Labral Pathology Research Articles

Anterior Rotator Interval Lesion (ARIL), its association with glenoid labrum pathology in patients with anterior shoulder pain and surgical outcome of Arthroscopic Rotator Interval Closure (ARIC)

BackgroundAnterior rotator interval lesions (ARIL) have been associated with shoulder instability. However, a paucity of data exists on its association with labrum pathology as a source for persistent anterior shoulder pain. This study primarily aims to describe pathoanatomy of ARIL and the parameters we used that aid in the diagnosis of ARIL. Secondly, the objective is to describe and report the prevalence of ARIL in combination with labrum injuries presenting as anterior shoulder pain with mild or no instability. Lastly, we intend to present a cohort of patients with combined labrum injury and ARIL and report on the clinical results after labrum repair with Arthroscopic Rotator Interval Closure (ARIC). MethodsConsecutive patients at a single center in United States treated for labrum tears were included by retrospective chart-review. Patients presenting with anterior shoulder pain with mild or no instability were included. Patients with recurrent dislocations, moderate to severe instability and those with bony lesions were excluded. Besides history and physical examination, Magnetic Resonance Arthrography (MRA) was used to aid the diagnosis. Labrum tears with ARIL were treated with an additional ARIC procedure along with arthroscopic labrum repair. ResultsOut of two hundred fourty patients with a labrum tear, 114 had associated ARIL. The prevalence of ARIL ranged from 71 % with reverse Bankart tears to 46 % with anterior Bankart and 36 % in Type II SLAP tears. The success rate after labrum tear repair with ARIC performed in patients with ARIL with labrum pathology was 94.7 % at a 2-year follow-up in terms of relief from anterior shoulder pain. ConclusionAlmost half (47.5 %) of our patients presented with anterior shoulder pain with labrum tears were associated with ARIL. We recommend keeping a high index of suspicion for ARIL in labrum injuries presenting mainly with anterior shoulder pain for better treatment planning. Level of evidenceLevel IV (Retrospective case series without a comparision group)

Prevalence of spin reporting bias in hip labrum reconstruction: a qualitative assessment of systematic reviews and meta-analyses

Hip labral reconstruction is an evolving technique to treat labral pathology. Spin is a recent concept that is defined as a reporting bias that misrepresents research. The purpose of this study is to identify the prevalence of spin in meta-analysis and systematic review abstracts regarding acetabular labral reconstruction. Electronic libraries were queried for meta-analyses and systematic reviews regarding hip labrum reconstruction. The nine most severe types of spin found in abstracts were used as an evaluation tool. Two reviewers each performed a blinded assessment of each article for spin. A third reviewer was used to address any discrepancies between the original reviewers. Other variables evaluated include number of citations, journal impact factor, reported conflicts of interest (COI), adherence to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, and methodologic quality according to a measurement tool to assess systematic reviews (AMSTAR-2). The electronic database search resulted in 1,148 articles, of which 10 met inclusion criteria. Of these 10 articles, 70% (7/10) were found to have at least one form of spin present, 20% (2/10) contained 3 different types of spin, 30% (3/10) contained 2 different types of spin, and 20% (2/10) contained 1 type of spin. The most common type of spin found was type 5, “conclusion claims the beneficial effect of the experimental treatment despite high risk of bias in the primary studies,” which was found in 60% (6/10) of the articles. When assessing AMSTAR-2 score, 90% (9/10) of the articles were found to be ‘low quality’ or ‘critically low quality.’ Spin was present in 70% of the abstracts of meta-analyses and systematic reviews pertaining to hip labrum reconstruction. Recognition of spin is crucial for orthopaedic surgeons. Improved guidelines should be considered to reduce the prevalence of spin in orthopaedic literature.

A Cadaveric Study of the Rotator Cable: Interrogating the Suspension Bridge Model.

