Extra-articular findings in patients with suspected labral tear and value of screening pelvis sequence

Objectives: There are multiple etiologies of hip pain, of which labral tear is one of the most common in young adults which may be difficult to distinguish on history and clinical examination. Labral tears can be diagnosed using high-resolution non-contrast magnetic resonance imaging (MRI) or MR arthrogram that involves imaging the concerned hip. At our institute, we perform an additional proton density fat saturated axial sequence of the pelvis to screen for alternative pathology and we investigate the value of this in this study. Material and Methods: A retrospective review of high-resolution non-arthrographic 3T MR of hips that were referred from young adult hip services with a history of hip or groin pain and the clinical suspicion of a labral tear over 2 years was performed. Those <50 years were included in the study. Results: Of 648 patients with suspected labral tears, 18% showed evidence of extra-articular hip pathologies (sacroiliac joint pathology, iliopsoas pathology, and ischiofemoral impingement) on MRI. This study has shown that approximately one in five patients with a clinically suspected labral tear showed radiological evidence of extra-articular hip pathology (sacroiliac joint pathology, iliopsoas pathology, ischiofemoral impingement, and hamstring pathology). There is therefore the potential for misdiagnosis and increased morbidity if these alternative diagnoses were not appreciated. Conclusion: A high-resolution hip MRI protocol for suspected labral tears of the hip joint should include at least one sequence of the entire pelvis to evaluate for extra-articular findings.