Acetabular Labral Tears Research Articles

Comparison Between 3-Dimensional Multiple-Echo Recombined Gradient Echo Magnetic Resonance Imaging and Arthroscopic Findings for the Evaluation of Acetabular Labrum Tear

To evaluate radially reconstructed 3.0-Tesla 3-dimensional multiple-echo recombined gradient echo (MERGE) magnetic resonance imaging (MRI) without arthrography for the assessment of acetabular labrum tears, using arthroscopic evaluation as the reference standard. A total of 71 consecutive hips, including 29 with femoroacetabular impingement, 26 with borderline developmental dysplasia of the hip, and 16 with early-stage osteoarthritis, were evaluated in this retrospective study. MERGE MRI findings were evaluated according to the modified Czerny classification for 3 regions of interest: anterior region, anterolateral region, and lateral region. Cases with severe degeneration that was not concordant with any stage in the original Czerny classification were defined as stage Ⅳ. MERGE MRI findings were compared with arthroscopic findings, and the sensitivity, specificity, positive predictive value, and negative predictive value in terms of the existence of labrum tears were calculated. MERGE MRI findings revealed labrum tears more frequently in the anterolateral region than in the anterior and lateral regions (P < .01). In cases of femoroacetabular impingement and borderline developmental dysplasia of the hip in particular, labrum tears were more frequently observed on MRI in the anterolateral region than in the lateral region (P < .05). In comparison with MRI findings and arthroscopic findings, our newly defined stage IV in the modified Czerny classification was more frequently observed in cases with a Multicenter Arthroscopy of the Hip Outcomes Research Network (MAHORN) classification of degenerative or complex (P < .01). The average sensitivity and specificity of all regions for the existence of labrum tears were 85% and 56%, respectively. Sensitivity and specificity were 79% and 50%, respectively, in the anterior region; 96% and 50%, respectively, in the anterolateral region; and 70% and 57%, respectively, in the lateral region. We validated the diagnostic performance of 3.0-Tesla 3-dimensional MERGE MRI for evaluating acetabular labrum tears and made comparisons with arthroscopic findings. Radially reconstructed MERGE magnetic resonance images showed excellent sensitivity for the diagnosis of labrum tears, particularly in the anterolateral region. The newly defined stage IV was distinctive of early-stage osteoarthritis cases with degeneration and/or complex arthroscopic findings. The noninvasive imaging modality of radially reconstructed MERGE MRI may be an alternative to magnetic resonance arthrography for evaluating labrum tears. Level Ⅱ, development of diagnostic criteria.

Hip Alpha Angle is Associated with Anterior-Superior Labral Tears but not Anterior Labral Tears

IntroductionThe purpose of this study is to examine the associations between hip and acetabular morphology, clinical and demographic patient factors, and acetabular labral tear location in young adults. Materials and methodsThis study was reviewed by the local Institutional Review Board. The hip magnetic resonance imaging arthrograms from 100 young adult patients (aged 18-35 years) who underwent hip arthroscopy within 1 month of the arthrogram were reviewed. Clinical and demographic variables including age, height, weight, body mass index (BMI) and quantitative hip measurements of acetabular anteversion, alpha and beta angles, femoral head extrusion index, lateral center edge angle, acetabular depth-width ratio, Sharp's and Tönnis’ angles were measured, and compared based on acetabular tear location. ResultsNinety-six (96%) of patients had arthroscopically confirmed acetabular tears, and 4 (4%) patients had a normal acetabula labrum. Most (85 [88.5%]) patients had tears involving the anterior-superior labrum and another location, 41 (42.7%) patients had tears involving the anterior labrum and another location, and 35 (36.5%) had tears involving the superior-lateral labrum and another location. Tears commonly occurred in more than one location, with 37 (38.5%) patients having tears in both the anterior and anterior-superior labrum; 28 (29.2%) patients with tears in both the anterior-superior and superior-lateral labrum and 11 (11.5%) patients with tears in the anterior and superior-lateral labrum. Patients with isolated tears of the anterior-superior labrum had on average higher alpha angles than patients with isolated tears of the anterior labrum (P = 0.007). In patients with anterior-superior labral tears, increased BMI (P = 0.033), and weight (P = 0.024) were associated with having concomitant tears of the superior-lateral labrum. DiscussionMR arthrograms are 96% sensitive for detecting acetabular labral tears. Acetabular labral tears tend to co-occur in different locations, with anterior and anterior-superior labral tears most commonly co-occurring. Patients with isolated anterior-superior labral tears had on average higher alpha angles than patients with isolated anterior labral tears.

