Magn Reson Imaging Clin N Am
13 (2005) 605615
MR Imaging of the Normal Hip
Deep S. Chatha, MD, Ritika Arora, MD*
Department of Radiology, New York University, Hospital for Joint Diseases Orthopaedic Institute,
301 East 17th Street, Room 600, New York, NY 10003, USA
The construct of the hip joint is unique in that
it is designed to support the entire body weight
and shifting mechanical loads during ambulation
and activity. When considering normal ambula-
tion, this translates to four to seven times the
body weight being transmitted through each hip
joint. The hip joint accomplishes this via its
unique structure as a ball and socket, or enar-
throdial, joint, where the sphere of the femoral
head moves freely within the rounded cavity of the
acetabulum [1].
In contradistinction to the shoulder joint, the
hip joint is designed for stability. The femoral head
is tightly apposed to the acetabulum, and the
shapes of the acetabulum and femoral head are
designed to complement one another. The apposi-
tion is further accentuated by the addition of
a surrounding brocartilaginous ring, the glenoidal
labrum, which lends even further stability. Sur-
rounding capsular and ligamentous structures pro-
vide additional support. The proximal femur and
adjacent pelvis and acetabulum allow tendinous
attachments for all the muscles involved in ambu-
lation. These surrounding structures are divided
into static and dynamic stabilizers of the hip. The
hip capsule and ligaments, primarily the ilio-
femoral ligament, act as static stabilizers. The dy-
namic stabilizers are composed of the surrounding
muscles and their tendinous attachments, with the
most signicant group being the abductors [2].
Hip imaging protocols
The pelvis should be imaged using a pelvic
or torso phased-array coil. At our institution,
* Corresponding author.
E-mail address: ritika.arora@nyumc.org (R. Arora).
1064-9689/05/$ - see front matter 2005 Elsevier Inc. All rights reserved.
doi:10.1016/j.mric.2005.08.012
dedicated pelvic imaging includes a T1-weighted
sequence and a short tau inversion recovery
(STIR) sequence in the coronal plane, an axial
T1-weighted sequence, and an axial T2-weighted
sequence with fat saturation. For any suspected
marrow process or patients older than 40 years
of age, coronal opposed phase imaging can be
added. The eld of view is large enough to cover
the skin surfaces overlying both hips, and the axial
images are obtained from the top of the iliac crest
to below the lesser trochanters.
If there is a specic complaint regarding one
hip, a local surface coil should be used over the
symptomatic side, usually a shoulder coil. A side-
to-side comparison may be performed with
a coronal or axial sequence of the entire pelvis.
Again, at our institution, dedicated hip imaging
includes a T1-weighted sequence and a STIR
sequence in the coronal plane, an oblique axial
proton densityweighted sequence, and a sag-
ittal T2-weighted sequence with fat saturation
(Table 1).
If there is suspicion of labral pathologic nd-
ings, an MR arthrogram is useful in evaluating the
detailed articular structures. Initially, a uoro-
scopically guided arthrogram is performed just
before MR imaging. Again, a surface coil is used,
because only one hip is of interest. Our MR hip
arthrogram protocol includes a coronal T1-
weighted sequence, an axial T2-weighted sequence
with fat saturation, and triplane (axial, sagittal,
and coronal) T1-weighted sequences with fat
saturation (Table 2). A T2-weighted sequence is
useful for identifying extra-articular uid collec-
tions, such as paralabral cysts, as well as subtle
bone marrow edema [3]. The axial plane is an ob-
lique axial sequence that is oriented along the axis
of the femoral neck.
mri.theclinics.com
606 CHATHA & ARORA

Table 1
Routine hip protocol
Echo train
Sequence FOV Matrix TR TE TI Bandwidth length
Coronal T1-weighted SE 18 256192 400800 Minimum d 16 d
Coronal STIR 18 256192 O2000 2040 150 16 16
Oblique axial 1416 256256 O2000 3040 d 32/64 8
PD-weighted TSE
Sagittal T2-weighted 18 256256 20006000 45 d 32 16
fat-sat TSE
Routine hip MR imaging should be performed with a phased array coil.
Abbreviations: fat-sat, fat-saturated; FOV, eld of view; PD, proton density; SE, spin echo; TE, echo time; TI, in-
version time; TR, repetition time; TSE, turbo spin echo.

