1 Akhtar hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Rowan University, NJ, USA

3 Shahid Beheshti University of Medical Sciences, Tehran, Iran


Background: Acetabular Retroversion (AR) is a hip disorder and one of the causes of pain in this area. Evaluation
of positive Cross Over Sign (COS) on AP X-Rays of the hip is currently the best method of diagnosis of AR. Several
studies have measured co-existence of Ischial Spine Sign (ISS) in patients with AR. In this study we evaluated the
diagnostic value of ISS in confirmation of AR and compared it with the diagnostic value of COS.
Methods: In this study, 4120 AP hip X-Rays from Akhtar Hospital, Shahid Beheshti University of Medical Sciences,
Tehran, were studied. Based on radiologic criteria, 1180 X-Rays were considered as standards and evaluated for ISS,
COS and PWS (Posterior Wall Sign). Data analysis was done for correlation between ISS and COS.
Results: A total of 1180 out of 4120 X-Rays were considered as standard; among which, 86 were diagnosed with
AR based on positive COS in presence of PWS. Both ISS and COS were positive concurrently in 69 X-Rays. ISS
was positive in absence of COS in 11 X-rays. No significant difference in diagnostic value for diagnosis of acetabular
retroversion was found between ISS and COS (P<0.05).
Conclusion: According to our results, both ISS and COS signs can be employed for diagnosis of AR (acetabular
retroversion). Considering the absence of a significant difference between these two signs in confirmation of AR, it can
be perceived that the diagnostic value of ISS in confirmation of AR is equal to COS. Validation of the mentioned results
requires further studies.
Level of evidence: IV


Main Subjects

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