The Diagnostic Value of Ultrasound in Anterosuperior Acetabular Labral Tear

To investigate diagnostic value of ultrasound in acetabular labral tears compared with magnetic resonance (MR) imaging, using arthroscopic surgery as the gold standard in a relatively large sample size. We retrospectively evaluated patients who attended the sports medicine clinic of our department and underwent arthroscopic surgery for the diagnosis of an anterosuperior acetabular labral tear between June 2014 and April 2018. All the patients received hip joint ultrasound examination and MR imaging evaluation before arthroscopic surgery. The sensitivity, specificity, and accuracy of ultrasound and MR imaging were calculated and compared. A total of 195 patients were enrolled in this study. Of these, 184 had arthroscopically confirmed anterosuperior acetabular labral tear. The sensitivity, specificity, positive predictive value (PPV), negative predictive value, and accuracy by ultrasound were, respectively, 68.5%, 81.8%, 98 4%, 13.4%, and 69.2%, retrospectively. For MR imaging, the sensitivity, specificity, PPV, negative predictive value, and accuracy were 84.8%, 63.6%, 97.5%, 20.0%, and 83.6%, respectively. Although ultrasound had a slightly lower sensitivity for detecting anterosuperior acetabular labral tear, it had a higher specificity and PPV than MR imaging. With the advantages of being inexpensive, relatively quick, noninvasive, and having dynamic evaluation, ultrasound could be used as a feasible method to evaluate anterosuperior acetabular labral tear. Level IV, case series.

Hip muscle atrophy in patients with acetabular labral joint pathology.

Intra-articular hip joint pathology is a source of hip and groin pain in active individuals and is thought to be a precursor to hip osteoarthritis. Limited evidence exists to guide appropriate physiotherapy management for these patients. Identification of which hip muscles are affected may help clinicians to develop effective exercise programs. A cross-sectional observational study in a hospital setting was conducted to investigate the size of individual hip abductor, hip extensor, and hip external rotator muscles in patients with acetabular labral joint pathology compared with age and sex matched healthy subjects. Twelve participants (eight females, four males), aged 20-53 years, with a medical diagnosis of unilateral acetabular labral tear and 12 healthy participants were recruited. Magnetic resonance imaging was used to assess cross-sectional areas of the gluteus minimus, gluteus medius, upper gluteus maximus, lower gluteus maximus, piriformis, and quadratus femoris muscles bilaterally. Gluteus medius muscle cross-sectional area was significantly different between groups (P < 0.01, effect size = 0.92) with muscle size found to be smaller in the pathology group. No differences were found for the other hip muscles (P > 0.05). These findings suggest that hip muscles are not all affected equally by the presence of intra-articular hip joint pathology. Atrophy of specific hip muscles, which are important in hip joint and pelvic stability, may alter hip joint function during gait and functional tasks. Clinicians treating patients with intra-articular hip joint pathology may need to prescribe exercises targeting the specific muscles with demonstrated dysfunction. Clin. Anat. 33:538-544, 2020. © 2019 Wiley Periodicals, Inc.

Acetabular Subchondral and Cortical Breach During Labral Repair with Suture Anchors: Influence of Portal Location, Curved vs Straight Drill Guides, and Drill Starting Point

