Size and shape of the lunate surface in different types of pincer impingement: theoretical implications for surgical therapy S.D. Steppacher, T.D. Lerch,

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Size and shape of the lunate surface in different types of pincer impingement: theoretical implications for surgical therapy S.D. Steppacher, T.D. Lerch, K. Gharanizadeh, E.F. Liechti, S.F. Werlen, M. Puls, M. Tannast, K.A. Siebenrock Osteoarthritis and Cartilage Volume 22, Issue 7, Pages 951-958 (July 2014) DOI: 10.1016/j.joca.2014.05.010 Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 1 (A) Retroversion was defined by a combination of a positive crossover sign14 (crossing of the anterior and posterior acetabular rim; asterisk), a positive posterior wall sign14 (positive if the posterior wall runs medially to the center of the femoral head; red arrow), and a positive ischial spine sign4 (positive if the anterior superior spine protrudes into the true pelvis; black arrow). (B) A deep acetabulum was defined as a lateral center-edge angle (LCE) exceeding 38°15. (C) A positive protrusio sign was defined by a femoral head touching or crossing the ilioischial line (red dotted line). (D) The normal acetabulum group included hips with a normal appearing acetabulum. (E) Dysplasia was defined as an LCE angle less than 25°17 and a minimal AI of 14°15. Osteoarthritis and Cartilage 2014 22, 951-958DOI: (10.1016/j.joca.2014.05.010) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 2 (A) To assess the three-dimensional morphology of the lunate surface an MRI arthrography of the hip was performed with seven radial slices perpendicular to the head neck axis and 14 positions of measuring. Position 8 was defined as the acetabular notch and position 1 as the opposite position. Anterior was defined as position 4 and 5 for both right and left hips. The subsequent slices were acquired rotating clockwise and counterclockwise around the femoral head neck axis for right and left hips, respectively. (B) The size of the lunate surface was assessed at each position with outer (α) and inner (β) center-edge angles. These angles were defined by the femoral neck axis (a) and a line through the center of the femoral head (C) and the outer (O) and inner (I) edge of the lunate surface, respectively. The arc (γ) was calculated as the difference between outer and inner center-edge angles. Osteoarthritis and Cartilage 2014 22, 951-958DOI: (10.1016/j.joca.2014.05.010) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 3 The three-dimensional shape of the lunate surface was quantified with the outer and inner center-edge angles. The outer (inner) center-edge angle (α and β, respectively) was constructed by the femoral neck axis (a) and a line through the center of the acetabular sphere (C) and the radial position on the outer (inner) edge of the lunate surface. The arc (γ) was the difference between outer and inner center-edge angle and a measure for the width of the lunate surface. Positions 7 and 8 represent the acetabular notch. Osteoarthritis and Cartilage 2014 22, 951-958DOI: (10.1016/j.joca.2014.05.010) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 4 Relative size of the lunate surface for the five study groups. Osteoarthritis and Cartilage 2014 22, 951-958DOI: (10.1016/j.joca.2014.05.010) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions

Fig. 5 Average shape of the lunate surface of the four hip pathologies. For comparison each shape is merged with the lunate surface of the normal acetabulum group (gray shape). (A) Dysplastic hips have a clearly decreased size of the lunate surface, a decreased outer acetabular rim, and an increased acetabular fossa. (B) Hips with retroversion have a decreased size of the lunate surface, a normal shape of the outer rim, and an increased acetabular fossa. (C) Deep hips do not have an increased size of the lunate surface. Their shape of the outer acetabular rim does not significantly differ compared to the normal acetabulum group. The size of the acetabular fossa is increased. (D) Hips with protrusio have an increased size of the lunate surface, a clearly increased outer acetabular rim, and an increased acetabular fossa. In all study groups and the normal acetabulum group three consistent prominences of the outer acetabular rim were found anterosuperiorly, anteroinferiorly, and posteroinferiorly. Osteoarthritis and Cartilage 2014 22, 951-958DOI: (10.1016/j.joca.2014.05.010) Copyright © 2014 Osteoarthritis Research Society International Terms and Conditions