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Does MRI Scan Enable Optimally Informed Pre-Operative Planning In Hip Arthroscopy?

Vitali Goriainov, FRCS (Orth), BM, PhD, MSc
UNITED KINGDOM

Does MRI Scan Enable Optimally Informed Pre-Operative Planning In Hip Arthroscopy?

Vitali Goriainov, FRCS (Orth), BM, PhD, MSc, UNITED KINGDOM Fadi Hindi, BM, MRCS, UNITED KINGDOM Andrew Langdown, BSc MB ChB FRCS(Tr&Orth), UNITED KINGDOM

Queen Alexandra Hospital, Portsmouth, UNITED KINGDOM

2021 Congress Abstract Presentation 5 minutes Not yet rated

Anatomic Location

Hip / Groin / Thigh

Sports Medicine

Orthopaedic Sports Medicine Basic Science Evidence Based Medicine

Anatomic Structure

Bones Labrum

Diagnosis / Condition

Impingement

Diagnosis Method

MRI

Treatment / Technique

Arthroscopy

Labrum

Labrum Tears

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Summary: Examination under anaesthetic of hips with FAI is a reliable method of defining underlying pathomorphology.

Introduction.
Femoro-acetabular impingement (FAI) is a dynamic phenomenon. The decisions on FAI management are guided by radiological findings, most prominently MRI scan. However, MRI is suboptimal in assessing the precise dynamic nature of FAI, bony pathomorphology (CAM/pincer lesions) and, infrequently, labral pathology. There is paucity of knowledge on how informed our pre-operative planning is when based purely on MRI findings. We additionally aimed to evaluate the value of anterior acetabular sector angle (AASA) as a measure of anterior acetabular coverage assessment.

Materials.
We performed a review of a single high-volume surgeon’s cohort of patients that underwent hip arthroscopy for FAI. Pre-operative MRI findings were analysed, and correlated with examination under anaesthetic (EUA) and intra-operative arthroscopic findings (benchmark). The parameters analysed included alpha-angles versus presence of CAM lesions, precise nature of labral lesions, presence of pincer lesions and their correlation to AASA. Alpha-angle >50 degrees and AASA >65 degrees were deemed pathological.

Results.
We reviewed 150 patients who underwent 150 hip arthroscopies. There were 78 females and 72 males, average age 38 years (53-18). Intra-operatively, pincer was present in 20% of patients, CAM in 26%, and mixed impingement in 54%. MRI scans correctly identified the presence of pincer in 36% of cases, CAM lesions in 44%, and precise labral abnormalities in 80%. Although there was a statistically significant difference in reported AASA values between pure CAM-type and impingements involving the presence of pincer lesions (57o vs 63o p<0.05), this difference was absent between pure pincer and mixed impingement (62o vs 63o, p=0.62). Pre-operative EUA accurately identified the presence of CAM lesions in 89% and pincer-type lesions in 77%.

Conclusions.
Ability to precisely establish pathology enables thorough pre-operative planning. MRI scans, even when reported by experienced MSK radiologists, frequently fail to identify the impingement pattern. Pathological threshold of AASA >65 degrees in MRI-based axial-plane evaluation of pincer-type pathomorphology was shown to be unreliable. Therefore, we advocate pre-operative EUA to enhance the understanding of pathology, treatment planning and, ultimately, the success of hip arthroscopy.

