Application of ultrasound for evaluation of anterosuperior acetabular labral tear / 北京大学学报(医学版)

Objective:To explore the value of ultrasound in the diagnosis of anterosuperior acetabular labral tear.Methods:A total of 102 patients [(42 males and 60 females,age from 13 to 60 years,average age was (35.14 ± 9.16) years] with suspected anterosuperior acetabular labral tear were included in this study,including 44 left hip joints and 58 right hip joints.All the patients received hip joint ultrasound and magnetic resonance imaging (MRI) evaluation before arthroscopy surgery.Using arthroscopy as golden standard,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy between ultrasound and MRI were calculated and compared.Results:There were 91 anterosuperior acetabular labral tears of 102 patients which were confirmed during arthroscopy surgery.Sixtynine patients were diagnosed correctly by ultrasound,including 60 anterosuperior acetabular labral tears and 9 with no acetabular labral tears,whereas 2 were false-positive and 31 were found to be false-negative.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy by ultrasound were respectively 65.93％,81.82％,96.77％,22.50％ and 67.65％.In contrast,seventy-seven patients were diagnosed correctly by MRI,including 70 anterosuperior acetabular labral tears and 7 with no acetabular labral tears,whereas 4 were false-positive and 21 were found to be false-negative.For MRI,the sensitivity,specificity,positive predictive value,negative predictive value and accuracy were respectively 76.92％,63.64％,94.59％,25.00％ and 75.49％.The results of ultrasound and MRI were in accordance in 68 of the 102 patients.There were 51 anterosuperior acetabular labral tears of the 68 patients who were diagnosed by both ultrasound and MRI,whereas there were 17 with no acetabular labral tears of the 68 patients who were diagnosed by both ultrasound and MRI.The results of ultrasound and MRI were inconsistent in 34 of the 102 patients.In 11 of the 34 patients,in which case ultrasound diagnosed anterosuperior acetabular labral tear,MRI found no acetabular labral tear.Whereas,in 23 of the 34 patients,in which case MRI diagnosed anterosuperior acetabular labral tear,ultrasound found no acetabular labral tear.As compared with MRI findings,ultrasound had a lower accuracy for anterosuperior acetabular labral tear than MRI,there was statistical difference on the accuracy for anterosuperior acetabular labral tear (P ＜ 0.01).Conclusion:Although ultrasound had a slightly lower sensitivity for anterosuperior acetabular labral tear,it had a higher specificity than MRI.Dynamic evaluation of anterosuperior acetabular labral tear is an advantage of ultrasound.Ultrasound could be used as a feasible method to evaluate anterosuperior acetabular labral tear.

Hip Arthroscopy for Incarcerated Acetabular Labrum following Reduction of Traumatic Hip Dislocation: Three Case Reports / 대한고관절학회지

Traumatic hip fracture-dislocations are associated with chondral and labral pathology as well as loose bodies that can be incarcerated in the hip joint. Incarceration, such as interposed labrum between acetabulum and femoral head that is not readily visualized preoperatively, is a rare but important cause of pain and can potentially be a source for early degeneration and progression to osteoarthritis. We present three cases, arthroscopic surgery of incarcerated acetabular osseo-labral fragment following reduction of traumatic hip fracture-dislocation.

Patient Satisfaction after Arthroscopic Repair of Acetabular Labral Tears

BACKGROUND: Acetabular labral tear is a main cause of hip pain and disability, often requiring surgical treatment. Improvements of hip arthroscopic technique have produced positive outcomes after labral repair with arthroscopy. The purpose of this study was to determine clinical outcomes and patient satisfaction after arthroscopic repair of acetabular labral tear. METHODS: We interviewed 21 patients (10 men and 11 women; mean age, 36 years [range, 22 to 57 years]) with acetabular labral tears that had been repaired arthroscopically in terms of satisfaction of the procedure. In addition, clinical outcome was assessed using visual analog scale (VAS) score, University of California, Los Angeles (UCLA) activity, Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, and Harris hip score, and radiologic outcome was assessed using serial radiography. The patients were followed for 24-50 months. RESULTS: The mean Harris hip score was 73 points (range, 64 to 84 points) preoperatively and 83 points (range, 66 to 95 points) postoperatively. Fifteen hips (71%) were rated excellent and good. The mean WOMAC osteoarthritis index and VAS scores were improved at final follow-up. UCLA activity at the latest follow-up improved in 16 patients. The Tonnis grade of osteoarthritis at the latest follow-up did not change in all patients. Eighteen of the patients (86%) were satisfied with the procedure. CONCLUSIONS: High rate of satisfaction after arthroscopic repair of acetabular labral tears is an encouraging outcome. Arthroscopic treatment of labral tears might be a useful technique in patients with hip pathologies, such as femoroacetabular impingement with labral tears.

