Comparison of 2D, 3D, and radially reformatted MR images in the detection of labral tears and acetabular cartilage injury in young patients

2020 ◽  
Vol 50 (2) ◽  
pp. 381-388
Author(s):  
Stephanie Watson Mayer ◽  
Anne Skelton ◽  
Jonathan Flug ◽  
Tatum McArthur ◽  
Whitney Hovater ◽  
...  
Keyword(s):  
Young Patients ◽  
Cartilage Injury ◽  
Acetabular Cartilage ◽  
Mr Images ◽  
Labral Tears

scholarly journals Reliability of the classification of cartilage and labral injuries during hip arthroscopy

2020 ◽  
Vol 7 (3) ◽  
pp. 448-457
Author(s):  
Stephanie W Mayer ◽  
Tobias R Fauser ◽  
Robert G Marx ◽  
Anil S Ranawat ◽  
Bryan T Kelly ◽  
...  
Keyword(s):  
Femoral Head ◽  
Transition Zone ◽  
Central Compartment ◽  
Classification Systems ◽  
Cartilage Injury ◽  
Intraobserver Agreement ◽  
Acetabular Cartilage ◽  
Femoral Head Cartilage ◽  
Labral Tears

Abstract To determine interobserver and intraobserver reliabilities of the combination of classification systems, including the Beck and acetabular labral articular disruption (ALAD) systems for transition zone cartilage, the Outerbridge system for acetabular and femoral head cartilage, and the Beck system for labral tears. Additionally, we sought to determine interobserver and intraobserver agreements in the location of injury to labrum and cartilage. Three fellowship trained surgeons reviewed 30 standardized videos of the central compartment with one surgeon re-evaluating the videos. Labral pathology, transition zone cartilage and acetabular cartilage were classified using the Beck, Beck and ALAD systems, and Outerbridge system, respectively. The location of labral tears and transition zone cartilage injury was assessed using a clock face system, and acetabular cartilage injury using a five-zone system. Intra- and interobserver reliabilities are reported as Gwet’s agreement coefficients. Interobserver and intraobserver agreement on the location of acetabular cartilage lesions was highest in superior and anterior zones (0.814–0.914). Outerbridge interobserver and intraobserver agreement was >0.90 in most zones of the acetabular cartilage. Interobserver and intraobserver agreement on location of transition zone lesions was 0.844–0.944. The Beck and ALAD classifications showed similar interobserver and intraobserver agreement for transition zone cartilage injury. The Beck classification of labral tears was 0.745 and 0.562 for interobserver and intraobserver agreements, respectively. The Outerbridge classification had almost perfect interobserver and intraobserver agreement in classifying chondral injury of the true acetabular cartilage and femoral head. The Beck and ALAD classifications both showed moderate to substantial interobserver and intraobserver reliabilities for transition zone cartilage injury. The Beck system for classification of labral tears showed substantial agreement among observers and moderate intraobserver agreement. Interobserver agreement on location of labral tears was highest in the region where most tears occur and became lower at the anterior and posterior extents of this region. The available classification systems can be used for documentation regarding intra-articular pathology. However, continued development of a concise and highly reproducible classification system would improve communication.

scholarly journals Dynamic shear analysis: a novel method to determine mechanical integrity of normal and torn human acetabular labra

2018 ◽  
Vol 7 (7) ◽  
pp. 440-446 ◽  
Author(s):  
A. K. Woods ◽  
J. Broomfield ◽  
P. Monk ◽  
F. Vollrath ◽  
S. Glyn-Jones
Keyword(s):  
Storage Modulus ◽  
Structural Integrity ◽  
Biomechanical Testing ◽  
Young Patients ◽  
Dynamic Shear ◽  
Mechanical Integrity ◽  
Labral Tears ◽  
Significant Difference ◽  
Novel Method ◽  
End Stage

ObjectivesThe aim of this study was to investigate the structural integrity of torn and non-torn human acetabular labral tissue.MethodsA total of 47 human labral specimens were obtained from a biobank. These included 22 torn specimens and 25 control specimens from patients undergoing total hip arthroplasty with macroscopically normal labra. The specimens underwent dynamic shear analysis using a rheometer to measure storage modulus, as an indicator of structural integrity.ResultsThere was a significant difference in the storage modulus between torn (mean modulus = 2144.08 Pa) and non-torn (3178.1 Pa) labra (p = 0.0001).ConclusionThe acetabular labrum of young patients with a tear has significantly reduced structural integrity compared with a non-torn labrum in older patients with end-stage osteoarthritis. This study contributes to the understanding of the biomechanics of labral tears, and the observation of reduced structural integrity in torn labra may explain why some repairs fail. Our data demonstrate that labral tears probably have a relatively narrow phenotype, presenting a basis for further investigations that will provide quantifiable data to support their classification and a means to develop a standardized surgical technique for their repair. This study also demonstrates the value of novel biomechanical testing methods in investigating pathological tissues of orthopaedic interest. Cite this article: A. K. Woods, J. Broomfield, P. Monk, F. Vollrath, S. Glyn-Jones. Dynamic shear analysis: a novel method to determine mechanical integrity of normal and torn human acetabular labra: Implications for prediction of outcome of repair. Bone Joint Res 2018;7:440–446. DOI: 10.1302/2046-3758.77.BJR-2017-0282.R2.

