Treatment of Labral Pathology: Reattachment and Replacement

2013 ◽  
pp. 213-229
Author(s):  
Lisa M. Tibor ◽  
Martin Beck
Keyword(s):  
Labral Pathology

Accuracy of MRI With and Without Contrast for Identifying Rotator Cuff and Labral Pathology (SS-39)

2006 ◽  
Vol 22 (6) ◽  
pp. e20-e21
Author(s):  
Lam K. Sien ◽  
John Nyland ◽  
Harvey Damacen ◽  
David N.M. Caborn
Keyword(s):  
Rotator Cuff ◽  
Labral Pathology

scholarly journals Sensitivity of Magnetic Resonance Imaging for Acetabular Labral Pathology in Adolescent and Young Adult Athletes

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0043
Author(s):  
Christine M. Kelly ◽  
Nicole M. Chevalier ◽  
Laura A. Vogel ◽  
Jonathan D. Gelber ◽  
Carl W. Nissen ◽  
...  
Keyword(s):  
Young Adult ◽  
Sports Medicine ◽  
False Negative ◽  
False Negative Rate ◽  
Adolescent And Young Adult ◽  
Radiology Report ◽  
Negative Rate ◽  
Labral Tears ◽  
Mri Scans ◽  
Labral Pathology

Objectives: Hip impingement and associated labral tears are a common source of pain in adolescent and young adult athletes. The majority of current literature focuses on adult populations while there is a relative paucity of literature on younger athletes. It has been our experience that the proper diagnosis and management of patients with labral pathology in the adolescent athletes is often delayed. One of the reasons for this delay may be the sensitivity of MRIs in diagnosing hip pathology. The sensitivity of MRI to detect labral tears in adults has been reported to be 71-91%. However, the sensitivity of MRI to detect labral pathology in adolescent athletes is unknown. The purpose of this study was to evaluate the sensitivity of MRI in diagnosing labral tears in an adolescent and young adult population. Methods: Patients undergoing hip arthroscopy by 3 sports medicine trained orthopedic surgeons between 2006-2018 were retrospectively reviewed. Patients were included in this study if they had a MRI and subsequently confirmed labral pathology during hip arthroscopy. Patients were excluded if they had a history of prior surgeries of the ipsilateral hip, did not have a diagnosis of femoral-acetabular impingement (FAI) or acetabular labral pathologies, were over the age of 25 or if the MRI did not have a radiologist report available for review. The MRI reports of the patients who met study criteria were reviewed to determine if the radiologist suspected labral pathology. The MRIs were also reviewed by a sports medicine fellowship trained orthopaedic surgeon who was not involved in the patients’ care and was blinded to the radiologist reports. The radiology report and the orthopaedist’s read were then compared against the surgical findings to determine the sensitivity and false negative rates for MR imaging in this patient population. Results: A total of 140 hips in 132 patients (26 males, 106 females) were included in this study with a mean age of 16.7 ± 2.4 years. Of this study cohort, 112 patients had a labral repair and 20 had a labral debridement. Results showed that of the 140 hip MRIs, the official radiology report described the presence of labral pathology in only 76 MRI scans; indicating that the MRI has a sensitivity of 55% and a false negative rate of 44% for the presence of labral pathology. Results of the blinded orthopaedic surgeon’s review showed that of the 140 hip MRIs available, the presence of labral pathology was seen in only 92 MRI scans with a sensitivity of 65% and a false negative rate of 34%. Conclusion: Routine MRI scans had a low sensitivity and high false negative rate for labral pathology in adolescent and young adults regardless of reviewer, even in the presence of retrospective bias. The sensitivity of MRI for labral pathology in this population is lower than that reported in the literature for adult patients. These findings have implications for clinicians who rely heavily on MRI results and radiologist reports in their clinical decision making which may result in delays in appropriate surgical management.

scholarly journals ADOLESCENT POSTERIOR-SUPERIOR GLENOID LABRAL PATHOLOGY: DOES INVOLVEMENT OF THE BICEPS ANCHOR MAKE A DIFFERENCE?