Marrow the next region to undergo conversion, and there

is progression of conversion toward the metaphy-
The appearance of marrow signal on MR
seal regions. In the adult, most of the marrow
imaging is dependent on the age of the patient,
within the femur is fatty; however, if hematopoi-
specically the relation of yellow or fatty marrow
etic marrow is present, it is generally restricted to
to that of red or hematopoietic marrow. On T1-
the proximal femoral metaphysis (Fig. 1).
weighted images, predominantly fatty or yellow
In the pelvis, there is usually widely distributed
marrow appears hyperintense, whereas on T2-
hematopoietic marrow throughout childhood.
weighted images, it demonstrates intermediate
The conversion pattern here is much less predict-
signal intensity. Hematopoietic marrow demon-
able than in the femur, and although there may be
strates intermediate signal on both T1- and T2-
fatty marrow replacement as the patient ages,
weighted images because of its higher water
there is often patchy red marrow distribution
content [4,5]. Conversely, cortical and trabecular
throughout adulthood as well.
bone has signicantly lower water content and
thus is markedly hypointense on T1- and T2-
weighted images [6,7].
Osseous and articular anatomy
The signal changes related to the conversion of
marrow in the proximal femur are quite organized The femoral head forms two thirds of a sphere,
and well recognized. In a fetus and at the time of and its articular surface is thicker along the
birth, all bone marrow is hematopoietic; thus, mediocentral aspect and thinnest along the pe-
uniform intermediate signal is present in the femur riphery. The femoral head is directed upward,
and pelvis. Subsequently, there is organized con- slightly anteriorly and medially. Conversely, the
version to yellow marrow, beginning in apophyses acetabular cavity faces obliquely forward, lateral,
and epiphyses of the femur, which generally and downward to create close apposition of the
occurs by 1 year of age. The femoral diaphysis is two articular surfaces. The acetabulum itself is

Table 2
Routine direct hip arthrogram
Echo train
Sequence FOV Matrix TR TE TI Bandwidth length
Coronal T1-weighted fat-sat 18 256256 400800 Minimum d 16 d
Sagittal T1-weighted fat-sat 20 256192 400800 Minimum d 16 d
Oblique axial T1-weighted 18 256256 400800 Minimum d 16 d
fat-sat
Coronal T1-weighted 18 256256 400800 Minimum d 16 d
Axial T2-weighted 18 256256 O2000 2040 d 16 16
fat-sat TSE
Abbreviations: fat-sat, fat-saturated; FOV, eld of view; TE, echo time; TI, inversion time; TR, repetition time; TSE,
turbo spin echo.
 NORMAL HIP 607

Fig. 1. (A) Coronal T1-weighted image of the hip in an adult demonstrates normal marrow distribution in a skeletally
mature individual. The medullary cavity is predominantly hyperintense, corresponding to fatty marrow replacement.
The cortical bone demonstrates hypointense signal on all pulse sequences (arrowheads). Note the intermediate signal
in the supra-acetabular region, indicating patchy red marrow (arrow). The marrow conversion pattern within the pelvis
is less predictable than that of the femur. (B) Coronal T1-weighted image from an MR arthrogram in a young adult with
preservation of red marrow throughout much of the proximal femur and pelvis (arrows). There is fatty marrow replace-
ment within the femoral head and greater trochanter, an apophysis (arrowheads). This is also a normal marrow pattern
in adults.

composed of all three bones of the pelvis and is

hemispheric in shape. Medially, the acetabulum
is formed by the pubis; laterally and inferiorly, it
is formed by the ischium; and superiorly, it is
formed by the ilium [1]. There is a normal cortical
articular ridge along the superior acetabulum that
is often seen on coronal images, which should not
be mistaken for osseous pathologic change
(Fig. 2).
There is also a surrounding brocartilaginous
rim, termed the acetabular labrum or cotyloid liga-
ment, that acts to deepen the hip joint and provide
further stability. At the anteroinferior aspect of the
acetabulum, there is a focal deciency of the bony
acetabulum, termed the acetabular notch. This
notch is bridged by the transverse ligament. The re-
maining opening deep to the ligament is referred to
as the acetabular foramen, which is lled with fat.
It is through this structure that nutrient vessels
Fig. 2. Coronal T1-weighted image of the hip demon-
and nerves perforate to enter the joint (Fig. 3). strating the normal cortical articular ridge (arrow) along
The periphery of the notch subsequently acts as the superior acetabulum. This is a normal nding and
an attachment site for the ligamentum teres. should not be mistaken for osseous pathologic change.
The construct of the hip is further strengthened Normal fat signal (arrowheads) is seen within the acetab-
by attachments to surrounding osseous structures, ular fossa.
608 CHATHA & ARORA

