ACETABULAR LABRAL TEARS ARE COMMON IN ASYMPTOMATIC CONTRALATERAL HIPS WITH FEMOROACETABULAR IMPINGEMENT

Review written by Dr Joanne Kemp info

BACKGROUND & OBJECTIVE

Hip-related groin pain is common in young and middle-aged active people, and hip morphology (bony shape) and intra-articular pathology (labral tears, cartilage tears) are thought to be a primary cause of the pain. Hip arthroscopy surgery is then often performed to treat the morphology and pathology. However, in other conditions such as back pain, knee pain, and shoulder pain, findings that have previously been considered to be “pathology” (e.g. disc bulges, meniscal tears, rotator cuff tears) have been found in people who do not have pain. Similarly, around 22% of non-athletes, and 66% of athletes have cam morphology of the hips, but do not have pain. These findings have created questions and challenged long held beliefs about the relationship between structural findings seen on scans and pain. It is now no longer clear whether the morphology and intra-articular pathology seen in people with hip pain, is actually the cause of pain. As such, it is of critical importance to determine whether these findings are associated with pain. This study tackled this important question. The aim of this study was:

  1. To determine, in people who had hip arthroscopy for femoroacetabular impingement (FAI), how many had intra-articular pathology on the opposite side that was asymptomatic;
  2. To follow these people over time to see if the other (asymptomatic) side developed symptoms;
  3. To see whether there was a relationship between the presence of intra-articular findings on MRI, and age, sex and body mass index (BMI).

METHODS

The authors identified 100 people who were scheduled to have hip arthroscopy surgery for FAI, who had pain on one side only, but who had magnetic resonance imaging (MRI) scans on both hips. The MRI scans were reviewed by two orthopaedic surgeons, who assessed both hips of each person for intra-articular hip pathology. Pathologies that were assessed included labral tears and cartilage tears. The numbers of each of the pathologies were counted. After 2 years, the subjects were phoned and asked whether the side that had been pain-free at the beginning of the study had developed any symptoms or required surgery.

A diagnosis for the cause of hip pain should never be made by only using the scan.

RESULTS

The authors found that on the MRI scans, 97% of the hips on the painful side had a labral tear, whereas 43% of the non-painful hips had a labral tear. When they looked at the MRIs for cartilage tears, they

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