Purpose
A large prospective cohort was used (1) to evaluate the overall ability of magnetic
resonance imaging (MRI) to detect Outerbridge grade III and IV cartilage defects found
during surgery and (2) to identify the specific MRI findings most associated with
these cartilage defects so that the practicing hip arthroscopist can better predict
cartilage injury before surgery.
Methods
All patients undergoing hip arthroscopy between February 2015 and May 2017 at 1 institution
were enrolled in a prospective cohort. Intra-articular findings were documented at
the time of surgery. MRI reports were retrospectively reviewed for radiologist-reported
articular cartilage, osseous, or synovial abnormalities. Sensitivity and specificity
of MRI findings were calculated; multivariate logistic regression analysis determined
which findings were associated with high-grade chondral damage at the time of arthroscopy
and used to create an online risk calculator, https://orthop.washington.edu/hiprisk/.
Results
Of 598 patients who underwent hip arthroscopy, 550 had MRI reports available for review
(92%). Grade III and IV cartilage injuries were reported on arthroscopy in 70 patients
(13%) of average age 33 ± 13 years. On univariate analyses, individual MRI findings
were not sensitive in detection of articular cartilage injury (mean 22%; range, 1.4%-46%),
but positive findings were highly specific (mean 90%,; range, 76%-99%). Multivariate
analysis revealed that older age (odds ratio [OR] 1.09 [1.06-1.11], P < .001) and osseous findings such as subchondral cyst or edema (OR 4.77 [2.51-9.05],
P < .001) were most predictive of grade III and IV defects (P < .001).
Conclusion
MRI was a specific but not sensitive tool in diagnosing articular cartilage injury.
Surgeons should be aware that osseous findings such as cysts or edema are highly predictive
of full-thickness cartilage loss in FAI.
Level of Evidence
Level III, development of diagnostic criteria (consecutive patients with consistently
applied reference standard, no blinding).
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Article Info
Publication History
Published online: March 30, 2021
Accepted:
March 15,
2021
Received:
September 22,
2020
Footnotes
The authors report the following potential conflicts of interest or sources of funding: M.S.H. reports grants from University of Washington CLEAR center (NIH sponsored); T.S.L. reports personal fees from Smith & Nephew; J.R. reports personal fees from Smith & Nephew; R.W. reports personal fees from Smith & Nephew and Conmed. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Dr Hannay should be considered as a co-first author.
Identification
Copyright
© 2021 by the Arthroscopy Association of North America
