi Nanbu Hospital, Kanagawa, Japan;5. Department of Orthopaedic Surgery, Kyorin University School of Medicine, Tokyo, Japan;6. Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Narita, Japan;7. Keio Spine Research Group (KSRG), Tokyo, Japan;1. Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 6348522, Japan;2. Department of Orthopedic Surgery, Wada Orthopedic Clinic, 2-1-21 Nagao Motomachi, Hirakata, Japan;3. Department of Orthopedic Surgery, Miyata Orthopedic Clinic, 1-11-26 Koganedai, Tondabayashi, Japan;4. Department of Orthopedic Surgery, Kisanuki Orthopedic Clinic, 4-2-21 Nakagawa Ikunoku, Osaka, Japan;5. Department of Orthopedic Surgery, Tatsumi Orthopedic & Plastic Surgery Clinic, 1-257-1 Midorigaoka, Itami, Japan;6. Department of Orthopedic Surgery, Nishimori Orthopedic Clinic, 5-1-4 Hitotsuya, Matsubara, Japan |
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| Abstract: | BackgroundTendinosis at the origin of the direct head of rectus femoris causing anterior hip pain is termed AIISpinitis, but no study has investigated its imaging findings. The aim of the present study was to determine the characteristic imaging findings of AIISpinitis and clarify their pathological significance.MethodsWe reviewed the preoperative imaging findings of 62 hips in 58 patients who had undergone endoscopy with a diagnosis of AIISpinitis. The origin of the direct head of rectus femoris was evaluated by ultrasound (US) and magnetic resonance imaging (MRI), and the positive rate of abnormal findings and their agreement with endoscopy regarding injury of the direct head of rectus femoris were measured. Signal changes in the fat pad around the anterior inferior iliac spine (AIIS fat pad) in MRI were compared with the pathological findings of that harvested endoscopically.ResultsHypoechoic regions in US (53/62, 85%) and signal change in MRI (55/62, 89%) were observed with high frequency and corresponded with injury of the direct head of rectus femoris observed by endoscopy (58/62, 94%) (kappa coefficient, 0.43 moderate agreement], 0.69 good agreement] respectively). Hypoechoic regions had high sensitivity (85%) and specificity (86%) for AIISpinitis. Regarding the AIIS fat pad, punctate and completely hypo-intense change relative to normal fat corresponded to fibrosis and scar formation, respectively (weighted kappa coefficient, 0.51 moderate agreement]).ConclusionsHypoechoic regions on US which had high sensitivity and specificity; and signal change at the origin of the direct head of rectus femoris and hypo-intensity of the AIIS fat pad on MRI were characteristic findings of tendinosis of the direct head of rectus femoris. These findings correspond pathologically to injury of the direct head of rectus femoris and fibrosis or scar formation in the AIIS fat pad, respectively. |
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