Fig. 3. (A) Sagittal proton densityweighted image at the medial aspect of the hip joint demonstrates the roughened de-
pression of the femoral head, the fovea capitis (FC), as a rounded low-signal irregularity devoid of articular cartilage.
Along the inferior aspect of the joint, the linear low-signal transverse ligament (TL) is seen spanning the acetabular notch
and serves as the attachment site for the ligamentum teres. (B) Axial T2-weighted fat-saturated image after intra-artic-
ular administration of gadolinium at the level of the inferior acetabulum clearly shows the transverse ligament (TL)
spanning the acetabular notch. The two bands of the ligamentum teres (LT) are seen as they extend inferiorly to attach
to the transverse ligament.

namely, the greater and lesser trochanters. The
greater trochanter is a quadrilateral bony emi-
nence at the superior aspect of the junction of the
femoral neck and proximal shaft. The surface of
the greater trochanter has four distinct facets for
tendinous attachments and sites for bursae [2,8].
The lesser trochanter is more of a triangular or
conical eminence that arises at the inferior aspect
of the junction of the femoral neck and the prox-
imal femur and projects posteriorly. Again, there
are three distinct facets along its bony margins
that allow for tendinous insertions.
It is important to examine the surrounding
osseous structures of the hip carefully, because
they are often the cause of cryptic hip pain. The
eld of view for an examination of the pelvis
should include the anterior superior iliac spine, an
anterior protrusion at the junction of the iliac
crest and the anterior border of the pelvis,
whereas a dedicated hip examination is not likely
to include this area. Along the superior margin of
the acetabulum is the second anterior protrusion,
the anterior inferior iliac spine. The anterior
superior iliac spine and anterior inferior iliac spine
serve as important attachment sites for muscles of
the anterior quadrant of the hip, and avulsion
injuries from these sites are not uncommon. The
superior and inferior pubic rami should also be
included in all examinations of the hip, as should
the symphysis pubis, to exclude an insuciency
fracture or arthritic process of the symphysis. The
most posterior and inferior extent of the ischium
is a roughened prominence, the ischial tuberosity,
that allows for the attachment of the hamstring
tendons. Avulsive injuries from this location are
also a common cause of occult hip pain and
should be included in the eld of view for
dedicated hip MR imaging.
Cartilage
The acetabulum is lined by a nearly circumfer-
ential region of articular cartilage known as the
lunate cartilage because of its moon-shaped ap-
pearance en face. The cartilage does not extend
over the acetabular fossa. The fovea capitis is the
only aspect of the femoral head that is not covered
with articular cartilage. The thickest cartilage is
located along the superior margin of the femoral
head, corresponding to the greatest region of
weight bearing. The posterior margin of the
femoral head contains the thinnest region of
articular cartilage [9,10]. On routine MR imaging
of the hip, the articular cartilage of the femoral
head and acetabulum is identied as a thin zone
 NORMAL HIP 609

Fig. 4. Axial (A) and sagittal (B) proton densityweighted fat-saturated images with articular cartilage appearing as
a thin zone of intermediate signal (arrowheads) between the femoral head and acetabulum. Note the absence of articular
cartilage at the fovea capitis (FC) of the femoral head, allowing for the insertion of the ligamentum teres. The low-signal
triangular labrum (La) is well delineated posteriorly.

