Aims. Acetabular dysplasia is frequently associated with intra-articular pathology such as labral tears, but whether labral tears should be treated at the time of periacetabular osteotomy (PAO) remains controversial. The purpose of this study was to compare the clinical outcomes and radiographic corrections of PAO for acetabular dysplasia between patients with and without labral tears pre-operatively. Patients and Methods. We retrospectively reviewed 70 hips in 67 patients with acetabular dysplasia who underwent PAO. Of 47 hips (45 patients) with labral tears pre-operatively, 27 (25 patients) underwent PAO alone, and were classified as the labral tear alone (LT) group, and 20 (20 patients) underwent combined PAO and osteochondroplasty, and were classified as the labral tear osteochondroplasty (LTO) group. The non-labral tear (NLT) group included 23 hips in 22 patients. Results. There were no significant differences between groups for post-operative Harris hip scores, degree of progression of osteoarthritis or rate of reoperation. The pre-operative alpha angle was significantly larger in the LTO group compared with the other groups (p < 0.0001). Conclusion. PAO provides equivalent short-term relief of pain and functional outcome in patients with or without labral tears. The rate of progression of osteoarthritis and reoperation was not significantly increased in patients with labral tears. Take home message: PAO provides equivalent short-term pain relief and functional outcomes in patients with acetabular dysplasia with and without labral tears. We did not find significantly increased risks of progression of osteoarthritis or re-operation in those with labral tears. Cite this article: Bone Joint J 2016;98-B:741–6

Labral tears are commonly associated with femoroacetabular impingement. We reviewed 151 patients (156 hips) with femoroacetabular impingement and labral tears who had been treated arthroscopically. These were subdivided into those who had undergone a labral repair (group 1) and those who had undergone resection of the labrum (group 2). In order to ensure the groups were suitably matched for comparison of treatment effects, patients with advanced degenerative changes (Tönnis grade > 2, lateral sourcil height < 2 mm and Outerbridge grade 4 changes in the weight-bearing area of the femoral head) were excluded, leaving 96 patients (101 hips) in the study. At a mean follow-up of 2.44 years (2 to 4), the mean modified Harris hip score in the labral repair group (group 1, 69 hips) improved from 60.2 (24 to 85) pre-operatively to 93.6 (55 to 100), and in the labral resection group (group 2, 32 hips) from 62.8 (29 to 96) pre-operatively to 88.8 (35 to 100). The mean modified Harris hip score in the labral repair group was 7.3 points greater than in the resection group (p = 0.036, 95% confidence interval 0.51 to 14.09). Labral detachments were found more frequently in the labral repair group and labral flap tears in the resection group. No patient in our study group required a subsequent hip replacement during the period of follow-up. This study shows that patients without advanced degenerative changes in the hip can achieve significant improvement in their symptoms after arthroscopic treatment of femoroacetabular impingement. Where appropriate, labral repair provides a superior result to labral resection

We investigated differences in the location and mode of labral tears between dysplastic hips and hips with femoroacetabular impingement (FAI). We also investigated the relationship between labral tear and adjacent cartilage damage. We retrospectively studied 72 symptomatic hips (in 68 patients: 19 men and 49 women) with radiological evidence of dysplasia or FAI on high-resolution CT arthrography. The incidence and location of labral tears and modes of tear associated with the base of the labrum (Mode 1) or body of the labrum (Mode 2) were compared among FAI, mildly dysplastic and severely dysplastic hips. The locations predominantly involved with labral tears were different in FAI and mild dysplastic hips (anterior and anterosuperior zones) and in severely dysplastic hips (anterosuperior and superior zones) around the acetabulum. Significant differences were observed in the prevalence of Mode 1 versus Mode 2 tears in FAI hips (72% (n = 13) vs 28% (n = 5)) and severe dysplastic hips (25% (n = 2) vs 75% (n = 6)). The frequency of cartilage damage adjacent to Mode 1 tears was significantly higher (42% (n = 14)) than that adjacent to Mode 2 tears (14% (n = 3)). Hip pathology is significantly related to the locations and modes of labral tears. Mode 1 tears may be a risk factor for the development of adjacent acetabular cartilage damage. Cite this article: Bone Joint J 2013;95-B:1320–5