Purpose The objective of this cadaveric study was to describe the anatomical relationships between the rotator cuff muscles and the rotator cable. Methods In 30 formaldehyde-fixed shoulders from 20 cadavers, the rotator cuff and rotator cable were dissected and the glenohumeral joint opened. The orientation and attachments of the rotator cable to the rotator cuff muscles were described, and the severity of any osteoarthritis, labral pathology, and rotator cuff pathology present was documented. The width and thickness of the infraspinatus attachments to the rotator cable were measured. Results The infraspinatus muscle was noted to be more loosely adherent to the rotator cable, while the supraspinatus and teres minor were tightly adherent to the cable. Specifically, the superior-most portion of the infraspinatus was found to be less tightly adherent than the inferior-most portion in 26 of the 30 shoulders studied. The thickness/width ratio of the inferior-most portion of infraspinatus was significantly different in shoulders with more-than-minimal osteoarthritis and labral pathology (p=0.048 and p=0.041, respectively). Conclusion While the supraspinatus and teres minor muscles were tightly adherent to the cable in all shoulders, the degree of attachment of the superior-most portion of the infraspinatus muscle was notably less in 26 of the 30 shoulders studied. This could mean that only the inferior portion of the infraspinatus participates in stress shielding through the cable or be a compensatory response to increased load on the tendon. This work is expected to provide insight into the function of the rotator cable and the different functions of the infraspinatus.

Labral pathology predicts cartilage loss over 2 years in young adult football players: findings from the femoroacetabular impingement and hip osteoarthritis cohort study

Labral pathology predicts cartilage loss over 2 years in young adult football players: findings from the femoroacetabular impingement and hip osteoarthritis cohort study

Assessing hip joint-related structure and patient-reported outcomes in people with Marfan syndrome.

People with Marfan syndrome (MFS) have clinical symptoms of hip pain, but to date, there is limited knowledge about hip-related structural abnormalities in these patients. Therefore, the purpose of this cross-sectional study was to assess hip-related structural abnormalities and patient-reported outcomes (PRO) in a cohort of patients with MFS compared to healthy controls. Nineteen individuals with MFS(17 females, 39.8±11.5 years) and 19 age, sex, and body mass index-matched healthy, asymptomatic individuals (17 females, 36.2±12.5 years)underwent radiographic imaging and unilateral hip MRI. The Scoring Osteoarthritis with MRI (SHOMRI) technique was used to assess hip-related morphological abnormalities between the MFS and control groups. All participants completed the Hip disability and Osteoarthritis Outcome Score (HOOS) to assess hip-related symptoms, pain, and function during activities of daily living (ADL) and quality of life (QOL). The MFS group exhibited higher lateral center edge angles (p < .001). Despite similar severity of femoral cartilage damage (p = 1.0), the MFS group exhibited a higher severity (p = 0.046)of acetabular cartilage degeneration (1.21±1.08) compared to the controls(0.53±1.02). There were no between-group differences in severity of labral pathology, subchondral cysts, or edema. Individuals with MFS also self-reported significantly lower HOOS symptoms (p = 0.003), pain (p = 0.014), ADL (p = 0.028), and QOL (p = 0.014) sub-scores, indicating worse hip-related PRO in MFS. Our study results suggest that individuals with MFS exhibit early signs of acetabular cartilage degeneration and poor hip-related clinical outcomes compared to healthy individuals. Future work should investigate the underlying biomechanical mechanisms associated with hip joint degeneration in the MFS population.

Two-Year Outcomes of Primary Arthroscopic Surgery in Patients with Femoroacetabular Impingement: A Comparative Study of Labral Repair and Labral Reconstruction.

Labral repair has become the preferred method for the arthroscopic treatment of acetabular labral tears that are associated with femoroacetabular impingement (FAI) resulting in pain and dysfunction. Labral reconstruction is performed mainly in revision hip arthroscopy but can be utilized in the primary setting for absent or calcified labra. The purpose of this study was to compare the minimum 2-year patient-reported outcomes (PROs) and risk of revision or conversion to arthroplasty between primary labral reconstruction and primary labral repair. Patients with FAI who underwent primary hip arthroscopy with labral repair or reconstruction performed by the senior author between 2006 and 2018 were identified from a prospectively enrolled patient outcome registry. Exclusion criteria included confounding injuries, dysplasia, prior ipsilateral hip surgery, or a joint space of <2 mm. Patients who were 18 to 80 years old were eligible for inclusion. Multiple regression with inverse propensity score weighting was conducted to estimate the average treatment effect in the treated (ATT) for labral reconstruction versus labral repair with respect to postoperative PROs and the likelihood of subsequent surgery (revision hip arthroscopy or conversion to arthroplasty). PRO end points included the Hip Outcome Score Activities of Daily Living subscale (HOS-ADL), modified Harris hip score, Western Ontario and McMaster Universities Osteoarthritis Index total score (WOMAC), 12-Item Short Form Health Survey Physical Component Summary score (SF-12 PCS), and patient satisfaction. A total of 150 hips undergoing primary labral reconstruction and 998 hips undergoing primary labral repair were included. The median follow-up time was 5.3 years in the reconstruction group and 5.8 years in the repair group. Compared with labral repair, labral reconstruction was associated with a higher risk of conversion to total hip arthroplasty (THA) (20% versus 7%; adjusted odds ratio, 3.2; 95% confidence interval [CI], 1.2 to 8.8; p = 0.024). Inverse propensity score-weighted multiple regression estimated a significant negative effect of labral reconstruction, relative to labral repair, on the postoperative values for the HOS-ADL (ATT, -3.3; 95% CI, -5.8 to -0.7; p = 0.012) and WOMAC (ATT, 2.6; 95% CI, 0.1 to 5.2; p = 0.044). Compared with primary labral reconstruction, primary labral repair resulted in better postoperative HOS-ADL and WOMAC values and decreased conversion to THA. These findings were demonstrated in both the unadjusted group comparisons and multivariable modeling. These data support the use of labral repair in the primary setting of labral tears and the reservation of labral reconstruction for more advanced labral pathology or for revision cases. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Effect of the presence of cysts in the hip joint on hip arthroscopy.

