PMC9091960_01
(A) Anterior-posterior (AP) radiograph of the left hip: signs of acetabular retroversion are present; posterior wall sign (PWS), red circle; crossover sign (COS), dotted red and yellow line; ischial spine sign, dashed yellow line. (B) AP radiograph of the left hip: satisfying bony correction and correct screw placement after anteverting periacetabular osteotomy (PAO) of the left hip.
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F1
Initial anterior-posterior (AP) pelvis and left 45 -Dunn-view radiographs before the PAO showed a crossover sign (COS), posterior wall sign (PWS), ischial spine sign, and a lateral center edge angle (LCEA) of 38  (Figure 1A). The post-PAO radiograph of the pelvis obtained showed satisfying bony correction (COS and PWS not observed, LCEA 38 ) and correct placement of osteosynthesis screws as well as complete consolidation of the osteotomy (Figure 1B).
Pre-PAO MRI of the left hip shows the iliopsoas tendon running extracapsularly (red arrow).
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F2
The initial magnetic resonance imaging (MRI) of the left hip showed a lesion of the labrum and an anterolateral subchondral acetabular edema, while the course of the psoas tendon was clearly extraarticular (Figure 2).
Follow-up MRI after minimal invasive PAO with anteversion of the acetabulum showing normal anatomy of the right psoas tendon (yellow arrow) and intraarticular position of the left iliopsoas tendon (red arrow).
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F3
(A) Intraopertive view showing the labrum (L), locally inflamed adhesion (A), and intraarticular position of the iliopsoas tendon (T). (B) View after the arthroscopic release of the adhesion and iliopsoas tendon to prevent further impingement.
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F4
The labrum showed adhesions that were locally inflamed (Figure 4).