We have reviewed the current literature to compare the results of surgery aimed to repair or debride a damaged acetabular labrum. We identified 28 studies to be included in the review containing a total of 1631 hips in 1609 patients. Of these studies 12 reported a mean rate of good results of 82% (from 67% to 100%) for labral debridement. Of the 16 studies that reported a combination of debridement and re-attachment, five reported a comparative outcome for the two methods, four reported better results with re-attachment and one study did not find any significant difference in outcomes. Due to the heterogeneity of the studies it was not possible to perform a meta-analysis or draw accurate conclusions. Confounding factors in the studies include selection bias, use of historical controls and high rates of loss of follow-up. It seems logical to repair an unstable tear in a good quality labrum with good potential to heal in order potentially to preserve its physiological function. A degenerative labrum on the other hand may be the source of discomfort and its preservation may result in persistent pain and the added risk of failure of re-attachment. The results of the present study do not support routine refixation for all labral tears. Cite this article: Bone Joint J 2014;96-B:24–30

This paper highlights the fact that full length labral tears are a cause of instability in posterior fracture-dislocations of the hip. From July 1994 to March 2001, 133 consecutive posterior fracture-dislocations of the hip were surgically treated. On admission, all patients were initially subjected to closed reduction, and in some cases skeletal or skin traction was applied. Pelvic radiographs were taken to confirm relocation, and CT done to look for intra-articular bone fragments. Intra-operative findings and surgical technique were recorded. Redislocation occurred in eight patients, whose surgical notes were reviewed to determine the cause. Despite 9 kg of skeletal traction, one patients’s hip redislocated the day after closed reduction. In the other seven, redislocation occurred postoperatively. The time to redislocation varied from one day to 16 weeks, and because redislocation was sometimes painless, not all patients reported it immediately. Two patients, whose radiographs showed very small fragments at the superior-posterior position, would normally have been treated conservatively. On one, surgery was performed because the fragment was lodged at the weight-bearing area of the joint. The hip of the other redislocated on skeletal traction the day after closed reduction. At surgery, it was noted that both patients had extensive soft tissue stripping and full length tears of the labrum. The other six patients had clear posterior wall fractures requiring surgical reconstruction. The fragments were often attached to the capsule but were too small to fix with screws, so buttress plating was used alone. Full-length labral tears in posterior dislocations of the hip cause instability, and failure to address this adequately at surgery may result in redislocation

We treated 133 traumatic posterior dislocations surgically between July 1994 and March 2001. In 16 patients, labral tears had occurred. Operating on posterior hip dislocations, initially we fixated the posterior wall with screws and/or buttress plate, depending on the size of the fragment, and did suture the torn labrum, relying rather on the buttress plate or intact posterior wall for stability. We began repairing the torn labrum when we realised that any small fragments still attached to the labrum simply pull out from under the buttress plate, allowing the hip to redislocate. Once the wall has been reconstructed, interrupted sutures are passed through the labrum, with the hip internally rotated to prevent shortening of the capsule when sutures are tied. A one-third tubular plate is placed over the sutures lying on the posterior wall and fixed with screws. The sutures are then tied individually over the plate. Postoperatively the patient is kept in bed for six weeks, with the hip abducted and knee extended. Seven patients in whom the labrum was not repaired experienced redislocation. We performed second operations on two of them, repositioning the plates and reconstructing the posterior wall, but redislocation again occurred. The redislocated femoral heads were damaged because they rubbed against the plate and screws. In the other nine patients, we sutured the labrum, and in a 3 month to 2.5 year follow-up, no redislocation has occurred. . Labral repair restores stability, and tying interrupted sutures over a buttress plate is an easy and effective method of repair

In order to clarify how intra-articular lesions influence the survival of a periacetabular osteotomy in patients with dysplasia of the hip, we performed an observational study of 121 patients (121 hips) who underwent a transposition osteotomy of the acetabulum combined with an arthroscopy. Their mean age was 40.2 years (13 to 64) and the mean follow-up was 9.9 years (2 to 18). Labral and cartilage degeneration tended to originate from the anterosuperior part of the acetabulum, followed by the femoral side. In all, eight hips (6.6%) had post-operative progression to Kellgren–Lawrence grade 4 changes, and these hips were associated with the following factors: moderate osteoarthritis, decreased width of the joint space, joint incongruity, and advanced intra-articular lesions (subchondral bone exposure in the cartilage and a full-thickness labral tear). Multivariate analysis indicated subchondral bone exposure on the femoral head as an independent risk factor for progression of osteoarthritis (p = 0.003). In hips with early stage osteoarthritis, femoral subchondral bone exposure was a risk factor for progression of the grade of osteoarthritis.

