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dc.contributor.authorPacker, J.D.
dc.contributor.authorCowan, J.B.
dc.contributor.authorRebolledo, B.J.
dc.date.accessioned2019-05-17T13:21:17Z
dc.date.available2019-05-17T13:21:17Z
dc.date.issued2018
dc.identifier.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85056599199&doi=10.1177%2f2325967118807176&partnerID=40&md5=78b74953df23e9cdd3bcd8238b3d5f4b
dc.identifier.urihttp://hdl.handle.net/10713/9208
dc.description.abstractBackground: The preoperative diagnosis of hip microinstability is challenging. Although physical examination maneuvers and magnetic resonance imaging findings associated with microinstability have been described, there are limited reports of radiographic features. In patients with microinstability, we observed a high incidence of a steep drop-off on the lateral edge of the femoral head, which we have named the "cliff sign." Purpose: (1) To determine the relationship of the cliff sign and associated measurements with intraoperative microinstability and (2) to determine the interobserver reliability of these measurements. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 115 consecutive patients who underwent hip arthroscopy were identified. Patients with prior hip surgery, Legg-Calve-Perthes disease, fractures, pigmented villonodular synovitis, or synovial chondromatosis were excluded, resulting in the inclusion of 96 patients in the study. A perfect circle around the femoral head was created on anteroposterior pelvis radiographs. If the lateral femoral head did not completely fill the perfect circle, it was considered a positive cliff sign. Five additional measurements relating to the cliff sign were calculated. The diagnosis of microinstability was made intraoperatively by the (1) amount of traction required to distract the hip, (2) lack of hip reduction after initial traction release following joint venting, or (3) intraoperative findings consistent with hip microinstability. Continuous variables were analyzed through use of unpaired t tests and discrete variables with Fisher exact tests. Interobserver reliability (n = 3) was determined for each measurement. Results: Overall, 89% (39/44) of patients with microinstability had a cliff sign, compared with 27% of patients (14/52) without instability (P <.0001). Conversely, 74% of patients with a cliff sign had microinstability, while only 12% of patients without a cliff sign had instability (P <.0001). In women younger than 32 years with a cliff sign, 100% (20/20) were diagnosed with instability. No differences were found in any of the 5 additional measurements. Excellent interobserver reliability was found for the presence of a cliff sign and the cliff angle measurement. Conclusion: We have identified a radiographic finding, the cliff sign, that is associated with the intraoperative diagnosis of hip microinstability and has excellent interobserver reliability. Results showed that 100% of young women with a cliff sign had intraoperative microinstability. The cliff sign may be useful in the preoperative diagnosis of hip microinstability. Copyright The Author(s) 2018.en_US
dc.description.urihttps://dx.doi.org/10.1177/2325967118807176en_US
dc.language.isoen_USen_US
dc.publisherSAGE Publications Ltden_US
dc.relation.ispartofOrthopaedic Journal of Sports Medicine
dc.subjectarthroscopyen_US
dc.subjectcliff signen_US
dc.subjecthipen_US
dc.subjectmicroinstabilityen_US
dc.subjectradiographsen_US
dc.titleThe Cliff Sign: A New Radiographic Sign of Hip Instabilityen_US
dc.typeArticleen_US
dc.identifier.doi10.1177/2325967118807176


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