of intermediate signal on spin echo and gradient inverted Y shape anteriorly, thus lending to its
echo images (Fig. 4) [1113]. lesser used name, the Y ligament of Bigelow (see
With the subsequent evolution of high resolu- Fig. 6C, D). The pubofemoral ligament extends
tion MR imaging techniques, bilaminar and horizontally from the superior pubic ramus and
trilaminar appearances of the articular cartilage obturator crest to the undersurface of the femoral
have been described [1416]. On routine imaging, neck and blends in with the bers of the capsule
these are not often discernible, however. and deep surface of the iliofemoral ligament.
There is an inherent weakening or hole between
the vertical band of the iliofemoral ligament and
Capsular and ligamentous anatomy
An inelastic brous capsule envelops the hip
joint and attaches proximally to the acetabulum,
labrum, and transverse ligament and extends
distally to surround most of the femoral neck
with attachment at the base of the trochanters.
Anteriorly, the capsule extends further laterally
over the femoral neck compared with the poste-
rior aspect (Fig. 5). Most of the bers of the cap-
sule are oriented longitudinally from the pelvis to
the femur. There is a deep layer of circularly
oriented bers termed the zona orbicularis that
encircles the capsule at the base of the femoral
neck, however (Fig. 6A, B). These bers do not
directly attach to bone and may be mistaken for
the acetabular labrum at arthroscopy [17]. Fig. 5. Axial T2-weighted fat-saturated image after
The brous capsule is reinforced by several intra-articular gadolinium administration demonstrates
the anterior (AC) and posterior (PC) capsular insertions
ligaments, namely, the ischiofemoral, iliofemoral,
on the femoral neck. The fovea capitis (FC) and inser-
and pubofemoral ligaments, which are discernible tion of the ligamentum teres are well outlined by the
thickenings of the capsule. The iliofemoral liga- intra-articular contrast. Anteriorly and posteriorly are
ment is the thickest and strongest ligament and thickenings of the capsule and the iliofemoral (IFL)
extends from the anterior inferior iliac spine to the and ischiofemoral (ISL) ligaments, demonstrated as
intertrochanteric line of the femur with an low signal intensity bands.
610 CHATHA & ARORA

Fig. 6. (A) Coronal T1-weighted fat-saturated image from an MR arthrogram delineates the ligamentum teres (LT) and
its attachment to the femoral head at the fovea capitis. The ligamentum teres extends inferiorly to attach along the trans-
verse ligament (TL). At the base of the femoral neck, the zona orbicularis (ZO) is identied as a region of circumferential
bers surrounding the capsule. The superior margin of the iliofemoral ligament (IFL) is well demonstrated as a low-sig-
nal region of capsular thickening. The triangular low-signal acetabular labrum (La) is visualized superolaterally. (B) Line
drawing of coronal section of the hip demonstrates the capsule along with the ligamentum teres and transverse ligament.
(C) Line drawing of anterior view of the hip demonstrates the iliofemoral and pubofemoral ligaments as thickenings of
the capsule anteriorly. (D) Line drawing of posterior view of the hip demonstrates the ischiofemoral ligament and zona
orbicularis bers of the posterior joint capsule.

the pubofemoral ligament anteriorly that can al-
low communication of the joint with the iliopsoas
tendon bursa, which is present in 10% to 15% of
individuals [2]. On MR arthrograms in these pa-
tients, the iliopsoas bursa distends with contrast
and is readily visualized on axial images (Fig. 7)
[18,19]. There are several other smaller bursae sur-
rounding the hip joint; however, these are not
routinely visualized in the normal hip. The ischio-
femoral ligament extends superolaterally from the
ischium along the posterior aspect of the femoral
neck to combine with the bers of the zona orbi-
cularis and insert on the greater trochanter
[19,20].
The ligamentum teres is a weak intra-articular
ligament with a pyramidal morphology. It is
 NORMAL HIP 611

Fig. 7. (A) Axial T1-weighted fat-saturated image after intra-articular administration of gadolinium demonstrates a nor-
mal iliopsoas bursa (IPB) lling with contrast, which is present in 10% to 15% of individuals. The bursa can be seen to
extend around the adjacent iliopsoas tendons (arrowhead ). (B) Axial T1-weighted fat-saturated image of the same pa-
tient at a slightly more inferior level delineates a communication (arrow) with the joint space via an inherent weakening
or hole between the vertical band of the iliofemoral ligament and the pubofemoral ligament anteriorly. (C) Sagittal T1-
weighted fat-saturated image of the same patient shows the anterior relation of the IPB with the hip joint. The transverse
ligament (TL) is well appreciated.

