‫‪Hip bone‬‬

‫‪Snuday, Monday, Tuesday, Wednesday 9-10‬‬

‫‪Student number‬‬ ‫‪Name‬‬ ‫‪No.‬‬

‫‪12325465‬‬ ‫أسيل محمود حسن شاللفة‬ ‫‪1‬‬

‫‪12324302‬‬ ‫مراد جمال عطا جابر‬ ‫‪2‬‬

‫‪12325454‬‬ ‫محمد طالل حسن بري‬ ‫‪3‬‬

‫‪12325277‬‬ ‫ملك فراس عبداهلل غزال‬ ‫‪4‬‬

‫‪12324783‬‬ ‫مصطفى منذر مصطفى صوافطه‬ ‫‪5‬‬

‫‪By : Dr. Malek Sabboubah‬‬

‫‪1 of 10‬‬
 Hip bone
Abstract
intensity on MRI, and lack of a cartilaged
P elvic stability and lower limb function
depend on the complicated anatomical
structure of the hip bone, which is made up
defect on arthroscopy, the existence of SAF
can be clearly distinguished from an
acetabular cartilage defect.
of the pubis, ischium, and ilium.This study
focuses on the supraacetabular fossa (SAF), The pectinofoveal fold, often referred to as
pectinofoveal fold, and iliopsoas tendon the middle retinaculum of Weinbrecht, is
while examining several anatomical another important anatomical element of
variants and clinical ramifications related to the hip joint. This fold, which extends from
the hip bone.Located close to the acetabular the lesser trochanter to the fovea capitis,
roof, the SAF is classified into two types: houses the posteroinferior retinacular
type 1 (fluid-filled) and type 2 (cartilage- arteries and branches off of the medial
filled), with prevalence rates that range femoral circumflex artery. Despite being
from 10.5% to 12.6% in adults and higher first diagnosed as a plica, pectinofoveal
in teenagers.The pectinofoveal fold , shown fold usually asymptomatic and can be
in 95% of hip MRIs, can mimic stress detected in 95% of patients on hip MR
fractures of the femur neck but usually arthrogram and 99% on hiparthroscopies. It
manifests with milder symptoms.The can have multiple attachment points and
morphology of the iliopsoas tendon is curves; in 52% of cases, the contour is
diverse, as evidenced by the variances in smooth, and in 48%, the contour is
single-, double-, and triple-banded irregular.
structures that have been found in cadaveric
studies. Further more, the clinical The iliopsoas tendon is a cranial structure
importance of synovial herniation pits, os that serves as the main hip flexor and
astabuli, and other hip bone deformities connects the iliacus muscle, which is the
was examined.Knowing these variances is major muscle, to the lower trochanter of the
essential for making an accurate diagnosis femur. Research has documented changes
and treatment plan for individuals who in the iliopsoas tendon, encompassing
present with hip discomfort or possible hip configurations with one, two, or three
pathology.This study emphasizes how bands. For example, a study utilizing
crucial it is to identify these variances in cadaveric specimens discovered that 28.3%
order to prevent misdiagnosis and of the samples had a single-banded tendon,
guarantee the best possible patient care. 64.2% had a double-banded tendon, and
7.5% had a triple-banded tendon. It is
The supraacetabular fossa (SAF) is a essential for radiologists and surgeons to
frequent anatomic variant that is typically comprehend these variances in order to
found in hip MRIs. It is situated close to prevent misinterpretations, assure proper
the acetabular roof. Dietrich et al.divided diagnosis, and plan treatment for patients
SAF into two types depending on how it with hip pathology.
appeared on MR arthrography: type 1,
which is partially filled with fluid or In conclusion, there are a number of
contrast material because the hyaline structural changes in the hip bone that
cartilage is imperfect, and type 2, which is should be recognized for a precise
totally filled with cartilage.Research has diagnosis and course of treatment. A few
indicated that the frequency of SAF in examples of these variations include the
adults ranges from 10.5% to 12.6%, with SAF, pectinofovealfold, and iliopsoas
greater rates seen in teenagers. Depending tendon, each having unique clinical
on the location, underlying marrow signal importance and ramifications. This study
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emphasizes how crucial it is to comprehend dorsoventrally and articulates with the body
these variances in order to give patients of the pubic bone at the pubic symphysis
with hip discomfort or suspected hip on the other side. It also has pubic tubercle
disease the best care possible. to which inguinal ligament attach.
The superior pubic ramus projects
posterolaterally from the body and joins
Introduction with the ilium and ischium. The superior
margin of pubis is the pecten pubis
Hip bone anatomy (pectineal line), which forms part of the

