Acetabular Labral Injuries Research Articles

髋臼盂唇损伤修复的研究进展

髋臼盂唇损伤修复的研究进展

Comparative analysis between operative and non-operative acetabular labral tear injuries in division 1 collegiate athletes

Acetabular labral tears have shown to be difficult to diagnose and manage in an active and competitive athletic population. The goal of this study was to compare NCAA Division 1 collegiate athletes undergoing operative and non-operative management of their labral injuries by assessing ability to return to competition and secondarily evaluate days lost from sport. A retrospective cohort analysis was conducted on Division 1 collegiate athletes from 2005 to 2020, incorporating all varsity university sports. Records showing MRI confirmed diagnosis were included in the cohort, as well as all pertinent clinical data. Data revealed 10/18 (55%) of individuals managed conservatively versus 23/29 (79%) surgically (p-value = 0.0834) were able to return to sport following treatment. Of those athletes, 22 surgical patients experienced a mean of 324 days ± 223 days lost from sport and nine conservatively managed patients experienced a mean of 27 days ± 70 lost days (p-value < 0.001) Seven of nine conservatively managed patients were able to continue competition while undergoing treatment. Findings suggest no statistical significance regarding operative vs non-operative management of acetabular labral tears. The majority of athletes returning to sport and treated conservatively were able to resume competition during treatment. Therefore, treatment of these injuries should be individualized based on athlete’s symptoms.

Research progress in arthroscopic treatment of acetabular labrum injury

To review the surgical methods of arthroscopy in the treatment of acetabular labrum injury, and to provide reference for clinical treatment. The literature about the surgical methods and clinical results of hip arthroscopy in the treatment of acetabular labrum injury was reviewed and analyzed. In the early stages of hip arthroscopy, the removal of the torn labrum is the primary treatment option. The current principles of treatment are based on the specific circumstances of a torn labrum, including acetabular labrum debridement, acetabular labrum repair, acetabular labrum reconstruction, and acetabular labrum augmentation. Hip arthroscopy has become the preferred technique for the treatment of acetabular labrum injury. Labral repair is still the first choice, and labral reconstruction is used when acetabular labrum injury cannot be repaired.

All-suture anchors in arthroscopic acetabular labral repair: our experience.

Background:Over the past years, the role of the acetabular labrum in hip joint biomechanics and its relations with joint health has been of particular interest. There is a good clinical improvement of patients in whom the acetabular labrum is preserved during arthroscopic hip surgery. The purpose of this study is to report the results of arthroscopic repair of labral tears at a medium term follow up.Materials and methods:We performed a retrospective review of all cases that underwent hip arthroscopy at our Institution from January 2013 until December 2018. There were 24 patients, 13 males and 11 females, and their mean age at the time of surgery was 29, 42 years (range, 19 to 43 years). All patients were treated by the same surgeon with an extracapsular OUT-IN approach. Suture was performed using a non-absorbable suture anchor all-suture. Clinical assessment was performed at December 2019 using a modified Harris hip score (mHHS), hip outcomes score activities of daily living (HOS ADL), hip outcomes score activities of sport scale (HOS SS). All patients with acetabular labrum injury had femoro-acetabular impingement.Results:The mean overall values in the preoperative period were 67.21 ± 10.31 for mHHS, 70.04 ± 12.11 for HOS-ADL and 60.06 ± 14.58 for HOS –SS. The results obtained in the re-evaluations of patients in December 2019 with a mean follow-up of 38, 3 months (minimum 1 year) are on average 82.17 ± 11.36 for mHHS, 83.00 ± 12.80 for HOS-ADL and 76.09 ± 18.52 for HOS-SS.Conclusions:The progress of knowledge and the advancement of diagnostic and therapeutic skills has led to a greater awareness of the importance of treating acetabular labrum tears. Arthroscopic treatment with suture appear to be a good option for these patients and we had encouraging results in our center. (www.actabiomedica.it)

Improvement in Functional Outcome Scores Despite Persistent Pain With 1 Year of Nonsurgical Management for Acetabular Labral Tears With or Without Femoroacetabular Impingement

