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Arthroscopic Treatment of Femoral Nerve Paresthesia Caused by an Acetabular Paralabral Cyst Taira Kanauchi, MD; Jun Suganuma, MD; Ryuta Mochizuki, MD; Shinichi Uchikawa, MD
abstract Healio.com/Orthopedics. Search: 00000 Full article available online at Healio.com/Orthopedics This report describes a rare case of femoral nerve paresthesia caused by an acetabular paralabral cyst of the hip joint. A 68-year-old woman presented with a 6-month history of right hip pain and paresthesia along the anterior thigh and radiating down to the anterior aspect of the knee. Radiography showed osteoarthritis with a narrowed joint space in the right hip joint. Magnetic resonance imaging showed a cyst with low T1- and high T2-weighted signal intensity arising from a labral tear at the anterior aspect of the acetabulum. The cyst was connected to the joint space and displaced the femoral nerve to the anteromedial side. The lesion was diagnosed as an acetabular paralabral cyst causing femoral neuropathy. Because the main symptom was femoral nerve paresthesia and the patient desired a less invasive procedure, arthroscopic labral repair was performed to stop synovial fluid flow to the paralabral cyst that was causing the femoral nerve paresthesia. After surgery, the cyst and femoral nerve paresthesia disappeared. At the 18-month follow-up, the patient had no recurrence. There have been several reports of neurovascular compression caused by the cyst around the hip joint. To the authors’ knowledge, only 3 cases of acetabular paralabral cysts causing sciatica have been reported. The current patient appears to represent a rare case of an acetabular paralabral cyst causing femoral nerve paresthesia. The authors suggest that arthroscopic labral repair for an acetabular paralabral cyst causing neuropathy can be an option for patients who desire a less invasive procedure.
Figure: Preoperative anteroposterior radiograph of the right hip joint showing narrowing of the joint space (arrow) and cystic lesions in the femoral head (arrowhead).
The authors are from the Department of Orthopaedic Surgery, Hiratsuka City Hospital, Hiratsuka, Kanagawa, Japan. The authors have no relevant financial relationships to disclose. Correspondence should be addressed to: Taira Kanauchi, MD, Department of Orthopaedic Surgery, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka, Kanagawa 254-0065, Japan ([email protected]). Received: April 2, 2013; Accepted: October 9, 2013; Posted: May 14, 2014. doi: 10.3928/01477447-20140430-62
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uxta-articular cysts, including synovial cysts and ganglionic cysts, can potentially compress neurovascular structures.1-3 Around the hip joint, such cysts have been called paralabral cysts and are reported to be a cause of compression of the sciatic or femoral nerve or a vessel.4-7 Hip dysplasia, osteoarthritis, or trauma may be associated with a torn acetabular labrum, which can lead to a paralabral cyst.8 To the authors’ knowledge, only 3 cases of large acetabular paralabral cysts causing sciatica have been reported.9-11 This report describes a case of an acetabular paralabral cyst causing femoral nerve palsy that was cured with arthroscopic surgery.
B
A
Figure 1: Preoperative anteroposterior radiograph of the right hip joint (A) shows narrowing of the joint space (arrow) and cystic lesions in the femoral head (arrowhead). Axial T2-weighted magnetic resonance imaging of the right hip joint (B) shows a cyst (white arrows) arising from the labral tear of the anterior aspect of the acetabulum (white arrowhead), displacing the femoral nerve (N) to the anteromedial side. The femoral artery (A) is also displaced in the same direction, and the femoral vein (V) is compressed into a flat shape.
