Abstract
Background:
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 in younger athletes. It has been our experience that the proper diagnosis and management of patients with labral pathology in the adolescent athlete is often delayed or missed. 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 and may be lower. To our knowledge, this is the largest study to date regarding the sensitivity of MRI for labral pathology in adolescent and young adults. 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 surgery by 3 sports medicine trained orthopedic surgeons between 2006-2018 were retrospectively reviewed. The initial search resulted in 300 surgeries. Patients were included in this study if they had confirmed labral pathology during hip arthroscopy. Patients were excluded from the study if they underwent non-arthroscopic hip surgeries. Patients were also 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 30, or if they did not have an MRI of the hip with 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 radiology report was then compared against the surgical findings to determine the sensitivity and false positive rates for MR imaging in this patient population. Furthermore, a sports medicine trained orthopedic surgeon who was not involved in the patients’ care reviewed 140 MRIs to determine the presence of labral pathology compared to surgical findings, and sensitivity and false positive rates were evaluated.
Results:
A total of 147 hips in 137 patients (28 males, 109 females) were included in this study with a mean age of 17.1 ± 3.0 years. Of this study cohort 114 patients had a labral repair and 23 had a labral debridement. Results showed that of the 147 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 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/Significance:
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 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 in their clinical decision making and may result in delays in appropriate surgical management.