Ultrasonographic Usefulness for Diagnosis of Acetabular Labral Tear / 대한고관절학회지

PURPOSE: This study evaluated the usefulness of ultrasonography for a diagnosis of acetabular labral tear in femoroacetabular impingement (FAI). MATERIALS AND METHODS: From March 2010 to October 2011, an ultrasonographic examination was performed in 58 patients(58 hips: 26 men and 32 women) with acetabular labral tear. The sensitivity and positive predictive value of ultrasonography were evaluated for 58 cases with acetabular labral tear confirmed by hip arthroscopy. RESULTS: The sensitivity and positive predictive value for an acetabular labral tear using ultrasonography was 89.6% and 100%, respectively. The concordance rate of an acetabular labral tear between arthroscopy and ultrasonography was 84.6%. CONCLUSION: Hip ultrasonography can make a significant contribution to a pathologic diagnosis and isa useful diagnostic tool for acetabular labral tears.

Arthroscopic Labral Repair Associated with Femoroacetabular Impingement: Short Term 2-5 Years Follow-up Results / 대한고관절학회지

PURPOSE: The purpose of this study is to report on the short term follow-up of patients who underwent arthroscopic acetabular labral repair for femoroacetabular impingement and acetabular labral tear. MATERIALS AND METHODS: A total of 45 consecutive patients who underwent arthroscopic acetabular labral repair after diagnosis of femoroacetabular impingement and acetabular labral tear from January 2008 to December 2010 were included in this study. Modified Harris hip score (MHHS), VAS, Hip outcomes score (HOS), and patient satisfaction were used for evaluation of the clinical results. RESULTS: Patients included 22 males and 23 females, and the mean age of the patients was 33.0(range, 16-54) years old, and the mean follow up period was 26.7(range, 24-56) months. Of the clinical results, mean VAS score was 6.4 and 2.5 points before and after surgery, respectively, and mean MHHS score improved from 59.5 points before surgery to 85.4 points after surgery. Activities of daily living and sports-related activities of HOS were 58.3% and 51.2%, respectively, before surgery, and 83.0% and 79.8% after surgery. Revision arthroscopic surgery was performed on five cases(12.1%); labro-synovial adhesion, three cases, pull-out of suture anchor, one case, heterotropic ossification, one case. CONCLUSION: Arthroscopic acetabular labral repair is considered an effective treatment for femoroacetabular impingement and accompanying acetabular labral tear.

Paralabral Cysts and Their Correlation with Acetabular Disorder / 대한고관절학회지

PURPOSE: To evaluate the correlation between MRI findings and hip joint lesions evaluated by arthroscopy in patients affected by paralabral cyst. MATERIALS AND METHODS: Of patients treated by hip arthroscopy from Jan 1996 to Mar 2010, 17 cases symptomatic of paralabral cyst as observed by preoperative MRI were analyzed. The presence of an acetabular labrum tear, and the location and size of the cyst were evaluated using both preoperative MRI and intraoperative arthroscopy. Visual analogue scale (VAS), modified Harris hip scale, and Hip outcome score results were compared as determined by the two assessment methods. RESULTS: According to the MRI findings, the locations of the cysts included 5 cases in the anterosuperior, 2 anterior, 4 anteroinferior, 2 posterosuperior and 4 posteroinferior. The mean size of all cysts was 25.1x12.5x13.8 mm3. Postoperatively, the mean VAS score for all patients improved from 7.7 to 1.5, their modified Harris hip score improved from 58.8 to 90.7, and their Hip outcome score improved from 54 to 93.5. CONCLUSION: Painful paralabral cyst was mainly associated with an acetabular labral tear and we concluded that observation of paralabral cyst upon preoperative MRI provided indirect evidence of proximal acetabular labral pathology.

Second-look Hip Arthroscopy after Arthroscopic Labrectomy of the Hip: Preliminary Report / 대한정형외과학회잡지

PURPOSE: To evaluate the cause of sustained symptoms after previous hip arthroscopy through second-look hip arthroscopy. MATERIALS AND METHODS: From 243 cases of acetabular labrectomy performed in our hospital from 1995 to 2007, we selected for review 9 cases, that had possible follow-up of more than 12 months with second-look hip arthroscopy. The male to female ratio was 3:6, the mean age was 32.2 years, and the mean follow-up period was 19.9 months. We evaluated the cause of sustained symptoms by comparing previous radiographs and second-look arthroscopic findings, and compared the pre-second-look and post-second-look state through physical examination, using the Japanese Orthopedic Association (JOA) pain score. RESULTS: We performed additional osteoplasty or chondroplasty in 6 cases of femoroacetabular impingement, that were due to previously insufficient arthroscopic treatment. Second-look hip arthroscopy revealed 6 cases with labral adhesions, 4 with synovial hypertrophy, 4 with a remnant labral tear, and 1 with a posterior periacetabular cyst. We did a procedure to release the labral adhesion, a synovectomy for the synovial hypertrophy, a labrectomy for the remnant labral tear and a cystectomy for the periacetabular cyst. Secondary arthroscopic treatment showed a post-operative improvement in the range of motion, in 5 cases and the JOA pain score increased improved from 0 to 2, indicating less pain, in all 9 cases. CONCLUSION: The most common cause of a second-look hip arthroscopy is post-operative, sustained femoroacetabular impingement and insufficient labrectomy and labral adhesion. To prevent failure of the arthroscopic treatment, adequate osteoplasty for femoroacetabular impingement, accurate labrectomy for labral tears and constructive rehabilitation treatment for preventing post-operative labral adhesion are recommended.