Although the outcome of transposition osteotomy of the acetabulum was satisfactory, post-operative progression of osteoarthritis occurred at a high rate in hips with advanced intra-articular lesions, particularly in those where the degenerative process had reached the point of femoral subchondral bone exposure.

The gold standard treatment of hip dysplasia is a peri-acetabular osteotomy (PAO). Labral tears are seen in the majority of patients presenting with hip dysplasia and diagnosed using Magnetic Resonance Imaging (MRI). The goal was to (1) evaluate utility/value of MRI in patients undergoing hip arthroscopy at time of PAO, and (2) determine whether MRI findings of labral pathology can predict outcome. A prospective randomized controlled trial was conducted at tertiary institutions, comparing patients with hip dysplasia treated with isolated PAO versus PAO with adjunct hip arthroscopy. This study was a subgroup analysis on 74 patients allocated to PAO and adjunct hip arthroscopy (age 26±8 years; 89.2% females). All patients underwent radiographic and MRI assessment using a 1.5-Tesla with or 3-Tesla MRI without arthrography to detect labral or cartilage pathology. Clinical outcome was assessed using international Hip Outcome Tool-33 (iHOT). 74% of patients (55/74) were pre-operatively diagnosed with a labral tear on MRI. Among these, 41 underwent labral treatment (74%); whilst among those without a labral tear on MRI, 42% underwent labral treatment (8/19). MRI had a high sensitivity (84%), but a low specificity (56%) for labral pathology (p=0.053). There was no difference in pre-operative (31.3±16.0 vs. 37.3±14.9; p=0.123) and post-operative iHOT (77.7±22.2 vs. 75.2±23.5; p=0.676) between patients with and without labral pathology on MRI. Value of MRI in the diagnostic work-up of a patient with hip dysplasia is limited. MRI had a high sensitivity (84%), but low specificity (44%) to identify labral pathology in patients with hip dysplasia. Consequently, standard clinical MRI had little value as a predictor of outcome with no differences in PROM scores between patients with and without a labral tear on MRI. Treatment of labral pathology in patients with hip dysplasia remains controversial. The results of this subgroup analysis of a prospective, multi-centre RCT do not show improved outcome among patients with dysplasia treated with labral repair

Acetabular labral tears and associated intra-articular pathology of the hip have been recognised as a source of symptoms. However, it is now appreciated that there is a relatively high prevalence of asymptomatic labral tears. In this study, 70 young asymptomatic adult volunteers with a mean age of 26 years (19 to 41) were recruited and underwent three tesla non-arthrographic MR scans. There were 47 women (67.1%) and 23 men (32.9%). Labral tears were found in 27 volunteers (38.6%); these were an isolated finding in 16 (22.9%) and were associated with other intra-articular pathology in the remaining 11 (15.7%) volunteers. Furthermore, five (7.1%) had intra-articular pathology without an associated labral tear. Given the high prevalence of labral pathology in the asymptomatic population, it is important to confirm that a patient's symptoms are due to the demonstrated abnormalities when considering surgery. Cite this article: Bone Joint J 2015;97-B:623–7

