Postoperative MRI Findings and Associated Pain Changes After Arthroscopic Surgery for Femoroacetabular Impingement
Sarah C Foreman1,2, Alan L Zhang3, Jan Neumann2
1Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA.
Abstract:
OBJECTIVE. The purpose of this study is to describe postoperative MRI findings after femoroacetabular impingement surgery in correlation with pain changes and surgical findings. SUBJECTS AND METHODS. We prospectively enrolled 42 patients (43 hips) who were scheduled for FAI surgery. Pre- and postoperative MR images were obtained using a 3-T MRI system. Changes in pain scores were assessed using the hip dysfunction and osteoarthritis outcome score. MR images were evaluated for the presence of acetabuloplasty or femoroplasty, presence of chondral and labral repair surgery, bone marrow edema, subchondral cysts, chondral defects, labral tears, capsular defects, and effusion. The optimal orientation to detect these changes was noted. Imaging findings were compared with pain score changes using linear regression analysis. Sensitivity and specificity were assessed using surgical correlation as the reference standard. RESULTS. Increased acetabular bony débridement length was associated with decreased improvement in pain scores (coefficient, -2.07; 95% CI, -3.53 to -0.62; p = 0.008), whereas other imaging findings were not significantly different. Femoroplasty and capsular alterations were best detected on oblique axial sequences; acetabuloplasty and cartilage and labral repair were best seen on sagittal sequences. MRI showed excellent sensitivity (100%) and specificity (100%) for detecting labral repair and excellent sensitivity for detecting femoroplasty (98%). Sensitivity and specificity were lower for detecting acetabuloplasty (83% and 80%, respectively) and chondral repair (75% and 54%, respectively). CONCLUSION. Arthroscopic acetabuloplasty showed a greater association with postoperative pain than did other aspects of surgical correction for femoroacetabular impingement. Femoroplasty and labral repair were reliably diagnosed on 3-T MRI; however, limitations were found in the evaluation of acetabular chondral repair.
