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‘Pop’ sign may be indicator for severity of hip injury

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SAN DIEGO — Presence or absence of a ‘pop’ sign in the hip is correlated with the relative severity of labrum or chondral injury, according to a recent study.

Benjamin Domb, MD, presented his findings at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons.

“An observation in cadaveric models has been resistance followed by a ‘pop’ upon dislocation of the femoral head from the acetabulum,” Domb said. “This has been present with the intact acetabular labrum and absent with the disrupted labrum … we termed that the ‘pop’ sign.”

Prospective evaluation

Benjamin Domb

Domb and his group prospectively evaluated 239 consecutive hip arthroscopies, excluding those with arthritis, loose bodies or dysplasia. The team documented intraoperative arthroscopic findings — such as location and pattern of labral tear, grade and size of chondral damage, and ligamentum teres tear — on these hips, comparing those findings to the presence or absence of ‘pop’ sign.

“Looking at the ‘pop’ sign relative to acetabular cartilage injury, we found a positive ‘pop’ sign signified a lower likelihood of higher levels of acetabular cartilage injury,” Domb said. “We found a similar finding with femoral cartilage injury, so a positive ‘pop’ sign signified that patients were less likely to have high levels of femoral cartilage injury.”

Domb reported that the ‘pop’ sign was positive in 69 hips and negative in 153 others. Every patient reported as having labral tears, with larger tears appearing more likely to have an absent ‘pop’ sign. Furthermore, patients who had higher levels of acetabular or femoral damage were determined to be less likely to display a positive ‘pop’ sign.

A gross indicator

“The absence of a ‘pop’ sign was correlated with larger labral tears and larger cartilage defects,” Domb concluded. “We believe that this suggests the size of a labral tear has an effect on the suction seal and on stability, and the fact that higher grades of cartilage damage with the negative ‘pop’ sign being observed suggests that perhaps we may implicate microinstability as a cause of that chondral damage in the hip.”

“The ‘pop’ sign may be a gross indicator of compromise of the labral suction seal and of increased grades of cartilage damage,” he added.

Reference:

• Domb B, McAsey CJ, Botser I, et al. The “pop” sign of the hip: Association with arthroscopic intra-articular findings. Paper #639. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19. San Diego.
• Disclosure: Domb is a paid consultant for and receives research or institutional support from Arthrex Inc.

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