The aim of this study was to investigate whether the presence and size of fibrous cysts affected postoperative results in patients undergoing hip arthroscopy. Between January 2010 and December 2019, a total of 261 patients (138 males, 123 females; mean age: 39.5±11.9 years; range, 18 to 66 years) who underwent hip arthroscopy with the diagnosis of cam-pincer-mixed-type femoroacetabular impingement (FAI) and labral pathologies were retrospectively analyzed. The study groups (impingements and labral pathologies) and the presence of cyst (or cyst size: <5 mm, 5-8 mm, >8 mm) were used as the fixed effects, and the analysis was adjusted for baseline age, sex, and preoperative scores. Pre- and postoperative modified Harris Hip Score (mHHS) and Visual Analog Scale (VAS) scores that were applied to all patients were used as an indication of clinical results. The mean preoperative mHHS score of the patients with a cyst was significantly lower compared to the patients without a cyst (56.8±12.3 vs. 60.3±12.7, p=0.026). The mean change in the mHHS score and the mean percentage change in VAS score were significantly higher in the patients with a cyst compared to the patients without a cyst (mHHS score: 28.1±14.0 vs. 22.5±14.1, p=0.002; VAS score: 61.9±30.2 vs. 52.6±47.4, p=0.038). The increase in mHHS score over time for patients with a cyst was significantly higher than the patients without cysts in the pincer group (38.1±11.1 vs. 19.3±13.5, p<0.001). The patients with a cyst size of >8 mm had a significantly higher increase in the mHHS scores compared to the patients with a cyst size of <5 mm (29.5±12.9 vs. 23.5±13.8, p=0.043). Subchondral cysts in the femoral head and neck junction accompanied cam-type and mixed-type FAI, while subchondral cysts in the acetabulum accompanied pincer-type impingement. In all groups, the mean increase in mHHS scores and the mean decrease in VAS scores were higher in patients with subchondral cysts than in patients without cysts. In patients with subchondral cysts, if the lesion causing FAI is treated arthroscopically, it can positively affect the functional results.

Patients With Shoulder Labral Tears Search the Internet to Understand Their Diagnoses and Treatment Options

PurposeTo analyze the most frequently searched questions associated with shoulder labral pathology and to evaluate the source type availability and quality. MethodsCommon shoulder labral pathology related search terms were entered into Google and the suggested frequently asked questions were compiled and categorized. Suggested sources were also recorded, categorized, and scored for quality of information utilizing Journal of the American Medical Association (JAMA) benchmark criteria. Statistical analysis was performed to compare the types of questions and their associated sources, as well as the quality of sources. ResultsFive-hundred and thirteen questions and 170 sources were identified and categorized. The most popular topics were Diagnosis/Evaluation (21.5%) and Indications/Management (21.1%.). The most common website types were Academic (27.9%), Commercial (25.2%), and Medical Practice (22.5%). Multiple statistically significant associations were found between specific question categories and their associated source types. The average JAMA quality score for all sources was 1.56 and medical websites had significantly lower quality scores than non-medical sites (1.05 vs 2.12, p<0.001). ConclusionPatients searching the internet for information regarding shoulder labral pathology often look for facts regarding the management of their condition. They use various source types to understand their conditions, with government sources being the highest quality, while medical sites showed statistically lower quality. Across the spectrum of questions, the quality of readily available resources varies substantially.

