Femoroacetabular impingement in amateur athletes: The value of response to anaesthetic injection during hip MR arthrography

Evangelos Perdikakis, Athanasios Papavasiliou, Vasileios Thomaidis, Aliki Fiska, Dimitrios Souftas, Vasileios Souftas

Abstract


Purpose: Femoroacetabular impingement (FAI) represents a common aetiology of hip pain. The purpose of the present study was to prospectively evaluate MR imaging findings and intra-articular block results in amateur athletes presenting with symptoms of FAI that were treated arthroscopically.

Material and Methods: During a five-year period (January 2014 to January 2019), 197 amateur athletes (116 male, 81 female, aged 18-54 years, mean age 33 years) presented with symptoms of hip pain and were referred with the possible diagnosis of FAI. After careful clinical evaluation 27 of them met the diagnostic criteria of FAI and were subsequently studied with direct MR Arthrography (MRA) in combination with intra-articular block. Patients were consequently treated by means of arthroscopy. MRA findings and Visual Analog Scale (VAS) scores pre and post intra-articular block were recorded and were analysed to verify the clinical suspicion of impingement.

Results: FAI was verified in all patients (27/27, 100%). Labral tears were depicted in 23 patients (85.2%) by arthroscopy. High sensitivity and specificity were recorded for MRA regarding labral tears (96% and 85% respectively). Evaluation of intra-articular blocks showed high positive predictive value (PPV) and accuracy for the diagnosis of intra-articular pathology (PPV: 92%, accuracy: 96.5%). The mean pain scores pre and post intra-articular blocks were 8 and 2 respectively.

Conclusions: MR arthrography in combination with intra-articular block showed high sensitivity and specificity for the diagnosis of FAI syndrome.


Keywords


Hip joint; Magnetic resonance arthrography; Acetabular labral tear; Femoroacetabular impingement; Anaesthetics, Local/administration & dosage

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References


Broadley P, Offiah AC. Hip and groin pain in the child athlete. Semin Musculoskelet Radiol 2014; 18: 478-488.

Ross JR, Larson CM, Bedi A. Indications for hip arthroscopy. Sports Health 2017; 9: 402-413.

Narvani AA, Tsiridis E, Kendall S, et al. A preliminary report on prevalence of acetabular labrum tears in sports patients with groin pain. Knee Surg Sports Traumatol Arthrosc 2003; 11: 403-408.

Groh MM, Herrera J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med 2009; 2: 105-117.

Stephenson JW, Davis KW. Imaging of traumatic injuries to the hip. Semin Musculoskelet Radiol 2013; 17: 306-315.

Ayeni OR, Banga K, Bhandari M, et al. Femoroacetabular impingement in elite ice hockey players. Knee Surg Sports Traumatol Arthrosc 2014; 22: 920-925.

Ghaffari A, Davis I, Storey T, et al. Current concepts of femoroacetabular impingement. Radiol Clin North Am 2018; 56: 965-982.

Mintz DN, Hooper T, Connell D, et al. Magnetic resonance imaging of the hip: detection of labral and chondral abnormalities using noncontrast imaging. Arthroscopy 2005; 21: 385-393.

Caliesch R, Sattelmayer M, Reichenbach S, et al. Diagnostic accuracy of clinical tests for cam or pincer morphology in individuals with suspected FAI syndrome: a systematic review. BMJ Open Sport Exerc Med 2020; 6:e000772.

Beck M, Leunig M, Parvizi J, et al. Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res 2004; 418: 67-73.

Philippon MJ, Stubbs AJ, Schenker ML, et al. Arthroscopic management of femoroacetabular impingement: osteoplasty technique and literature review. Am J Sports Med 2007; 35: 1571-1580.

Smith TO, Simpson M, Ejindu V, et al. The diagnostic test accuracy of magnetic resonance imaging, magnetic resonance arthrography and computer tomography in the detection of chondral lesions of the hip. Eur J Orthop Surg Traumatol 2013; 23: 335-344.

Ilizaliturri VM, Jr, Byrd JW, Sampson TG, et al. A geographic zone method to describe intra-articular pathology in hip arthroscopy: cadaveric study and preliminary report. Arthroscopy 2008; 24: 534-539.

Gwathmey FW, Jones KS, Thomas Byrd JW. Revision hip arthroscopy: findings and outcomes. J Hip Preserv Surg 2017; 4: 318-323.

Matar HE, Rajpura A, Board TN. Femoroacetabular impingement in young adults: assessment and management. Br J Hosp Med (Lond) 2019; 80: 584-588.

Mascarenhas VV, Castro MO, Rego PA, et al. The Lisbon Agreement on femoroacetabular impingement Imaging-part 1: overview. Eur Radiol 2020; 30: 5281-5297.

Griffin DR, Dickenson EJ, O’Donnell J, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med 2016; 50: 1169-1176.

Toomayan GA, Holman WR, Major NM, et al. Sensitivity of MR arthrography in the evaluation of acetabular labral tears. AJR Am J Roentgenol 2006; 186: 449-453.

Llopis E, Cerezal L, Kassarjian A, et al. Direct MR arthrography of the hip with leg traction: feasibility for assessing articular cartilage. AJR Am J Roentgenol 2008; 190: 1124-1128.

Czerny C, Hofmann S, Neuhold A, et al. Lesions of the acetabular labrum: accuracy of MR imaging and MR arthrography in detection and staging. Radiology 1996; 200: 225-230.

Perdikakis E, Karachalios T, Katonis P, et al. Comparison of MR-arthrography and MDCT-arthrography for detection of labral and articular cartilage hip pathology. Skeletal Radiol 2011; 40: 1441-1447.

Smith TO, Hilton G, Toms AP, et al. The diagnostic accuracy of acetabular labral tears using magnetic resonance imaging and magnetic resonance arthrography: a meta-analysis. Eur Radiol 2011; 21: 863-874.

Kheterpal AB, Bunnell KM, Husseini JS, et al. Value of response to anesthetic injection during hip MR arthrography to differentiate between intra- and extra-articular pathology. Skeletal Radiol 2020; 49: 555-561.

Martin RL, Irrgang JJ, Sekiya JK. The diagnostic accuracy of a clinical examination in determining intra-articular hip pain for potential hip arthroscopy candidates. Arthroscopy 2008; 24: 1013-1018.

Kehlet H, Andersen LO. Local infiltration analgesia in joint replacement: The evidence and recommendations for clinical practice. Acta Anaesthesiol Scand 2011; 55: 778-784.

McCarthy D, Iohom G. Local infiltration analgesia for postoperative pain control following total hip arthroplasty: A systematic review. Anesthesiol Res Pract 2012; 2012:709531.

Gulihar A, Robati S, Twaij H, et al. Articular cartilage and local anaesthetic: A systematic review of the current literature. J Orthop 2015; 12(Suppl 2): S200-210.

Jayaram P, Kennedy DJ, Yeh P, et al. Chondrotoxic effects of local anesthetics on human knee articular cartilage: A systematic review. PM R 2019; 11: 379-400.




DOI: http://dx.doi.org/10.36162/hjr.v6i2.411

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