Leary Steven M, Zadeh Catherina, Hashimi Mustafa, Fatemi Nastaran, Christensen Garrett V, Rund Joseph M, Seffker Courtney, Willey Michael C, Westermann Robert W
Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Iowa Orthop J. 2025;45(1):187-192.
To determine the accuracy of preoperative magnetic resonance arthrogram (MRA) in detecting capsulolabral adhesions in patients undergoing revision hip arthroscopy.
We retrospectively reviewed revision hip arthroscopies performed by a single surgeon between 2019 and 2022. Patients without preoperative MRA were excluded. Musculoskeletal radiologists blinded to surgical variables assessed pre-operative axial T1 FS MRA for adhesions and graded adhesions as mild (length <5 mm), moderate (5-10 mm), or severe (> 10mm). Paralabral sulcus effacement increased the grade one level beyond adhesion length. Intraoperative arthroscopy images were evaluated for the incidence and severity of adhesions. Adhesions were graded intraoperatively as mild (rare, small adhesions), moderate (multiple or large adhesions), or severe (many adhesions disrupting labral function). A grade of 0 was assigned if no adhesions were present. Graders were blinded to each other, and Wilcoxon signed-rank test compared diagnosis methods. Sensitivity, specificity, and predictive values (PPV, NPV) were also calculated.
We identified 42 patients, 45 hips with pre-operative MRA undergoing revision hip arthroscopy. On MRA grading, there were 41 patients with adhesions (93%), of which 14 were considered severe (33%), 22 moderate (52%), and 6 mild (14%). On intraoperative grading (ICC 0.73, Kappa 0.35), there were 32 cases (71%) with 14 considered severe (31%), 10 moderate (22%), and 8 mild (18%). There was no difference in severity assessment between pre-operative MRA and intraoperative findings (P<0.001). Pre-operative MRA was moderately able to predict intra-operative adhesions (sensitivity 90.6%, PPV 69%). Specificity could not be calculated.
Axial T1 FS MRA is a sensitive tool to assess for capsulolabral adhesions in the revision arthroscopy setting. MRA best predicts severe adhesions and is moderately predictive of mild and moderate adhesions. .
确定术前磁共振关节造影（MRA）在检测接受髋关节翻修关节镜手术患者的关节囊盂唇粘连方面的准确性。
我们回顾性分析了2019年至2022年间由一名外科医生进行的髋关节翻修关节镜手术。排除术前未行MRA的患者。对手术变量不知情的肌肉骨骼放射科医生评估术前轴向T1脂肪抑制（FS）MRA的粘连情况，并将粘连分为轻度（长度<5mm）、中度（5-10mm）或重度（>10mm）。盂唇沟消失使分级在粘连长度基础上提高一级。评估术中关节镜图像粘连的发生率和严重程度。术中粘连分为轻度（罕见、小粘连）、中度（多个或大粘连）或重度（许多粘连破坏盂唇功能）。若未发现粘连则评为0级。分级者相互不知情，采用Wilcoxon符号秩检验比较诊断方法。还计算了敏感性、特异性和预测值（阳性预测值、阴性预测值）。
我们确定了42例患者，45髋接受了术前MRA的髋关节翻修关节镜手术。根据MRA分级，41例患者存在粘连（93%），其中14例为重度（33%），22例为中度（52%），6例为轻度（14%）。术中分级（组内相关系数0.73，kappa值0.35）显示，32例（71%）存在粘连，其中14例为重度（31%），10例为中度（22%），8例为轻度（18%）。术前MRA与术中发现的严重程度评估无差异（P<0.001）。术前MRA对术中粘连有中度预测能力（敏感性90.6%，阳性预测值69%）。无法计算特异性。
轴向T1 FS MRA是评估髋关节翻修关节镜手术中关节囊盂唇粘连的敏感工具。MRA对重度粘连预测最佳，对轻度和中度粘连有中度预测性。