Poster 199: High Prevalence of Elevated Beighton Scores in Females Undergoing FAI Surgery

Objectives: Femoroacetabular impingement (FAI) is classically described as restricted internal rotation in flexion resulting in labral and cartilage pathology. Despite 20 years of FAI research, there is still limited understanding of the drivers of symptomatology in the subset of patients with underlying FAI morphology. While the prevalence of FAI morphologies is substantially higher in men, numerous studies have shown more women being treated for FAI compared to men. Soft-tissue laxity and hip instability are increasingly recognized as a potential contributor to symptoms in addition to FAI. The Beighton score is a well-accepted means to quantify soft-tissue laxity and has been validated for self-scoring. The purpose of the current study was to (1) investigate the prevalence of soft-tissue laxity in male and female patients presenting with symptomatic FAI in a multicenter prospective cohort study, and (2) correlate soft-tissue laxity with patient primary complaints of either mobility, stability, or pain. Methods: A prospective multicenter cohort study of 696 FAI patients undergoing primary hip arthroscopy surgery was performed and utilized for the current study. Inclusion criteria are patients aged 14 to 45 years old with idiopathic FAI not caused by childhood disease. Exclusion criteria are previous ipsilateral hip procedures or disease processes such as neuromuscular disease or Tonnis 2 or greater osteoarthritis. The Beighton score was assessed by electronic patient self-scoring. Beighton scores &gt;4 were considered a marker of soft-tissue laxity. The MSP index was utilized to have patients rank from most to least the biggest problems with their hip: Mobility (M), Stability (S), or Pain (P). The chi-square or Fisher exact test were utilized to compare groups. Results: The prevalence of Beighton scores &gt;4 was 57.2% in female patients, compared to 29.3% in male patients (p &lt; 0.001). In female patients, 44.4%, 22.6%, and 7.7% had Beighton scores of 5+, 7+, and 9 respectively, compared to 16.7%, 5.8%, and 1.8% in male patients (all p &lt; 0.005). In the overall FAI cohort, pain was the primary complaint in 72.1% of patients, compared to 24.2% complaining primarily of mobility and 3.7% complaining primarily of stability. Among female patients, the presence of soft-tissue laxity (relative to thresholds of Beighton 4, 5, 7, and 9) did not significantly influence the patient primary complaints (with pain being the predominant complaint). Overall, 85 female patients had a Beighton score of 7 or greater and only 2.4% reported stability of the hip as a primary complaint, compared to 2.4% of female patients with a Beighton &lt;7. Stability was more commonly indicated as a second most important factor in the setting of soft-tissue laxity, compared to mobility. Among female patients with a Beighton &gt;7, 29.5% reported stability as a primary or secondary complaint, compared to 15.2% of female patients with a Beighton score &lt;7. Conclusions: Over half of female patients undergoing FAI surgery have underlying soft-tissue laxity as measured by the Beighton score. In the setting of soft-tissue laxity, patient primary symptomatic complaint remains pain, but a secondary complaint is significant more likely to be stability rather than mobility (compared to FAI patients without soft tissue laxity complain of mobility secondarily over stability). Further research is needed to better understand the role of soft-tissue laxity in the pathophysiology of FAI and the outcomes of surgical treatment.