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0024
Author(s):  
Cody H. Hansen ◽  
Alicia M. Asturias ◽  
Andrew T. Pennock ◽  
Eric W. Edmonds
Keyword(s):  
Limited Information ◽  
Self Assessment ◽  
Superior Labrum ◽  
Labral Tears ◽  
Posterior Group ◽  
Outcome Scores ◽  
Age Cohort ◽  
Biceps Anchor ◽  
Labral Pathology ◽  
Overhead Sport

Background: Adolescent athletes are at risk to sustain an injury to the posterior and superior labrum of the glenoid. Limited information is available regarding the outcomes of surgical intervention in this specific age cohort. Purpose: To compare those patients with pure posterior pathology and those with involvement of the biceps anchor (superior labrum anterior-posterior tears - SLAP) to determine risks for failure in the surgical management. Methods: A retrospective review was performed on all patients under the age of 19 years over an eight year period to identify those treated for superior and posterior labral pathology, followed by chart review, radiographic review and arthroscopic findings. Demographics and other variables were recorded, including: etiology (traumatic versus atraumatic), activity/sports (overhead versus non-overhead), involvement of the biceps anchor – crossing the 12 o’clock position (Posterior vs SLAP), associated pathologies, outcome scores (SANE – Self Assessment Numerical Evaluation versus PASS – Pediatric Adolescent Shoulder Score), and complications. Results: 48 patients (30 males, 18 females) with a mean age at surgery of 16.5 years (range 13.5 to 19) were identified that met criteria with a mean follow-up of 4.1 years (range 1.3 to 6.9). Nineteen subjects had SLAP tears, and 29 subjects had posterior tears. All but 2 regularly participated in sports at the time of their injury; of the athletes, 26 (56.5%) played an overhead sport and 20 (43.5%) played a non-overhead sport. The etiology of the injury was traumatic in 25 cases (52.1%), and atraumatic in 23 cases (47.9%). Outcome scores were not significantly different between etiology or type of sports played; but, the mean PASS score in the SLAP group was 88.7, compared to 76.2 in the posterior group (p=0.005) at final assessment. Only 1 SLAP patient failed management (5.3%) compared to 5 patients in the posterior only cohort (17.2%). Conclusion: SLAP tears have better outcomes and lower failure rates than posterior only tears in the adolescent population. Posterior-superior labral tears can occur in all sport types with multiple etiologies, but the only factor that appears to play a role in ultimate outcome is whether or not the tear crosses under the biceps anchor to the anterior side.

scholarly journals Indirect magnetic resonance arthrography of the shoulder; a reliable diagnostic tool for investigation of suspected labral pathology

2013 ◽  
Vol 42 (9) ◽  
pp. 1225-1233 ◽  
Author(s):  
Farshid Fallahi ◽  
Nick Green ◽  
Sarat Gadde ◽  
Lisa Jeavons ◽  
Patrick Armstrong ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Diagnostic Tool ◽  
Magnetic Resonance Arthrography ◽  
Labral Pathology

Superior labral pathology in sports

2000 ◽  
Vol 29 (10) ◽  
pp. 917-927 ◽  
Author(s):  
A. B. Imhoff ◽  
J. D. Agneskirchner ◽  
U. König ◽  
C. Temme ◽  
G. Öttl ◽  
...  
Keyword(s):  
Labral Pathology

scholarly journals Professional golfers’ hips: prevalence and predictors of hip pain with clinical and MR examinations

2016 ◽  
Vol 50 (17) ◽  
pp. 1087-1091 ◽  
Author(s):  
Edward Dickenson ◽  
Imran Ahmed ◽  
Miguel Fernandez ◽  
Philip O'Connor ◽  
Philip Robinson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Hip Pain ◽  
Hip Morphology ◽  
Hip Range Of Motion ◽  
Related Quality ◽  
Professional Golfers ◽  
Labral Pathology ◽  
Outcome Tool ◽  
Α Angle

