Magnetic resonance arthrography versus arthroscopy in the evaluation of articular hip pathology

In this study, we compared magnetic resonance arthrography results with hip arthroscopy findings to assess the diagnostic value of this imaging technique in evaluating acetabular labral tears and concurrent articular hip pathology. One hundred one consecutive patients (102 hips) with a clinical diagnosis of acetabular labral tear were assessed using magnetic resonance arthrography and had hip arthroscopy after failing to improve with nonoperative treatment. Magnetic resonance arthrography detected 71 of 93 (76%) acetabular labral tears (92 patients) with five false positive studies in five patients (4.9%). Articular cartilage findings diagnosed by magnetic resonance arthrography were confirmed by arthroscopy in 64 hips in 64 patients (62.7%). With respect to labral pathology, magnetic resonance arthrography showed a sensitivity of 71%, specificity of 44% positive predictive value of 93%, negative predictive value of 13%, and accuracy of 69%. With respect to articular cartilage pathology, magnetic resonance arthrography had a sensitivity of 47%, specificity of 89%, positive predictive value of 84%, negative predictive value of 59%, and accuracy of 67%. Although magnetic resonance arthrography is an excellent positive predictor in diagnosing acetabular labral tears and articular cartilage abnormalities, it has limited sensitivity. A negative imaging study does not exclude important intra-articular pathology that can be identified and treated arthroscopically.