Anterior joint capsule of the normal hip and in children with transient synovitis: US study with anatomic and histologic correlation

PURPOSE: To study the anatomic components of the anterior joint capsule of the normal hip and in children with transient synovitis. MATERIALS AND METHODS: Six cadaveric specimens were imaged with ultrasonogr aphy (US) with special attention to the anterior joint capsule. Subsequentl y, two specimens were analyzed histologically. These anatomic findings were correlated with the US findings in 58 healthy children and 105 children wi th unilateral transient synovitis. RESULTS: The anterior joint capsule comprises an anterior and posterior lay er, mainly composed of fibrous tissue, lined by only a minute synovial memb rane. Both fibrous layers were identified separately at US in 98 of 116 (84 %) hips of healthy subjects and in all hips with transient synovitis. Overa ll, the anterior layer was thicker than the posterior layer. In transient s ynovitis compared with normal hips, no significant thickening of both layer s was present (P = .24 and (.)57 for the anterior and posterior layers, res pectively). Normal variants include plicae, local thickening of the capsule , and pseudodiverticula. CONCLUSION: Increased thickness of the anterior joint capsule in transient synovitis is caused entirely by effusion. There is no US evidence for addit ional capsule swelling or synovial hypertrophy.