Case Report A 68-year-old woman had experienced right hip pain and paresthesia along the anterior thigh, radiating down to the anterior aspect of the knee, since November 2010. The inguinal pain became worse when climbing stairs or walking. She visited the clinic in May 2011 because she had gradually become unable to walk long distances because of paresthesia of the anterior thigh and the medial side of the lower leg. Radiography of the right hip joint showed narrowing of the joint space and cystic lesions in the femoral head (Figure 1A). Magnetic resonance imaging (MRI) of the right hip showed a large cyst with low T1- and high T2-weighted signal intensity arising from a labral tear at the anterior aspect of the acetabulum (Figure 1B). The cyst was connected to the joint space and displaced the femoral nerve to the anteromedial side. The lesion was diagnosed as an acetabular paralabral cyst causing femoral neuropathy. During surgery in August 2011, the cyst was punctured under echo guidance and yellow fluid was released. Then arthroscopic surgery was performed with 3 portals (anterior, anterolateral, and lateral). The cartilage of both the femoral head and the acetabulum was eroded and classified as grade 4 (International
MAY 2014 | Volume 37 • Number 5
A
B
Figure 2: Arthroscopic view of the right hip joint from the lateral portal. The damaged cartilage of the acetabulum (A) suggests osteoarthritis. The labrum (L) of the right hip is damaged at the anterosuperior aspect (black arrow). Labral repair was performed with a simple looped suture (B).
Cartilage Repair Society).12 Acetabular labral degeneration and tears creating a flap were observed at the anterosuperior side of the acetabulum (Figure 2A). After debridement of the degenerative labrum and trimming of the acetabular rim, labral repair was carried out with simple stitch sutures with two anchors (BIORAPTOR, Smith & Nephew, Memphis, Tennessee) (Figure 2B). The patient was restricted to nonweight bearing for 2 weeks after surgery. After that, the patient started partial weight bearing, and full weight bearing was permitted 4 weeks after surgery. MRI at the 3-month follow-up showed that the large cyst arising from the acetabulum had not recurred (Figure 3), and the patient reported no problems at the 18-month follow-up.
Figure 3: Postoperative axial T2-weighted magnetic resonance imaging of the right hip joint at the 3-month follow-up. The large cyst had disappeared, but residual portions of the cyst are still visible. The femoral nerve (N), artery (A), and vein (V) have returned to their normal positions and are no longer compressed.
Discussion Some reports of juxta-articular cysts around the hip causing compression of
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adjacent neurovascular structures, such as the femoral nerve, vessels, or sciatic nerve, have been published.4-7,9-11 Cystic lesions that occur near the joint may be classified as either ganglionic or synovial cysts. These 2 entities usually cannot be distinguished with MRI alone, and they are treated similarly. The term acetabular paralabral cyst is therefore usually used for a cystic lesion that arises adjacent to the acetabular labrum.13,14 Thus, some paralabral cysts, namely synovial cysts, are associated with a labral tear.1 Magee and Hinson13 reported that of 13 patients with paralabral cysts of the hip, 10 were found to have a labral tear during surgery. Paralabral cysts of the hip have been described in patients with developmental dysplasia of the hip and osteoarthritis. Shear stress placed on the labrum in these conditions leads to degeneration and tearing. Tears of the labrum also can produce loss of congruity between the femoral head and the acetabulum, which may lead to elevated intra-articular pressure. Dorrell and Catterall15 reported that elevated pressure in the hip joint can force synovial fluid through the labral degenerative tissue or tear into the acetabulum or the soft tissues adjacent to the acetabulum, resulting in a paralabral cyst. In previous reports, acetabular paralabral cysts were more likely to appear posteriorly. The posterosuperior part of the labrum is the most frequent site of involvement because that area is most vulnerable to mechanical stress.8 In recent studies, however, labral tears have usually presented in the anterosuperior aspect of the acetabulum and femoroacetabular impingement is more often reported.16 The current patient had osteoarthritis and ossification in the anterosuperior aspect of the acetabular rim in the right hip joint, suggesting possible femoroacetabular impingement. Therefore, the cyst appeared to be the result of elevated intra-articular pressure and tearing of the labrum at the anterosuperior region of the acetabulum, which led to
