Howard Roland, Miltenberg Benjamin, Johns William L, Patel Neel, Brahmabhatt Shyam, Salvo John P
Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Orthop J Sports Med. 2025 Aug 8;13(8):23259671251360343. doi: 10.1177/23259671251360343. eCollection 2025 Aug.
The anterior center edge angle (ACEA) is a radiographic parameter commonly utilized for the assessment of anterior acetabular coverage in the setting of various hip abnormalities. However, this measurement is greatly dependent on patient positioning and imaging technique.
To evaluate the utility of a measurement technique utilizing a horizontal reference line and femoral head perfect circles for better control of pelvic obliquity and the assessment of its potential as a more reproducible method for determining the ACEA.
Cohort study (diagnosis); Level of evidence, 3.
There were 3 authors who retrospectively reviewed the false-profile radiographs of 21 patients. Traditional ACEA measurements and novel ACEA measurements utilizing a horizontal reference line and best-fit circles on each femoral head were recorded by each author on 2 separate occasions. A paired test was used to establish the difference between traditional and novel measurements for each reviewer. The intraclass correlation coefficient (ICC) was used to determine interrater and intrarater reliability across both methods. Significance was set at < .05.
The mean ACEA value obtained using the traditional method was 39.72°, and the mean ACEA value obtained using the novel method was 37.68° ( = .36). Intrarater reliability for the novel method was found to be strong (ICC = 0.805-0.966) in all instances. Interrater reliability was found to be strong in all instances utilizing the horizontal reference line (ICC = 0.831-0.902) but was weak for 2 of 3 reviewers using the traditional method (ICC = 0.420, 0.585, and 0.769).
The novel method of measurement was found to have strong agreement within each reviewer across both measurement attempts as well as between all 3 physician reviewers. The traditional method was found to have weak intrarater reliability for 1 of 3 physician reviewers and weak interrater reliability for 2 of 3 reviewers. These results demonstrate that the novel method was more reproducible across individual reviewers and between different reviewers. As such, consideration should be given to utilizing the novel method for measuring the ACEA as a standardized technique in future research efforts on hip dysplasia and femoroacetabular impingement.
前中心边缘角（ACEA）是一种常用于评估各种髋关节异常情况下髋臼前侧覆盖情况的影像学参数。然而，该测量结果在很大程度上取决于患者的体位和成像技术。
评估一种利用水平参考线和股骨头完美圆的测量技术在更好地控制骨盆倾斜方面的实用性，以及其作为一种更可重复的确定ACEA方法的潜力。
队列研究（诊断）；证据等级，3级。
3位作者回顾性分析了21例患者的假斜位X线片。每位作者在两个不同时间记录传统的ACEA测量值以及利用水平参考线和每个股骨头的最佳拟合圆的新型ACEA测量值。采用配对t检验确定每位审阅者传统测量值与新型测量值之间的差异。组内相关系数（ICC）用于确定两种方法之间的评分者间和评分者内信度。显著性设定为P < 0.05。
使用传统方法获得的ACEA平均值为39.72°，使用新型方法获得的ACEA平均值为37.68°（P = 0.36）。发现在所有情况下新型方法的评分者内信度都很强（ICC = 0.805 - 0.966）。在所有使用水平参考线的情况下评分者间信度都很强（ICC = 0.831 - 0.902），但在3位审阅者中有2位使用传统方法时评分者间信度较弱（ICC = 0.420、0.585和0.769）。
发现新型测量方法在每位审阅者的两次测量尝试之间以及所有3位医生审阅者之间都有很强的一致性。发现传统方法在3位医生审阅者中有1位评分者内信度较弱，在3位审阅者中有2位评分者间信度较弱。这些结果表明，新型方法在个体审阅者之间以及不同审阅者之间更具可重复性。因此，在未来关于髋关节发育不良和股骨髋臼撞击症的研究中，应考虑将新型测量ACEA的方法作为一种标准化技术。
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