covered by a synovial membrane and extends aspect of the joint capsule inserts several milli-
from its basal attachment as two bands on the meters above the labrum, which creates a normal
acetabular notch and transverse ligament to its perilabral recess (Fig. 8) [23,24]. In addition, the
apex at the fovea capitis, a centrally located joint capsule inserts directly at the base of the la-
roughened depression on the femoral head, which, brum along the anterior and posterior margins of
incidentally, is the only region of the femoral head the joint, thus creating smaller perilabral recesses.
that is not covered by articular cartilage [21]. In
some individuals, only the synovial sheath is pres-
ent without a discernible ligament, and in a small
percentage of the population, neither can be iden-
tied [17]. The ligamentum teres transmits the
foveal artery, which provides a minimal contribu-
tion of the blood supply to the femoral head [22].
The ligamentum teres does not provide signicant
structural integrity to the hip joint, and other than
surrounding this small nutrient artery to the fem-
oral head, its function is not known.
The acetabular labrum is a brocartilaginous
rim that serves to deepen the acetabular cavity.
The transverse ligament is a part of the acetabular
labrum, which bridges over the acetabular notch
at the inferolateral acetabulum to form a complete
circle and blends in with the labrum [17,23]. It
consists of strong attened bers that dier from
the labrum because they do not contain cartilage Fig. 8. Coronal T1-weighted fat-saturated image from
and transform the acetabular notch into a foramen an MR arthrogram demonstrates gadolinium invaginat-
ing into a focal cleft, the perilabral recess (PLR) between
through which nutrient vessels enter the joint. The
the labrum, seen as a triangular hypointense structure
brocartilaginous labrum is most often triangular arising from the acetabulum, and the low-signal linear
in cross-section and is thicker posterosuperiorly capsule superiorly. Again noted is the ligamentum teres
[18,19]. The normal labrum is most often seen as (LT) extending from the fovea capitis to attach to the
a well-dened triangular structure of homoge- transverse ligament (TL). A normal cortical articular
neous low signal intensity [2426]. The superior ridge (AR) is identied.
612 CHATHA & ARORA

Muscle and tendon anatomy just distal to the lesser trochanter. The sartorius
muscle arises from the anterior superior iliac spine
The hip musculature is well identied on T1- or
and runs inferiorly and medially along the thigh to
proton densityweighted images, where the
insert on the proximal tibia as part of the pes an-
muscles demonstrate intermediate signal and are
serinus tendon group. The rectus femoris muscle
separated by high signal intensity fat along the
arises as two tendons: the anterior, or straight,
fascial divisions. In addition to the muscles
tendon arises from the anterior inferior iliac spine,
surrounding the hip and their tendinous attach-
and the posterior, or reected, tendon is anterolat-
ments, the sciatic nerve is a structure that should
eral to the iliofemoral ligament and follows the
be routinely identied on all imaging of the pelvis
lateral brim of the acetabulum (Fig. 10C) [1,2].
or hip. The sciatic nerve is the largest nerve in the
The adductor muscles of the hip lay anterome-
body and measures approximately 2 cm in width.
dially and include the adductor longus, brevis,
It begins as a continuation of the sacral plexus
and magnus as well as the gracilis and pectineus
and travels laterally through the pelvis and out the
and arise from the pubic bone (see Fig. 10D).
greater sciatic foramen just anterior and inferior
The obturator externus arises from the ramus of
to the piriformis muscle, where it is generally seen
the pubis and ischium as well as from the external
as an isointense rounded structure or grouping of
surface of the obturator membrane. Its tendon
neural fascicles surrounded by fat (Fig. 9B).
extends posterolaterally and inserts into the tro-
The muscles in the anterior quadrant of the
chanteric fossa on the medial aspect of the greater
hip, including the iliopsoas, sartorius, rectus
trochanter (Fig. 11A, B).
femoris, and pectineus, act as the primary exors
The lateral quadrant contains the abductor
of the hip. The iliopsoas muscle is seen anterior to
muscles, including the gluteus medius and minimus
the femoral head at the 12 oclock position on
and the tensor fascia latae more supercially (see
axial images and traverses the pelvis and exits
Fig. 10A). The gluteus medius muscle arises lat-
anteriorly over the superior pubic ramus to insert
erally from the ilium and inserts onto the
on the lesser trochanter (see Fig. 9A, B). The pec-
lateral and superoposterior facet of the greater
tineus arises from the iliopubic ramus and inserts

Fig. 9. (A) Sagittal proton densityweighted image demonstrates the origin of the straight tendon of the rectus femoris
(RF) muscle (arrowhead ) from the anterior inferior iliac spine (AIIS). The iliopsoas muscle (ILP) runs anterior to the hip
joint as it descends to insert on the lesser trochanter. The iliofemoral ligament (IFL) is clearly seen anteriorly from its
insertion on the anterior labrum (*) as well as a portion of the ischiofemoral ligament (ISL) posteriorly. (B) Axial T1-
weighted image at the level of the inferior pubic ramus demonstrates the iliopsoas tendon (IPT) inserting onto the lesser
trochanter. The origin of the hamstring muscles from the ischial tuberosity is appreciated as well as the iliotibial band
(ITB) laterally. The sciatic nerve (SN) is clearly seen and surrounded by fat. HT, hamstring tendons.
 NORMAL HIP 613