Objectives: Acetabular labral tears are commonly treated with arthroscopic repair using suture anchors. Iatrogenic chondral injury has been cited as one of the more common complications during hip arthroscopy, and can occur while pre-drilling for suture anchors. Proposed factors contributing to penetration of the articular subchondral bone or the far cortex of the acetabulum include the portal utilized for drilling; the position of the drill guide relative to the acetabular rim (on rim, ON; off rim, OFF); and the use of straight (ST) versus curved (CU) drill guides. The purpose of this study was to evaluate the relative impact of these variables on drill penetration of the acetabular subchondral bone or the far cortex of the acetabulum. Methods: Sixty sawbone acetabula models were marked at the 3, 2, 1, 12, and 11 o’clock position. A Simulated anterior (AP), anterolateral (AL), and distal anterolateral accessory (DALA) portals were created. Twelve groups of five acetabula were drilled at each clock face position: ST/AP/ON; ST/AL/ON; CU/AP/ON; CU/AL/ON; ST/AP/OFF; ST/AL/OFF; CU/AP/OFF; CU/AL/OFF; ST/DALA/ON; ST/DALA/OFF; CU/DALA/ON; CU DALA/OFF. Perforations of the articular subchondral bone and far cortex of the acetabulum were recorded. Results were tabulated and analyzed to assess the relative impact of each variable both in aggregate and at each position on the clock face. Results: A total of 300 acetabular suture anchor drill holes were created on 60 acetabula 12 combinations of portal utilized (anterior, anterolateral, distal anterolateral accessory), drill guide type (curved or straight), and rim position (on rim, off rim). A total of 38/300(12.7%) drillings perforated the subchondral bone, and 45/300(15%) breach the far cortex. Drilling from the AP, AL, and DALA portal breached the articular subchondral bone 21/100 (21%), 17/100(17%), and 0/100(0%) respectively; and breached the far acetabular cortex 36/100(36%), 1/100(1%), and 8/100(8%) respectively. Drillings using a curved drill guide penetrated the subchondral bone on 14/150(9.3%) attempts and drillings using a straight drill guide penetrated the subchondral bone 33/150(22%) attempts (p=0.0025). Drillings with an “On Rim” start point breached the articular subchondral bone 29/150(19.3%) versus 9/150(6%) for drillings with an “Off Rim” start point; and breached the far acetabular cortex 21/150(14%) times versus 24/150(16%) times. Articular surface penetrations were most frequent at the 2 and 3 o’clock positons, and far cortex perforations were most frequent at the 11 and 12 o’clock positions. Conclusion: This study quantifies the relative impact of portal location, drill guide, and starting point on the acetabular rim on acetabular subchondral bone and far cortex penetration. Portal location had the highest impact, with the DALA portal noted to be the safest. Curved drill guides also reduced the number of acetabular subchondral bone penetrations. These findings can be used to influence arthroscopic technique during acetabular labral repair.

A Study of CT Versus MR Arthrography in Detection of Acetabular Cartilage Defects and Labral Tears

Background: the most important role of imaging in the preoperative period is to reveal labro-cartilaginous lesions in patients with chronic hip pain and suggested FAI. MRI particularly 3T MRI has a good ability to detect labral and chondral pathologies in FAI. Objective: to evaluate CT hip arthrography in the detection of acetabularlabral lesions and articular cartilage defects in comparison with MR arthrography in patients with chronic intractable hip pain. Patients and Methods: this is a cross sectional study in Cairo Scan Radiology center and Al-Azhar University hospital over 5 years period. The study included 61 patients who were referred for identification of source of chronic hip pain or assessing previous hip arthroscopic intervention. All cases were subjected to evaluation by both MDCT and MR arthrography. Confirmation of diagnosis was primarily based upon MR arthrography findings. Result: sixty-one patients were included in this study. Of them, 51 patients have been proved to have intra articular pathology; 31 males (61%) and 20 females (39%). Femoro-acetabular deformities were readily detectable via CT arthrography. Compared to MRA, CT arthrography had a sensitivity and specificity of 90.7% and 100% in detection of acetbularlabral lesions, 95% and 100% specificity in detection of femoral and acetabularchondral lesions, and 86% and 100% specificity in the detection of other intra articular pathologies, respectively. Conclusion: multidetector CT arthrography is an efficient alternative to MR arthrography in the evaluation of internal derangements of the hip.

Influence of Acetabular Labral Tear Length on Postoperative Clinical Outcomes and Patient Satisfaction following Hip Arthroscopy for Femoroacetabular Impingement Syndrome with Capsular Plication