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displacement of the femoral nerve in the anteromedial direction. Spontaneous healing of labral tears associated with labral cysts has not been reported. If left untreated, labral cysts tend to enlarge over time.17 Therefore, excision of acetabular paralabral cysts is usually the treatment of choice. Jones et al10 and Sherman et al11 reported a paralabral cyst arising from the posterior aspect of the acetabulum that caused sciatica and was excised with surgery. Sherman et al11 reported that if a paralabral cyst is caused by a labral tear, the cyst may recur after excision of the cyst. In this case, however, synovial fluid flowed between the intraarticular lesion and the paralabral cyst through the tear in the labrum, as seen on MRI. Thus, arthroscopic surgery was selected to allow direct observation of the intra-articular lesions. The operative findings showed a labral tear at the anterosuperior side of the acetabulum that was repaired arthroscopically. Whether a labral tear in an elderly person should be treated with arthroscopy remains controversial. Philippon et al18 reported the survivorship of 153 patients, aged 50 to 77 years, with femoroacetabular impingement who underwent hip arthroscopy. Patients were considered survivors if they had not undergone total hip replacement (THR). Three years after arthroscopic surgery, patients with greater than 2 mm of joint space had a survivorship of 90%, whereas those with 2 mm or less had a survivorship of 57%. In patients with 2 mm of joint space or less, early conversion to THR was reported. The current patient was 68 years old, and radiography showed that the joint space of the right hip was less than 2 mm. However, the main symptom was femoral nerve paresthesia caused by the large acetabular paralabral cyst. Therefore, arthroscopic labral repair was chosen in an effort to stop synovial fluid flow to the paralabral cyst that was causing the femoral nerve paresthesia and because the patient desired a less invasive procedure.19
The results remained satisfactory at least 18 months after surgery, although this is not a well-established treatment for the underlying diagnosis of degenerative joint disease of the hip and the patient may require THR in the future.
References 1. Sanders TG, Tirman PF. Paralabral cyst: an unusual cause of quadrilateral space syndrome. Arthroscopy. 1999; 15(6):632-637. 2. Feldman MD, Rotman MB, Manske PR. Compression of the deep motor branch of the ulnar nerve by a midpalmar ganglion. Orthopedics. 1995; 18(1):65-67. 3. Ogino T, Minami A, Kato H. Diagnosis of radial nerve palsy caused by ganglion with use of different imaging techniques. J Hand Surg Am. 1991; 16(2):230-235. 4. Byström S, Adalberth G, Milbrink J. Giant synovial cyst of the hip: an unusual presentation with compression of the femoral vessels. Can J Surg. 1995; 38(4):368-370. 5. Kalacı A, Dogramaci Y, Sevinç TT, Yanat AN. Femoral nerve compression secondary to a ganglion cyst arising from a hip joint: a case report and review of the literature. J Med Case Rep. 2009; 3:33. doi: 10.1186/17521947-3-33. 6. Stuplich M, Hottinger AF, Stoupis C, Sturzenegger M. Combined femoral and obturator neuropathy caused by synovial cyst of the hip. Muscle Nerve. 2005; 4:552-554. 7. Tatsumura M, Mishima H, Shiina I, et al. Femoral nerve palsy caused by a huge iliopectineal synovitis extending to the iliac fossa in a rheumatoid arthritis case. Mod Rheumatol. 2008; 18(1):81-85. 8. Steiner E, Steinbach LS, Schnarkowski P, Tirman PF, Genant HK. Ganglia and cysts around joints. Radiol Clin North Am. 1996; 34(2):395-425. 9. Juglard G, Le Nen D, Lefevre C, Leroy JP, Le Henaff B. Synovial cyst of the hip with revealing neurologic symptoms [in French]. J Chir (Paris). 1991; 128(10):424-427. 10. Jones HG, Sarasin SM, Jones SA, Mullaney P. Acetabular paralabral cyst as a rare cause of sciatica: a case report. J Bone Joint Surg Am. 2009; 91(11):2696-2699. 11. Sherman PM, Matchette MW, Sanders TG, Parsons TW. Acetabular paralabral cyst: an uncommon cause of sciatica. Skeletal Radiol. 2003; 32(2):90-94. 12. Mainil-Varlet P, Aigner T, Brittberg M, et al. Histological assessment of cartilage repair: a report by the Histology Endpoint Committee of the International Cartilage Repair Society (ICRS). J Bone Joint Surg Am. 2003; 85(suppl 2):45-57.