Background: Acetabular labral tears are increasingly recognized as a source of hip pain in a younger active population. Given the significant focus on surgical intervention, there has been limited investigation on the nonsurgical management and natural history of such injuries. Hypothesis: Patients undergoing nonsurgical treatment for symptomatic acetabular labral tears experience functional improvement based on patient-reported outcome measures over the course of 1 year. Study Design: Case series; Level of evidence, 4. Methods: Seventy-one patients were identified who had acetabular labral injuries confirmed by magnetic resonance imaging or arthrography, received a minimum of 1 year of nonsurgical treatment, and completed baseline functional outcome questionnaires: modified Harris Hip Score (mHHS), Hip Outcome Score (HOS)–Activities of Daily Living, HOS-Sports, and iHOT-33 (International Hip Outcome Tool–33). Of these, 52 (73.2%) completed the minimum 1-year follow-up questionnaires. Chart review was conducted to obtain demographic information. Statistical significance (P < .05) was determined by paired t test, independent samples t test, and chi-square test. Results: Twenty-two male and 30 female patients completed 1-year follow-up questionnaires. Mean ± SD follow-up time was 16.2 ± 3.1 months. The cohort had a mean age of 38.9 ± 9.3 years. Baseline radiographs demonstrated minimal arthritis (Tönnis grades 0-2). Mean alpha angle differed significantly between men and women at 52.9°± 8.6° and 46.3°± 8.5°, respectively. At 1-year follow-up, patients experienced a significant improvement in all 4 functional outcome measures (mHHS: 72.6 vs 81.8, HOS–Activities of Daily Living: 78.6 vs 86.4, HOS-Sports: 56.0 vs 71.1, iHOT-33: 47.5 vs 67.9). Patients with and without femoroacetabular impingement demonstrated a significant improvement in the mHHS. However, 48.1% reported no improvement in their pain; 69.2% were limited in their activities; and 40.4% were still considering surgery. Overall, 71.2% were satisfied with nonsurgical treatment. Conclusion: Patients with symptomatic labral tears can experience functional improvement after a minimum 1 year of nonsurgical treatment in the presence and absence of femoroacetabular impingement. However, many report residual pain, alteration of their activities, and interest in surgery. This information is important when patients are counseled in the treatment options for this injury. Identifying the population that responds best to nonsurgical management and comparing outcomes with those undergoing surgical management should be the focus of future research. Longer-term follow-up may be necessary to reevaluate pain, function, and return to activities.

Utility of radial reformation of three-dimensional fat-suppressed multi-echo gradient-recalled-echo images for the evaluation of acetabular labral injuries and femoroacetabular impingement.

To assess the utility of the radial reformation of three-dimensional fat-suppressed multi-echo gradient-recalled-echo (3D FS me-GRE) for evaluating acetabular labral injuries and femoroacetabular impingement (FAI). A total of 25 patients with suspected acetabular labral injuries were examined using 3D FS me-GRE and radial 2D T2*-weighted imaging (T2*WI) on a 3-T magnetic resonance imaging (MRI) scanner. The range of acetabular labral injuries was evaluated by radial reformation through the center of the acetabulum perpendicular to the plane across the entire acetabular rim (type 1 radial reformation) of 3D FS me-GRE and radial 2D T2*WI. To evaluate the FAI morphology, we performed radial reformation perpendicular to the central axis of the femoral head and neck (type 2 radial reformation) of 3D FS me-GRE. Acetabular labral injuries were identified in 23 patients, and no acetabular labral injury was seen in two patients on type 1 radial reformation of 3D FS me-GRE and radial 2D T2*WI. The diagnostic concordance rate for the range of acetabular labral injuries between the two imaging methods was 76.0%, and there was excellent agreement for the injured angles (r = 0.977, p < 0.001). FAI morphology could be evaluated in all patients (no FAI, n = 8; cam, n = 10; pincer, n = 4; combined cam and pincer, n = 3) using type 2 radial reformation of 3D FS me-GRE. Type 1 and type 2 radial reformations of 3D FS me-GRE imaging were useful for evaluating acetabular labral injuries and determining whether patients with acetabular labral injuries have FAI, respectively.

Magnetic Resonance Imaging of the Hip.

Hip pain is common in all age groups, and osteoarthritis of this joint is an increasingly recognized problem particularly in aging populations. One of the primary goals in the diagnostic evaluation in patients with hip pain is to identify and correct pathologies that could progress to osteoarthritis. Magnetic resonance imaging (MRI) has become an important noninvasive method for characterizing hip anatomy and pathology in these patients. Improvements in MRI hardware and techniques have allowed high spatial and contrast resolution imaging to detect subtle abnormalities, such as acetabular labral and articular cartilage injuries, which often contribute to patient symptoms. Newer MRI techniques, such as delayed gadolinium-enhanced MRI of cartilage and T2 mapping, can give insight into the biochemical structure of tissues such as the articular cartilage. In turn, these can allow quantitative assessment and enable imagers to more directly compare the findings of patients at earlier stages of disease. It is important to understand the fundamental principles of various MRI techniques and their limitations to know when these techniques can best be applied. In addition, understanding of normal hip anatomy and common anatomic variants is useful for being able to accurately detect and localize areas of pathology and to prevent misinterpreting normal structures as diseased. The aims of this work were to briefly review normal hip anatomy and common anatomic variants seen on routine MRI examination, to discuss principles often used in high-resolution hip MRI and newer techniques for biochemical evaluation, and to examine several intra-articular pathologic conditions of the hip joint that are of current clinical interest.