Objectives: To determine the effect of labral tear length on post-operative outcomes following hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Methods: Patients undergoing primary hip arthroscopy for FAIS from January 2012 to January 2016 were identified in a prospectively collected database. All patients completed the hip outcome score (HOS)-activities of daily living (ADL), HOS-sports subscale (HOS-SS), modified Harris hip score (mHHS), international hip outcome tool-12 (IHOT-12), and visual analog scales (VAS) for pain and satisfaction. Patients were stratified by labral tear length into small (&lt;2.5 cm) or large (&gt;2.5 cm) labral tear based on the ROC curve analysis. Patient demographics and outcomes were analyzed using parametric and multivariate linear regression analyses to identify predictors of labral tear length. Binary logistic regression analysis was performed to determine whether labral tear length predicted the likelihood of achieving the Minimal Clinically Important Difference (MCID). Results: A total of 747 eligible patients were included in the analysis. Mean age and BMI were 33.5±12.3 years and 25.4±8.6 kg/m2 22, respectively. Mean length of labral tears was 2.7±0.7 cm with 99% occurring in the anterosuperior position. Men had a higher proportion of large tears (&gt;2.5 cm) when compared to women (75% vs 44%; p&lt;0.001). All PROs showed improvement at a minimum of 2-years postoperatively (p&lt;0.05 for all). Independent T-test demonstrated significant differences in two-year outcomes between patients with tears less than and greater than 2.5 cm: HOS-ADL (87.3±16.3 vs. 84.3±18.3, p=0.033), HOS-SS (76.6±23.5 vs. 70.5±27.7, p=0.005), mHHS (82.5±18.0 vs. 78.5±18.2, p=0.009), and satisfaction (83.5±23.4 vs. 77.8±34.9, p=0.026). Multivariate regression analysis demonstrated that labral tear length is an independent predictor of VAS satisfaction, HOS-ADL, -SS, and mHHS. Binary logistic regression analysis demonstrated that patients with small labral tears (&lt;2.5 cm) had a higher likelihood of achieving MCID HOS-SS (OR: 1.61; p-value&lt;0.02) and PASS mHHS (OR:1.56; p-value 0.038) than those with larger tears (more than 2.5 cm). Conclusion: Labral tear length is associated with numerous preoperative factors. These factors were found to be predictive of injury pathology and outcomes following hip arthroscopy for FAIS. Furthermore, patients with smaller tears (&lt; 2.5 cm) had better outcomes and a higher likelihood of achieving a minimal clinically important difference at 2 years follow-up. [Table: see text]

Hip Screening of a Professional Ballet Company Using Ultrasound-Assisted Physical Examination Diagnosing the At-Risk Hip.

The artistic nature of dance in combi- nation with the technical perfection required during performance makes it a highly demanding discipline. Starting at a young age, serious ballet students undergo long hours of training. Professional ballet dancers continue to train intensively in order to maintain their technical proficiency. Hip pathology in ballet dancers has been frequently reported in the literature, including femoroacetabular impingement syndrome, hip instability, muscle injuries, and early osteoarthritis. Screening programs to identify these hip joint pathologies (at- risk hips) in ballet dancers when they are still asymptomatic or their injury does not affect their performance are useful to aid in the development of prevention and treatment strategies. The purpose of this cross-sectional study was to identify hips at risk in the members of a professional ballet company using ultrasound-assisted physical examination. A high prevalence of cam lesions was detected in this cohort. Dancers with cam lesions were more likely to have an acetabular labral tear. In addition, there was a positive correlation between cam lesions and positive dial test, which is an indication of hip microinstability. Work of this kind can help to improve understanding of hip pathology in dancers and facilitate activity modification programs to prevent progression of their hip injuries.

The outcome of arthroscopic repair of acetabular labral tears using the iHOT-33

BackgroundThe purpose of this study was to determine patient reported outcome measures (PROMS) after arthroscopic repair of an isolated labral tear using the validated International Hip Outcome Tool (iHOT-33). The iHOT-33 specifically measures (1) symptoms and functional limitations, (2) sport and recreation limitations, (3) job related concerns and social and (4) emotional and lifestyle concerns.MethodsA retrospective review was performed on 45 procedures in 43 patients between September 2012 and September 2015. Two patients had bilateral isolated labral tears. Patients were excluded if they were younger than 18 years, had prior ipsilateral hip surgery and had radiological or arthroscopic evidence of femoroacetabular impingement (FAI), hip dysplasia or other bony dysmorphism.ResultsOf the 43 patients undergoing arthroscopy there were 29 right and 16 left hips repaired. There were 34 females and 9 males. The mean age at surgery was 37.4 years (range 19–63 years) with a mean follow up of 1.7 years (range 1.0–2.6 years). At follow up the mean total iHOT-33 score improved from 34.1 to 67.3 (p < 0.02). The mean improvement was 33.2 (p = < 0.02). Significant improvements were described in all 4 iHOT-33 sub sections.ConclusionThe study showed statistically significant favourable outcomes in selected patients with short follow-up for patients that underwent hip arthroscopy for an isolated labral tear using the validated iHOT-33.Level of EvidenceIV, retrospective non-randomised study.