ORTHOPEDICS | Healio.com/Orthopedics
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13. Magee T, Hinson G. Association of paralabral cysts with acetabular disorders. AJR Am J Roentgenol. 2000; 174(5):1381-1384. 14. Schnarkowski P, Steinbach LS, Tirman PF, Peterfy CG, Genant HK. Magnetic resonance imaging of labral cysts of the hip. Skeletal Radiol. 1996; 25(8):733-737. 15. Dorrell JH, Catterall A. The torn acetabular labrum. J Bone Joint Surg Br. 1986; 68(3):400-403.
MAY 2014 | Volume 37 • Number 5
16. Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005; 87(7):1012-1018. 17. Ikeda T, Awaya G, Suzuki S, Okada Y, Tada H. Torn acetabular labrum in young patients: arthroscopic diagnosis and management. J Bone Joint Surg Br. 1988; 70(1):13-
16. 18. Philippon MJ, Schroder E, Souza BG, Briggs KK. Hip arthroscopy for femoroacetabular impingement in patients aged 50 years or older. Arthroscopy. 2012; 28(1):59-65. 19. Lee KH, Park YS, Lim SJ. Arthroscopic treatment of symptomatic paralabral cysts in the hip. Orthopedics. 2013; 36(3):373376. doi: 10.3928/01477447-20130222-29.
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Arthroscopic Treatment of Femoral Nerve Paresthesia Caused by an Acetabular Paralabral Cyst Taira Kanauchi, MD; Jun Suganuma, MD; Ryuta Mochizuki, MD; Shinichi Uchikawa, MD
abstract Healio.com/Orthopedics. Search: 00000 Full article available online at Healio.com/Orthopedics This report describes a rare case of femoral nerve paresthesia caused by an acetabular paralabral cyst of the hip joint. A 68-year-old woman presented with a 6-month history of right hip pain and paresthesia along the anterior thigh and radiating down to the anterior aspect of the knee. Radiography showed osteoarthritis with a narrowed joint space in the right hip joint. Magnetic resonance imaging showed a cyst with low T1- and high T2-weighted signal intensity arising from a labral tear at the anterior aspect of the acetabulum. The cyst was connected to the joint space and displaced the femoral nerve to the anteromedial side. The lesion was diagnosed as an acetabular paralabral cyst causing femoral neuropathy. Because the main symptom was femoral nerve paresthesia and the patient desired a less invasive procedure, arthroscopic labral repair was performed to stop synovial fluid flow to the paralabral cyst that was causing the femoral nerve paresthesia. After surgery, the cyst and femoral nerve paresthesia disappeared. At the 18-month follow-up, the patient had no recurrence. There have been several reports of neurovascular compression caused by the cyst around the hip joint. To the authors’ knowledge, only 3 cases of acetabular paralabral cysts causing sciatica have been reported. The current patient appears to represent a rare case of an acetabular paralabral cyst causing femoral nerve paresthesia. The authors suggest that arthroscopic labral repair for an acetabular paralabral cyst causing neuropathy can be an option for patients who desire a less invasive procedure.
Figure: Preoperative anteroposterior radiograph of the right hip joint showing narrowing of the joint space (arrow) and cystic lesions in the femoral head (arrowhead).