Acetabular Labral Tears in Patients with Sports Injury

BACKGROUND: We wanted to investigate acetabular labral tears and their correlation with femoroacetabular impingement in patients with sports injury. METHODS: Among 111 patients who were diagnosed with the acetabular labral tears after arthroscopic treatment from January 2004 to December 2007, we selected 41 patients with sports injury. There were 12 cases of Taekwondo injury, 5 of golf injury, 4 of soccer injury, 3 of gymnastics injury, 2 of Hapkido injury, 2 of aerobics injury, 2 of rock-climbing injury, 2 of fitness training injury and 9 of other sports injuries. We checked the subtypes of acetabular labral tears and the accompanying femoroacetabular impingement. For the cases with accompanying femoroacetabular impingement, we investigated the subtypes according to the types of sports, gender and age. At last follow-up, we checked the Harris Hip Score (HHS), the Hip Outcome Score (HOS) sports scale and the percentage of patients who returned to their sports activity. RESULTS: The average age of symptomatic onset was 26 years (range, 12 to 65 years). The ratio of males to females was 29 : 12. An average duration of the hip pain was 17 months (range, 1 to 60 months). The degenerative type of acetabular labral tears was the most prevalent with 32 cases (78%), and there were 9 cases (22%) of the partial tear type. Thirty cases (73%) were accompanied by femoroacetabular impingement. The average age of the 23 cases (56%) of the cam-type was 23 years (range, 12 to 48 years), and it was more likely to occur in men (87%) and for people practicing martial arts such as Taekwondo or Hapkido. An average age of the 5 cases (12%) of the pincer-type was 26 (range, 16 to 43 years), it usually occurred in women (60%) and for non-martial arts such as golf and gymnastics. There were 2 cases of the mixed type (cam + pincer-type). At 27 months follow-up, the HHS was 61 to 92 points, the HOS sports scale increased 43 to 75%, and the rate of returning to sports was 71%. CONCLUSIONS: In spite of the early expression of symptoms and the short duration of the acetabular labral tears, the high rate of degenerative acetabular labral tears in sports patients is likely associated with repetitive injury after the expression of symptoms. Femoroacetabular impingement in sports patients is seemed to be a cause of the early occurrence of acetabular labral tears. Because the possibility of acetabular labral tears is high in femoroacetabular impingement, sports patients may need to undergo early screening for the diagnosis and care of femoroacetabular impingement.

Treatment of Acetabular Avulsion Fracture with Labral Tear Using Suture Anchor: A Case Report

We present here an operative method that uses the suture anchor technique in the case of a tiny avulsion fracture of the acetabulum along with a labral tear. Generally it is very difficult to determine how to treat patient with either the conservative method or the operative method because it is difficult to decide on the proper method to fix tiny avulsion fracture fragments to the acetabulum. Unstable hip dislocation was perceived in our case, so we tried to fix the fracture fragments to the acetabular rim&repair the labral tear that was seen on the operation field by using the sutue anchor technique. This is now a popular method to repair labral tear of the shoulder joint.

Morphological Study on the Acetabular Labrum

For the diagnosis and treatment of the labral pathology, the cross sectional morphology of the labrum is needed. Fifty-four labra (male: female=44: 10) from 32 adult Korean cadavers were cut in radial and perpendicular fashions to their longitudinal axis. Each labrum was divided into 8 segments, resulting 8 equally distanced points. To analyze the 432 cut surfaces, which consisted of 378 labra and 54 transverse acetabular ligaments cut surfaces, all dimensions of the cut surfaces were measured, and the attachment patterns, including the sublabral slit, observed. The shapes of the cut surfaces were classified into four types (3 subtypes of triangle and 1 quadrangle) and the attachment patterns into five types. At the anterior portion of the labrum, which other studies reported as the predilection area for labral tears, there were several common findings: 1) Tall triangular shapes were dominant (61.1%) or relatively common type (25.9%). 2) The average heights of the labrum were longer (7.4 and 7.0 mm) than at the other sites (4.0 - 6.8 mm). 3) The attachment types with no extra-extended portion (68.5%) and sublabral slits (39.0%) were most commonly observed. It was concluded that there were different types of cut surface and attachment patterns of the acetabular labrum, and these findings had a tendency to be distributed with some labral tears. These anatomical data are believed could be useful in the management of an acetabular labral pathology.