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Not Every Hip Impingement Requires Hip Arthroscopy. Abstract Presentation 5 minutes Vitali Goriainov, FRCS (Orth), BM, PhD, MSc, UNITED KINGDOM Mohamed Zubair Farook, MBBS, D.Ortho, FRCS (Orth), UNITED KINGDOM Rajiv Kaila, MRCS, MSc, MFSEM(UK), FEBOT, UNITED KINGDOM Tom CB Pollard, MD, FRCS (Tr & Orth), UNITED KINGDOM Antonio J. M. D. Andrade, MB BS, M.Sc., FRCS(Tr&Orth), UNITED KINGDOM
Is Arthroscopy An Adequate Therapy For All Borderline Dysplastic Hips? Correlation Between Radiologic Findings And Clinical Outcomes Abstract Presentation 6 minutes Alexander Zimmerer, MD, GERMANY Wolfgang Miehlke, MD, GERMANY Christian Sobau, MD, GERMANY
Labral Size Correlates With Increasing Intraarticular Damage At Time Of Arthroscopy In Borderline Dysplastic Patients ePoster Presentation Jacob Shapira, MD, UNITED STATES Jeffrey Chen, BA, UNITED STATES Mitchell Yelton, BS, UNITED STATES Philip Joseph Rosinsky, MD, UNITED STATES David R. Maldonado, MD, UNITED STATES Mitchell Meghpara, MD, UNITED STATES Ajay C. Lall, MD, MS, FAAOS, UNITED STATES Benjamin G. Domb, MD, UNITED STATES
Efficacy Of Tranexamic Acid In Hip Fracture Surgeries ePoster Presentation Aabid Sanaullah, MBBS,MRCS,MRCPS,PGDipTrauma Surg.FEBOT,FRCSTr&Orth, UNITED KINGDOM Adeel Nawab Ditta, MBBS, MRCS, UNITED KINGDOM Olufunso Damilare Onayemi, MRCS MCH (Ortho), UNITED KINGDOM Ahsan Sheeraz, BSc MBBS MRCS, UNITED KINGDOM Atif A. Malik, MB ChB, MRCS Ed, MSc. (Orto. Eng), FRCS Tr & Orth, UNITED KINGDOM
Segmental Labral Reconstruction With A Polyurethane Scaffold: Assessment Of Femoro-Acetabular Contact Mechanics Abstract Presentation 5 minutes Bruno Capurro, MD, PhD., SPAIN Marc Tey Pons, MD, PhD, MScs, SPAIN Francisco Reina, MD, PhD, SPAIN Anna Carrera, MD, PhD., SPAIN Mauricio Gidi, MD, SPAIN Joan Carles Monllau, MD, PhD, Prof., SPAIN
Female Athletes Demonstrate Greater Improvement in Patient Reported Outcome Scores and Equal Return To Sport Rates Compared to Males After Hip Arthroscopy A Gender Based Matched Comparison of High-Level Athletes Abstract Presentation 4 minutes Andrew Jimenez, MD, UNITED STATES Rachel Glein, BS, UNITED STATES Kara Miecznikowski, BS, UNITED STATES Benjamin Saks, MD, UNITED STATES Hari Krishna Ankem, MD, UNITED STATES Payam William Sabetian, MD, GUATEMALA Benjamin G. Domb, MD, UNITED STATES
Capsular Complications And Subsequent Instability On The Rise As Indications For Revision Hip Arthroscopy ePoster Presentation Ryan S. Selley, MD, UNITED STATES Molly A Day, MD, UNITED STATES Reena Olsen, BS, UNITED STATES Cort D. Lawton, MD, UNITED STATES Matthew S. Dooley, MA, UNITED STATES Stephanie S Buza, MD, UNITED STATES Bryan T. Kelly, MD, UNITED STATES Anil S. Ranawat, MD, UNITED STATES Danyal H. Nawabi, MD, FRCS(Orth), UNITED STATES
Evaluation of endoscopically gluteus medius repair in patients with Femoro-acetabular impingement and labrum detachment ePoster Presentation George D. Tsikouris, MD, GREECE Nikolaos D. Gravvanis, MD, GREECE Georgia S. Dedousi, MD, GREECE Panagiota Vlaserou, BSc in Physiotherapy, MSc Biomedical Engineer, GREECE Fanis P. Papadakis, BSc, MSc(cand.), GREECE Ioannis K. Antonopoulos, GREECE Vassilis N. Psychoyios, MD, GREECE Theodoros G. Troupis, Prof, GREECE
Endoscopic Shelf Acetabuloplasty Concomitant With Labral Repair, Cam Osteoplasty, And Capsular Plication For Treating Artistic Dancers In The Setting Of Acetabular Dysplasia: A Case Series Abstract Presentation 4 minutes Soshi Uchida, MD, PhD, JAPAN Yoichi Murata, MD, JAPAN Hajime Utsunomiya, MD, PhD, JAPAN Tsukamoto Manabu, MD, PhD, JAPAN Akihisa Hatakeyama, MD, JAPAN Shiho Kanezaki, MD, PhD, JAPAN Akinori Sakai, MD, PhD, JAPAN
Efficacy Of Enoxaparin As A Thromboprophylactic Agent In Major Lower Limb Orthopedic Surgeries. ePoster Presentation Raghavendra Raju, MBBS,MS, INDIA Prasad Soraganvi, MBBS, MS, DNB, MRCS, SICOT-dip, INDIA
Defining Sex-Based Outcomes Following Hip Arthroscopy In Patients With Borderline Hip Dysplasia. ePoster Presentation Benjamin Saks, MD, UNITED STATES James Fox, BBA, UNITED STATES Jade S Owens, BS, UNITED STATES Andrew Jimenez, MD, UNITED STATES Hari Krishna Ankem, MD, UNITED STATES Payam William Sabetian, MD, GUATEMALA Ajay C. Lall, MD, MS, FAAOS, UNITED STATES Benjamin G. Domb, MD, UNITED STATES
Characterizing the Incidence of Avascular Necrosis after Corticosteroid Injections of the Hip Abstract Presentation 5 minutes Nathan Varady, MD, MBA, UNITED STATES Paul F Abraham, BS, UNITED STATES Ahab Chopra, BA, UNITED STATES Michael Peter Kucharik, BS, UNITED STATES Wendy Madeline Meek, BBA, UNITED STATES Christopher T Eberlin, BS, UNITED STATES David Freccero, MD, UNITED STATES Eric L. Smith, MD, UNITED STATES Scott D Martin, MD, UNITED STATES
Midterm Outcomes Following Hip Labral Augmentation Abstract Presentation 4 minutes Joseph J. Ruzbarsky, MD, UNITED STATES Rui Soares, BS, UNITED STATES Justin W. Arner, MD, UNITED STATES Lauren Pierpoint, PhD, UNITED STATES Maitland Martin, BS, UNITED STATES Spencer M Comfort, BS, UNITED STATES Marc J. Philippon, MD, UNITED STATES
Cleft Sign and Bone Marrow Edema of the Pubic Synthesis are Associated with Sports Activity and Bony Morphology Related to Femoroacetabular Impingement in Symptomatic Patients with Labral Tears: A Cohort Study Abstract Presentation 5 minutes Keisuke Nakayama, MD, PhD, JAPAN Hajime Utsunomiya, MD, PhD, JAPAN Soshi Uchida, MD, PhD, JAPAN
Results After Arthroscopic Treatment Of Iliopsoas Impingement After Total Hip Arthroplasty ePoster Presentation Wolfgang Miehlke, MD, GERMANY Christian Sobau, MD, GERMANY Alexander Zimmerer, MD, GERMANY
“X-Square” Technique For Radial Meniscal Root Tear ePoster Presentation Winyou Ratanachai, MD.M Ch(Orth)., THAILAND Keerati Klinchanhom, MD, THAILAND
Hip Arthroscopic Portals:A New Approach Through Accessory Portals Established Within 3Cm Around Anterolateral Portal ePoster Presentation Kiran Kumar Shah, MD, NEPAL

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