Influence of Acetabular Labral Tear Length on Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome With Capsular Plication

Background: The literature on the effects of labral tear on patient-reported outcomes, midterm pain, and overall patient satisfaction is limited. Purpose: To determine the effect of labral tear length on postoperative outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Study Design: Cohort study; Level of evidence, 3. Methods: Consecutive patients undergoing primary hip arthroscopy for FAIS from January 2012 to January 2016 were identified in a prospectively collected database. All patients completed the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), and visual analog scale for pain and satisfaction. Patients were stratified by labral tear length into small (<2.5 cm) or large (≥2.5 cm) based on the receiver operating characteristic curve analysis. Patient characteristics and outcomes were analyzed with multivariate linear regression analyses to identify predictors of labral tear length. Binary logistic regression analysis was performed to determine whether labral tear length predicted the likelihood of achieving the minimal clinically important difference. Results: Of the 747 eligible patients, 600 (80.3%) had 2-year reported outcomes and were included in the final analysis. Mean age, body mass index, and tear length were 33.5 ± 12.3 years, 25.4 ± 9.2 kg/m2, and 2.7 ± 0.7 cm, respectively. Men had higher frequency of large tears when compared with women (77% vs 43.7%, P < .001). Independent t test demonstrated significant differences in 2-year outcomes between patients with tears <2.5 and ≥2.5 cm, respectively: HOS-ADL (87.3 ± 16.3 vs 84.3 ± 18.1, P = .033), HOS-SS (76.6 ± 23.5 vs 70.5 ± 27.7, P = .005), mHHS (82.5 ± 18.0 vs 78.5 ± 18.2, P = .009), and satisfaction (83.5 ± 23.4 vs 77.8 ± 34.9, P = .026). Binary logistic regression analysis demonstrated that labral tear length is an independent predictor of visual analog scale for satisfaction, HOS-ADL, HOS-SS, and mHHS. Binary logistic regression analysis demonstrated that patients with small labral tears had a higher likelihood of achieving the minimal clinically important difference for the HOS-SS (odds ratio, 1.61; 95% CI, 1.39-1.92; P < .02) and the patient acceptable symptomatic state for the mHHS (odds ratio, 1.56; 95% CI, 1.11-2.2; P = .038) than those with larger tears. Conclusion: Labral tear length is independently predictive of patient-reported outcomes after hip arthroscopy for FAIS. Furthermore, patients with smaller tears (<2.5 cm) had better outcomes and a higher likelihood of achieving a minimal clinically important difference at 2-year follow-up. However, the mean differences between changes in pre- and postoperative outcomes were relatively small and may not be clinically meaningful.

Application of ultrasound-guided hip joint drug injection in the postoperative rehabilitation of arthroscopie repair of acetabular labral tears

To explore the clinical application of ultrasound-guided hip joint drug injection in the postoperative rehabilitation of arthroscopie repair of acetabular labral tears. This research retrospectively analyzed a total of 38 hips from 36 patients (2 of them were bilateral) whose imaging examination showed acetabular labral well healed but the rehabilitating training was limited due to hip pain after arthroscopie repair of acetabular labral tears in our hospital between June 2015 and May 2017. All the patients underwent ultrasound-guided hip joint drug injection treatment. Through comparing the pain and the function of hip before and after drug injection, the clinical application values of ultrasound-guided hip joint drug injection in the postoperative rehabilitation of arthroscopie repair of acetabular labral tears were explored. The degree of hip pain was assessed by visual analogue score (VAS), which were scored before and after the injection. The hip function was assessed by the hip range of activity. The SPSS 21.0 statistical software was used for the data analysis. The effective rate of hip injection was calculated, which was defined as: ("excellent" + "good")/total number of cases×100%. The degree of hip pain was assessed by VAS, which was divided into 0 to 10 points with 0 for no pain and 10 for unbearable severe pain. The function of hip was assessed by the hip range of activity. The therapeutic effect of "excellent" meant no pain or occasional slight pain in the hip, along with Patrick test was negative and hip joint was not limited; the therapeutic effect of "good" meant that the pain was significantly reduced, and the hip's activity was slightly restricted. "No effect" meant that the pain of hip was not relieved, and the Patrick test was positive. The VAS score of the patient before drug injection was 5.46±1.46, and the VAS score was 2.01±0.53 after drug injection 4 weeks later. The score of the latter was significantly lower than that of the former, and the difference was statistically significant (P<0.05). The hip joint activity after ultrasound-guided hip joint drug injection was significantly improved. The therapeutic effective rate was 84.2%. For patients with hip pain and limitations after arthroscopie repair of acetabular labral tears, ultrasound-guided drug injection can effectively reduce hip pain, improve hip activity, and promote hip functional reconstruction.

