Anterior Inferior Iliac Spine Morphology Correlates With Hip Range of Motion: A Classification System and Dynamic Model

The anterior inferior iliac spine (AIIS) contributes to hip dysfunction in patients with symptomatic impingement and resection of a prominent AIIS can reportedly improve function. However, the variability of the AIIS morphology and whether that variability correlates with risk of associated symptomatic impingement are unclear. We characterized AIIS morphology in patients with hip impingement and tested the association between specific AIIS variants and hip range of motion. We evaluated three-dimensional CT reconstructions of 53 hips (53 patients) with impingement and defined three morphological AIIS variants: Type I when there was a smooth ilium wall between the AIIS and the acetabular rim, Type II when the AIIS extended to the level of the rim, and Type III when the AIIS extended distally to the acetabular rim. A separate cohort of 78 hips (78 patients) with impingement was used to compare hip range of motion among the three AIIS types. Mean hip flexion was limited to 120A degrees, 107A degrees, and 93A degrees in hips with Type I, Type II, and Type III AIIS, respectively. Mean internal rotation was limited to 21A degrees, 11A degrees, and 8A degrees in hips with Type I, Type II, and Type III AIIS, respectively. When the AIIS is classified into three variants based on the relationship between the AIIS and the acetabular rim in patients with impingement, Type II and III variants are associated with a decrease in hip flexion and internal rotation, supporting the rationale for considering AIIS decompression for variants that extend to and below the rim. Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.