Objectives. The aim of this study was to investigate the structural integrity of torn and non-torn human acetabular labral tissue. Methods. A total of 47 human labral specimens were obtained from a biobank. These included 22 torn specimens and 25 control specimens from patients undergoing total hip arthroplasty with macroscopically normal labra. The specimens underwent dynamic shear analysis using a rheometer to measure storage modulus, as an indicator of structural integrity. Results. There was a significant difference in the storage modulus between torn (mean modulus = 2144.08 Pa) and non-torn (3178.1 Pa) labra (p = 0.0001). Conclusion. The acetabular labrum of young patients with a tear has significantly reduced structural integrity compared with a non-torn labrum in older patients with end-stage osteoarthritis. This study contributes to the understanding of the biomechanics of labral tears, and the observation of reduced structural integrity in torn labra may explain why some repairs fail. Our data demonstrate that labral tears probably have a relatively narrow phenotype, presenting a basis for further investigations that will provide quantifiable data to support their classification and a means to develop a standardized surgical technique for their repair. This study also demonstrates the value of novel biomechanical testing methods in investigating pathological tissues of orthopaedic interest. Cite this article: A. K. Woods, J. Broomfield, P. Monk, F. Vollrath, S. Glyn-Jones. Dynamic shear analysis: a novel method to determine mechanical integrity of normal and torn human acetabular labra: Implications for prediction of outcome of repair. Bone Joint Res 2018;7:440–446. DOI: 10.1302/2046-3758.77.BJR-2017-0282.R2

Arthroscopic hip surgery is increasingly common in Australia. Hip arthroscopy is indicated for a range of diagnostic and therapeutic purposes, including labral tears, capsular laxity and femoral-acetabular impingement (FAI). Despite this, previous cohort studies aiming to characterise hip pathology seen on arthroscopic examination are mostly limited to patients with known diagnoses of FAI. Therefore, little is known of the native articular wear patterns encountered in other disease states. Therefore, we aimed to define common osteochondral wear patterns for a cohort of patients managed via hip arthroscopy. We retrospectively analysed intraoperative data for 1127 patients managed via hip arthroscopy between 2008 and 2013, for either therapeutic or diagnostic purposes. Intraoperative data was categorized by location (A-E as defined by Fontana et al. 2016) and chondral damage (0-4 scale as defined by Beck et al. 2005) with respect to both acetabulum and femoral head. Data for 1127 patients were included. Location of acetabular chondral pathology was variable with locations C. 1. and D. 1. representing the most common regions of damage. Labral tears predominated in locations C and D. Femoral chondral pathology was evenly distributed. The degree of femoral chondral injury was predominantly grade 1, whilst acetabular wear was evenly distributed. Large proportions of wear were observed at the peripheral superior and anterior regions of the lunate surface of the acetabulum in keeping with prior works. However, we observed higher rates of central wear and lower rates of grade 4 acetabular damage extending into superior/posterior zones, in our cohort. Our work characterises common articular wear patterns encountered at the time of hip arthroscopy. Further inquiry into the natural history of osteochondral lesions is needed to better understand and manage these conditions

There has been a marked increase in the number of hip arthroscopies performed over the past 16 years, primarily in the management of femoroacetabular impingement (FAI). Insights into the pathoanatomy of FAI, and high-level evidence supporting the clinical effectiveness of arthroscopy in the management of FAI, have fuelled this trend. Arthroscopic management of labral tears with repair may have superior results compared with debridement, and there is now emerging evidence to support reconstructive options where repair is not possible. In situations where an interportal capsulotomy is performed to facilitate access, data now support closure of the capsule in selective cases where there is an increased risk of postoperative instability. Preoperative planning is an integral component of bony corrective surgery in FAI, and this has evolved to include computer-planned resection. However, the benefit of this remains controversial. Hip instability is now widely accepted, and diagnostic criteria and treatment are becoming increasingly refined. Instability can also be present with FAI or develop as a result of FAI treatment. In this annotation, we outline major current controversies relating to decision-making in hip arthroscopy for FAI. Cite this article: Bone Joint J 2022;104-B(5):532–540

