In particular, we reviewed the operative notes for the presence and details of 3 common intra-articular pathologies- Ligamentum teres (LT) tears, labral tears, and chondral damage. Once we identified those that met the inclusion criteria, we looked at the arthroscopic findings by 2 fellowship-trained hip arthroscopists and recorded the details of the pathology found. Another study has demonstrated the response to injection is 90% accurate for detecting the presence of intra-articular pathology. , pain secondary to chondral damage and femoroacetabular impingement (FAI) respond particularly well to diagnostic intra-articular local anaesthetic injections. Local anaesthetic injection for diagnostic purposes with or without corticosteroid for therapeutic purposes is a common practice. MR arthrography remains the more sensitive diagnostic test when compared to MRI for intra-articular hip pathology and in particular labral tears, although there are discrepancies in the literature. Early diagnosis is therefore crucial for early successful management.Īlthough it has been well established that a negative MRI should not preclude hip arthroscopy if there is high clinical suspicion, there is very limited literature looking at this population. Diagnosis may not be made until sufficient damage has occurred that is irreversible (e.g. Despite the recent advancements in imaging, hip pathology can be missed resulting in progressive symptoms and pathology. The majority of cases require the use of additional investigative and diagnostic tests. The diagnostic accuracy of physical examination tests of the hip are unfortunately poor, although combined with a detailed history can often predict the presence of intra-articular pathology. We hypothesized that standard XR and non-contrast MRI miss clinically significant pathology if there was a positive response to intra-articular local anaesthesia. These patients pose diagnostic dilemmas that can be difficult to manage with little literature addressing how to approach the diagnostic workup in this select group. This study explores the arthroscopic findings in patients with suspected hip pathology and normal hip X-ray (standing anteroposterior (AP) Pelvis, Lateral hip and Dunn views) and Magnetic Resonance Imaging (MRI) without contrast imaging but a positive response to an intra-articular hip injection of a local anaesthetic and corticosteroid.