Department of Orthopaedic Surgery, Brigham & Women's Hospital, Boston, Massachusetts, U.S.A.; Center for Hip Preservation, Hospital for Special Surgery, New York, New York, U.S.A..
Department of Orthopaedic Surgery, McGovern Medical School University of Texas Health Science Center, Houston, Texas, U.S.A.
Arthroscopy. 2022 Nov;38(11):3013-3019. doi: 10.1016/j.arthro.2022.03.025. Epub 2022 Mar 29.
To assess the clinical utility of preoperative magnetic resonance imaging (MRI) and quantify the delay in surgical care for patients aged ≤40 years undergoing primary hip arthroscopy with history, physical examination, and radiographs concordant with femoroacetabular impingement syndrome (FAIS).
From August 2015 to December 2020, 1,786 consecutive patients were reviewed from the practice of 1 fellowship-trained hip arthroscopist. Inclusion criteria were FAIS, primary surgery, and age ≤40 years. Exclusion criteria were MRI contraindication, reattempt of conservative management, or concomitant periacetabular osteotomy. After nonoperative treatment options were exhausted and a surgical plan was established, patients were stratified by those who presented with versus without MRI. Those without existing MRI received one, and any deviations from the surgical plan were noted. All preoperative MRIs were compared with office evaluation and intraoperative findings to assess agreement. Demographic data, Hip Disability and Osteoarthritis Outcome Score (HOOS)-Pain, and time from office to MRI or arthroscopy were recorded.
Of the patients indicated by history, physical examination, and radiographs alone (70% female, body mass index 24.8 kg/m, age 25.9 years), 198 patients presented without MRI and 934 with MRI. None of the 198 had surgical plans altered after MRI. Patients in both groups had MRI findings demonstrating anterosuperior labral tears that were visualized and repaired intraoperatively. Mean time from office to arthroscopy for patients without MRI versus those with was 107.0 ± 67 and 85.0 ± 53 days, respectively (P < .001). Time to MRI was 22.8 days. No difference between groups was observed among the 85% of patients who surpassed the HOOS-Pain minimal clinically important difference (MCID).
Once indicated for surgery based on history, physical examination, and radiographs, preoperative MRI did not alter the surgical plan for patients aged ≤40 years with FAIS undergoing primary hip arthroscopy. Moreover, preoperative MRI delayed time to arthroscopy. The necessity of routine preoperative MRI in the young primary FAIS population should be challenged.
评估术前磁共振成像（MRI）对于病史、体格检查和 X 线片均符合股骨髋臼撞击综合征（FAIS）的≤40 岁行初次髋关节镜检查患者的临床实用性，并量化其手术治疗的延迟。
自 2015 年 8 月至 2020 年 12 月，对 1 位髋关节镜 fellowship培训医师的实践中连续的 1786 例患者进行了回顾性研究。纳入标准为 FAIS、初次手术和年龄≤40 岁。排除标准为 MRI 禁忌证、再次尝试保守治疗或同时行髋臼周围截骨术。在非手术治疗方案用尽并制定手术计划后，根据是否存在 MRI 将患者分层。未进行 MRI 检查的患者接受一次 MRI 检查，并记录与手术计划的任何偏差。将所有术前 MRI 与门诊评估和术中发现进行比较，以评估其一致性。记录患者的人口统计学数据、髋关节残疾和骨关节炎结果评分（HOOS）-疼痛评分以及从门诊到 MRI 或关节镜的时间。
仅根据病史、体格检查和 X 线片（70%为女性，体重指数 24.8kg/m2，年龄 25.9 岁）提示的患者中，有 198 例未进行 MRI 检查，934 例行 MRI 检查。在这两组患者中，均有术前 MRI 发现前上盂唇撕裂，术中可见并进行修复。未行 MRI 检查的患者与行 MRI 检查的患者从门诊到关节镜的平均时间分别为 107.0±67 天和 85.0±53 天（P<.001）。行 MRI 检查的时间为 22.8 天。在达到 HOOS-Pain 最小临床重要差异（MCID）的 85%患者中，两组之间无差异。
对于病史、体格检查和 X 线片提示手术的≤40 岁 FAIS 行初次髋关节镜检查患者，术前 MRI 不会改变手术计划。此外，术前 MRI 延迟了关节镜检查的时间。在年轻的原发性 FAIS 人群中，常规行术前 MRI 的必要性应受到质疑。