T he Hip or pelvic bone is irregular in linea terminalis (which is the pronounced

shape bone formed by the union of line separating the greater and lesser
pubis, ischium and ilium, bones, together pelves, formed by, the arcuate line, the
these bones form pelvic girdle (which is sacral promontory, the pectineal line, and
part of appendicular skeleton), and with the pubic crest) and the pelvic inlet.
sacrum and coccyx form the pelvis, in Anteriorly the pubic crest, which also is
addition, the hip bone laterally has a large part of the linea terminalis and pelvic inlet,
articular socket, the acetabulum, which which gives attachment for internal
articulates with femur forming the hip joint, oblique, transversus abdominis, and rectus
which is ball and socket synovial joint, abdominis muscles, and participates in
inferior to acetabulum, also, other joints are formation of the superficial inguinal ring.
formed such as pubic symphysis, the The superior pubic ramus is also marked by
lumbosacral, sacroiliac, and sacrococcygeal obturator groove, which forms the upper
joints. The obturator foramen is formed margin of the obturator canal. The inferior
by the union of inferior pubic ramus and ramus projects inferolaterally to join with
ramus of ischium, it’s almost entirely the ramus of the ischium.[1]
covered with obturator membrane, a
small aperture remains open superiorly The ilium, which is the most superior in
called obturator canal, through which position, is separated into upper and lower
obturator nerves, arteries and veins pass parts by ridge on the medial surface, its
providing communication between lower upper part provides bony support for the
limb and the pelvic cavity.[1] lower abdomen and attachment for muscles
associated with the lower limb, also
contains iliac fossa on the anteromedial
surface filled with iliacus muscle, and the
superior margin of the ilium forms the iliac
crest to which muscles, such as Iliocostalis
lumborum, external and internal oblique
and latissimus dorsi muscle, and fascia
attach. While the irregular anterior margin
of the pelvic bone is marked by the iliac
spine anterior inferior, which serves as
attachment for the rectus femoris muscle of
and the iliofemoral ligament associated
with the hip joint and, anterior superior
iliac spine, to which inguinal ligament
attaches, laterally, tuberculum of the iliac
Figure 1 : Ilium, ischium, and pubis.[1] crest projects and posterior end of the crest
The pubis is the anteroinferior part of the thickens to form the iliac tuberosity.
pelvic bone, which has a body and two Posteriorly, posterior superior and
arms (rami), The body is flattened posterior inferior iliac spine protrude,
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 which helps in formation of the superior features called anatomical variations,
margin of the greater sciatic notch.[1] these variations are present in bones, joints,
The ischium is the posterior and inferior bone markings, arteries, veins and,
part of the pelvic bone. The ischium has a limitedly, nerves.[2]
body, that projects superiorly and joins
ilium and superior arm of pubis, and a Some anatomical variations can lead to
ramus, that projects anteriorly to join with
significant medical conditions, so the
the inferior arm of pubis. On the posterior
knowledge of these variations may help in
margin, ischial spine, separates between
two notches, the greater sciatic notch, prevention from further complications,
through which the piriformis muscle pass, treatment of these conditions (pre-
and superior gluteal vessels and nerves disposition to illness), or can help in
leave the pelvis, and the lesser sciatic surgical field, such as laparoscopy, and
notch, through which the tendon and nerve clinical examination. [2]
of obturator internus as well as the
pudendal nerve and vessels pass. There are a lot of anatomical variations
The posterior margin terminates inferiorly observed in the hip bone to which the
as the ischial tuberosity which forms the radiologist must be aware; To differentiate
origin for some muscles such as between false abnormalities and variations
Ischiocavernosus and Superficial transverse that may resemble pathologic abnormalities
perineal muscles.[1] (Figure 1 and Figure 2) on hip MRI. These variants include
synovial herniation pits, os acetabuli,
De nition of anatomical variation iliopsoas bursa, accessory iliacus tendon,
ligamentum teres, plicae, pectinofoveal

A s well known, structures of human

body are very different, even the same
structures or body parts of different
fold, supraacetabular fossa, stellate crease,
and tubular tracking.

individuals, these unique morphological

B
A

Figure 2 : Components of the pelvic bone. A . Medial surface B . Lateral surface.[1] 4 of 10