Hip Arthroscopy in Patients Less than 25 Years of Age in the Treatment of Labral Tears: Aetiology and Clinical Outcomes

2017 ◽  
Vol 27 (5) ◽  
pp. 436-442 ◽  
Author(s):  
Gillian Bayley ◽  
Stephane Poitras ◽  
Gillian Parker ◽  
Paul E. Beaulé
Keyword(s):  
Quality Of Life ◽  
Clinical Outcomes ◽  
Hip Arthroscopy ◽  
Periacetabular Osteotomy ◽  
Cartilage Damage ◽  
Alpha Angle ◽  
Young Patients ◽  
Labral Repair ◽  
Labral Tears

Background Hip arthroscopy has evolved into a well-established and rapidly growing field of orthopedic surgery for the management of labral tears. The purpose of this study was to review clinical outcomes of patients less than 25 years of age undergoing hip arthroscopy for treatment of a labral tear. Methods From 2005 to 2013, 82 hips in 76 patients with mean age of 20.4 (16-25 range) underwent hip arthroscopy for treatment of labral-chondral damage. The Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and hip disability and osteoarthritis outcome score (HOOS) were recorded at latest follow-up. Results 36 of 86 hips (42%) had isolated labral pathology with no associated bony pathology (normal alpha and centre-edge angle; no retroversion). Beck score (intraoperative cartilage damage) of 3 or more was significantly associated with an alpha angle of more than 55 degrees (odds ratio [OR], 3.6; confidence interval [CI], 1.2-11.0) and presence of femeroacetabular impingement (OR, 4.5; CI, 1.3-15.2). HOOS pain, sports/recreation, and quality of life significantly improved from preoperative to one year after surgery (p<0.05). 8 patients had re-operations for persistent pain; 5 underwent arthroscopic labral repair; 2 underwent arthroscopy with subsequent periacetabular osteotomy (PAO); 1 had only a periacetabular osteotomy (PAO). Complications included 2 lateral femoral cutaneous nerve deficits and 1 deep vein thrombosis. Conclusions Labral tears in patients less than 25 years of age occurs commonly without bony deformities, with those with normal head/neck contour demonstrating significantly less early cartilage damage than those with bony pathology. Hip arthroscopy in young patients can improve function and quality of life with minimal morbidity.

Outcomes After Arthroscopic Repair in Patients With Tears of Hypertrophic Versus Morphologically Normal Acetabular Labra

2020 ◽  
Vol 48 (5) ◽  
pp. 1168-1174 ◽  
Author(s):  
Jae-Young Lim ◽  
Ye-Hoon Jang ◽  
Jun-Il Yoo ◽  
Young-Kyun Lee ◽  
Kyung-Hoi Koo ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Scale Score ◽  
Arthroscopic Repair ◽  
Labral Tear ◽  
Cartilage Injury ◽  
Labral Tears ◽  
Acetabular Labral Tear ◽  
Patient Reported ◽  
And Cartilage

Background: Recently, a hypertrophic labrum has been reported in the absence of hip dysplasia, which can possibly contribute to an acetabular labral tear. Purpose: To compare the clinical outcomes and complications, including the incidence of iatrogenic acetabular labrum and cartilage injury, in patients with tears of hypertrophic versus morphologically normal acetabular labra over a minimum follow-up period of 2 years and to assess the morphologic changes at follow-up computed tomography arthrography in the 2 groups. Study Design: Cohort study; Level of evidence, 3. Methods: Between January 2010 and December 2016, 20 patients (22 hips) with a hypertrophic labrum underwent arthroscopic hip surgery. A total of 22 patients (22 hips) without a hypertrophic labrum were assigned to the control group based on matching criteria, including age, sex, body mass index, labral tear, and labral repair. Clinical outcomes were assessed with the visual analog scale score, UCLA activity scale score (University of California, Los Angeles), and modified Harris Hip Score. Radiologic outcomes were assessed through serial radiography. Patients were followed for at least 2 years. Results: The mean age at surgery was 42 years. The most common cause of arthroscopic surgery in the study group was an isolated acetabular labral tear without any bony structural abnormalities (68.2%, 15 of 22 hips). All improvements in both groups were statistically significant at the last postoperative follow-up ( P < .001). Although the radiologic and clinical outcomes were not significantly different between the groups, the complication rates, including iatrogenic labral perforations and cartilage injury, were significantly higher in patients with hypertrophic acetabular labral tears (9 vs 3, P = .042). The patient-reported satisfaction scores at the last postoperative follow-up were 8.4 and 7.9 in the study and control groups, respectively ( P = .351). Conclusion: The high rates of patient-reported satisfaction and the clinical outcomes after arthroscopic repair in both groups are encouraging. Arthroscopic treatment in patients with hypertrophic acetabular labral tears should be carefully performed to prevent iatrogenic injury during the surgery, and isolated hypertrophic labral tears can have good results after repair.

Management of Labral Tears of the Hip in Young Patients

2013 ◽  
Vol 44 (4) ◽  
pp. 477-487 ◽  
Author(s):  
Jack G. Skendzel ◽  
Marc J. Philippon
Keyword(s):  
Young Patients ◽  
Labral Tears

Advocating for Insurance for Young Patients

ASHA Leader ◽  
2004 ◽  
Vol 9 (3) ◽  
pp. 3-23
Author(s):  
Katrina Zeit
Keyword(s):  
Young Patients

607: Different Genetic Patterns of Bladder Cancer in Young Patients?

2006 ◽  
Vol 175 (4S) ◽  
pp. 196-196
Author(s):  
Kerstin Junker ◽  
lnes Kania ◽  
Arndt Hartmann ◽  
Robert Stoehr ◽  
Ellen Zwarthoff ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Young Patients ◽  
Genetic Patterns

Coping With the Death of Young Patients

2005 ◽  
Vol 36 (12) ◽  
pp. 14
Author(s):  
ROBERT S. MCKELVEY
Keyword(s):  
Young Patients

Exertion Not Implicated in Young Patients' SCD

2010 ◽  
Vol 43 (1) ◽  
pp. 41
Author(s):  
BRUCE JANCIN
Keyword(s):  
Young Patients
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