Turner Elizabeth H G, Hund Samuel J, Dooley Matthew S, Spiker Andrea M
University of Wisconsin-Madison, Madison, Wisconsin, USA.
Video J Sports Med. 2021 May 11;1(3):26350254211008191. doi: 10.1177/26350254211008191. eCollection 2021 May-Jun.
Previous literature has found that hip magnetic resonance imaging (MRI) has lower accuracy and reliability in preoperative diagnosis of cartilage and labral pathology compared with knee and shoulder MRI. This is a notable limitation, as MRI findings play a significant role in the determination for surgical intervention in femoroacetabular impingement syndrome (FAIS) and aid in surgical planning, intraoperative cartilage management, and in postoperative rehabilitation expectations.
Hip arthroscopy is most commonly utilized for the treatment of FAIS and associated labral tears and chondral pathology of varying grades, particularly at the chondrolabral junction. Given the difficulty in assessing chondrolabral pathology on preoperative MRI, we present our preferred method of correlating MRI to intraoperative findings at the chondrolabral junction.
Using preoperative MRI and the Outerbridge classification system, we describe our method to assess cartilage injuries and chondrolabral junction pathology in patients who undergo hip arthroscopy for FAIS. We correlate chondral injuries with preoperative MRI to aid surgeons in interpreting the degree of chondral injury from MRI and corresponding surgical findings.
Given that MRI of the hip is neither as accurate nor as reliable as MRI of the knee or shoulder, an understanding of how to correlate preoperative MRI with intraoperative appearance can better prepare the surgeon for findings at the chondrolabral junction of the hip. The absence of findings on MRI does not rule out the possibility of cartilage or labral pathology.
DISCUSSION/CONCLUSION: Intraoperatively, hip cartilage is assessed using either the Outerbridge or Beck classification systems. These classification systems require direct visualization of the hip joint, and full assessment of the chondrolabral junction and associated pathology may not be possible until intra-articular work is complete. While MRI evaluation of the hip is difficult due to the depth of the hip joint, location of the hip relative to the MR magnet, and thinness of the acetabular cartilage, it is a useful tool for preoperative hip joint cartilage assessment, though not as accurate as knee and shoulder MRIs. Understanding the correlation between preoperative hip MRI and intraoperative chondrolabral pathology can aid the surgeon in preparation for hip arthroscopy in the treatment of FAIS.
既往文献发现，与膝关节和肩关节磁共振成像（MRI）相比，髋关节MRI在术前诊断软骨和盂唇病变方面的准确性和可靠性较低。这是一个显著的局限性，因为MRI检查结果在股骨髋臼撞击综合征（FAIS）手术干预的判定中起着重要作用，并有助于手术规划、术中软骨处理以及术后康复预期。
髋关节镜检查最常用于治疗FAIS以及相关的盂唇撕裂和不同程度的软骨病变，尤其是在软骨盂唇交界处。鉴于术前MRI评估软骨盂唇病变存在困难，我们介绍了将MRI与软骨盂唇交界处术中发现相关联的首选方法。
利用术前MRI和Outerbridge分类系统，我们描述了在接受髋关节镜检查治疗FAIS的患者中评估软骨损伤和软骨盂唇交界处病变的方法。我们将软骨损伤与术前MRI相关联，以帮助外科医生从MRI和相应的手术发现中解读软骨损伤的程度。
鉴于髋关节MRI的准确性和可靠性不如膝关节或肩关节MRI，了解如何将术前MRI与术中表现相关联可以让外科医生更好地为髋关节软骨盂唇交界处的发现做好准备。MRI未发现异常并不排除软骨或盂唇病变的可能性。
讨论/结论：术中，使用Outerbridge或Beck分类系统评估髋关节软骨。这些分类系统需要直接观察髋关节，在关节内操作完成之前，可能无法对软骨盂唇交界处及相关病变进行全面评估。虽然由于髋关节的深度、髋关节相对于MR磁体的位置以及髋臼软骨的薄度，髋关节的MRI评估存在困难，但它仍是术前髋关节软骨评估的有用工具，尽管不如膝关节和肩关节MRI准确。了解术前髋关节MRI与术中软骨盂唇病变之间的相关性有助于外科医生为治疗FAIS的髋关节镜检查做好准备。