Higher Prevalence of Concomitant Shoulder Labral Tears in Patients With Femoroacetabular Impingement

To examine the prevalence of concomitant symptomatic glenoid labral tears in patients with femoroacetabular impingement (FAI) in comparison to a control group of patients undergoing anterior cruciate ligament (ACL) reconstruction. We retrospectively identified 1,644 patients who underwent femoroacetabular osteoplasty (FAO) and labrum repair from January 2007 to September 2016 and 1,055 patients who underwent arthroscopic ACL reconstruction from January 2012 to December 2014, which acted as our control group. An electronic questionnaire, including 8 questions regarding history of shoulder pathology, was sent to all patients in both groups. Symptomatic shoulder labral tears were identified on the basis of a positive magnetic resonance imaging scan or history of labral repair by reviewing patients' medical records and the filled questionnaire. Continuous variables were compared by use of a Mann-Whitney U test, and categorical variables were compared using Fisher's exact test. The Holm-Bonferroni sequential correction method was used to adjust P values for multiple comparisons of the presence of shoulder pathology. A total of 443 patients (405 cam lesion) in the FAO group and 307 patients in the ACL reconstruction group completed the prepared questionnaire and were included in the study. Patients in the FAO group were slightly older (36.3years [range, 15.4-61.7] vs 32.3years [range, 16.3-75.7]) and more commonly female in the FAO group (58.0%, n= 257) compared with those in the ACL group (48.9%, n= 150). The prevalence of shoulder labral tear was 12.0% (95% confidence interval [CI], 9.3%-15.3%) for the FAO group compared with only 3.3% (95% CI, 1.8%-5.9%) for the ACL group. This represents a 3.7-fold (95% CI, 1.9-7.1) increase in the risk of shoulder labral tear for patients in the FAO group. Furthermore, shoulder labral tears were reported to be traumatic in only 43.4% of patients in the FAO group compared with 80.0% of patients in the ACL group. A similar proportion of patients in both groups (66.0% for FAO vs 60.0% for ACL) underwent a shoulder labral repair procedure. There appears to be an association between acetabular labral tear caused by FAI and shoulder labral lesions. Patients in the FAI group had a 3.7-fold increase in the risk of shoulder labral tear compared with the ACL group. Future studies are needed to examine a possible cause behind the current findings. Level III, comparative trial study.

Location and Correlation of Acetabular Labral Tears and Paralabral Cysts Using Magnetic Resonance Imaging or Magnetic Resonance Arthrography in Patients With Femoroacetabular Impingement

To evaluate the prevalence and location of paralabral cysts and the correlation between the type of femoroacetabular impingement (FAI) and acetabular labral tears, as well as the location of the paralabral cysts. Patients who received a diagnosis of FAI syndrome using plain radiography, magnetic resonance imaging or magnetic resonance arthrography, or computed tomographic arthrography from 2010 to 2015 were included in this study. The exclusion criteria were patients with arthritis (Tönnis grade 2 or greater) or dysplasia. We identified paralabral cysts and their location, size, configuration. Correlations between the type of FAI and labral tears and paralabral cysts were analyzed using the χ-square test. Among 506 patients with FAI, paralabral cysts were found in 51 patients (55 hips) and were located anterosuperiorly in 40% of cases, posterosuperiorly in 36%, anteroinferiorly in 17%, and posteroinferiorly in 8%. We identified multilocular cysts in 60% of hips and unilocular cysts in 40%. Labral tears were radiographically found in 44 of 55 hips with paralabral cysts (80%); they were located anterosuperiorly in 59% and posterosuperiorly in 41%. Although paralabral cysts were found in the anteroinferior and posteroinferior areas, acetabular labral tears were not identified in the anteroinferior and posteroinferior areas. Classification of the type of FAI showed cam type in 14 of 55 hips (25.5%), pincer type in 16 (29%), mixed type in 7 (13%), labral tears in 15 (27%), and normal findings in 3 (5.5%). No correlation was found between the type of FAI and labral tears (P= .739) or the location of paralabral cysts (P= .228). Paralabral cysts in patients with FAI most commonly are found in the anterosuperior area and are of the multilocular type. Although paralabral cysts in the anterosuperior and posterosuperior portions are related to labral tears, those in the anteroinferior and posteroinferior portions are not. LevelIV, diagnostic case series.

