title: Labral morphologic characteristics in patients with symptomatic acetabular dysplasia.
abstract: BACKGROUND
  The morphologic characteristics of the labrum in patients with symptomatic acetabular dysplasia have been described to some extent in smaller retrospective series, but the need remains to further define these disease characteristics and their importance as a diagnostic feature of hip instability.
  
  
  OBJECTIVE
  To (1) characterize the morphologic characteristics of the labrum in patients with symptomatic acetabular dysplasia and (2) test the relationships between specific labral variants, severity of dysplasia, and duration of symptoms.
  
  
  METHODS
  Cross-sectional study; Level of evidence, 3.
  
  
  METHODS
  Thirteen surgeons from 10 centers enrolled patients undergoing periacetabular osteotomy (PAO) for symptomatic acetabular dysplasia from 2008 to 2014. Patient demographics, presenting characteristics, preoperative radiographic data, operative data, and intraoperative findings were prospectively collected and retrospectively reviewed.
  
  
  RESULTS
  A total of 942 patients (972 hips) met the initial inclusion criteria, with a mean age of 25.2 years (range, 9-51 years; 84% female, 16% male). In addition to having PAO, 52.6% of hips had an anterior arthrotomy and 19.8% had a hip arthroscopy either to perform an osteochondroplasty of the femoral head-neck junction or to address labral pathologic changes. Of these 553 hips in which the labrum was visualized, labral morphologic status was graded as hypertrophic in 50%, normal in 45%, hypoplastic in 4%, and ossified in less than 1%. Decreased lateral center-edge angle and anterior center-edge angle and increased acetabular inclination were associated with labral hypertrophy, but chronicity of symptoms was not. Of the 553 hips, 64% had tears of the labrum, with the majority being degenerative-type tears.
  
  
  CONCLUSIONS
  Labral pathologic changes are common in patients with symptomatic acetabular dysplasia. Labral hypertrophy, however, is not a universal finding, particularly in hips with mild dysplasia, and therefore should not be considered a reliable diagnostic criterion for instability.
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA sankarw@email.chop.edu.
authors.forename: Wudbhav N
authors.initials: WN
authors.lastname: Sankar
authors.affiliation: Ottawa General Hospital, Ottawa, Ontario, Canada.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Beaulé
authors.affiliation: Washington University, St Louis, Missouri, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Clohisy
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Young-jo
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Millis
authors.affiliation: University of Utah, Salt Lake City, Utah, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Peters
authors.affiliation: Texas Scottish Rite Hospital for Children, Dallas, Texas, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Podeszwa
authors.affiliation: Washington University, St Louis, Missouri, USA.
authors.forename: Perry L
authors.initials: PL
authors.lastname: Schoenecker
authors.affiliation: Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Rafael J
authors.initials: RJ
authors.lastname: Sierra
authors.affiliation: Hospital for Special Surgery, New York, New York, USA.
authors.forename: Ernest L
authors.initials: EL
authors.lastname: Sink
authors.affiliation: Texas Scottish Rite Hospital for Children, Dallas, Texas, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Sucato
authors.affiliation: William Beaumont Hospital, Royal Oak, Michigan, USA.
authors.forename: Ira
authors.initials: I
authors.lastname: Zaltz
mesh_terms: D000077:Acetabulum / Q000000981:diagnostic imaging; D000293:Adolescent; D000328:Adult; D001182:Arthroscopy / Q000379:methods; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D005270:Femur Head / Q000000981:diagnostic imaging; D005272:Femur Neck / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006618:Hip Dislocation, Congenital / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D006801:Humans; D006984:Hypertrophy / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods; D011859:Radiography; D012189:Retrospective Studies; D055815:Young Adult
keywords: acetabular dysplasia; labral morphologic characteristics; labrum; periacetabular osteotomy