RAPID Score for Acetabular Chondrolabral Disruption

RAPID Calculator

Refractory Symptoms Despite Conservative Treatment

Age < 40 Years

Positive Anterior Impingement Test

Internal Rotation < 20°

Delayed Gadolinium Enhancement of Cartilage (dGEMRIC)

Total RAPID Score: –

Score: 0

Default scoring assumes 0 for un-set fields.

Predicts probability of finding high-grade hip cartilage damage intraoperatively.

Why Use

High-grade damage may necessitate the availability of specific tools to treat microfractures and other, more advanced cartilage treatments. May help in setting realistic and specific rehabilitation goals for patients, e.g. potential need for partial weight bearing for microfracture and cell-based therapies in patients with higher scores. Provides added benefit to diagnostic value of preoperative MRI as a readily employable, in-clinic system for predicting high-grade cartilage damage. Requires only exam and radiographs to assess. Discriminatory value ( AUC = 0.75) compares favorably with previous MRI and MRA studies.

When to Use

Patients undergoing primary hip arthroscopic procedures. Should not be used in patients with previous ipsilateral hip surgery.

Formula

Addition of the selected points: Variable Points Sex Female 0 Male 1 Tönnis Grade* Grade 0: No signs of osteoarthritis 0 Grade 1: Increased sclerosis of the head and acetabulum, slight narrowing of the joint space, and slight lipping at the joint margins 2 Grade 2: Small cysts in the head or acetabulum, increased narrowing of the joint space, and moderate loss of sphericity of the head 3 Cam morphology (alpha angle >55°) Not present 0 Present 1 *Tönnis grade 3 is an absolute contraindication to hip arthroscopy.

Pearls / Pitfalls

Reliability of the score was not assessed in the initial study. Differentiation between Tönnis grades 0 and 1 is particularly challenging and has poor interobserver reliability. Similarly, defining mild cam morphologies can be challenging, and its definition depends on the surgeon. Can be a useful adjunct to MRI/ MRA , especially in patients with indeterminate advanced imaging findings (e.g. motion or implant artifact). While MRI and MRA have been shown to have more sensitivity to acetabular articular cartilage disease, this score can provide further predictive preoperative data in surgical decision-making, counseling, and planning. Generalizable in clinical practice and able to stratify patients with varying pathological patterns. While Tönnis grade 2 is generally considered a contraindication to hip preservation surgery, its inclusion in the score should not be used as rationale to operate on these patients, as nonfocal cartilage disease is generally present in this population.

Management

In patients with higher RAPID Scores (4-5), surgeons should have their preferred tools for managing ALAD grade 3-4 lesions (e.g. microfracture awls, cell-based therapies) listed and available at the time of surgery. Additionally, patients should be preoperatively counseled on preferred high-grade lesion treatment and its potential influence on rehabilitation components, e.g. continuous passive motion (CPM) machines and time course.

Advice

Should not replace clinical examination and surgical decision-making in determining operative candidates for hip arthroscopy.

More Information

Interpretation: RAPID Score Risk of high-grade delamination 0 10.5% 1 27.0% 2 36.6% 3 45.9% 4 73.7% 5 88.0%