Oblique sagittal MRI arthrogram
A 35-year-old man presents to the office with right hip pain after a twist and split-type fall while working construction 3 months ago. He has experienced sharp pain when rotating his hip since the injury. On examination, he has pain with hip flexion and internal rotation. Anteroposterior and lateral X-rays (Figures 1 and 2) of the hip show no signs of femoroacetabular impingement or arthritis. Oblique sagittal MRI arthrogram (Figure 3) shows a degenerative labral tear.
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Hip arthroscopy is an increasingly used procedure in orthopedic practice. Debridement of labral tears remains the most common indication for hip arthroscopy. Indications for hip arthroscopy include hip pain beyond 1 month, positive findings on physical exam, and MRI confirmation of labral pathology. Hip arthroscopy with debridement is an effective treatment option for patients with degenerative labral tears. Arthroscopic debridement with partial labrectomy has been found to reduce hip pain and resolve mechanical symptoms in 91% of patients with labral tears. Poor prognostic indicators after hip arthroscopy include pre-existing arthritis, femoroacetabular impingement, and ages 45 years and older. During an arthroscopic labral debridement loose flaps of labrum and calcifications are shaved away, leaving as much normal labrum intact as possible. Patients with an unstable degenerative flap-type labral tear, such as this patient, will likely do well with an arthroscopic debridement. A labral repair is performed only if the labrum is non-viable after debridement.
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).
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- Domb BG, Hartigan DE, Perets I. Decision making for labral treatment in the hip: repair versus debridement versus reconstruction. J Am Acad Orthop Surg. 2017;25:e53-e62.