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What is the role of clinical tests and ultrasound in acetabular labral tear diagnostics?

Troelsen A, Mechlenburg I, Gelineck J, Bolvig L, Jacobsen S, Søballe K - Acta Orthop (2009)

Bottom Line: The impingement test had the best diagnostic ability of the clinical tests, with a sensitivity of 59% and a specificity of 100%.The positive predictive value was 100% while the negative predictive value was 13%.The impingement test is helpful in identifying acetabular labral tears.

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic Research Unit, Aarhus University Hospital, Denmark. a_troelsen@hotmail.com

ABSTRACT

Background and purpose: An acetabular labral tear is a diagnostic challenge. Various clinical tests have been described, but little is known about their diagnostic sensitivity and specificity. We investigated the diagnostic validity of clinical tests and ultrasound as compared with MR arthrography.

Patients and methods: We examined 18 patients (18 hips, 2 men, median age 43 (32-56) years) with impingement test, FABER test, resisted straight leg raise test, ultrasound, and MR arthrography. They had had previous periacetabular osteotomies due to symptomatic, acetabular dysplasia. All hips showed no or only slight signs of osteoarthritis (Tönnis grade 0-1).

Results: MR arthrography identified labral tears in 17 of the 18 hips. Ultrasound had a sensitivity of 94%, a positive predictive value of 94%, and was false negative in only 1 case compared to MR arthrography. The impingement test had the best diagnostic ability of the clinical tests, with a sensitivity of 59% and a specificity of 100%. The positive predictive value was 100% while the negative predictive value was 13%.

Interpretation: The impingement test is helpful in identifying acetabular labral tears. If this test is negative and if a labral tear is still suspected, ultrasound can reliably diagnose most tears of the acetabular labrum. MR arthrography is indicated in cases where ultrasound is negative, but the patient suffers continued, specific symptoms.

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An acetabular labral tear visualized with ultrasound. The crosses mark the approximate limits of the triangular-shaped labrum. The thick arrow points to the hypoechoic cleft that runs through the base of the labrum, ending in cystic formation just superior to the labrum (3 thin arrows).
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Figure 0005: An acetabular labral tear visualized with ultrasound. The crosses mark the approximate limits of the triangular-shaped labrum. The thick arrow points to the hypoechoic cleft that runs through the base of the labrum, ending in cystic formation just superior to the labrum (3 thin arrows).

Mentions: Ultrasound visualized labral tears in 17 of 18 hip joints (Figure 5). Of these, 16 were confirmed by MR arthrography, whereas 1 was false-positive and another was found to be false-negative (Table 1). Thus, ultrasound in labral tear diagnostics had a sensitivity of 94% and a positive predictive value of 94%. We found no true negatives, i.e. absence of a labral tear in both ultrasound and MR arthrography. Specificity and negative predictive value were therefore not assessed (Table 4).


What is the role of clinical tests and ultrasound in acetabular labral tear diagnostics?

Troelsen A, Mechlenburg I, Gelineck J, Bolvig L, Jacobsen S, Søballe K - Acta Orthop (2009)

An acetabular labral tear visualized with ultrasound. The crosses mark the approximate limits of the triangular-shaped labrum. The thick arrow points to the hypoechoic cleft that runs through the base of the labrum, ending in cystic formation just superior to the labrum (3 thin arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2823204&req=5

Figure 0005: An acetabular labral tear visualized with ultrasound. The crosses mark the approximate limits of the triangular-shaped labrum. The thick arrow points to the hypoechoic cleft that runs through the base of the labrum, ending in cystic formation just superior to the labrum (3 thin arrows).
Mentions: Ultrasound visualized labral tears in 17 of 18 hip joints (Figure 5). Of these, 16 were confirmed by MR arthrography, whereas 1 was false-positive and another was found to be false-negative (Table 1). Thus, ultrasound in labral tear diagnostics had a sensitivity of 94% and a positive predictive value of 94%. We found no true negatives, i.e. absence of a labral tear in both ultrasound and MR arthrography. Specificity and negative predictive value were therefore not assessed (Table 4).

Bottom Line: The impingement test had the best diagnostic ability of the clinical tests, with a sensitivity of 59% and a specificity of 100%.The positive predictive value was 100% while the negative predictive value was 13%.The impingement test is helpful in identifying acetabular labral tears.

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic Research Unit, Aarhus University Hospital, Denmark. a_troelsen@hotmail.com

ABSTRACT

Background and purpose: An acetabular labral tear is a diagnostic challenge. Various clinical tests have been described, but little is known about their diagnostic sensitivity and specificity. We investigated the diagnostic validity of clinical tests and ultrasound as compared with MR arthrography.

Patients and methods: We examined 18 patients (18 hips, 2 men, median age 43 (32-56) years) with impingement test, FABER test, resisted straight leg raise test, ultrasound, and MR arthrography. They had had previous periacetabular osteotomies due to symptomatic, acetabular dysplasia. All hips showed no or only slight signs of osteoarthritis (Tönnis grade 0-1).

Results: MR arthrography identified labral tears in 17 of the 18 hips. Ultrasound had a sensitivity of 94%, a positive predictive value of 94%, and was false negative in only 1 case compared to MR arthrography. The impingement test had the best diagnostic ability of the clinical tests, with a sensitivity of 59% and a specificity of 100%. The positive predictive value was 100% while the negative predictive value was 13%.

Interpretation: The impingement test is helpful in identifying acetabular labral tears. If this test is negative and if a labral tear is still suspected, ultrasound can reliably diagnose most tears of the acetabular labrum. MR arthrography is indicated in cases where ultrasound is negative, but the patient suffers continued, specific symptoms.

Show MeSH
Related in: MedlinePlus