So Prem's going to talk to us about preoperative MRI offers minimal clinical utility, delays access to hip arthroscopy, and lacks cost-effectiveness in patients age 40 and under for FAI retrospective five-year analysis. Thanks to the AOS assignment, also the Erudite Society, and also my co-authors. So introduction, FAI is basically diagnosed through history, physical, and exam. Most people here agree it's primarily a bony operation. It's a very fast-growing procedure, obviously, but insurance companies are fixated on these images showing the MRI. So we're obviously pushing towards value-based care. And so the question we ask is, are MRIs necessary for surgeons? Are they necessary for payers, and are they necessary for patients and their outcomes? Dr. Westerman had a study that showed patients are experiencing over two grand per patient just to get that preop MRI. And then time to arthroscopy from symptom onset has been shown to actually matter. You get them on the operating room faster, they do better. So the question is, do we always need the preop MRI if the diagnosis of FAI is based on history, exam, and radiographs are concordant? If they have failed non-operative management completely, and if the surgeon has already preoperatively decided that this patient would benefit from a hip scope procedure, including femoroplasty, acetabuloplasty, and labral repair, and this is a primary patient, and they're under age 40. So we explore that. We excluded patients if they didn't have a concordant history, such as atypical hip pain, stress reaction, question of synovitis, pain out of proportion, or just the clinical story did not match up, if they had prior hip surgery, if they're over the age of 40, or they had questionable radiographs, which includes arthritic changes, overt dysplasia, signs of aspericity. So we had surgeons from four different centers, specifically lower, middle, and higher volume surgeons. We basically paired down these patients into two groups, surgeons who were indicated that already showed up with an MRI, 1,069, and patients who were indicated who presented without an MRI, which was 322 patients. And so those are the two groups. So the patients who presented without an MRI went on to get one prior to arthroscopy, but they were all indicated for surgery, and the decision was made before even getting that MRI. So data was collected, basic demographics, making sure the history, exam, and physical were concordant. The surgeon and radiologist both reviewed the MRI and had to confirm that there was a presence and location of the labral tear, noted the intraoperative findings, again, the presence and location, whether it was repaired, debrided, reconstructed, and any surprise diagnoses. And then we also looked at the time in terms of took from the clinic visit to the OR, as well as the clinic visit to the MRI for the group that did not have an MRI. So looking at these total volume of cases, overall pretty similar demographics. And then looking at what these hip scope fellowship trained sports surgeons had, the clinical exam was concordant, and, you know, there was about 2.6% discrepancy where radiologists did not see what the surgeons saw when looking at the MRI. And all the tears were found to be anterosuperior, and there were no surprise diagnoses in this study. And intraoperatively, 99.8% repaired the labrum, the 0.2% did not, and there were no surprise labral reconstructions for this group. And then time from surgical indication visit to hip arthroscopy basically shows that if you showed up with an MRI, you got surgery faster, although this study did not include the time that it took to get there before. But if you showed up without an MRI, you only, you got surgery about 30 days later. So when you take a step back and look at people's booking rates, it basically suggests that their booking rate for this group was about 63 days, but it was faster if they presented without an MRI because they already knew that they would be going on to surgery, and the MRI was just done for either insurance reasons or for confirmation reasons. So key takeaways, you know, the surgeon history, exam, and radiographic evaluation were sufficient to diagnose this and indicate young primary patients for hip arthroscopy. The preoperative MRI did not alter the decision to operate or the actual surgical plan for the 322 indicated patients without an MRI. For this group, this wasted about three weeks of these patients' time in their lives. In total, this wasted about 209 hours of scheduling time and nearly $3 million in terms of cost expenditures. And regardless of the surgeon's volume, all MRIs demonstrated anterosuperior labral tears that were repaired almost entire time. There were no surprise diagnoses or no surprise reconstructions. And the take-home message is that the hip MRI should be left to the discretion of the surgeon. Although referral to the hip arthroscopist with an MRI saved a month, this study did not follow patients who never received surgery or carried non-FAI diagnoses. So prospective study is ideal, but challenging due to prior authorization concerns, and you cannot extrapolate this study for CAT scans, especially version. So if we're not really following the evidence, are we just appeasing payers or perpetuating dogma? Above all, a concordant history, exam, and radiographs is critical to the diagnosis. Thank you.

preoperative MRI

hip arthroscopy

femoroacetabular impingement

cost-effectiveness

symptom onset