Systematic Review With Video Illustration
Diagnostics of Femoroacetabular Impingement and Labral Pathology of the Hip: A Systematic Review of the Accuracy and Validity of Physical Tests

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Purpose

Femoroacetabular impingement (FAI) and labral pathology have been recognized as causative factors for hip pain. The clinical diagnosis is now based on MRI-A (magnetic resonance imaging-arthrogram) because the physical diagnostic tests available are diverse and information on diagnostic accuracy and validity is lacking. The purpose of this systematic review was to identify the diagnostic accuracy and validity of physical tests that are used to assess FAI and labral pathology of the hip joint.

Methods

We performed a computerized literature search using PubMed, Medline, Web of Science, PEDro, the Cochrane Library, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) (through EBSCO). Studies describing tests and diagnostic accuracy studies were included. All included studies were assessed by the Levels of Evidence for Primary Research Questions list. All diagnostic accuracy studies were assessed by the QUADAS (Quality Assessment of Diagnostic Accuracy Studies) score.

Results

We included 21 studies in which 18 different tests were described. For 11 of these tests, diagnostic accuracy figures were presented. Sensitivity was examined for all tests. Other diagnostic accuracy figures were often lacking, and when available, these were low. All articles describing tests had Level IV or V evidence. All diagnostic accuracy studies, except 1, had Level II or III evidence. Three articles had a good QUADAS score.

Conclusions

In previous studies a wide range of physical diagnostic tests have been described. Little is known about the diagnostic accuracy and validity of these tests, and if available, these figures were low. The quality of the studies investigating these tests is too low to provide a conclusive recommendation for the clinician. Thus, currently, no physical tests are available that can reliably confirm or discard the diagnoses of FAI and/or labral pathology of the hip in clinical practice.

Level of Evidence

Level III, systematic review of Level III studies.

Section snippets

Methods

The objective of this study was to identify (1) which physical diagnostic tests are used to assess intra-articular hip pathology, especially FAI and labral pathology; (2) the diagnostic accuracy and validity of these tests; and (3) the quality of the diagnostic accuracy studies describing these tests.

Results

The search identified a total of 307 studies. Based on the title and abstract, 245 studies were excluded. There were 16 doubles, and 25 studies were excluded based on full-text assessment, which left a total of 21 studies to be included (Fig 1). Of these studies, 7 described tests for diagnosing FAI and/or labral pathology and 14 focused on diagnostic accuracy. There were minor disagreements between reviewers regarding inclusion of studies, but consensus was reached in all cases.

Discussion

This review identified 21 studies describing 18 physical diagnostic tests for the assessment of FAI and/or labral pathology of the hip joint. Of the studies, 7 gave a description of these tests and 14 were diagnostic accuracy studies. Many physical tests were the objective of previous studies, but results show that there was a lack of diagnostic accuracy parameters or these parameters had poor values. This was supported by our finding that based on the QUADAS score, only 3 of 14 diagnostic

Conclusions

There exists a wide range of physical diagnostic tests for FAI and/or labral pathology and little information on the diagnostic accuracy and validity. The methodologic quality of the diagnostic accuracy studies is moderate to poor. Uniformity in test executions is warranted, and these should be thoroughly investigated for diagnostic accuracy and validity. For now, no (combination of) physical diagnostic tests are available that can reliably confirm or discard the diagnoses of FAI and/or labral

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The authors report that they have no conflicts of interest in the authorship and publication of this article.

Note: To access the video accompanying this report, visit the June issue of Arthroscopy at www.arthroscopyjournal.org.

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