The authors are from the Department of Orthopaedic Surgery, Hiratsuka City Hospital, Hiratsuka, Kanagawa, Japan. The authors have no relevant financial relationships to disclose. Correspondence should be addressed to: Taira Kanauchi, MD, Department of Orthopaedic Surgery, Hiratsuka City Hospital, 1-19-1 Minamihara, Hiratsuka, Kanagawa 254-0065, Japan ([email protected]). Received: April 2, 2013; Accepted: October 9, 2013; Posted: May 14, 2014. doi: 10.3928/01477447-20140430-62
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uxta-articular cysts, including synovial cysts and ganglionic cysts, can potentially compress neurovascular structures.1-3 Around the hip joint, such cysts have been called paralabral cysts and are reported to be a cause of compression of the sciatic or femoral nerve or a vessel.4-7 Hip dysplasia, osteoarthritis, or trauma may be associated with a torn acetabular labrum, which can lead to a paralabral cyst.8 To the authors’ knowledge, only 3 cases of large acetabular paralabral cysts causing sciatica have been reported.9-11 This report describes a case of an acetabular paralabral cyst causing femoral nerve palsy that was cured with arthroscopic surgery.
B
A
Figure 1: Preoperative anteroposterior radiograph of the right hip joint (A) shows narrowing of the joint space (arrow) and cystic lesions in the femoral head (arrowhead). Axial T2-weighted magnetic resonance imaging of the right hip joint (B) shows a cyst (white arrows) arising from the labral tear of the anterior aspect of the acetabulum (white arrowhead), displacing the femoral nerve (N) to the anteromedial side. The femoral artery (A) is also displaced in the same direction, and the femoral vein (V) is compressed into a flat shape.
Case Report A 68-year-old woman had experienced right hip pain and paresthesia along the anterior thigh, radiating down to the anterior aspect of the knee, since November 2010. The inguinal pain became worse when climbing stairs or walking. She visited the clinic in May 2011 because she had gradually become unable to walk long distances because of paresthesia of the anterior thigh and the medial side of the lower leg. Radiography of the right hip joint showed narrowing of the joint space and cystic lesions in the femoral head (Figure 1A). Magnetic resonance imaging (MRI) of the right hip showed a large cyst with low T1- and high T2-weighted signal intensity arising from a labral tear at the anterior aspect of the acetabulum (Figure 1B). The cyst was connected to the joint space and displaced the femoral nerve to the anteromedial side. The lesion was diagnosed as an acetabular paralabral cyst causing femoral neuropathy. During surgery in August 2011, the cyst was punctured under echo guidance and yellow fluid was released. Then arthroscopic surgery was performed with 3 portals (anterior, anterolateral, and lateral). The cartilage of both the femoral head and the acetabulum was eroded and classified as grade 4 (International
MAY 2014 | Volume 37 • Number 5
A
B
Figure 2: Arthroscopic view of the right hip joint from the lateral portal. The damaged cartilage of the acetabulum (A) suggests osteoarthritis. The labrum (L) of the right hip is damaged at the anterosuperior aspect (black arrow). Labral repair was performed with a simple looped suture (B).
Cartilage Repair Society).12 Acetabular labral degeneration and tears creating a flap were observed at the anterosuperior side of the acetabulum (Figure 2A). After debridement of the degenerative labrum and trimming of the acetabular rim, labral repair was carried out with simple stitch sutures with two anchors (BIORAPTOR, Smith & Nephew, Memphis, Tennessee) (Figure 2B). The patient was restricted to nonweight bearing for 2 weeks after surgery. After that, the patient started partial weight bearing, and full weight bearing was permitted 4 weeks after surgery. MRI at the 3-month follow-up showed that the large cyst arising from the acetabulum had not recurred (Figure 3), and the patient reported no problems at the 18-month follow-up.
Figure 3: Postoperative axial T2-weighted magnetic resonance imaging of the right hip joint at the 3-month follow-up. The large cyst had disappeared, but residual portions of the cyst are still visible. The femoral nerve (N), artery (A), and vein (V) have returned to their normal positions and are no longer compressed.
