Clinical diagnosis and arthroscopic treatment of acetabular labral tears

Wang, Weiguo; Yue, Debo; Zhang, Nianfei; Wen, Huaxuan; Li, Zirong

doi:10.1111/j.1757-7861.2010.00121.x

Cited by 24 publications

(22 citation statements)

References 19 publications

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“…Labral tears were found in 20 (38%) hips and most commonly co-existed with other pathology, which is consistent with previous findings [23–26] The sensitivity and specificity of MRI in the diagnosis of acetabular labral tears is 66 and 79% respectively in the literature [27]. Most labral tears were in the anterior superior quadrant, which is consistent with previous literature [28].…”

Section: Discussionsupporting

confidence: 89%

Arthroscopic findings of a diagnostic dilemma- hip pathology with normal imaging

Buikstra

Fary

Tran

2017

BMC Musculoskelet Disord

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BackgroundPatients with groin, hip and pelvic pain but normal findings on MRI and minimal changes on x-ray can be a diagnostic problem. This paper looks at the arthroscopic findings of patients who have had hip pain and a positive response to an intra-articular anaesthetic but have non-contributory imaging. We hypothesized that standard MRI’s were missing significant pathology and if there was a response to intra-articular local anaesthesia, pathology found during arthroscopy was likely.MethodsA retrospective review of all hip arthroscopies performed from March 2011 to January 2015 by two orthopaedic surgeons specializing in hip arthroscopy was conducted to identify patients with clinically suspected intra-articular hip pathology despite a normal MRI report and X-ray. Clinical suspicion of intra-articular hip pathology was confirmed with a positive response to a fluoroscopically guided intra-articular injection of local anaesthetic and corticosteroid. Pathologic findings were collated from the standardised operative notes.ResultsFifty-three hip arthroscopies performed in 51 patients met the inclusion criteria from a total of 1348 hip arthroscopies performed over a 46-month period. All but one of the 53 (98%) hips had arthroscopically confirmed pathology. Mean patient age was 32.5 years [15 to 67 years] with 40 (78%) females and 11 (22%) males. 92.5% of the hips (49/53) were FADIR (flexion, adduction and internal rotation) positive on clinical examination, giving this test a positive predictive value of 98% (95% CI: 89.31 to 99.67%) for intra-articular pathology.ConclusionsIn patients with a normal MRI without contrast and a positive response (relief of pain) to an intra-articular injection that failed conservative management, there is a 98% chance of intra-articular hip pathology being discovered on hip arthroscopy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1485-5) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 89%

Arthroscopic findings of a diagnostic dilemma- hip pathology with normal imaging

Buikstra

Fary

Tran

2017

BMC Musculoskelet Disord

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“…Only five studies comprising 317 hips commented on the presence of lesions of the ligamentum teres. The incidence of an associated lesion of the ligamentum teres in these studies was 13% (10 of 75 27 ), 84% (94 of 112 32 ), 93% (26 of 28 36 ), 17% (14 of 81 6 ) and 19% (4 of 21 35 ), respectively. Rehabilitation protocols were variable.…”

Section: Resultsmentioning

confidence: 64%

“…1,6,12,18,20,21,24,25,27,[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] The studies were published between 1995 and 2012. All reported outcomes of treatment of a labral tear by reattachment, debridement or both.…”

Section: Resultsmentioning

confidence: 99%

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Debridementversusre-attachment of acetabular labral tears

Haddad

Konan

Haddad

2014

The Bone & Joint Journal

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We have reviewed the current literature to compare the results of surgery aimed to repair or debride a damaged acetabular labrum. We identified 28 studies to be included in the review containing a total of 1631 hips in 1609 patients. Of these studies 12 reported a mean rate of good results of 82% (from 67% to 100%) for labral debridement. Of the 16 studies that reported a combination of debridement and re-attachment, five reported a comparative outcome for the two methods, four reported better results with re-attachment and one study did not find any significant difference in outcomes. Due to the heterogeneity of the studies it was not possible to perform a meta-analysis or draw accurate conclusions. Confounding factors in the studies include selection bias, use of historical controls and high rates of loss of follow-up. It seems logical to repair an unstable tear in a good quality labrum with good potential to heal in order potentially to preserve its physiological function. A degenerative labrum on the other hand may be the source of discomfort and its preservation may result in persistent pain and the added risk of failure of re-attachment. The results of the present study do not support routine refixation for all labral tears.

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“…However, the reported sensitivity and specificity of MRA in the available literature varies. Toomayan et al reported a 92% sensitivity in detecting labral tears in 2006 and more recently some authors have reported a sensitivity of 100% (4,5). A recent meta-analysis of the available literature by Smith et al reported moderate sensitivity and specificity (87% and 64% respectively), and noted that there were limited sample sizes in the studies evaluated (6).…”

Section: Introductionmentioning

confidence: 99%

Magnetic Resonance Arthrography for Labral Tears and Chondral Wear in Femoroacetabular Impingement

et al. 2012

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Magnetic resonance arthrography (MRA) is a useful pre-operative investigation for patients with clinical signs and symptoms of femoroacetabular impingement. Our aim was to assess the diagnostic accuracy of MRA in detecting labral tears and chondral wear in this context. Sixty nine hips were included in the study after exclusions. All patients underwent pre-operative MRA and then subsequent hip arthroscopy. The findings at MRA were compared to those found intraoperatively. For labral tears, sensitivity, specificity and accuracy were 81%, 51% and 58% respectively. For chondral wear these figures were 17%, 100%, and 55% respectively. In our institution, MRA was therefore not as accurate as previously published work suggests.

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Clinical diagnosis and arthroscopic treatment of acetabular labral tears

Abstract: Acetabular labral injury is closely correlated with femoro-acetabular impingement. Impingement tests and MRA have high sensitivity and accuracy in clinical diagnosis of labral tears. Arthroscopic debridement, repair and osteoplasty for labral tears results in a good early outcome.

Cited by 24 publications

References 19 publications

Arthroscopic findings of a diagnostic dilemma- hip pathology with normal imaging

Arthroscopic findings of a diagnostic dilemma- hip pathology with normal imaging

Debridementversusre-attachment of acetabular labral tears

Magnetic Resonance Arthrography for Labral Tears and Chondral Wear in Femoroacetabular Impingement

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