Prevalence of labral tears and cartilage loss in patients with mechanical symptoms of the hip: Evaluation using MR arthrography

Musculoskeletal Division, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Osteoarthritis and Cartilage (Impact Factor: 4.17). 08/2007; 15(8):909-17. DOI: 10.1016/j.joca.2007.02.002
Source: PubMed


To determine the prevalence of labral tears and cartilage lesions in patients with mechanical symptoms of the hip using magnetic resonance (MR) arthrography.
A total of 100 patients with mechanical symptoms of the hip such as pain, clicking, locking and giving way underwent MR arthrography of the hip to rule out a labral tear. Hip joints were evaluated for labral alterations, bone marrow edema (BME), and other pathology using a novel semi-quantitative scoring system. Cartilage changes were graded separately for the acetabulum and femoral head in the anterior, posterior, central, medial, and lateral hip joint regions (10 locations) on a 6-point scale: 0=normal; 1=signal heterogeneity; 2=fissuring, 3=thinning <50% of the normal thickness; 4=thinning >50% of the normal thickness; 5=full thickness cartilage loss. Labral tears were categorized into normal, intrasubstance degeneration, simple tear or complex tear with two or more tear regions. Statistical methods were contingency tables, Fisher's exact test for discrete outcomes (based on grade scores), Spearman's rank correlation (r) and t tests for continuous outcomes, using pooled and stratified analyses.
On MR arthrography, labral tears were found in 66 patients (66% prevalence) with 13 having more than one location involved. Locations were 19 lateral (13 simple, six complex), 54 anterior (39 simple, 15 complex), eight posterior (six simple, two complex). Cartilage lesions were found in 76 patients (76% prevalence) with 53 demonstrating involvement of more than one compartment. The most common finding was cartilage thinning <50% in 99 regions in 44 patients. Cartilage thinning >50% was shown in 34 patients in 67 areas. When we correlated the grade of cartilage abnormality with the grade of labral tear, we found a statistically significant correlation (r=0.29; P< or =0.01). The size of cartilage abnormality was correlated with the grade of labral tear in the lateral acetabulum (r=0.38; P<0.001), anterior acetabulum (r=0.22; P< or =0.002), and lateral femoral head (r=0.29; P< or =0.004). The grade of cartilage loss was correlated with the grade of BME (r=0.44; P< or =0.001).
Labral tears and cartilage loss are common in patients with mechanical symptoms in the hip. Cartilage loss, labral tears and BME appear interrelated and may represent important risk factors that may affect the development and progression of osteoarthritis in the hip joint.

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    • "This may be followed by cartilage delamination and the development of osteoarthritis (McCarthy et al. 2001). Up to nine-tenths of patients with a labral defect have an associated cartilage defect (Neumann et al. 2007). The typical labrum in dysplastic hips is bulbous or hypertrophied, due to the lack of osseous containment and the continually increased joint load forces delivered to the labrum. "
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    ABSTRACT: A periacetabular osteotomy (PAO) is the preferred joint preserving treatment for young adults with symptomatic hip dysplasia and no osteoarthritis. In symptomatic dysplasia of the hip, there is labral pathology in up to 90% of cases. However, no consensus exists as to whether a labral tear should be treated before the periacetabular osteotomy (PAO), treated simultaneously with the PAO, or left alone and only treated if symptoms persist after the PAO. This review is an update of aspects of labral anatomy and function, the etiology of labral tears in hip dysplasia, and diagnostic assessment of labral tears, and we discuss treatment strategies for coexisting labral tears and hip dysplasia.
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    • "Labral tears are often diagnosed in a clinical setting, suggesting that the labrum can be subjected to substantial loads in vivo (Blankenbaker et al., 2007; Burnett et al., 2006; Fitzgerald, 1995; Guevara et al., 2006; Leunig et al., 2004; Leunig et al., 1997; McCarthy and Lee, 2002; McCarthy et al., 2001; Neumann et al., 2007; Seldes et al., 2001; Wenger et al., 2004). There is an increased incidence of labral tears, labral hypertrophy, and labral calcification in hips that exhibit acetabular dysplasia (Dorrell and Catterall, 1986; Groh and Herrera, 2009; Guevara et al., 2006; Haene et al., 2007; Klaue et al., 1991; Leunig et al., 2004, 1997), which suggests that the geometry of the dysplastic hip results in increased loads on the labrum in comparison to the normal hip. "
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    ABSTRACT: The relatively high incidence of labral tears among patients presenting with hip pain suggests that the acetabular labrum is often subjected to injurious loading in vivo. However, it is unclear whether the labrum participates in load transfer across the joint during activities of daily living. This study examined the role of the acetabular labrum in load transfer for hips with normal acetabular geometry and acetabular dysplasia using subject-specific finite element analysis. Models were generated from volumetric CT data and analyzed with and without the labrum during activities of daily living. The labrum in the dysplastic model supported 4-11% of the total load transferred across the joint, while the labrum in the normal model supported only 1-2% of the total load. Despite the increased load transferred to the acetabular cartilage in simulations without the labrum, there were minimal differences in cartilage contact stresses. This was because the load supported by the cartilage correlated with the cartilage contact area. A higher percentage of load was transferred to the labrum in the dysplastic model because the femoral head achieved equilibrium near the lateral edge of the acetabulum. The results of this study suggest that the labrum plays a larger role in load transfer and joint stability in hips with acetabular dysplasia than in hips with normal acetabular geometry.
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    • "Only subjects with positive findings from imaging were listed for arthroscopy (Neumann et al., 2007); only complex cases or those failing conservative management were listed for surgery (Byrd and Jones et al., 2004); and, only those found at arthroscopy to have a labral tear were included in retrospective analyses (Burnett et al., 2006). As a consequence, simple tears that responded to conservative management were not included and subjects with disabling hip symptoms but negative imaging results were, then, often excluded (Czerny et al., 1996; Chan et al., 2005; Neumann et al., 2007). Hence, there were very few reports of false negative images. "
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    ABSTRACT: Acetabular labral tears are an area of increasing interest to clinicians involved in the diagnosis of musculoskeletal complaints of the hip. This review systematically evaluated the evidence for the diagnostic accuracy and validity of reported symptoms, physical examination and imaging in this complex population. Studies published in English prior to May 2010 were included. One reviewer searched information sources to identify relevant articles. Two reviewers independently assessed studies for inclusion, extracted data and evaluated quality using the Quality Assessment of Diagnostic Studies Tool. Twenty one studies were included. Meta-analysis was limited owing to heterogeneity between studies. Results showed Magnetic Resonance Arthrography to consistently outperform Magnetic Resonance Imaging. Computerised Tomography also showed high accuracy levels for the few studies identified. Studies investigating physical tests were of poor quality demonstrating a need for further research in this area. Symptoms likely to be present in patients presenting with acetabular labral tears were found to be anterior groin pain and mechanical hip symptoms; however, additional good quality studies are needed to consolidate findings.
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