Discussion Some reports of juxta-articular cysts around the hip causing compression of
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adjacent neurovascular structures, such as the femoral nerve, vessels, or sciatic nerve, have been published.4-7,9-11 Cystic lesions that occur near the joint may be classified as either ganglionic or synovial cysts. These 2 entities usually cannot be distinguished with MRI alone, and they are treated similarly. The term acetabular paralabral cyst is therefore usually used for a cystic lesion that arises adjacent to the acetabular labrum.13,14 Thus, some paralabral cysts, namely synovial cysts, are associated with a labral tear.1 Magee and Hinson13 reported that of 13 patients with paralabral cysts of the hip, 10 were found to have a labral tear during surgery. Paralabral cysts of the hip have been described in patients with developmental dysplasia of the hip and osteoarthritis. Shear stress placed on the labrum in these conditions leads to degeneration and tearing. Tears of the labrum also can produce loss of congruity between the femoral head and the acetabulum, which may lead to elevated intra-articular pressure. Dorrell and Catterall15 reported that elevated pressure in the hip joint can force synovial fluid through the labral degenerative tissue or tear into the acetabulum or the soft tissues adjacent to the acetabulum, resulting in a paralabral cyst. In previous reports, acetabular paralabral cysts were more likely to appear posteriorly. The posterosuperior part of the labrum is the most frequent site of involvement because that area is most vulnerable to mechanical stress.8 In recent studies, however, labral tears have usually presented in the anterosuperior aspect of the acetabulum and femoroacetabular impingement is more often reported.16 The current patient had osteoarthritis and ossification in the anterosuperior aspect of the acetabular rim in the right hip joint, suggesting possible femoroacetabular impingement. Therefore, the cyst appeared to be the result of elevated intra-articular pressure and tearing of the labrum at the anterosuperior region of the acetabulum, which led to
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displacement of the femoral nerve in the anteromedial direction. Spontaneous healing of labral tears associated with labral cysts has not been reported. If left untreated, labral cysts tend to enlarge over time.17 Therefore, excision of acetabular paralabral cysts is usually the treatment of choice. Jones et al10 and Sherman et al11 reported a paralabral cyst arising from the posterior aspect of the acetabulum that caused sciatica and was excised with surgery. Sherman et al11 reported that if a paralabral cyst is caused by a labral tear, the cyst may recur after excision of the cyst. In this case, however, synovial fluid flowed between the intraarticular lesion and the paralabral cyst through the tear in the labrum, as seen on MRI. Thus, arthroscopic surgery was selected to allow direct observation of the intra-articular lesions. The operative findings showed a labral tear at the anterosuperior side of the acetabulum that was repaired arthroscopically. Whether a labral tear in an elderly person should be treated with arthroscopy remains controversial. Philippon et al18 reported the survivorship of 153 patients, aged 50 to 77 years, with femoroacetabular impingement who underwent hip arthroscopy. Patients were considered survivors if they had not undergone total hip replacement (THR). Three years after arthroscopic surgery, patients with greater than 2 mm of joint space had a survivorship of 90%, whereas those with 2 mm or less had a survivorship of 57%. In patients with 2 mm of joint space or less, early conversion to THR was reported. The current patient was 68 years old, and radiography showed that the joint space of the right hip was less than 2 mm. However, the main symptom was femoral nerve paresthesia caused by the large acetabular paralabral cyst. Therefore, arthroscopic labral repair was chosen in an effort to stop synovial fluid flow to the paralabral cyst that was causing the femoral nerve paresthesia and because the patient desired a less invasive procedure.19
The results remained satisfactory at least 18 months after surgery, although this is not a well-established treatment for the underlying diagnosis of degenerative joint disease of the hip and the patient may require THR in the future.