fi
 years; 66.8% female). 12.6% of the 27 hips
Findings had SAF. There were twenty-three type 2
SAF. (age 33.0-16.3 years) and five type 1
Supraacetabular Fossa SAF (mean age 16.8±2.2 years). According
t o t h i s s t u d y, t h e p r e v a l e n c e o f
O n both coronal and sagittal imaging,
the supraacetabular fossa (SAF) is
typically seen near the acetabular roof's 12
supraacetabular fossa in hips is 12.6%. The
sensitivity of radiology reports in
accurately detecting Supraacetabular Fossa
o'clock position. Dietrich et al. divided the on MRI was 7.1%.[4]
supraacetabular fossa into two types for
MR arthrography: Type 1 in which contrast
material or fluid is seen due to the Pectinofoveal Fold
incomplete hyaline cartilage filling the
depth within three fossa, while type 2 is
fully filles with cartilage. Types 1 and 2 are
T he posteroinferior retinacular arteries
and branches of the medial femoral
circumflex artery are located in the
detected in 1.6% and 8.9% of instances on pectinofoveal fold, commonly referred to as
MR arthrography, respectively. The the middle retinaculum of Weitbrecht. It
placement of supraacetabular fossa, the runs from the lesser trochanter to the fovea
existence of normal underlying marrow capitis. Initially classified as a plica, the
signal strength on MRI, and the lack of pectinofoveal fold is unlikely to develop
cartilage defects on arthroscopy allow for symptoms, in contrast to plicae. 99% of
an easy differentiation from an acetabular cases on arthroscopy and 95% of cases on
cartilage defect, despite the fact that it can hip MR arthrography have the
mirror one.[3] pectinofoveal fold, which is a highly
common finding . The fold can have
several attachment locations and looks.
Compared to the femur, which only occurs
in 25% of cases, the joint capsule is the
location of insertion in 75% of cases. The
most crucial factor in firmly identifying the
pectinofoveal fold is its location; if the
structure is discovered elsewhere in the
joint, it ought to be classified as a plica. In
52% of cases, a smooth contour is
observed, however in 48% of cases, an
uneven contour is. Therefore, a fold that
appears irregularly need, not always, to be
regarded as aberrant or pathological. [5]

In 144 of the 152 patients (95%) and 150 of

the 152 patients (99%) in this study, the
pectinofoveal fold was visible on hip MR
arthrograms and at hip arthroscopy,
respectively. In the mediolateral dimension,
Figure 3 : Supraacetabular Fossa.[2] the average thickness of the fold was 2.6
mm (range: 1–13 mm), while in the
A previous study aimed to determine anteroposterior dimension, it was 17 mm
Supraacetabular Fossa prevalence on MRI (range: 1-32 mm). The superior-inferior
of patients with hip pain. Analysis was dimension fold had an average length of
done on 214 hips (age range: 35.9–14.2 23.3 mm (range: 7-44 mm). Seventy-five of
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the 144 patients (52%) whose exams respectively. The psoas major tendon was
revealed the pectinofoveal fold had a consistently the most medial tendinous
smooth shape, while 69 of the 144 patients structure, and the primary iliacus tendon was
(48%) did not. Of the 144 individuals, 108 found immediately lateral to the psoas major
(or 75%) had the fold insert onto the tendon within the belly of the iliacus muscle.
capsule, whereas the remaining 36 had the When present, an accessory iliacus tendon was
fold insert onto the femur. [6] located adjacent to the primary iliacus tendon,
lateral to the primary iliacus tendon. [9][10]
[11][12]

Figure 6 : frontal T1-weighted image, the arrow

Figure 5 : Pectinofoveal Fold.[3] is pointing on the bi d iliopsoas tendon at
level of the femoral neck. [4]

The iliopsoas tendon

Synovial Herniation Pits

T he iliopsoas tendon is a tendon that

connects both of iliacus muscle and
psoas major muscle to lesser trochanter of S ynovial herniation pits, (Pitt pits), are
tiny, benign oval lesions that were
the femur, the main flexors of the hip joint. initially identified by Michael J. Pitt in
The tendon mostly consists of two tendons, 1982. And they are primarily seen at the
the iliacus and the psoas tendon, but the superolateral aspect of the proximal
numbers could vary among people. anterior femoral neck.[11]

A previous research studied 53 nonmatched,

Radiographically other cystic lesions, such
fresh-frozen, cadaveric hemipelvis specimens
as trabecular rearrangement at the anterior
(average age, 62 years; range, 47-70 years; 29
femoral neck, degenerative alterations, and
male and 24 female) were used. The iliopsoas
localized osteoporosis, can resemble
muscle was exposed via a Smith-Petersen
herniation pits. some research shows that
approach. A transverse incision was made
only 4–12% of the general population has
across the entire iliopsoas musculotendinous
herniation pits.[3]
unit at the level of the hip joint. Each distinctly
identifiable tendon was recorded, and the Os Acetabuli
distance from the lesser trochanter was
recorded.[7][8][9][10]
M ultiple primary and accessory
ossification centers fuse to produce
the acetabulum, which can occur as early as
The existence of a single-, double-, and triple-
banded iliopsoas tendon was in this
age 6. These ossification centers should
proportions: 28.3%, 64.2%, and 7.5%,
have combined to create a single bone by

