Magnetic resonance arthrography and the prevalence of acetabular labral tears in patients 50 years of age and older.
OBJECTIVE
Arthroscopy for acetabular labral tears has minimal impact on pain and function in older patients, especially in the setting of concomitant osteoarthritis. Still, many physicians seek this diagnosis with MR arthrography. Our purpose is to assess the frequency of acetabular labral tears in older patients with hip pain and correlate likelihood of labral pathology with severity of osteoarthritis as visualized on conventional radiograph.


METHODS
From 2004 to 2013, 208 hip MRI arthrograms and corresponding radiographs on patients aged 50 years and older were identified. Age, gender, grade and location of labral tear, alpha angle, Tönnis grade, and joint space width were documented. Labral tears and alpha angle were identified and measured on MR arthrogram. Tönnis grade and joint space width were measured on radiographs.


CONCLUSIONS
On MR arthrography, true labral tearing was identified in 73 % of patients. There was some degree of labral pathology in 93.3 % of patients, and this increased to 100 % in patients with moderate to severe osteoarthritis, as defined by Tönnis grade 2-3 or joint space width ≤ 2 mm. There were no statistically significant correlations between labral tear grade and Tönnis grade or joint space width. Given the high frequency of labral pathology and the questionable efficacy of arthroscopic surgical intervention in older patients, MR arthrography should be primarily for those with minimal arthritis on radiograph and potential to benefit from surgery. If further imaging beyond radiographs is necessary in these patients, standard MRI may be a more appropriate imaging tool.
Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. rjayakar1@gmail.com.
Rohit
R
Jayakar
Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Alexa
A
Merz
Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Benjamin
B
Plotkin
Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Dean
D
Wang
Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Leanne
L
Seeger
Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Sharon L
SL
Hame
D000077:Acetabulum / Q000000981:diagnostic imaging / Q000293:injuries*; D000368:Aged; D000369:Aged, 80 and over; D001175:Arthrography; D001182:Arthroscopy; D005260:Female; D025981:Hip Injuries / Q000000981:diagnostic imaging*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
Acetabular labrum; Economic and decision analysis; Hip arthroscopy; Labral tear; MR arthrography; Magnetic resonance imaging; Osteoarthritis