References 1. Sanders TG, Tirman PF. Paralabral cyst: an unusual cause of quadrilateral space syndrome. Arthroscopy. 1999; 15(6):632-637. 2. Feldman MD, Rotman MB, Manske PR. Compression of the deep motor branch of the ulnar nerve by a midpalmar ganglion. Orthopedics. 1995; 18(1):65-67. 3. Ogino T, Minami A, Kato H. Diagnosis of radial nerve palsy caused by ganglion with use of different imaging techniques. J Hand Surg Am. 1991; 16(2):230-235. 4. Byström S, Adalberth G, Milbrink J. Giant synovial cyst of the hip: an unusual presentation with compression of the femoral vessels. Can J Surg. 1995; 38(4):368-370. 5. Kalacı A, Dogramaci Y, Sevinç TT, Yanat AN. Femoral nerve compression secondary to a ganglion cyst arising from a hip joint: a case report and review of the literature. J Med Case Rep. 2009; 3:33. doi: 10.1186/17521947-3-33. 6. Stuplich M, Hottinger AF, Stoupis C, Sturzenegger M. Combined femoral and obturator neuropathy caused by synovial cyst of the hip. Muscle Nerve. 2005; 4:552-554. 7. Tatsumura M, Mishima H, Shiina I, et al. Femoral nerve palsy caused by a huge iliopectineal synovitis extending to the iliac fossa in a rheumatoid arthritis case. Mod Rheumatol. 2008; 18(1):81-85. 8. Steiner E, Steinbach LS, Schnarkowski P, Tirman PF, Genant HK. Ganglia and cysts around joints. Radiol Clin North Am. 1996; 34(2):395-425. 9. Juglard G, Le Nen D, Lefevre C, Leroy JP, Le Henaff B. Synovial cyst of the hip with revealing neurologic symptoms [in French]. J Chir (Paris). 1991; 128(10):424-427. 10. Jones HG, Sarasin SM, Jones SA, Mullaney P. Acetabular paralabral cyst as a rare cause of sciatica: a case report. J Bone Joint Surg Am. 2009; 91(11):2696-2699. 11. Sherman PM, Matchette MW, Sanders TG, Parsons TW. Acetabular paralabral cyst: an uncommon cause of sciatica. Skeletal Radiol. 2003; 32(2):90-94. 12. Mainil-Varlet P, Aigner T, Brittberg M, et al. Histological assessment of cartilage repair: a report by the Histology Endpoint Committee of the International Cartilage Repair Society (ICRS). J Bone Joint Surg Am. 2003; 85(suppl 2):45-57.
ORTHOPEDICS | Healio.com/Orthopedics
n Case Report
13. Magee T, Hinson G. Association of paralabral cysts with acetabular disorders. AJR Am J Roentgenol. 2000; 174(5):1381-1384. 14. Schnarkowski P, Steinbach LS, Tirman PF, Peterfy CG, Genant HK. Magnetic resonance imaging of labral cysts of the hip. Skeletal Radiol. 1996; 25(8):733-737. 15. Dorrell JH, Catterall A. The torn acetabular labrum. J Bone Joint Surg Br. 1986; 68(3):400-403.
MAY 2014 | Volume 37 • Number 5
16. Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005; 87(7):1012-1018. 17. Ikeda T, Awaya G, Suzuki S, Okada Y, Tada H. Torn acetabular labrum in young patients: arthroscopic diagnosis and management. J Bone Joint Surg Br. 1988; 70(1):13-
16. 18. Philippon MJ, Schroder E, Souza BG, Briggs KK. Hip arthroscopy for femoroacetabular impingement in patients aged 50 years or older. Arthroscopy. 2012; 28(1):59-65. 19. Lee KH, Park YS, Lim SJ. Arthroscopic treatment of symptomatic paralabral cysts in the hip. Orthopedics. 2013; 36(3):373376. doi: 10.3928/01477447-20130222-29.
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