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the time they reached the age of 18 or 20 affecting it’s normal function.
years old. Yet, study indicates that an
auxiliary ossification center referred to as The results indicate a significant variations
an os acetabulum may continue to exist as in the hip bone, using different equipment
an ossicle, the prevalence of Os is and sources.
estimated to be between 3.4% to 7.7%, with
higher numbers in males compared to Beginning with True Os acetabuli which
females. intact Hyaline cartilage surrounds was defined as an unfused secondary
the os acetabuli, which are not fused to the ossification centre along the acetabular rim.
acetabulum.[13] An interpretation of other studies in Os
Acetabuli reveals correspond between the
results, which focused on investigating the
results of arthroscopic treatment of Os
Acetabuli in 273 patients, by orthro MRI,
21 of them (7,7%) 20 of them were male,
were diagnosed with Os Acetabuli.[13]

While, as mentioned before, synovial

Herniation Pits is found in (4%-10%) of
adult population, and seen more frequently
in older men than women, another study
offer a higher rate, and that was explained
by them having Femoroacetabular
impingement (FAI), which then has been
presented as the main cause for these
Figure 7 : Os Acetabuli. [5]
herniation pits, FAI happens when flexion
and internal rotation of the hip cause
morphological changes in the femoral head
and neck and/or the acetabulum, which
then lead to contusional lesions to the
labrum and cartilage.

According to a 2005 study by Leunig

Metal, the cystic alterations observed in the
superolateral quadrant of the femoral neck
were most likely the result of repeated
mechanical contact between the acetabulum
and the femoral neck rather than a
coincidental finding. Radiographs from 117
hips with FAI and 132 hips with
Figure 8 : synovial herniation pits. [5]
developmental dysplasia (DD) were
compared retrospectively. In 33% of the
FAI group and none in the DD group, they
Discussion discovered fibrocystic alterations.[14]

W e aimed by doing this research to And in relation with iliopsoas tendon, in

present the unique morphological Evelina London Children's Hospital from
features of the hip bone that deviate from 2007 to 2013, MRI hip and pelvis images
those that have been classically described of 50 sequential children aged between
in known anatomy textbooks, without 7-15 years were checked, Included 37
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children with imaging of both hips and 13 Even though anatomical variations rarely
children with imaging of one hip only. so, effect the function of the organ, but
this one was based on a total of 87 hips. Observing such details could help avoiding
confusion with other injuries or infections,
In every 13 children (26%), there was at also to recognize the potential precursor for
least one bifid tendon. Out of 37 children more complicated issues and prevent them,
(14%), five had bilateral bifid tendons and in the following study The pectinofoveal
both hips were adequately imaged. fold is discussed in relation to MRI
Eighteen (21%) of the 87 hips that were findings that could be mistaken as femur
sufficiently imaged showed evidence of neck stress fractures.
two distinct distal iliopsoas tendons. [15]
The study found that, similar to plicae in
the knee, the pectinofoveal fold can induce
chondromalacia and bone marrow edema,
which can lead to hip discomfort. And then
concluded that reactive edema resulting
from a pectinofoveal fold is typically less
severe than edema resulting from a stress
fracture of the femur neck.[17]

Conclusion
Figure 9 : Transverse T1-weighted image In summary, anatomical variations occurs
showing the bi d iliopsoas tendon. [4] frequently in clinical anatomy and practice,
A further anatomical variation has been as a medical professional it is a must to
mentioned of the acetabular roof is the recognize these variations because they
supraacetabular fossa (SAF) that can may lead to a change in the clinical practice
resemble a cartilage defect. There are two routine or dissection sessions.
distinct subtypes known: type 1 fluid-filled
and type 2 cartilage-filled. According to In our research many studies were observed
reports, the adult prevalence of SAF ranged considering the anatomical variations
from 10.5% to 12.6%. an additional study compared to the normal hip bone anatomy,
that looks at the incidence of SAF in a via multiple approaches such as cadaveric
group of kids and young adults and looks dissections, MRI, and hip arthroscopy,
into any possible remodeling of the which indicates a variety of results
subtypes over time, found results that link including supraacetabular fossa,
the prevalence of the SAF and age. Where pectinofoveal fold, the ilipsoas tendon,
Study participants ranged in age from 4 to synovial Herniation Pits and Os acetabuli.
25. According to the study, 63 of the 323 Sex, age, and pathological factors were
115 (or 35.6%) participants with SAF had included in the discussion as a potential
type 1, 51 had type 2, and one had both. factors that could affect the prevalence of
The expected probability for SAF increases such unique anatomical characteristics of
up to the age of 14, at which point the the hip bone. Finally, there is a need for
combined predicted probability for both further research on the assessment and
subtypes declined once more. So learning of these anatomical variations in
Adolescents are more likely to experience the medical field.
SAF. thus the size and prevalence of the
SAF decreased with age.[16]

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 8) Tatu L., Parratte B., Vuillier M., et al.
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2) https://radiopaedia.org/cases/supra-
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