Determining Reliability of Arthroscopic Classifications for Hip Labral Tears.

Evaluate interobserver and intraobserver reliability of hip arthroscopic classifications for labral tears. Retrospective diagnostic study of nonconsecutive patients. Institutional study. From a database of 278 hip arthroscopy videos for treatment of femoroacetabular impingement, 70 videos were chosen by simple random sampling. Exclusion criteria included presence of radiological arthrosis (Tonnis > 2), previous hip surgery, inadequate lesion palpation, poor image quality, and refusal to participate in the study. The final sample included 60 videos. Four hip surgeons evaluated the videos twice at 1-month intervals and classified the lesions according to Lage, Seldes, and Beck classifications for hip labral tears. Interobserver and intraobserver reliability with the percent of agreement and weighted Cohen kappa values. Patients had a mean age of 33 years (SD, 7; range, 18-47 years), and 32 (53%) were men. Femoroacetabular impingement types included combined (CAM and pincer) in 31 (52%), CAM in 27 (45%), and pincer in 2 (3%). For interobserver reliability, the average weighted kappa values were 0.68, 0.65, and 0.78 for the Lage, Seldes, and Beck classifications, respectively. For intraobserver reliability, the mean weighted kappa values were 0.87, 0.64, and 0.93 for the Lage, Seldes, and Beck classifications, respectively. Beck classification had the highest average values for interobserver and intraobserver agreements. Lage, Seldes, and Beck scores for acetabular labrum tears showed substantial interobserver agreement. In the intraobserver evaluation, the Seldes system presented substantial agreement, whereas Lage and Beck classifications were considered excellent agreement.

Return to Sport Following Arthroscopic Treatment of Acetabular Labral Tears in Competitive Athletes: A Systematic Review

Return to Sport Following Arthroscopic Treatment of Acetabular Labral Tears in Competitive Athletes: A Systematic Review

Diagnosis and treatment of labral tear.

Objective:To review the literature regarding diagnosis and treatment of labral tear.Data sources:A systematic search was performed in PubMed using various search terms and their combinations including hip, labrum, acetabular labral tear, arthroscopy, diagnosis, and anatomy.Study selection:For each included study, information regarding anatomy, function, etiology, diagnosis, and management of acetabular labral tear was extracted.Results:Five hundred and sixty abstracts about anatomy, function, etiology, diagnosis, and management of acetabular labral tear were reviewed and 66 selected for full-text review. The mechanism of labral tear has been well explained while the long-term outcomes of various treatment remains unknown.Conclusions:Labral tear is generally secondary to femoroacetabular impingement, trauma, dysplasia, capsular laxity, and degeneration. Patients with labral tear complain about anterior hip or groin pain most commonly with a most consistent physical examination called positive anterior hip impingement test. Magnetic resonance arthrography is a reliable radiographic examination with arthroscopy being the gold standard. Conservative treatment consists of rest, non-steroidal anti-inflammatory medication, pain medications, modification of activities, physical therapy, and intra-articular injection. When fail to respond to conservative treatment, surgical treatment including labral debridement, labral repair, and labral reconstruction is often indicated.

CORR Insights®: Acetabular Labral Tears Are Common in Asymptomatic Contralateral Hips With Femoroacetabular Impingement.

CORR Insights®: Acetabular Labral Tears Are Common in Asymptomatic Contralateral Hips With Femoroacetabular Impingement.

Accuracy of Magnetic Resonance Imaging and Computed Tomography Arthrography in Diagnosing Acetabular Labral Tears and Chondral Lesions.

