Hip Joint Pathology: Clinical Presentation and Correlation Between Magnetic Resonance Arthrography, Ultrasound, and Arthroscopic Findings in 25 Consecutive Cases Bruce Mitchell, MBBS,*†‡ Paul McCrory, MBBS, FRACP,*‡ Peter Brukner, MBBS, FACSP,*‡ John O’Donnell, MBBS, FRACS§ Emma Colson, BApp Sci (Physio),*†‡ and Robert Howells, MBBS, FRACS§ *Olympic Park Sports Medicine Centre, †Reservoir Sports Medicine Centre, ‡Centre for Sports Medicine Research and Education, University of Melbourne, and §Mercy Private Hospital, Melbourne, Australia Background: The hip joint is becoming increasingly recog- nized as a source of groin pain and, in the authors’ experience, buttock and low back pain. Objectives: To determine the range of pathologic diagnoses, clinical presentation, and the correlation between magnetic resonance arthrographic, ultrasonographic, and arthroscopic findings in the hip joint. Methods: We prospectively studied 25 consecutive hip ar- throscopies to determine the range of pathologic diagnoses, clinical presentation, and the correlation between magnetic resonance arthrographic, ultrasonographic, and arthroscopic findings. Results: All of the hips arthroscoped had pathology. Back pain and hip pain were the 2 most common presentations. The only consistently positive clinical test result was a restricted and painful hip quadrant compared with the contralateral hip. Of the 17 patients whose flexion, abduction, external rotation (FABER) test results were reported at the time of examination, 15 (88%) were positive, and 2 (12%) negative. Plain radio- graphs were normal in all patients. All but 1 patient underwent magnetic resonance arthrography. Although specificity of 100% was achieved in our study, the sensitivity was signifi- cantly lower, with a relatively high number of false negatives. Hip arthroscopy proved the definitive diagnostic procedure for intraarticular pathology. Conclusions: Hip pathology, particularly labral pathology, may be more common than has been previously recognized. In those patients with chronic groin and low back pain, a high index of suspicion should be maintained. Clinical signs of a painful, restricted hip quadrant and a positive FABER test re- sult should suggest magnetic resonance arthrography in the first instance, but a negative magnetic resonance image should not preclude hip arthroscopy if there is high clinical suspicion of hip joint pathology. Clin J Sport Med 2003;13:152–156. INTRODUCTION Pathology of the hip joint is increasingly recognized in sports medicine as a result of increased clinical suspicion and advances in magnetic resonance (MR) imaging 1–6 and hip arthroscopy. 7–12 The differential diagnosis for patients who present with hip joint abnormalities and have normal plain radiographic findings include synovi- tis, labral tears, loose bodies, degenerative disease, liga- ment teres tears, and chondral defects. 13 A number of recent reports have suggested that labral tears are a frequent but unrecognized cause of groin and hip pain. 13,14–22 Labral tears, which also have been known as acetabular rim syndrome, 16 have been re- ported in association with dislocation of the hip 23–25 and following minor trauma. 12,15,26 Arthroscopy is the current gold standard for diagnos- ing intraarticular hip joint pathology and abnormalities. MR arthrography has been suggested as a sensitive im- aging method to detect labral tears, but there have been conflicting results as to its accuracy. 1–4,13,20 We prospectively studied 25 consecutive hip arthros- copies to (1) determine the range of pathologic diag- noses, (2) determine the clinical presentation, and (3) determine the correlation between MR arthrographic, ul- trasonographic, and arthroscopic findings. METHODS Clinical Assessment Subjects were enrolled sequentially over 4 months from 2 sports medicine centers in Melbourne, Australia. In all cases, a single experienced sports clinician (B.M.) took the history and performed the examination at the time of presentation. Particular attention was paid in the clinical history to the mechanism of injury, site of pain, Received for publication September 2002; accepted February 2003. Reprints: Bruce Mitchell, mbbs, Olympic Park Sports Medicine Cen- tre, Swan Street, Melbourne 3004, Australia. E-mail: opsmc@opsmc. com.au Clinical Journal of Sport Medicine, 13:152–156 © 2003 Lippincott Williams & Wilkins, Inc., Philadelphia 152