Location of Shoulder Glenoid Labral Tears: A Study of 1763 Consecutive Patients

Background: Anterior shoulder labral tearing has historically been considered the most common location of shoulder labral pathology. Recently, smaller studies have reported that posterior labral involvement may be more common than previously recognized. Purpose: To examine the location of surgically repaired labral tears by a single surgeon over a consecutive 23-year period. Study Design: Case series; Level of evidence, 4. Methods: A total of 1763 consecutive patients who underwent arthroscopic or open shoulder labral repair by a single seniorsports medicine fellowship–trained orthopaedic surgeon between April 2000 and April 2023 were retrospectively reviewed. Current Procedural Terminology codes were used to identify patients, which included 29806, 29807, 29822, and 29823. Exclusion criteria included isolated shoulder manipulation or glenohumeral joint or labral debridement that did not include repair. Intraoperative glenoid labral tears observed were categorized into 7 broad categories: (1) anterior labral tears, (2) posterior labral tears, (3) superior labral anterior posterior (SLAP) type II tears (A, B, or C), (4) SLAP type V tears, (5) SLAP type VIII tears, or (6) circumferential labral tears (combined SLAP, anterior, and posterior labral tear). Shoulders diagnosed with multiple tear patterns (ie, anterior and posterior) were also noted. Results: During the 23-year period, 1763 patients underwent arthroscopic or open labral repair; they included 1295 male and 468 female patients, ranging in age from 12 to 70 years, with a mean age of 23.2 years and median age of 19 years. Overall, 28.4% of tears involved the anterior labrum, 64.9% involved the posterior labrum, and 59.6% involved the superior labrum. Regarding isolated tears, 9.3% were isolated anterior labral tears, 19.7% were isolated posterior labral tears, 11.5% involved the anterior and posterior labrum, 22.2% were isolated superior (SLAP type II-IV) tears, 3.63% were isolated SLAP type V tears, 29.8% were isolated SLAP type VIII tears, and 4.1% were circumferential tears. Conclusion: Posterior shoulder labral tearing was more common than anterior tearing in a large consecutive series of 1763 patients who underwent surgical repair. This highlights the importance of posterior labral pathology, which sometimes may be overlooked because of more vague complaints, with pain and loss of function being the most common.

The Otto Aufranc Award: Does Hip Arthroscopy at the Time of Periacetabular Osteotomy Improve the Clinical Outcome for the Treatment of Hip Dysplasia? A Multicenter Randomized Clinical Trial

BackgroundA periacetabular osteotomy (PAO) is often sufficient to treat the symptoms and improve quality of life for symptomatic hip dysplasia. However, acetabular cartilage and labral pathologies are very commonly present, and there is a lack of evidence examining the benefits of adjunct arthroscopy to treat these. The goal of this study was to compare the clinical outcome of patients undergoing PAO with and without arthroscopy, with the primary end point being the International Hip Outcome Tool-33 at 1 year. MethodsIn a multicenter study, 203 patients who had symptomatic hip dysplasia were randomized: 97 patients undergoing an isolated PAO (mean age 27 years [range, 16 to 44]; mean body mass index of 25.1 [range, 18.3 to 37.2]; 86% women) and 91 patients undergoing PAO who had an arthroscopy (mean age 27 years [range, 16 to 49]; mean body mass index of 25.1 [17.5 to 25.1]; 90% women). ResultsAt a mean follow-up of 2.3 years (range, 1 to 5), all patients exhibited improvements in their functional score, with no significant differences between PAO plus arthroscopy versus PAO alone at 12 months postsurgery on all scores: preoperative International Hip Outcome Tool-33 score of 31.2 (standard deviation [SD] 16.0) versus 36.4 (SD 15.9), and 12 months postoperative score of 72.4 (SD 23.4) versus 73.7 (SD 22.6). The preoperative Hip disability and Osteoarthritis Outcome pain score was 60.3 (SD 19.6) versus 66.1 (SD 20.0) and 12 months postoperative 88.2 (SD 15.8) versus 88.4 (SD 18.3). The mean preoperative physical health Patient-Reported Outcomes Measurement Information System score was 42.5 (SD 8.0) versus 44.2 (SD 8.8) and 12 months postoperative 48.7 (SD 8.5) versus 52.0 (SD 10.6). There were 4 patients with PAO without arthroscopy who required an arthroscopy later to resolve persistent symptoms, and 1 patient from the PAO plus arthroscopy group required an additional arthroscopy. ConclusionsThis randomized controlled trial has failed to show any significant clinical benefit in performing hip arthroscopy at the time of the PAO at 1-year follow-up. Longer follow-up will be required to determine if hip arthroscopy provides added value to a PAO for symptomatic hip dysplasia.

Current Evidence Based Recommendations on Rehabilitation following Arthroscopic Shoulder Surgery: Rotator Cuff, Instability, Superior Labral Pathology, and Adhesive Capsulitis.

