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RAPID Score for Acetabular Chondrolabral Disruption

Preoperative estimate of high-grade acetabular cartilage damage before hip arthroscopy.

RAPID Score for Acetabular Chondrolabral Disruption
Sex
Tonnis grade (radiographic osteoarthritis)
Preoperative AP pelvis radiograph.
Cam morphology (alpha angle >55 degrees on Dunn view)
Result0 points

Low predicted probability of grade 3-4 (high-grade) acetabular chondrolabral disruption at arthroscopy.

Sex
Female
Tonnis grade points
0
Cam morphology
Absent
Reported risk of high-grade damage
~10.5 %

When to use

  • Counseling patients preoperatively about the likelihood of high-grade (ALAD grade 3-4) acetabular cartilage damage before hip arthroscopy for femoroacetabular impingement or labral tear.
  • Supplementing indeterminate or artifact-limited MRI/MR arthrogram findings when planning for possible cartilage procedures (e.g., microfracture).

Formula

RAPID score (0-5) = points for male sex (1) + Tonnis grade (grade 0 = 0, grade 1 = 2, grade 2 = 3) + cam morphology, alpha angle >55 degrees on Dunn view (1). Derived by multivariable stepwise logistic regression (Akaike information criterion) from 652 primary hip arthroscopies; validated prospectively in 167 additional cases.

Pearls and pitfalls

  • In the derivation and validation cohorts, risk of high-grade damage rose from about 10.5% at 0 points to about 88.0% at 5 points (AUC 0.75 and 0.76, respectively).
  • A score of 5 had 99.1% specificity for high-grade damage in the original cohort.
  • Age and BMI were significant on univariate analysis but were not retained in the final multivariable model.

References

  1. Hevesi M, Hartigan DE, Wu IT, et al. The Rapidly Assessed Predictor of Intraoperative Damage (RAPID) Score: An In-Clinic Predictive Model for High-Grade Acetabular Chondrolabral Disruption. Orthop J Sports Med. 2018;6(10):2325967118799068.