AimsThis study aimed to determine the prevalence of hip pain in professional golfers, comparing the lead (left hip in right-handed golfer) and trail hips, and to establish what player characteristics predicted hip symptoms.MethodsMale elite professional golf players were invited to complete questionnaires and undergo clinical and MR examinations while attending the Scottish Hydro Challenge 2015. Questionnaires determined player demographics, self-reported hip pain and an International Hip Outcome Tool 12 (iHOT12) score (hip-related quality of life). Clinical examinations determined hip range of motion and the presence of a positive impingement test. MR scans determined the presence of labral pathology and player hip morphology with measures of α angle (cam), acetabular depth (pincer) and femoral neck antetorsion.ResultsA total of 109 (70% of tournament field) of players completed questionnaires, 73 (47%) underwent clinical examination and 55 (35%) underwent MR examination. 19.3% of players reported of hip pain. 11.9% of lead and 9.1% of trail hips were painful (p=0.378), iHOT12 scores were lower in the lead (94.1) compared to the trail hip (95.3) (p=0.007). Stepwise multiple linear regression modelling was able to predict 20.7% of the variance in iHOT12 scores with mean α angles between 12 and 3 o'clock, and increasing age-significant variables (R2=0.207, p<0.001; β=−0.502, p<0.001 and β=−0.399, p=0.031, respectively).Conclusions19.3% of male professional golfers reported hip pain. The presence of an increasing α angle and increasing age were significant predictors of reduced hip-related quality of life.

scholarly journals The Borderline Dysplastic Hip: Arthroscopy or PAO?

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0010
Author(s):  
George Grammatopoulos ◽  
Cecilia Pascual-Garrido ◽  
Jeffrey Nepple ◽  
Christopher M. Larson ◽  
Asheesh Bedi ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Hip Arthroscopy ◽  
Treatment Options ◽  
Treatment Decision ◽  
Patient Characteristics ◽  
Adjunct Treatment ◽  
Treatment Decision Making ◽  
Labral Pathology ◽  
Dysplastic Hip

Objectives: The borderline dysplastic hip (characterized by a lateral centre-edge angle (LCEA): 20 - 25° and an acetabular index (AI): 10 - 15°) can pose a significant challenge as symptoms may be due to insufficient acetabular coverage, the presence of femoro-acetabular impingement (FAI) or both. Accordingly, different treatment options have been described, including peri-acetabular osteotomy (PAO), hip arthroscopy, open arthrotomy or a combination of procedures. This study aims to determine patient and deformity-specific characteristics that direct treatment decision-making in the borderline dysplastic hip. Furthermore, we describe the early-term results of both the PAO and hip arthroscopy in treating this challenging patient population. Methods: A prospective, multicenter, longitudinal surgical cohort of young adult hips was searched. From 2060 hips, 291 hips satisfied the inclusion criteria of idiopathic borderline dysplasia, adequate follow-up (> 1-year) and functional outcome. Demographic and radiographic features are included in Table 1. Fifty-five hips (19%) had a previous hip operation (most commonly a hip arthroscopy). A number of different procedure types were performed which were broadly divided into 3 groups; PAO-only (n=42), hip arthroscopy-only (n=127) or PAO and intra-articular treatment (either arthroscopically or open, addressing the cam morphology and/or labral pathology) (n=122). Outcome measures included complications-, re-operations- rates and clinical outcomes using the Harris Hip (HHS) and HOOS scores; pre-operatively and at follow-up; the difference was defined as Δ. Patient characteristics, radiographic morphology and clinical outcome measures were compared between the 3 groups. Results: Patients that underwent a PAO were younger and more likely to be female. The PAO groups had a greater number of previous hip procedures (26%, 24%), most of which were hip arthroscopies. The patients that underwent hip arthroscopy had greater incidence of high alpha angles (66%) compared to the PAO groups (35%, 38%) (p<0.001). The PAO groups having slightly more dysplastic features (LCEA, AI, ACEA) (Table 1). At a mean follow-up of 2.5 years, there were no differences in the complication (7-10%, p=0.8) or re-operation rates (13%). Pre-operatively, the PAO groups had inferior HOOS and WOMAC scores compared to the arthroscopy group (p=0.02-7). No differences in the post-op scores were seen (Table 1). The groups that addressed the intra-articular pathology (arthroscopy and PAO-articular treatment) had significantly greater ΔHHS (23) compared to PAO-only (13) (p=0.02). Conclusion: Younger patients, those with a failed previous arthroscopy, without evidence of intra-articular wear and with worse pre-operative function were more likely to receive a PAO (with or without articular adjunct treatment). Addressing the intra-articular and impingement-related pathology (in addition to a when a PAO is considered necessary) was associated with better improvement in PROMs and should be strongly considered in the borderline hip. [Table: see text]

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