Alberto Aliprandi1, Marco Brioschi2, Sandro Magnani3, Silvana Sdao4, Domenico Albano5, Luca Maria Sconfienza6,7, Filippo Randelli8. 1. Radiology Unit, Istituti Clinici Zucchi, Via Bartolomeo Zucchi, 24, 20052, Monza, Italy. 2. Postgraduate School in Orthopedic Surgery, Università degli Studi di Milano, Via Pascal 36, 20135, Milan, Italy. 3. Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy. 4. Department of Radiology, Ospedale Alessandro Manzoni, Via dell'Eremo 9, 23900, Lecco, Italy. 5. Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy. albanodomenico@me.com. 6. Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy. 7. Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Pascal 36, 20135, Milan, Italy. 8. Hip Department, Orthopedics and Trauma, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097, Italy.
Abstract
INTRODUCTION: Hip magnetic resonance arthrography (MRA) is the pre-operative imaging modality of choice in patients with labral damage, with several classifications of labral tears having been reported based on MRA findings. Nevertheless, none of the available classification systems allows the surgeon to predict before surgery how a labral tear could be treated. Our purpose was to develop a new MRA-based scoring system of labral tears to predict before surgery the treatment option more suitable for labral tears. MATERIALS AND METHODS: Forty-seven patients (29 males and 18 females; mean age: 35.9 ± 12.4) performed hip MRA for suspicious of femoroacetabular impingement and were afterwards subjected to arthroscopic treatment. Two musculoskeletal radiologists reviewed all pre-operative examinations and provided the Extension-Thickness-Damage score for each patient, based on Extension of tear, Thickness of labrum, and type of Damage. Chondral lesions grading was based on the arthroscopic findings according to Konan classification. For statistical purposes, patients were divided into two groups, depending on the type of treatment: labral repair or debridement. Mann-Whitney U, Chi-square, receiver operator curves, and Cohen kappa statistics were used. RESULTS: 35/47 underwent repair, while 12/47 were debrided. In both groups, the median chondral damage was grade III, with no significant differences (p = 0.439). The median Extension-Thickness-Damage score in the repair group (6) was significantly lower (p < 0.001) than that in the debridement group (8). The highest diagnostic performance (area under the curve) of Extension-Thickness-Damage was 0.819. The inter-observer agreement was substantial in the evaluation of Extension (k = 0.626) and Thickness (k = 0.771), and almost perfect for Damage (k = 0.827). Higher scores of Extension and Thickness were more frequently associated with debridement (p < 0.001; p = 0.0016, respectively), with no significant differences on the basis of Damage parameter (p = 0.284). CONCLUSIONS: The MRA-based Extension-Thickness-Damage score could represent a helpful pre-operative tool, expressing the extent of the damage and its reparability before arthroscopy.
INTRODUCTION: Hip magnetic resonance arthrography (MRA) is the pre-operative imaging modality of choice in patients with labral damage, with several classifications of labral tears having been reported based on MRA findings. Nevertheless, none of the available classification systems allows the surgeon to predict before surgery how a labral tear could be treated. Our purpose was to develop a new MRA-based scoring system of labral tears to predict before surgery the treatment option more suitable for labral tears. MATERIALS AND METHODS: Forty-seven patients (29 males and 18 females; mean age: 35.9 ± 12.4) performed hip MRA for suspicious of femoroacetabular impingement and were afterwards subjected to arthroscopic treatment. Two musculoskeletal radiologists reviewed all pre-operative examinations and provided the Extension-Thickness-Damage score for each patient, based on Extension of tear, Thickness of labrum, and type of Damage. Chondral lesions grading was based on the arthroscopic findings according to Konan classification. For statistical purposes, patients were divided into two groups, depending on the type of treatment: labral repair or debridement. Mann-Whitney U, Chi-square, receiver operator curves, and Cohen kappa statistics were used. RESULTS: 35/47 underwent repair, while 12/47 were debrided. In both groups, the median chondral damage was grade III, with no significant differences (p = 0.439). The median Extension-Thickness-Damage score in the repair group (6) was significantly lower (p < 0.001) than that in the debridement group (8). The highest diagnostic performance (area under the curve) of Extension-Thickness-Damage was 0.819. The inter-observer agreement was substantial in the evaluation of Extension (k = 0.626) and Thickness (k = 0.771), and almost perfect for Damage (k = 0.827). Higher scores of Extension and Thickness were more frequently associated with debridement (p < 0.001; p = 0.0016, respectively), with no significant differences on the basis of Damage parameter (p = 0.284). CONCLUSIONS: The MRA-based Extension-Thickness-Damage score could represent a helpful pre-operative tool, expressing the extent of the damage and its reparability before arthroscopy.
Entities:
Keywords:
Arthroscopy; Hip; Labrum; Magnetic resonance arthrography; Tear