February 2012

More evidence indicates imaging findings do not correlate with hip symptoms

In the moment: Sports medicine

Two studies presented this month at the AAOS meeting offered further evidence that magnetic resonance imaging (MRI) findings in the hip often do not correlate with symptoms, even up to two years later.

Following up on a study presented a year earlier at the same meeting, researchers from Penn State Hershey (PA) Medical Center reported that 10 of 13 hockey players remained asymp­tomatic two years after 3-T MRI scans revealed evidence of hip labral tears.

In the first Hershey study, which was subsequently published in the April 2011 issue of the American Journal of Sports Medicine, 30 of 39 asymptomatic professional and college hockey players demonstrated hip or groin pathology on MRI, and 54% had evidence of labral tears.

Twenty four players were available for two-year follow up. Of the 13 with earlier MRI evidence of labral tears, the three who reported symptoms at two years had not missed any games or undergone treatment. Five additional players with earlier MRI evidence of labral tears were available for one-year follow up; four remained asymptomatic and the other had not sought treatment. Only one player from the original study population had retired two years later, a college player who had evidence of tendinosis on MRI.

“No professional players had any limitations due to pain,” said Robert A. Gallo, MD, an orthopaedic sports medicine surgeon at Penn State Hershey who presented his group’s findings at the AAOS meeting.

A second study, from the Steadman-Philippon Research Institute in Vail, CO, suggests that the lack of correlation between symptoms and MRI findings in the hip is not limited to hockey players. Investigators used 3-T MRI to assess 45 asymptomatic volunteers with no history of hip injury and found evidence of pathology in 73% of hip joints, with labral tears specifically in 69% of hips.

Even asymptomatic volunteers in Vail are likely to be very active, which might increase the likelihood of early pathology in their hip joints, said Bradley C. Register, MD, now with the Athens Orthopedic Clinic in Athens, GA, who presented the Vail group’s results at the AAOS meeting. Register also noted, however, that the low body mass index levels seen in the volunteers would not be expected to correlate with pathology.

The study findings suggest that imaging alone should not be used to determine whether a patient is a candidate for surgical intervention, Register said.

“Our results stress the importance of correlating signs and symptoms with clinical findings,” he said.

Sources:

Silvis M, Stuck D, Gallo RA, et al. Hip labral tears among asymptomatic hockey players identified on MRI: Two-year follow-up study. Presented at annual meeting of the American Academy of Orthopaedic Surgeons, San Francisco, February 2012: Abstract 672.

Silvis ML, Mosher TJ, Smetana BS, et al. High prevalence of pelvic and hip magnetic resonance imaging findings in asymptomatic collegiate and professional hockey players. Am J Sports Med 2011;39(4):715-721.

Register B, Pennock AT, Philippon MJ, et al. Prevalence of hip pathology in asymptomatic subjects: An MRI pro­spec­tive investigation. Presented at annual meeting of the American Aca­demy of Orthopaedic Surgeons, San Francisco, February 2012: Abstract 664.

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