The Everted Acetabular Labrum: Patho-anatomy, Magnetic Resonance Imaging and Arthroscopic Findings of a Native Variant

Vogel, Laura A.; Kraeutler, Matthew J.; Jesse, Mary K.; Ho, Corey K.; Houck, Darby A.; Garabekyan, Tigran; Mei-Dan, Omer

doi:10.1016/j.arthro.2021.04.038

Cited by 13 publications

(9 citation statements)

References 31 publications

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“…18,24 We believe that the EL is an independent source of hip dysfunction and potentiates pain from other pathologies due to the constant disruption of the suction seal. 27 The consequences of an untreated EL can be extrapolated from studies that have demonstrated the deleterious effects of a compromised acetabular suction seal. 2,18,21 Previous studies have shown that the fluid seal formed by the acetabular labrum is a key contributor to normal hip biomechanical stability and longevity.…”

Section: Discussionmentioning

confidence: 99%

“…Our findings may explain the conclusions of Kaplan et al, 6 who reported significantly worse clinical outcomes for patients with a decreased labral width diameter. Vogel et al 27 demonstrated that ELs were frequently hypoplastic (mean labral length, 3.7 ± 1.3 mm for EL vs 5.3 ± 1.5 mm for control; P < .001), likely caused by diminished shear forces as a result of poor apposition to the femoral head. We believe that the reported poor functional outcomes after labral repair in patients with hypoplastic labra are explained by the unrecognized presence of an EL, given the association between hypoplastic labra with EL and functional debilitation with an EL as the sole diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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The Everted Acetabular Labrum: Outcomes of Surgical Management

Girardi,

Lee,

Genuario

et al. 2024

Am J Sports Med

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Background: An everted acetabular labrum (EL) is a pathologic variant in which the labrum is flipped to the capsular side of the acetabular rim. An iatrogenic EL is a known complication of a poorly executed labral repair, and a recent study described the native acetabular EL. Purpose: To analyze surgical outcomes after advancement or reconstruction of an EL in a native hip. Study Design: Cohort study; Level of evidence, 3. Methods: This was a multicenter retrospective review of prospectively collected data on primary hip arthroscopic surgeries performed between 2013 and 2023. An EL was identified arthroscopically as a labrum–femoral head gap while off traction in the native hip. All patients with EL who were analyzed in this study underwent arthroscopic labral repair and advancement or labral augmentation or reconstruction. Patients with hip dysplasia also underwent periacetabular osteotomy with or without a derotational femoral osteotomy. Patient-reported outcomes (PROs) were assessed using the 12-item International Hip Outcome Tool (iHOT-12) and the Nonarthritic Hip Score. PROs were obtained preoperatively and up to 24 months after surgery. PROs were compared with those of a case-matched control cohort in a 1:2 ratio. Only patients with PROs available at ≥1 year postoperatively were included in the outcome analysis. Results: A total of 111 patients (129 hips) with EL during the study period were identified, with PROs available in 96 hips. The mean age of patients with EL was 30.5 years, and women made up 87% of the cohort. Of the 129 hips with an EL, an isolated diagnosis of an EL was present in 11.6% of hips. Deficient acetabular coverage (lateral center-edge angle <25°) was seen in 40.6% of EL hips. No difference was seen in iHOT-12 scores between EL and control groups at 12- or 24-month follow-up ( P = .18 and .94, respectively). Patients with EL reported a significant improvement of PROs at latest follow-up ( P < .001 for iHOT-12 and Nonarthritic Hip Score). Conclusion: Surgical management of a native EL with restoration of the labral seal on the femoral head and correction of concomitant pathologies resulted in significant clinical improvement, with postoperative outcome scores comparable to those of patients without an EL. These findings provide evidence supporting surgical intervention for a native EL.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Everted Acetabular Labrum: Outcomes of Surgical Management

Girardi,

Lee,

Genuario

et al. 2024

Am J Sports Med

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“…47,48 Everted labra were also found to be smaller/hypoplastic than regular labra, even though an important proportion (approximately a third) of patients with everted labra appear with borderline dysplasia that predisposes to hypertrophic labra. 47…”

Section: Labramentioning

confidence: 95%

“…In cases of everted labra , articular cartilage lip sloping can be identified beneath the labrum in an area extending from superomedial to inferolateral. 47 An angle between the lateral edge of the iliac wing and the cartilaginous roof of the acetabulum > 65 degrees has been described, but a gap between the bony acetabulum and the labrum is necessary for the definition of everted labrum. 47 48 Everted labra were also found to be smaller/hypoplastic than regular labra, even though an important proportion (approximately a third) of patients with everted labra appear with borderline dysplasia that predisposes to hypertrophic labra.…”

Section: Imagingmentioning

confidence: 99%

Imaging of Anatomical Variants Around the Hip

Klontzas

Vassalou

Zibis

et al. 2023

Semin Musculoskelet Radiol

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Considering the current widespread use of imaging as an integral part of managing hip pain, variable hip geometries and anatomical variants are increasingly being detected. These variants are commonly found in the acetabulum and proximal femur, as well as the surrounding capsule-labral tissues. The morphology of specific anatomical spaces confined by the proximal femur and the bony pelvis may also vary significantly among individuals. Familiarity with the spectrum of imaging appearances of the hip is necessary to identify variant hip morphologies with or without potential clinical relevance and reduce an unnecessary work-up and overdiagnosis. We describe anatomical variations and variable morphologies of the bony structures comprising the hip joint and the soft tissues, around the hip. The potential clinical significance of these findings is further analyzed in conjunction with the patient's profile.

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“…This labral pathology is characterized by a labrum that sits on the capsular side of the acetabular rim, not contacting the femoral head, and thereby providing no suction seal for normal hip mechanics (Figure 4). 54 Vogel et al 54 found that 36.8% of everted labrum cases were in patients with an LCEA <25 . An everted labrum was found to sit off the femoral head by a mean of 1.4 mm on coronal MRI/MRA in the anteriorsuperior quadrant, was significantly shorter compared Figure 4.…”

Section: Everted Labrummentioning

confidence: 99%

Radiographic Parameters of Adult Hip Dysplasia

Welton

Kraeutler

Garabekyan

et al. 2023

Orthopaedic Journal of Sports Medicine

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As knowledge about the origin and morphologic characteristics of hip pain in the young adult has evolved, so too has the clinician’s ability to assess for various pathologies of the hip on radiographs, magnetic resonance imaging (MRI)/magnetic resonance arthrography (MRA), and computed tomography (CT). Because there is no algorithm at this time directly indicating what to do in more subtle hip morphologies, such as microinstability and borderline hip dysplasia (BHD), a skilled hip preservation specialist must use multiple imaging sources and know how to interpret them correctly. Imaging parameters used in the workup for hip dysplasia and BHD include the lateral center-edge angle, Tönnis angle, iliofemoral line, and presence of an upsloping lateral sourcil or everted labrum, among many others. The purpose of this narrative review was to detail various established criteria and parameters on anteroposterior pelvis plain radiographs, MRI/MRA, and CT that assist in defining the nature and severity of instability present in a dysplastic hip, thereby aiding in the development of patient-specific surgical treatment plans.

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The Everted Acetabular Labrum: Patho-anatomy, Magnetic Resonance Imaging and Arthroscopic Findings of a Native Variant

Cited by 13 publications

References 31 publications

The Everted Acetabular Labrum: Outcomes of Surgical Management

The Everted Acetabular Labrum: Outcomes of Surgical Management

Imaging of Anatomical Variants Around the Hip

Radiographic Parameters of Adult Hip Dysplasia

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