Arthroscopy has become increasingly popular for a addressing a wide variety of shoulder pathology. However, despite increasing interest, there is still much uncertainty and variability amongst providers regarding optimal post-operative rehabilitation. This review provides an overview of the evidence underlying common rehab protocols used following arthroscopic interventions for rotator cuff disease, shoulder instability, superior labral anterior to posterior (SLAP) tears and adhesive capsulitis. For small and medium sized rotator cuff tears, early motion protocols do not seem to affect healing or retear rates, however there is no difference with regards to long term functional outcomes when compared to standard motion protocols. For larger tears (> 3cm), early active motion may be associated with impaired tendon integrity. Early range of motion following arthroscopic Bankart repair has not been shown to increase rate of recurrence, however the data on return to sport requires more granularity to effectively guide care. Further research needs to be done to compare rehab protocols following SLAP repair and arthroscopic capsular release. Rehabilitation protocols following rotator cuff surgery and anterior shoulder stabilization have garnered the most research interest. However, there is still a need for larger higher-level studies examining the long-term effects of different rehab protocols. Regarding the arthroscopic management of other types of shoulder instability, SLAP tears and adhesive capsulitis, there is paucity of high-quality evidence. This knowledge gap likely underpins the variability in different rehab protocols seen in clinical practice, highlighting the need for more research.

Role of USG and MRI to detect the rotator cuff injury and to compare the efficacy of both

The objectives of this study were to detect the rotator cuff injury using high-resolution ultrasonography in clinically suspected patients, compute MRI findings and compare the effectiveness of ultrasound and MRI diagnostically in such patients. 30 patients who were suspected to be suffering from rotator cuff injury were referred to the Department of Radiodiagnosis, Medical Trust Hospital, Kochi, Kerala. MRI and high-resolution ultrasonography were used to evaluate them after taking their written consent. The present study was carried out from November 2018 to October 2019. In partial thickness tears, the specificity of ultrasound was 87.5% and sensitivity was 72% whereas it was 83.3 % and 95.8% respectively for full-thickness tears. MRI was more sensitive than USG in evaluating the capsular and labral pathologies. MRI was the most sensitive and specific modality in the evaluation of shoulder pain. A specificity of 94% and a sensitivity of 92.3% was seen in relation to MRI in case of partial thickness tears; whereas in full thickness tears a specificity of 95.8% and a sensitivity of 100.0% were seen. In calcific tendinitis, picking bursal fluid and impingement, MRI was better than USG and also highly sensitive for labral tears. In the evaluation of shoulder pain, MRI is the most appropriate evaluation modality and in case of labral tears it is highly sensitive. When compared to USG, MRI is better in picking bursal fluid, impingement as well as calcific tendinitis and also in evaluating labral and capsular pathologies.

Pre-operative Assessment of Shoulder Pathologies on MRI by a Radiologist and an Orthopaedic Surgeon.

Pathologies of the shoulder, i.e. rotator cuff tears and labral injuries are very common. Most patients receive MRI examination prior to surgery. A correct assessment of pathologies is significant for a detailed patient education and planning of surgery. Sixty-nine patients were identified, who underwent both, a standardised shoulder MRI and following arthroscopic shoulder surgery in our hospital. For this retrospective comparative study, the MRIs were pseudonymised and evaluated separately by an orthopaedic surgeon and a radiologist. A third rater evaluated images and reports of shoulder surgery, which served as positive control. Results of all raters were then compared. The aim was an analysis of agreement rates of diagnostic accuracy of preoperative MRI by a radiologist and an orthopaedic surgeon. The overall agreement with positive control of detecting transmural cuff tears was high (84% and 89%) and lower for partial tears (70-80%). Subscapularis tears were assessed with moderate rates of agreement (60 - 70%) compared to intra-operative findings. Labral pathologies were detected mostly correctly. SLAP lesions and pulley lesions of the LHB were identified with only moderate agreement (66.4% and 57.2%) and had a high inter-rater disagreement. This study demonstrated that tears of the rotator cuff (supraspinatus, infraspinatus) and labral pathologies can be assessed in non-contrast pre-operative shoulder MRI images with a high accuracy. This allows a detailed planning of surgery and aftercare. Pathologies of the subscapularis tendon, SLAP lesions and biceps instabilities are more challenging to detect correctly. There were only small differences between a radiologic and orthopaedic interpretation of the images.

What Is the Influence of Femoral Version on Size, Tear Location, and Tear Pattern of the Acetabular Labrum in Patients With FAI?