BackgroundWe investigated sensitivity, specificity, and accuracy of magnetic resonance imaging (MRI) and computed tomography arthrography (CTA), on the basis of arthroscopic findings, to diagnose acetabular labral tears and chondral lesions.MethodsWe retrospectively reviewed the results of MRI and subsequent CTA in 36 hips that underwent arthroscopic surgery (33 patients; 17 males [17 hips] and 16 females [19 hips]; average age, 35 years). All patients had positive impingement test results and groin pain. We analyzed sensitivity, specificity, and accuracy of MRI and CTA by comparing with the arthroscopic findings. Interobserver agreement and intraobserver reproducibility of the presence of tears and cartilage lesions on MRI and CTA were calculated using Kappa coefficients.ResultsThe sensitivity, specificity, and accuracy of MRI for detection of acetabular labral tears by two observers were 60%, 80%, and 64%, respectively, and 65%, 70%, and 69%, respectively. The sensitivity, specificity, and accuracy of CTA for detection of labral tears by both observers were 85%, 90%, and 86%, respectively, and 92%, 80%, and 89%, respectively. However, the sensitivity and specificity of MRI for detection of acetabular chondral lesions by both observers were 36% and 84%, respectively, and 46% and 88%, respectively. The sensitivity and specificity of CTA for detecting acetabular cartilage lesions by both observers were 46% and 72%, respectively, and 64% and 72%, respectively. Intraobserver reproducibility for detection of labral tears and chondral lesions by using MRI was substantial (κ = 0.756 and κ = 0.693, respectively). Interobserver reliability for detection of labral tears and chondral lesions by using MRI was substantial (κ = 0.700 and κ = 0.875, respectively). Intraobserver reproducibility for detection of labral tears and chondral lesions by using CTA was substantial (κ = 0.832 and κ = 0.774, respectively). Interobserver reliability for detection of labral tears and chondral lesions by using CTA was high (κ = 0.886 and κ = 0.596, respectively).ConclusionsThis study demonstrated that the accuracy of MRI to detect an acetabular labral tear and a chondral lesion of the hip joint was not sufficient. CTA was reliable in the diagnosis of acetabular labral tears. However, both CTA and MRI were also of limited value to detect chondral lesions.

Arthroscopic Repair of Acetabular Labral Tears Associated with Femoroacetabular Impingement: 7-10 Years of Long-Term Follow-up Results.

BackgroundThe purpose of this study is to report the long-term follow-up results of arthroscopic repair of acetabular labral tears with femoroacetabular impingement (FAI).MethodsOf 45 patients who underwent arthroscopic labral repair under the diagnosis of acetabular labral tears with FAI from January 2008 to December 2010 and met our inclusion criteria, 41 patients who were available for a long-term follow-up were included in the analysis. We compared the long-term follow-up results with the previously reported short-term follow-up results of the same patients. The mean follow-up period was 92.4 months (range, 85 to 117 months). There were 21 males and 20 females, and their mean age at surgery was 34.6 years (range, 16 to 54 years). A modified Harris hip score (mHHS), visual analog scale (VAS), hip outcome score-activity of daily living (HOS-ADL), hip outcome score-activity-sport-specific subscale (HOS-SSS), and patient satisfaction were used for evaluation of the clinical results and Tönnis grade for detection of early osteoarthritis (OA).ResultsThe mean VAS score decreased from 6.4 points to 1.8 points (p < 0.001), the mean mHHS increased from 59.5 points to 86.8 points (p < 0.001), and the mean HOS-ADL and HOS-SSS increased from 58.3 and 51.2, respectively, to 85.2 and 82.4, respectively (p < 0.001), between the preoperative and last follow-up assessment. The mean patient satisfaction score was 7.6 of 10. The average Tönnis grade at the last follow-up (0.67; range, 0 to 3) was not significantly different from the preoperative average (0.51; range, 0 to 1). Only one case was converted to total hip arthroplasty because of progression of OA at 8 years after surgery. Five cases of secondary arthroscopic surgery were performed before maximum 5 years postoperatively because of labro-synovial adhesion (three cases), pullout of the suture anchor (one case) or symptomatic heterotrophic ossification (one case).ConclusionsThe clinical and radiological long-term follow-up revealed that improvement after arthroscopic labral repair and osteoplasty for FAI were maintained in most cases without significant progression of arthritis. Anatomical recovery of the acetabular labrum was associated with the improvement of clinical symptoms.

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.