Labral Penetration Rate in a Consecutive Series of 300 Hip Arthroscopies

Background: Intraoperative labral injury during the establishment of the first portal in hip arthroscopy has been reported to be as high as 20%. Purpose: The purpose of the study was to prospectively identify the incidence of acetabular labral injuries that occurred while using a current technique for the establishment of portals during hip arthroscopy. Study Design: Case series; Level of evidence, 4. Methods: Between the years 2008 and 2010, data were prospectively collected for all patients undergoing hip arthroscopic surgery. Patients with previous labral resection or Tonnis grade greater than 1 were excluded. Patients were positioned supine, traction was applied, and portals were established. The anterolateral portal was created first by venting the joint with a spinal needle and then re-entering the joint with the same needle with the bevel side facing the labrum. Next, the midanterior portal was created under vision. A thorough examination of the acetabular labrum was conducted arthroscopically through multiple viewing portals, and labral injuries related to the establishment of portals were identified and noted. Results: A total of 300 patients were included in the study; only 2 patients (0.67%) suffered intraoperative labral injuries at the study period. One injury occurred during revision arthroscopy, while the second involved a hyperplastic labrum in a dysplastic hip. No patient with normal hip morphological characteristics undergoing a hip arthroscopy suffered a labral tear as a result of portal placement. Conclusion: The incidence of iatrogenic labral injury during hip arthroscopy can be as low as 0.67% when using the described technique.

Usefulness of Radial Contrast-Enhanced Computed Tomography for the Diagnosis of Acetabular Labrum Injury

The purpose of this study was to evaluate the usefulness of radial contrast-enhanced computed tomography (CT) in the diagnosis of acetabular labrum injury. We studied 21 hip joints in 21 patients (8 joints in 8 male patients and 13 joints in 13 female patients), aged between 16 and 81 years (mean, 43 years) at examination, who underwent both radial contrast-enhanced CT and hip arthroscopy. Plain radiography showed no abnormalities in the bone and joint in 19 joints and acetabular dysplasia in 2 joints. When we performed radial contrast-enhanced CT, a mixture of 5 mL of 2% lidocaine chloride and 10 mL of 64% iotrolan was injected intra-articularly under x-ray fluoroscopy. CT was conducted with a 4-slice multidetector CT system operated at a voltage of 120 kilovolt peak, current of 300 mA, collimation beam of 2 mm, field of view of 320 mm, slice thickness of 0.5 mm, table speed of 44 mm/s, and helical pitch of 5.5. Images were reconstructed by computer software for radial slices at 15 degrees intervals perpendicular to the labral rim. The mean interval between the CT scan and arthroscopy was 13.2 days. By contrast-enhanced CT, acetabular labrum tears were observed in 12 joints, loss of acetabular labrum was found in 1 joint, and no abnormalities were present in 8 joints. By arthroscopy, acetabular labrum tears were observed in 13 joints, loss of acetabular labrum was found in 1 joint, and no abnormalities were present in 7 joints. When the results of the 2 methods were compared, 12 joints had true-positive findings, 8 joints had true-negative findings, and 1 joint had a false-negative finding. Therefore contrast-enhanced CT had a sensitivity of 92.3%, specificity of 100%, and accuracy of 95.2%. The sensitivity, specificity, and accuracy of radial contrast-enhanced CT for the diagnosis of acetabular labrum injury are 92.3%, 100%, and 95.2%, respectively. We recommend radial contrast-enhanced CT for the diagnosis of acetabular labrum injury in patients in whom magnetic resonance imaging is contraindicated. Level IV, diagnostic study.

Sonography of the Acetabular Labrum

The purpose of this series was to describe the improved conspicuity in the sonographic appearance of acetabular labral injuries during routine sonographically guided intra-articular injections. Sonographic examinations of patients undergoing routine sonographically guided intra-articular hip injections were reviewed for evidence of labral injuries (n=21). Sonographic examinations were then correlated with magnetic resonance images of the ipsilateral hip when available (n=14). Before injection, 13 acetabular labra had linear or irregular hypoechoic clefts or fissures through the normally hyperechoic fibrocartilaginous labrum, thought to represent tears. Eight of the labra showed a more globular alteration in morphologic characteristics, with diffuse thickening and irregularity. During intra-articular injection, the visualized injected fluid outlined the labrum, yielding a "sonoarthrographic effect," providing a fluid interface along the labral boundaries, and confirming the presence of a tear by imbibition of injected material into the defect with a resultant subjective improvement in the labral injury. Evaluating the labrum after injection may improve visualization of labral injuries, as a result of greater labral conspicuity.

Imaging of Hip and Groin Athletic Injuries

SummaryHip and groin injuries are usually seen with kicking, running and jumping athletic activities. Both recreational and elite athletes can be involved with hip and groin injuries. Although not very common, sports‐related injuries of the hip and groin may impose a significant diagnostic dilemma for both the clinicians and the radiologists. Delayed diagnosis and treatment may result in complications, such as permanent disability or premature degenerative joint disease. Plain X‐rays are the initial examination although usually unremarkable. Computed tomography can be helpful in certain cases such as tiny avulsion injuries, intraarticular loose bodies and myositis ossificans. Magnetic resonance (MR) imaging of the hip and groin area has proven to be extremely valuable in the diagnosis of radiographically occult osseous abnormalities as well as musculotendinous injuries. MR imaging is helpful in clinically confusing disorders such as stress bone marrow reactions and bursitis. MR imaging following the intraarticular administration of gadolinium is valuable for evaluating the cartilaginous, osteochondral and acetabular labral injuries. The osseous and soft tissue conditions summarized in this article represent those most commonly considered in the differential diagnosis of hip and groin injuries in athletes.