Fig. 10. Axial oblique T1-weighted images at various levels through the hip joint. (A) Level immediately inferior to the
anterior superior iliac spine. The iliacus (IL) and psoas (PS) muscles are now identied as separate entities. GMax, glu-
teus maximus; GMed, gluteus medius; GMin, gluteus minimus; S, sartorius; TF, tensor fascia latae. (B) Level of the su-
perior acetabulum. The two tendons of the rectus femoris (RFT) are identied. The straight head, which arises from the
anterior inferior iliac spine, is seen more anterior to the reected head, which follows the lateral brim of the acetabulum.
The GMed tendon is seen inserting on the lateral and superoposterior facets of the greater trochanter. The piriformis
muscle (PF) courses out of the pelvis through the greater sciatic notch, and its tendon is visualized inserting on the upper
border of the greater trochanter. (C) Level of the femoral head. The tendon of the obturator internus (arrow) is seen as it
courses through the lesser sciatic notch and joins the superior and inferior gemelli muscles to insert onto the greater tro-
chanter. Gem, gemelli; ILP, iliopsoas; OI, obturator internus muscle; RF, rectus femoris. (D) Level of the lesser trochan-
ter. The muscles surrounding the hip are clearly demarcated by high signal intensity fat. AB, adductor brevis; AL,
adductor longus; OE, obturator externus; Pec, pectineus; QF, quadratus femoris; VL, vastus lateralis.

trochanter, which can be well visualized on sagittal
images. The gluteus minimus muscle lies deep to
the gluteus medius and inserts onto the anterior
facet of the greater trochanter (see Fig. 10C, D) [8].
The muscles in the posterior quadrant include
the extensors and external rotators, consisting of
the gluteus maximus, piriformis, obturator inter-
nus, superior gemellus, inferior gemellus, and
quadratus femoris. The gluteus maximus is a large
supercial muscle that inserts into the iliotibial
band. The piriformis muscle originates from the
anterior sacrum and passes out of the pelvis
614 CHATHA & ARORA

Fig. 11. (A) Coronal T1-weighted image demonstrates the tendinous insertions of the gluteus medius (GMed), gluteus
minimus (GMin), and piriformis (arrowhead) onto the greater trochanter. The muscle bellies of the obturator internus
(OI), obturator externus (OE), quadratus femoris (QF), and adductors (Add) are well seen. (B) Sagittal T1-weighted im-
age through the greater trochanters. The GMed tendon inserts onto the lateral and superoposterior facets of the greater
trochanter. The tendons of the piriformis (P), OI, and OE are seen proximal to their insertions on the greater trochanter
and intertrochanteric fossa.

through the greater sciatic notch to insert on the
upper border of the greater trochanter between
the iliofemoral ligament anteriorly and the gluteus
medius tendon posteriorly (see Fig. 10B). Lying
inferior to the piriformis, the obturator internus
muscle also arises from the medial surface of the
pubis, passes by the lesser sciatic notch, and joins
the superior and inferior gemelli muscles to insert
onto the greater trochanter laterally. The tendi-
nous insertions of these muscles can be well seen
on sagittal images along the facets of the greater
trochanter (see Fig. 11) [8]. The quadratus femoris
lies inferior to the gemelli muscles and inserts onto
the posterior aspect of the greater trochanter.
The hamstring tendons originate at the ischial
tuberosity and can be evaluated using all three
imaging planes. The semimembranosus tendon
arises from the superolateral aspect of the ischial
tuberosity, whereas the conjoined tendon of the
semitendinosus and long head of the biceps
femoris arise from a medial impression on the
superior aspect of the ischial tuberosity [27]. It
should also be noted that the adductor magnus
has a curvilinear attachment to the lateral surface
of the ischiopubic ramus and the inferolateral
aspect of the ischial tuberosity.
Summary
This article reviews the complex normal anat-
omy of the hip joint and its surrounding structures
on MR imaging, including MR arthrography.
Thorough knowledge of the normal appearance
of the marrow and osseous and articular anatomy
as well as the ligaments, tendons, and surrounding
muscles of the hip is essential for imaging
diagnosis.
Acknowledgments
The authors thank Hugh Nachamie for his
illustrations.
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