Sensitivity of Magnetic Resonance Imaging for Acetabular Labral Pathology in Adolescent and Young Adult Athletes

Abstract

Objectives:Hip impingement and associated labral tears are a common source of pain in adolescent and young adult athletes. The majority of current literature focuses on adult populations while there is a relative paucity of literature on younger athletes. It has been our experience that the proper diagnosis and management of patients with labral pathology in the adolescent athletes is often delayed. One of the reasons for this delay may be the sensitivity of MRIs in diagnosing hip pathology. The sensitivity of MRI to detect labral tears in adults has been reported to be 71-91%. However, the sensitivity of MRI to detect labral pathology in adolescent athletes is unknown. The purpose of this study was to evaluate the sensitivity of MRI in diagnosing labral tears in an adolescent and young adult population.Methods:Patients undergoing hip arthroscopy by 3 sports medicine trained orthopedic surgeons between 2006-2018 were retrospectively reviewed. Patients were included in this study if they had a MRI and subsequently confirmed labral pathology during hip arthroscopy. Patients were excluded if they had a history of prior surgeries of the ipsilateral hip, did not have a diagnosis of femoral-acetabular impingement (FAI) or acetabular labral pathologies, were over the age of 25 or if the MRI did not have a radiologist report available for review. The MRI reports of the patients who met study criteria were reviewed to determine if the radiologist suspected labral pathology. The MRIs were also reviewed by a sports medicine fellowship trained orthopaedic surgeon who was not involved in the patients’ care and was blinded to the radiologist reports. The radiology report and the orthopaedist’s read were then compared against the surgical findings to determine the sensitivity and false negative rates for MR imaging in this patient population.Results:A total of 140 hips in 132 patients (26 males, 106 females) were included in this study with a mean age of 16.7 ± 2.4 years. Of this study cohort, 112 patients had a labral repair and 20 had a labral debridement. Results showed that of the 140 hip MRIs, the official radiology report described the presence of labral pathology in only 76 MRI scans; indicating that the MRI has a sensitivity of 55% and a false negative rate of 44% for the presence of labral pathology. Results of the blinded orthopaedic surgeon’s review showed that of the 140 hip MRIs available, the presence of labral pathology was seen in only 92 MRI scans with a sensitivity of 65% and a false negative rate of 34%.Conclusion:Routine MRI scans had a low sensitivity and high false negative rate for labral pathology in adolescent and young adults regardless of reviewer, even in the presence of retrospective bias. The sensitivity of MRI for labral pathology in this population is lower than that reported in the literature for adult patients. These findings have implications for clinicians who rely heavily on MRI results and radiologist reports in their clinical decision making which may result in delays in appropriate surgical management.