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.

Background: Femoro-acetabular impingement (FAI) is increasingly recognised as a cause of mechanical hip symptoms in sportspersons. In femoro-acetabular impingement abnormal contact occurs between the proximal femur and the acetabular rim during terminal motion of the hip as a result of abnormal morphologic features involving the proximal femur (CAM) or the acetabulum (Pincer) or both (Mixed) leading to lesions of acetabular labrum and the adjacent acetabular cartilage. It is likely that it is a cause of early hip degeneration. Ganz developed a therapeutic procedure involving trochanteric flip osteotomy and dislocation of the hip, and have reported good results. We have developed an arthroscopic technique to reshape the proximal femur and remove prominent antero-superior acetabular rim thereby relieving impingement.

Methods: Twelve patients presented with mechanical hip symptoms and had demonstrable cam-type (eight patients) or mixed (four patients) FAI on radially-reconstructed MR arthrography, were treated by arthroscopic femoral osteochondroplasty and acetabular rim resection if indicated. All patients were competing at the highest level in their respective sport (football, rugby and athletics). All patients were followed up and post-operative Non-Arthritic Hip Scores (NAHS, maximum possible score 100) compared with pre-operative NAHS.

Results: There were no complications. All patients were asked to be partially weight-bearing with crutches for four weeks and most returned to training within six weeks. All of them returned to competitive sports by 14 weeks. Symptoms improved in all patients, with mean NAHS improving from 72 preoperatively to 97 at 3 months.

Conclusion: Arthroscopic reshaping to relieve FAI is feasible, safe and reliable. However it is technically difficult and time-consuming. The results are comparable to open dislocation and debridement, but avoid the prolonged disability and the complications associated with trochanteric flip osteotomy. This is important in elite athletes as they can return to training and competitive sports much quicker with less morbidity.

Introduction: Multiple scoring systems are available to evaluate arthritic hip pain and to assess outcome after arthroplasty. These scores focus on evaluating hip pain and function in elderly patients with degenerative joint disease. They are not specific for sports-related or mechanical hip symptoms in young people, or sensitive to change after new treatments such as arthroscopic hip surgery.

Methods: We systematically reviewed the literature since 1980, searching for systems used to measure severity of symptoms and outcome of treatment in these patients. We collected reports of performance of these systems. We then used the best of them to collect symptom scores from 200 patients, and measured the agreement of systems. We performed an item reduction process to identify the question items most associated with overall scores.

Results: Systematic review yielded 4 scoring systems which have been used to evaluate sports-related or mechanical hip symptoms: the Non-arthritic Hip Score (NHS), Hip Outcome Score (HOS), Hip disability and Osteoarthritis Outcome Score (HOOS)and a modified Harris Hip Score (mHHS). All scores are self administered and symptom related, requiring no physical examination. All but the mHHS have some evidence of reliability and validity. There is a great deal of overlap among the variables selected by the authors and agreement between the various scoring systems is surprisingly good. Most of the variability of all of the systems could be captured with ten simple questions.

Conclusion: We have developed a simple set of ten questions which capture outcome information as well as existing more complex systems. This will be useful is assessing outcome after new treatments such as hip arthroscopy in young active people.