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Reliability and Validity of Diagnosing Acetabular Labral Lesions with Magnetic Resonance Arthrography
Gustaaf Reurink, MD, MSc1; Sebastiaan P.L. Jansen, MD2; Jasper M. Bisselink, MD2; Patrice W.J. Vincken, MD2; Adam Weir, PhD3; Maarten H. Moen, MD4
1 Department of Orthopaedics, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail address: g.reurink@erasmusmc.nl
2 Department of Orthopaedics (S.P.L.J.) and Radiology (J.M.B. and P.W.J.V.), Rijnland Hospital, P.O. Box 4220, 2350 CC Leiderdorp, the Netherlands
3 Department of Sports Medicine, The Hague Medical Centre Antoniushove, P.O. Box 411, 2260 AK Leidschendam, the Netherlands
4 Department of Rehabilitation, Nursing Science and Sports Medicine, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, the Netherlands
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Investigation performed at Rijnland Hospital, Leiderdorp, the Netherlands

This article was chosen to appear electronically on August 8, 2012, in advance of publication in a regularly scheduled issue.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Sep 19;94(18):1643-1648. doi: 10.2106/JBJS.K.01342
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Arthroscopic surgery of the hip is being increasingly used to diagnose and treat various abnormalities, including acetabular labral tears. Magnetic resonance arthrography has been suggested as the imaging test of choice for the evaluation of the acetabular labrum. There is substantial variability in the previously reported accuracy of magnetic resonance arthrography for diagnosing labral lesions. Interobserver reliability has not been established previously. The purpose of this study was to establish the interobserver reliability and the validity of magnetic resonance arthrography for detecting lesions of the acetabular labrum in a retrospective case series.


Two radiologists independently assessed the acetabular labrum on magnetic resonance arthrograms of ninety-five hips in ninety-three patients who underwent hip arthroscopy for a suspected acetabular labral lesion. Magnetic resonance arthrography findings were compared with the gold standard, which was defined as the assessment of the labrum during the hip arthroscopy.


At arthroscopy, ninety-one labral lesions were identified in the ninety-five hips. The interobserver reliability of detecting labral lesions with magnetic resonance arthrography was fair (kappa = 0.268). Magnetic resonance arthrography, as interpreted by observers A and B, showed a sensitivity of 86% and 86%, specificity of 75% and 50%, negative predictive value of 19% and 13%, and positive predictive value of 99% and 98%, respectively.


Because of its limited reliability and the high prevalence of labral lesions, magnetic resonance arthrography provides a limited complementary benefit in the detection of labral lesions in patients with a high clinical suspicion of labral pathology. When there is a high clinical suspicion of a labral lesion, magnetic resonance arthrography has a poor negative predictive value and cannot be used to rule out a labral lesion. Physicians should critically consider whether the findings on a magnetic resonance arthrogram will alter the treatment strategy for an individual patient with a clinical suspicion of labral pathology.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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