Acetabular labral tear: Diagnosis and Treatment / 대한정형외과학회잡지

PURPOSE: To determine the significance of Magnetic Resornance Arthrography (MRA) and arthroscopy for diagnosis and treatment of acetabular labral tears as a cause of chronic hip pain. MATERIALS & METHODS: Thirty-seven hips with clinical suspicion of labral lesions were examined with MRA between Mar. 1995 and Mar. 1998. Among them, twenty-two patients underwent the diagnostic and operative arthroscopy. Another fifteen patients were observed closely without management. RESULTS: The mean age was 43 years (18-68 years) and male was twenty-five (68%) . Most common causes was degenerative (10 cases, 27%) and idiopathic (10 cases, 27%) . In MRA, stage IIA (partial tear by Czerny classification) were most common findings (twenty-one portion, 47%) . Including double tears in several patients, most common labral tear was located in the anterosuperior portion ( twenty-three cases, 51%) . Comparing arthroscopic finding, the accuracy of MRA for diagnosis of labral tear was 86.4%. Arthroscopically, we modified the morphological classification of labral tear to radial fibrillated (10 portions) , radial fibrillated + peripheral longitudinal (3) , peripheral longitudinal (4) , complete detachment (5) . All patients except three (86.4%) were improved by the arthroscopic partial labrectomy. In conservative patients, only three (20%) were spontaneously improved. CONCLUSION: MRA, and subsequent arthroscopic management appears to be a promising modality for detection and treatment of labral tear in patients with chronic hip pain.

Efficacy of MR Arthrography in the Diagnosis of the Acetabular Labral Tear

PURPOSE: To determine the accuracy of magnetic resonance (MR) arthrography in the detection and staging of lesions of the acetabular labrum. MATERIALS AND METHODS: Fifteen hips of 14 patients with chronic hip pain and clinical suspicion of labral lesions were examined with direct or indirect MR arthrography and underwent subsequent arthroscopic evaluation. The study population consisted of six women and eight men aged between 40 and 59 years. Nine arthrograms were obtained intra-articular administration of gadolinium solution, and six involved articular motion exercise after intravenous administration of gadolinium solution. In 14 cases a phased-array pelvic coil was used, and a shoulder coil in one. Fat-suppressed T1-weighted images were obtained in the coronal, oblique coronal and oblique axial planes, and T1-and T2-weighted images were obtained in the axial plane. Labral lesions were graded according to the Czerny classification and evaluated on the basis of presence or absence of a tear and location (anteroinferior, anterosuperior, superior, posterosuperior, posteroinferior). The findings were then correlated with the arthroscopic findings. RESULTS: After direct and indirect MR arthography, the findings-based on the Czerny classification -were as follows : stage IA:3; IB:1; IIA:8; IIB:1; IIIA:4; IIIB:0. MR arthrography also showed that seven cases were located in the anterosuperior portion of the labrum, seven in the superior portion, and three in the posteroinferior portion. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MR arthrography for diagnosis of the labral tear was 92%, 75%, 92%, 75 %, and 88 %, respectively. CONCLUSION: In this preliminary study, MR arthrography appears to be a promising imaging modality for accurate diagnosis and useful for screening patients with chronic hip pain.

Arthroscopic Diagnosis and Management for Painful Hip Diseases / 대한정형외과학회잡지

We have compared the findings of MRI with those of hip arthroscopy in 22 hips in adults with pilinful hip diseases. From March l995 to March 1997. We performed arthroscopy of the hips in symptomatic 22 patients. Fifteen cases were men and the mean average age was 46 years old. Preoperatively, the patients was diagnoseil with careful physical examinations and MR arthrogram or MR1. Among them, acetahular lahrum tears were 13 cases. synovial lesions were 3 cases and avascular necrosis of femoral head were 6 casee. We have examed cartilage softening, indentation or defect of femoral head and acetabulum, acetabular lahrum, loose hodies and synovial lesion hy arthroscopy. Under the arthroscopic guide, We had resected the torn Jahrum in S cases, removed a loose hodies such as synovial chondromatosis in 1 case and excised a synovial pathology in 2 cases. The others had a open arthrotomy in 8 cases. The sensitivity of MRI was 89.5% and its accuracy was 77.3% compared with arthroscopic findings. Average follow-up lengths was 8.6 months and 17(77.3%) of 22 patients were improved clinically. The arthroscopy of the hip is less invasive and a useful investigation for painful hip diseases for labral tears and synovial lesions in adults cspecially when standard MRI fails to prove a exact hip joint pathology, but it may be useless in avascular necrosis of femoral head. Also it is technical demanding and necessary to long-term follow-up.