Labral tears are increasingly recognized as a source of hip pain. These rarely occur in normal hips, but in individuals with subtle femoral deformities. Anterior impingement of the femoral neck on the acetabulum due to loss of anterior offset results in a labral tear in active individuals. Future surgeries should be directed at this anterior offset deficiency in order to completely alleviate pain and prevent further recurrences. To determine the incidence of anterior hip impingement and femoral pathology in patients undergoing hip arthroscopy for labral tear. Anterior labral tears occur in the presence of abnormal femoral anatomy, which results in anterior hip impingement. Future treatment of labral tears should include addressing the hip impingement. Labral tears of the hip are increasingly being recognized as a source of hip pain in young, active individuals. Athroscopic labral debridement is commonly associated with poor results. As a result, it is likely that other hip pathology is present at the time of labral tear. The purpose of this study was to determine the incidence of anterior hip impingement secondary to a pistol grip deformity in patients undergoing hip arthroscopy for labral tears. The charts and radiographs of forty consecutive patients who underwent hip arthroscopy were evaluated. X-rays were evaluated for presence of acetabular or femoral pathology. Femoral pathology was then graded based on degree of slip and posterior slip angle. All patients who underwent hip arthroscopy for labral tears had abnormal femoral or acetabular anatomy. In those patients without acetabular dysplasia, a pistol grip deformity of the femoral head was present in all cases. Evidence of anterior hip impingement with osteophyte formation was present in ninety-two percent. In these patients, hip arthroscopy results in complete resolution of mechanical symptoms, but hip pain was still present. Labral tears of the hip appear to be secondary to anterior femoral impingement. This is analogous to a rotator cuff tear in the presence of shoulder impingement. Anterior impingement of the femoral neck on the acatabulum due to an anterior femoral offset deformity results in both pain and labral tears. Future surgeries should be directed at this anterior offset deficiency in order to prevent recurrent injuries or residual pain

Background: Acetabular labral tears are increasingly recognised as a cause of hip pain in young adults and middle aged patients. Degenerative acetabular conditions and sporting activities can cause labral injury. Recent interest has focussed on anterior femoroacetabular impingement as a cause of labral injury, progressive articular cartilage damage and secondary osteoarthritis. Labral tears are difficult to diagnose clinically or with conventional radiographic techniques. Aim: The purpose of this study was to assess the accuracy of MR arthrography in locating labral tears and articular cartilage defects compared with hip arthroscopy. Materials and Methods: 200 consecutive patients with a diagnosis of acetabular labral tear underwent hip arthroscopy. All of them had a preoperative Magnetic Resonance Arthrogram done by a single musculoskeletal radiologist using a standard protocol. The labrum was assessed for abnormalities of morphology and signal intensity. Acetabular articular cartilage defects were expressed as a reduction in joint space. All hip arthroscopies were done by a single surgeon after a trial period of conservative therapy consisting of activity modification, physiotherapy and non-steroidal anti-inflammatory medications. All procedures were recorded digitally and documented in an operative report. Labral tears and acetabular cartilage abnormalities were described by location and appearance. Results: Comparison of MRA and hip arthroscopy findings demonstrate MRA to have a sensitivity of 100%, positive predictive value of 99%, negative predictive value of 100% and accuracy of 99% in predicting labral tears. MRA correctly identified the location of labral tears in 90% of cases. Acetabular cartilage abnormalities were under recognised by MRA (43 hips on MRA vs 54 hips on arthroscopy). MRA was not sensitive enough to pick up early delamination of cartilage adjacent to labral tear in 6 hips. Conclusion: Hip MRA with radial reformatting has high accuracy rates in diagnosing and localising hip labral lesions

This study aimed to analyse the incidence, the operative findings and outcomes of hip arthroscopy after periacetabular osteotomy (PAO). We conducted a retrospective study of prospective collected data to report the operative findings and outcomes of hip arthroscopy for recurrent pain following PAO for acetabular dysplasia. Demographic data, radiographic and arthroscopic findings were analysed. Pre- and post-operative patient reported outcome measures (PROMs) were collected. Of 184 PAO patients, 15 hips in 15 patients (8.2%) underwent post-PAO hip arthroscopy with 2 males and 13 females at a mean time of 3.9 ±2.9(0.3–10) years. Hip arthroscopy findings included labral tears (15 hips, 100%), chondral damage (11 hips, 73%) with one Beck 1, two Beck 2, four Beck 4, and four Beck 5 damage. There were 8 (53%) isolated labral debridement, 7 (47%) labral repair, and 2 (13%) adhesiolysis. A femoral osteochondroplasty was performed in 4 (27%) hips. Four hips (27%) were finally converted to total hip replacement at a mean delay of 2.3 ±1.4 (0.7–3.2) years post hip arthroscopy and these 4 patients were significantly older than those who were not (p=0.02). There were no significant differences in PROMs pre and post hip scope. 8.2% of patients undergoing a PAO required a hip scope for persistent hip pain. Common post-PAO hip arthroscopy findings included labral tears, chondral changes and femoroacetabular impingement. 27% of patients finally underwent conversion to total hip replacement at a mean follow-up of 4.5 years post hip scope