Femoral version deformities have recently been identified as a major contributor to femoroacetabular impingement (FAI). An in-depth understanding of the specific labral damage patterns caused by femoral version deformities may help to understand the underlying pathomorphologies in symptomatic patients and select the appropriate surgical treatment. We asked: (1) Is there a correlation between femoral version and the mean cross-sectional area of the acetabular labrum? (2) Is there a difference in the location of lesions of the acetabular labrum between hips with increased femoral version and hips with decreased femoral version? (3) Is there a difference in the pattern of lesions of the acetabular labrum between hips with increased femoral version and hips with decreased femoral version? This was a retrospective, comparative study. Between November 2009 and September 2016, we evaluated 640 hips with FAI. We considered patients with complete diagnostic imaging including magnetic resonance arthrography (MRA) of the affected hip with radial slices of the proximal femur and axial imaging of the distal femoral condyles (allowing for calculation of femoral version) as eligible. Based on that, 97% (620 of 640 hips) were eligible; a further 77% (491 of 640 hips) were excluded because they had either normal femoral version (384 hips), incomplete imaging (20 hips), a lateral center-edge angle < 22° (43 hips) or > 39° (16 hips), age > 50 years (8 hips), or a history of pediatric hip disease (20 hips), leaving 20% (129 of 640 hips) of patients with a mean age of 27 ± 9 years for analysis, and 61% (79 of 129 hips) were female. Patients were assigned to either the increased (> 30°) or decreased (< 5°) femoral version group. The labral cross-sectional area was measured on radial MR images in all patients. The location-dependent labral cross-sectional area, presence of labral tears, and labral tear patterns were assessed using the acetabular clockface system and compared among groups. In hips with increased femoral version, the labrum was normal in size (21 ± 6 mm 2 [95% confidence interval 20 to 23 mm 2 ]), whereas hips with decreased femoral version showed labral hypotrophy (14 ± 4 mm 2 [95% CI 13 to 15 mm 2 ]; p < 0.01). In hips with increased femoral version, labral tears were located more anteriorly (median 1:30 versus 12:00; p < 0.01). Hips with increased femoral version exhibited damage of the anterior labrum with more intrasubstance tears anterosuperiorly (17% [222 of 1322] versus 9% [93 of 1084]; p < 0.01) and partial tears anteroinferiorly (22% [36 of 165] versus 6% [8 of 126]; p < 0.01). Hips with decreased femoral version showed superior labral damage consisting primarily of partial labral tears. In the evaluation of patients with FAI, the term "labral tear" is not accurate enough to describe labral pathology. Based on high-quality radial MR images, surgeons should always evaluate the combination of labral tear location and labral tear pattern, because these may provide insight into associated femoral version abnormalities, which can inform appropriate surgical treatment. Future studies should examine symptomatic patients with normal femoral version, as well as an asymptomatic control group, to describe the effect of femoral version on labral morphology across the entire spectrum of pathomorphologies. Level III, prognostic study.

Value of MR arthrography for evaluation of children and adolescents with clinically suspected intraarticular cause of hip pain

PurposeTo evaluate the distribution of intra- and extraarticular MRI findings in children and adolescents with clinically suspected intraarticular cause of hip pain in order to assess the need for additional intraarticular contrast administration.Material and methodsDatabase was searched over a period of 34 months retrospectively for consecutive hip MR arthrography in young patients (8–17 years) with suspected intraarticular cause of hip or groin pain. Exclusion criteria were prior hip surgery, follow-up examination due to known intraarticular pathology, incomplete examination, qualitatively non-diagnostic examinations, and missing informed consent. Reports of fellowship-trained MSK radiologists were searched for intraarticular versus extraarticular findings explaining hip or groin pain.ResultsSeventy patients (68% female; median age: 14.5 years; range:10.8–16.9 years) were analyzed. No reason for pain was found in 30 (42.9%) hips, extraarticular reasons in 20 (28.6%) cases, intraarticular in 14 (20.0%), and both (intra- and extraarticular) in 6 (8.6%) hips. Most common extraarticular reasons were apophysitis (14.3%), other bony stress reactions (12.9%), intramuscular edema (7%), tendinitis (5.7%), and trochanteric bursitis (4.3%). Labral pathology was the most common intraarticular finding (overall:34.3%; partial tear:15.7%, complete tear:15.7%), most frequent at the anterosuperior position (81.8%). Cartilage defects (1.4%), intraarticular neoplasia (1.4%), and tear of the femoral head ligament (2.8%) were rarely found. Synovitis and loose bodies were not observed. Cam-(37.1%) and pincer-configurations (47.1%) were common while hip dysplasia was rare (5.7%).ConclusionMRI in children and adolescents with hip pain should be done primarily without intraarticular contrast administration since most cases show an extraarticular pain reason or no diagnosis detectable with MRI.

