Magnetic Resonance Arthrogram Improves Visualization of Hip Capsular Defects in Patients Undergoing Previous Hip Arthroscopy

Overview

Journal Arthrosc Sports Med Rehabil

Date 2022 May 2

PMID 35494278

Authors

Kelly M Tomasevich

Megan K Mills

Hailey Allen

Amanda M Crawford

Alexander J Mortensen

Angela P Presson

Chong Zhang

Stephen K Aoki

Affiliations

Soon will be listed here.

Abstract

Purpose: To compare magnetic resonance imaging (MRI) with magnetic resonance arthrogram (MRA) in the identification of hip capsular defects in patients who previously underwent hip arthroscopy.

Methods: Patients who underwent revision hip arthroscopy for capsular insufficiency by a single surgeon between March 2014 and December 2019 were identified by Current Procedural Terminology code. Patients with arthroscopically confirmed capsular defects treated surgically who underwent both MRI and MRA between their primary and revision surgeries were identified. Imaging studies were blinded, randomized, and distributed to two fellowship-trained musculoskeletal radiologists. Radiologists evaluated 14 components of different anatomic structures, including the presence of capsular defect and defect grading, over 2 months, with a 2-week washout period between 4 sets of reads to obtain 2 complete reads from each radiologist. Data were analyzed in R version 4.0.2.

Results: Two hundred thirty patients underwent revision hip arthroscopy between March 2014 and December 2019. Twelve patients had both an MRI and an MRA of the operated hip performed between their primary and revision surgeries. Time between primary and revision hip arthroscopy was 2.0 ± 1.5 years (R: .3-6.3). Time between MRI and MRA was .6 ± .6 years (R: .0-1.6). Sensitivity for detecting hip capsular defects was significantly higher for MRA than for MRI (87.5%, 95% CI: [68,96] vs 50%, 95% CI: [31,69], respectively; = .008).

Conclusions: This retrospective review demonstrates that MRA has higher sensitivity than MRI in detecting surgically confirmed capsular defects. MRA may be more helpful in identifying capsular defects in patients presenting with hip instability symptoms who have had a previous hip arthroscopy.

Level Of Evidence: Level IV, diagnostic case series.

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References

Wuerz T, Song S, Grzybowski J, Martin H, Mather 3rd R, Salata M . Capsulotomy Size Affects Hip Joint Kinematic Stability. Arthroscopy. 2016; 32(8):1571-80. DOI: 10.1016/j.arthro.2016.01.049. View

Magerkurth O, Jacobson J, Morag Y, Caoili E, Fessell D, Sekiya J . Capsular laxity of the hip: findings at magnetic resonance arthrography. Arthroscopy. 2013; 29(10):1615-22. DOI: 10.1016/j.arthro.2013.07.261. View

Frank R, Lee S, Bush-Joseph C, Kelly B, Salata M, Nho S . Improved outcomes after hip arthroscopic surgery in patients undergoing T-capsulotomy with complete repair versus partial repair for femoroacetabular impingement: a comparative matched-pair analysis. Am J Sports Med. 2014; 42(11):2634-42. DOI: 10.1177/0363546514548017. View

Philippon M, Trindade C, Goldsmith M, Rasmussen M, Saroki A, Loken S . Biomechanical Assessment of Hip Capsular Repair and Reconstruction Procedures Using a 6 Degrees of Freedom Robotic System. Am J Sports Med. 2017; 45(8):1745-1754. DOI: 10.1177/0363546517697956. View

Abrams G, Hart M, Takami K, Bayne C, Kelly B, Espinoza Orias A . Biomechanical Evaluation of Capsulotomy, Capsulectomy, and Capsular Repair on Hip Rotation. Arthroscopy. 2015; 31(8):1511-7. DOI: 10.1016/j.arthro.2015.02.031. View

Riff A, Kunze K, Movassaghi K, Hijji F, Beck E, Harris J . Systematic Review of Hip Arthroscopy for Femoroacetabular Impingement: The Importance of Labral Repair and Capsular Closure. Arthroscopy. 2019; 35(2):646-656.e3. DOI: 10.1016/j.arthro.2018.09.005. View