Purpose: A prospective investigation to define the syndrome associated with symptomatic labral tears definitively diagnosed at hip arthroscopy. Methods: 66 consecutive patients that had an arthroscopically documented labral tear were evaluated. Demographics, symptomatology, examination, previous treatments, functional limitations, were assessed prospectively. Onset/duration of symptoms to diagnosis of tears, other diagnoses offered by healthcare providers, and non-labral procedures that patients had undergone for the symptoms were analyzed. Radiographic abnormalities and MR arthrography findings were recorded. Results: There were 47 female and 19 male patients with a mean age of 38 years. Initial presentation: insidious in 61%, acute injury in 30%, and trauma in 9% hips. Moderate to severe pain occurred in 86% of patients, with groin pain predominating (92%). Fifty three percent had true mechanical symptoms - catching/locking. Walking, pivoting, impact activity aggravated patient symptoms (p< 0.05). Pain was characterized as a combination of dull aching pain with intermittent episodes of sharp pain in 70%(p=0.001). Pain was frequently activity related (p< 0.05) and night pain occurred in 71% of patients (p=0.0006). The majority of patients (98%) with a labral tear reported being active/athletic. On examination 39% patients had a limp, 38% a positive Trendelenburg sign, and 95% a positive impingement sign. The mean time to diagnosis of labral tear from the onset of symptoms was 21 months. A mean of 3.3 healthcare providers were seen prior to a definitive diagnosis. Surgery on another anatomic site was recommended in 11 patients and 4 of these underwent an unsuccessful surgery prior to diagnosis of the labral tear. Radiographic data indicated that 38% of hips had an underlying structural abnormality consistent with mild development dysplasia or anterior femoroacetabular impingement. Preoperative MRA detected 73% of the labral tears. Conclusions: The clinical presentation of a labral tear may vary, with duration of symptoms often greater than 12 months prior to diagnosis. In young, active patients with a predominant complaint of groin pain with or without a history of trauma, the diagnosis of a labral tear should be suspected, and investigated, as radiographs and history may be nonspecific for this diagnosis

Introduction: Hip pain in young adults can be associated with radiographic finding of acetabular labral tears in magnetic resonance arthrography. Acetabular labral tears can occur in dysplastic hips and in arthrotic hips as well, but often no comobidity is found. Up to now there is no prospective study published following patients with magnetic resonance arthrography verified acetabular labral tears over time and re-evaluating them with MR years later. There is also no stage related therapy published according to labral damage. The aim of this study was to follow 100 MRI verified acetabular labral tears for four years. Material and methods: Study design was prospective, observers were blinded. At primary investigation 36 clinical and 30 radiological parameters were recorded. At follow up these factors were recorded again and additionally SF36 and Harris Hip score were recorded. Results: 100 patients with average age 42 were included. 91% of all patients could be followed for over 48 months. 55 operations were performed in 50 patients . 20 patients showed concomitant developmental dysplasia of the hip, 16 patients arthrosis, 40 patients both and 15 patients had a labral lesion alone. The last group of patients never required any operation. 28 patients had a labral lesion grade I, 29 grade II, 34 grade III. Patients with grade III lesions had a significantly lower HHS at the first examination. At follow up between all groups of patients no difference regarding any clinical parameter was found. Operations were only necessary if comorbidity (dysplasia or arthrosis) was found. No single radiologic or clinical parameter could predict operation. Nine of thirteen labral surgeries were revised (triple osteotomies or THR). No correlation between severity of labral lesion at first MRI and any parameter at follow up could be found. Conclusion: If no comorbidity was found an acetabular labral tear alone never needed operative treatment. Although there exist a series of different operative treatment opportunities in meniscal/glenoid labrum surgery , we could not find the need for surgical intervention if the acetabular labral tear occurs alone. We therefore recommend physiotherapy and non – operative treatment for these patients

