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Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis
  1. M P Reiman1,2,
  2. A P Goode1,
  3. C E Cook1,
  4. P Hölmich3,4,
  5. K Thorborg3,5
  1. 1Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
  2. 2Duke University Medical Center, Durham, North Carolina, USA
  3. 3Sports Orthopedic Research Centre—Copenhagen (SORC-C), Arthroscopic Center Amager, Copenhagen University Hospital, Copenhagen, Denmark.
  4. 4Aspetar Sports Groin Pain Center, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  5. 5Physical Medicine & Rehabilitation Research—Copenhagen (PMR-C), and Departments of Orthopaedic Surgery and Physical Therapy, Copenhagen University Hospital, Copenhagen, Denmark
  1. Correspondence to Dr Michael P Reiman, Department of Orthopedic Surgery, Duke University School of Medicine, DUMC 104002, Durham, NC 27710, USA; reiman.michael{at}


Background Surgery for hip femoroacetabular impingement/acetabular labral tear (FAI/ALT) is exponentially increasing despite lacking investigation of the accuracy of various diagnostic measures. Useful clinical utility of these measures is necessary to support diagnostic imaging and subsequent surgical decision-making.

Objective Summarise/evaluate the current diagnostic accuracy of various clinical tests germane to hip FAI/ALT pathology.

Methods A computer-assisted literature search of MEDLINE, CINAHL and EMBASE databases using keywords related to diagnostic accuracy of the hip joint, as well as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for the search and reporting phases of the study. Quality assessment of bias and applicability was conducted using the Quality of Diagnostic Accuracy Studies-2 (QUADAS-2). Random effects models were used to summarise sensitivities (SN), specificities (SP), diagnostic odds ratio (DOR) and respective confidence intervals (CI).

Results The employed search strategy revealed 21 potential articles, with one demonstrating high quality. Nine articles qualified for meta-analysis. The meta-analysis demonstrated that flexion-adduction-internal rotation (pooled SN ranging from 0.94 (95% CI 0.90 to 0.97) to 0.99 (95% CI 0.98 to 1.00); DOR 5.71 (95% CI 0.84 to 38.86) to 7.82 (95% CI 1.06 to 57.84)) and flexion-internal rotation (pooled SN 0.96 (95% CI 0.81 to 0.99); DOR 8.36 (95% CI 0.41 to 171.3) tests possess only screening accuracy.

Conclusions Few hip physical examination tests for diagnosing FAI/ALT have been investigated in enough studies of substantial quality to direct clinical decision-making. Further high-quality studies across a wider spectrum of hip pathology patients are recommended to discern the confirmed clinical utility of these tests.

Trials registration number PROSPERO Registration # CRD42014010144.

  • Evaluation
  • Hip
  • Evidence based review
  • Groin
  • Injury

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