Using a simplified version of a common surgical grading scale for acetabular labral tears improves the utility of preope
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SCIENTIFIC ARTICLE
Using a simplified version of a common surgical grading scale for acetabular labral tears improves the utility of preoperative hip MRI for femoroacetabular impingement Patrick Morgan 1 & Amanda Crawford 2 & Shelly Marette 2 & Takashi Takahashi 2 & Joseph Luchsinger 2 & James Kirkham 2 & Baolin Wu 3 & Jutta M. Ellermann 2,4 Received: 15 April 2020 / Revised: 26 May 2020 / Accepted: 27 May 2020 # ISS 2020
Abstract Objective To evaluate whether a commonly used surgical grading scale, when applied to acetabular labral findings on MRI, could improve preoperative planning and counseling for patients undergoing hip arthroscopy. Materials and methods We evaluated 76 clinical MRIs performed on patients with femoroacetabular impingement. Three musculoskeletal radiologists and one musculoskeletal fellow reviewed each scan in a blinded fashion, classifying the acetabular labrum from 12:00 to 4:00 using the Beck scale, a common surgical grading scale. Clinical correlation was provided via surgical examination and classification. Reliability was determined between readers and between reader and surgical data using Cohen’s kappa and Krippendorff’s alpha at each clock position and for the worst grading for each scan. In addition, a simplified version of the scale comprised of only two grades, potentially reparable and not potentially reparable, was evaluated. Results When the scale was simplified into categories of potentially reparable and not potentially reparable, the sensitivity was excellent, ranging from 85.5 to 96%. Observer agreement when using individual Beck grades was found to range from poor to fair; Kappa ranged from 0.03 to 0.19, and Alpha ranged from − 0.27 to 0.22. Conclusion The simplified version of the Beck labral scale when applied to MRI is a highly sensitive predictor of potentially reparable labral pathology while excluding normal and grossly degenerative tissue. Use of this scale provides clinically relevant information that can drive preoperative planning and improve patient counseling. It does so in a standardized fashion that can be applied across practice sites and without additional cost. Keywords Femoroacetabular impingement (FAI) . MRI . Arthrogram . Hip . Acetabular labrum
Introduction Hip arthroscopy has seen exponential growth during the past decade [1], and labral surgery is the most common
* Jutta M. Ellermann [email protected] 1
Department of Orthopedic Surgery, University of Minnesota, 2512 South &th Street, Suite R200, Minneapolis, MN 55455, USA
2
Department of Radiology, University of Minnesota Mayo Memorial Building, 420 Delaware Street SE, Minneapolis, MN 55455, USA
3
Division of Biostatistics, University of Minnesota School of Public Health, A460 Mayo Building, MMC 303, 420 Delaware Street SE, Minneapolis, MN 55455, USA
4
Center for Magnetic Resonance Research, University of Minnesota, 2021 6th Street S.E., Minneapolis, MN 55455, USA
of the arthroscopic hip interventions performed [1]. Which labral procedure to perform—whether reconstruction, repair, or debri
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