Abstract
Introduction: Hip impingement syndrome with labral tear is debilitating for young patients. When magnetic resonance arthrogram (MRA) is equivocal for surgical decision making, an additional intra-articular diagnostic injection (IA) can further confirm the diagnosis. We assessed the effectiveness on surgical decision making by combining hip MRA + IA in one single procedure. Methods: We conducted a retrospective review of a prospectively enrolled cohort of patients with hip impingement syndrome who underwent a combined MRA + IA procedure. A 10-mL cocktail containing 0.2% ropivacaine and Omnipaque 300 contrast media was injected into the hip joint, followed by magnetic resonance scanning, in one single outpatient procedure. Patient demographics and MRA findings were documented. Preinjection pain and immediate postinjection pain were assessed using the visual analog scale (VAS). Surgical finding under hip arthroscopy was documented in those who had positive symptomatic relief after injection. Results: 26 patients (7 adolescent boys, 19 adolescent girls, median age 17 years) were analyzed. The VAS score improved from before injection to after injection (5.0 ± 2.6 vs. 2.2 ± 2.1, mean ± SD, P < 0.0001). 1 patient reported no postinjection improvement and had no labral tear identified under hip arthroscopy; all the other 25 patients reported postinjection improvement and had labral tears repaired under hip arthroscopy; 4 among these 25 had negative MRA findings. The average Cam lesion alpha angle was 63.4 ± 7.1°. Conclusions: Combined hip MRA + IA is effective for surgical decision making. One single injection procedure is efficient for both patients and surgeons by eliminating an additional visit and saving costs and lead time for surgical decision making. Avoiding a second needle insertion is also preferable among pediatric and adolescent patients.
Published Version
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