Larson C, Ross J, Stone R, Samuelson K, Schelling E, Giveans M . Arthroscopic Management of Dysplastic Hip Deformities: Predictors of Success and Failures With Comparison to an Arthroscopic FAI Cohort. Am J Sports Med. 2015; 44(2):447-53. DOI: 10.1177/0363546515613068. View

Studler U, Kalberer F, Leunig M, Zanetti M, Hodler J, Dora C . MR arthrography of the hip: differentiation between an anterior sublabral recess as a normal variant and a labral tear. Radiology. 2008; 249(3):947-54. DOI: 10.1148/radiol.2492080137. View

McCormick F, Slikker 3rd W, Harris J, Gupta A, Abrams G, Frank J . Evidence of capsular defect following hip arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2013; 22(4):902-5. DOI: 10.1007/s00167-013-2591-z. View

10.

Kurz A, Memon M, Williams D, Ayeni O . Anterior Capsule Reconstruction of the Native Hip: A Technique Guide. Arthrosc Tech. 2020; 8(10):e1247-e1253. PMC: 7000316. DOI: 10.1016/j.eats.2019.06.014. View

11.

Toomayan G, Holman W, Major N, Kozlowicz S, Vail T . Sensitivity of MR arthrography in the evaluation of acetabular labral tears. AJR Am J Roentgenol. 2006; 186(2):449-53. DOI: 10.2214/AJR.04.1809. View

12.

Magee T . Comparison of 3.0-T MR vs 3.0-T MR arthrography of the hip for detection of acetabular labral tears and chondral defects in the same patient population. Br J Radiol. 2015; 88(1053):20140817. PMC: 4743561. DOI: 10.1259/bjr.20140817. View

13.

Kraeutler M, Strickland C, Brick M, Garabekyan T, Woon J, Chadayammuri V . A multicenter, double-blind, randomized controlled trial comparing magnetic resonance imaging evaluation of repaired versus unrepaired interportal capsulotomy in patients undergoing hip arthroscopy for femoroacetabular impingement. J Hip Preserv Surg. 2019; 5(4):349-356. PMC: 6328748. DOI: 10.1093/jhps/hny045. View

14.

Ziegert A, Blankenbaker D, De Smet A, Keene J, Shinki K, Fine J . Comparison of standard hip MR arthrographic imaging planes and sequences for detection of arthroscopically proven labral tear. AJR Am J Roentgenol. 2009; 192(5):1397-400. DOI: 10.2214/AJR.08.1609. View

15.

Bolia I, Fagotti L, Briggs K, Philippon M . Midterm Outcomes Following Repair of Capsulotomy Versus Nonrepair in Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement With Labral Repair. Arthroscopy. 2019; 35(6):1828-1834. DOI: 10.1016/j.arthro.2019.01.033. View

16.

Koo T, Li M . A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. J Chiropr Med. 2016; 15(2):155-63. PMC: 4913118. DOI: 10.1016/j.jcm.2016.02.012. View

17.

Tian C, Wang J, Zheng Z, Ren A . 3.0 T conventional hip MR and hip MR arthrography for the acetabular labral tears confirmed by arthroscopy. Eur J Radiol. 2014; 83(10):1822-7. DOI: 10.1016/j.ejrad.2014.05.034. View

18.

Khair M, Grzybowski J, Kuhns B, Wuerz T, Shewman E, Nho S . The Effect of Capsulotomy and Capsular Repair on Hip Distraction: A Cadaveric Investigation. Arthroscopy. 2016; 33(3):559-565. DOI: 10.1016/j.arthro.2016.09.019. View

19.

Schmid M, Notzli H, Zanetti M, Wyss T, Hodler J . Cartilage lesions in the hip: diagnostic effectiveness of MR arthrography. Radiology. 2003; 226(2):382-6. DOI: 10.1148/radiol.2262020019. View

20.

Mei-Dan O, Garabekyan T, McConkey M, Pascual-Garrido C . Arthroscopic Anterior Capsular Reconstruction of the Hip for Recurrent Instability. Arthrosc Tech. 2016; 4(6):e711-5. PMC: 4739035. DOI: 10.1016/j.eats.2015.07.019. View