Purpose: Acetabular labral tears are most commonly associated with minor or atraumatic events. As a result, it is likely that these tears occur in the presence of an abnormal hip joint. The purpose of this investigation was to establish whether anterior hip impingement, secondary to an anterior femoral offset deficiency from a pistol grip deformity, was a common and poorly recognized cause of acetabular labral tears. Methods: Sixty-five consecutive patients who underwent a hip arthroscopy and were found to have a labral tear were evaluated. Preoperative hip radiographs were evaluated for abnormalities of the femur and /or acetabulum. The patient’s outcome with respect to resolution to pain and mechanical symptoms was assessed. Results: All labral tears identified at the time of hip arthroscopy were found to be located anteriorly. A pistol grip deformity of the proximal femur was identified on the preoperative radiographs in 92% of the patients. Labral excision resulted in complete resolution of hip pain in only 8 (28%). With the remaining 72% experiencing mild or moderate pain. Conclusions: Acetabular labral tears are the result of repetitive femoral-acetabular impingement, from a pistol grip deformity, with eventual tearing of the labrum from a relatively minor trauma. This is analogous to a rotator cuff repair in the shoulder that is secondary to repetitive impingement by the acromium. Decompression or correction of the anterior hip impingement should routinely be considered at the time of labral surgery to provide complete relief of symptoms and diminish the risk of future joint degeneration

Background. Magnetic resonance arthrography is the current method of choice for investigating patients with a clinical diagnosis of femoroacetabular impingement prior to performing hip arthroscopy. The aim of our study was to assess the efficacy of this investigation by comparing the findings of MR arthrogram with those found at arthroscopy, with reference to labral tears and chondral damage. Methods. A prospective trial to investigate the sensitivity, specificity, accuracy and predictive value of MRA for diagnosis of labral tears and chondral defects. Over a 25-month period 69 hips undergoing hip arthroscopy were investigated with MRA prior to the definitive operative procedure. MRA findings were compared to the intraoperative findings. Results. In the assessment of labral tears, MRA demonstrated a sensitivity of 81% with a specificity of 51% and an accuracy of 58%. Positive predictive value of MRA was 33% and negative predictive value 90%. For chondral defects MRA demonstrated a sensitivity of 17%, a specificity of 100% and accuracy of 55%. Positive predictive value of MRA was 100% and negative predictive value was 51%. Conclusions. In what the authors believe to be the first UK study to explore both chondral injury and labral tears in a prospective manner and looking specifically at accuracy, it can be seen that the MRA has poor accuracy for both pathologies. Therefore we suggest a moved away from MRA, which is an invasive procedure with associated risks

Background: Cam-type femoroacetabular impingement (FAI) is becoming more recognized. Cartilage lesions of the acetabulum and labral tears are frequently encountered. The goal of this study was to accurately describe and communicate these injuries and thus providing a standard for reporting injury, management, and outcome. Methods: We evaluated acetabular cartilage lesions and labral tears found during hip arthroscopy in 52 patients with radiological signs of cam-type FAI. They were graded according to the morphology and extent of the lesion. The labral tears were described according to the classification by Lage. Results: Eleven patients (21.2%) had normal cartilage, 14 (26.9%) had a grade 1, 17 (32.7%) a grade 2, 6 (11.5%) a grade 3, and 4 (7.7%) a grade 4 lesion. Labral tears were found in 31 patients (59.6%). There was a high correlation between age and the presence and extent of acetabular cartilage and labral lesions (r=0.70; p< 0.0001 and r=0.45; p< 0.001 respectively). There was also a high correlation between the extent of the acetabular cartilage lesion and the presence of labral lesions (r=0.62; p< 0.0001). Conclusion: In our study there was a high prevalence of associated injuries (86.5%) in cam-type FAI. Despite the recognized consequences of associated lesions on treatment and outcome, no classification system includes this aspect of FAI. Based on our findings, we developed a system to grade acetabular cartilage lesions according to their morphology and extent. This should provide the surgeon with a standardized tool to better describe the full extent of the injury and treat it accordingly