All-Arthroscopic Falciform Portal Biceps Tenodesis

Biceps tenodesis has been proven to be an effective treatment for biceps tendon and superior labral pathology. Many techniques including both open and arthroscopic approaches have been reported. Open techniques afford management of the entire proximal biceps tendon but are limited by wound healing issues, increased bleeding, and increased surgical time. Arthroscopic tenodesis offers benefits in terms of surgical efficiency, cosmesis, and bleeding risk. However, standard arthroscopic tenodesis only addresses intra-articular biceps pathology. In this report we describe an all-arthroscopic biceps tenodesis technique at the suprapectoral region of the humerus using knotless suture anchor fixation.

Comparison of conventional MR arthrography and 3D volumetric MR arthrography in detection of cartilage defects accompanying glenoid labrum pathologies.

In this study, we aimed to compare conventional and T1-weighted volumetric magnetic resonance arthrography (MRA) in the diagnosis and grading of glenoid cartilage defects that accompany labral pathologies. A total of 79 patients who were prediagnosed with labrum pathologies based on shoulder magnetic resonance imaging (MRI) had MRA and CTA between December 2021 and May 2022. CTA was regarded as reference standard. CTA images were examined by a radiologist experienced in musculoskeletal radiology, and MRA images were examined by two radiologists independently to determine presence, grade, and localization of any glenoid cartilage defect, if present. Sensitivity, specificity, and accuracy were calculated separately for conventional and T1-weighted volumetric MRA. In addition, at the last stage, two observers examined all MRAs together, and the presence of a cartilage defect was decided by consensus, and the overall sensitivity, specificity, and accuracy were calculated. Cartilage defect was detected on CTAs of 48 (60.75%) cases of among 79 patients with labrum pathology. The sensitivity, specificity, and accuracy of conventional MRA for two examiners were 17-19%, 100-100%, and 49-51%, respectively, while those values were 67-65%, 92-97%, and 84-77%, respectively, for T1-weighted volumetric MRA. Inter-examiner agreement was excellent for diagnosis of cartilage defects on all MRAs. The overall sensitivity, specificity, and accuracy for detection of glenoid cartilage lesions by MRA were 69%, 97%, and 80%, respectively. T1-weighted volumetric MRA seems to demonstrate cartilage defects accompanied with labrum pathologies accurately with high sensitivity, specificity, and excellent inter-examiner agreement.

Superior labrum anterior to posterior lesions: Part 2 - Classification with arthroscopic correlation.

The illustrated review functions as a crucial radiological guide for both radiologists and orthopaedic surgeons. The combination of illustrations, MR and correlative arthroscopic images enhances the comprehensive understanding of labral pathology. The value of the review lies in the presentation of imaging findings and classification, coupled with findings on arthroscopy. This understanding is vital in guiding orthopaedic management for patients, ensuring appropriate treatment strategies.

Posterior Compression Test: a Provocative Test for Detecting Posterior Labral Tears.

The purpose is to assess the diagnostic accuracy of a provocative test coined as the 'posterior compression test' (PCT) in those with the suspected posterior labral tear or lesion. A total of 515 'arthroscopic labral repairs' were identified between April 2013 and September 2020. Excluding those with concomitant shoulder pathologies, and only including those with pre-operative documentation of the PCT and/or the Jerk test, 191 patients were included. For the purposes of the analyses, the patients were divided into 'non-posterior' labral tear group which included the anterior labral tears and/or the superior labral anterior-to-posterior (SLAP) tears, versus 'any posterior' labral tear group which included the isolated posterior labral tears, the SLAP tears with posterior extension and the pan-labral tears. When the PCT was performed for the isolated posterior labral tears, the sensitivity was 92.6% with the specificity of 86.5%. The positive predictive value and negative predictive value were 71.4-97%, respectively. The Jerk test's sensitivity was 77.8% but when the two tests were combined, the sensitivity increased up to 96.3%. The combined sensitivity with the Jerk test was still up to 94.6% with the AUC (area under curve) /ROC (receiver operator characteristic) at 0.855. Low 'false-positive' rate with the PCT was observed when the test was performed for the 'non-posterior' labral group, with the sensitivity of 13.5%. The posterior compression test correlated well with the arthroscopic diagnoses in a subset of patients with suspected posterior labral pathology, possibly by means of direct stimulation. III; Diagnostic Study.