Abstract
Objectives:
The acetabular sourcil has been thought of as the radiographic representation of the weightbearing dome of the acetabulum; however, there are limited modern data to support this supposition. In the literature, assessment of weightbearing acetabular coverage has been described using both the sourcil-edge and bone-edge as anatomic landmarks, leading to confusion and controversy in classification of hip dysplasia, indications for hip preservation surgery, and intraoperative coverage assessment. The purpose of this study was to localize the three-dimensional (3D) anatomic correlates of the sourcil-edge and bone-edge radiographic position on false profile radiographs. The authors hypothesized that the sourcil-edge on the false profile represents anterolateral coverage while the bone-edge represents anterior coverage.
Methods:
Forty hips were grouped by large or small differences between bone-edge and sourcil-edge anterior center edge angles (ACEA). The small difference group comprised the lowest quartile of sourcil-edge to bone-edge difference of an initial cohort of 80 hips, while the large difference group comprised the highest quartile of difference. 3D surface mesh models and digitally reconstructed radiographs (DRRs) were generated from hip computed tomography scans using the 3D Slicer Image Computing Platform (Figures 1 & 3). Sourcil-edge, bone-edge, and ACEAs were identified on DRRs and registered to the 3D models with fiducial markers. Intersection of bone-edge and sourcil-edge projection lines with the acetabular rim were obtained from the 3D models (Figures 2 & 4). 3D Anterior acetabular rim morphology was correlated with ACEA difference.
Results:
The bone-edge and sourcil-edge projections intersected the acetabular rim at a mean of 2:08 ± 0:25 and 1:20 ± 0:24 o’clock, respectively. The 3D models consistently demonstrated that, in both large and small discrepancy groups, the sourcil-edge corresponded to an area just posterior to the AIIS projection while the bone-edge corresponded to the weight-bearing region inferior to the AIIS (Figures 2 & 4). Additionally, in large discrepancy hips, the bone-edge corresponded to a more prominent acetabular coverage in the region of the AIIS than when compared to the small discrepancy hips.
Conclusions:
This study demonstrates that both the sourcil-edge and bone-edge projections on false profile radiographs correlate with differing weightbearing regions of the acetabulum. The sourcil-edge ACEA represents coverage at 1:20 o’clock on the acetabular rim and is consistently posterior to the AIIS, while the bone-edge measurement represents the region of the acetabular rim at 2:08 o’clock and is consistently inferior to the AIIS. In hips with a large discrepancy between bone-edge and sourcil-edge (highest quartile), ACEA measurement differs by a mean of 19.7 degrees based on the selection of these radiographic landmarks. These findings have substantial implications for hip preservation surgery technique and clinical decision making.
A comprehensive understanding of femoral head coverage is essential for the treatment of young adult hip pathology. Although the sourcil and bone edge are two of the most important radiographic landmarks for assessment of acetabular dysplasia, descriptions of these landmarks are often over simplified. Some authors have advocated for greater utilization of measurements of coverage to the bone edge as it can be more consistently identified. Other authors have advocated for utilizing the sourcil-edge measurement as this is more representative of the “weight bearing dome”. These descriptions are limited as they do not improve our understanding of the anatomic and radiographic structure of the anterior acetabular rim. Although the concept of the “weight bearing dome” is classically described, it lacks anatomic precision.
The present study clarifies the anatomic features of the acetabular rim that correspond to these radiographic features. Increased difference between the sourcil-edge and bone edge is generated by the differences in undulation of the anterosuperior acetabular rim. Acetabuli that have maximal anterior rim prominence at or near the superior-most aspect of the acetabulum (generally counterclockwise from the AIIS) tend to demonstrate smaller discrepancy between the bone-edge and sourcil-edge (Figure 4). Acetabuli that have maximal rim prominence medial and anterior to the superior-most aspect of the acetabulum generally demonstrate larger discrepancy (Figure 2). The present anatomic description can be utilized by the hip arthroscopist to better determine which areas of the anterior rim may cause impingement. Similarly, while conducting a periacetabular osteotomy, the surgeon may use this information to better understand how acetabular rotation is contributing to both anterior and anterolateral coverage.
In conclusion, on false profile radiographs, the sourcil-edge corresponds to superior femoral head coverage, while the bone-edge corresponds to anterosuperior coverage. False profile radiographs with a large discrepancy between sourcil-edge and bone-edge measurements demonstrate a prominent weight bearing surface in the region of the AIIS. These data regarding the radiographic phenomena of the acetabular rim can aid in clinical decision-making and intraoperative technique.
