Diagnostic accuracy of clinical tests for cam or pincer morphology in individuals with suspected FAI syndrome: a systematic review.

Abstract

Objectives

To determine the diagnostic accuracy of clinical tests for cam or pincer morphology in individuals with suspected femoroacetabular impingement (FAI) syndrome and to evaluate their clinical utility.

Design

A systematic review of studies investigating the diagnostic accuracy of clinical tests for cam and pincer morphology.

Data sources

PubMed, Embase, CINAHL and SPORTDiscus.

Eligibility criteria for selecting studies

Studies investigating the diagnostic accuracy of clinical tests for cam, pincer or mixed morphology in symptomatic patients. Patients had to undergo an index test and a reference test able to identify cam or pincer morphology. Study results have to allow the calculation of true or false positives and/or negatives to calculate sensitivity, specificity, likelihood ratios (LR) and post-test probabilities.

Results

Eight studies were included, investigating 17 tests and two test combinations. The studies reported a low specificity for all tests, ranging from 0.11 to 0.56. Sensitivity ranged from 0.11 to 1.00, with high sensitivities for the flexion-adduction-internal rotation (FADIR), foot progression angle walking (FPAW) and maximal squat tests. We estimated that negative test results on all of these three tests would result in a negative LR of 0.15. However, we judged the studies to provide low-quality evidence.

Conclusion

There is low-quality evidence that negative test results reduce the post-test probability of cam or mixed morphologies and that consecutive testing with the FADIR, FPAW and maximal squat tests might be used as a clinical test combination. We would not recommend their use to confirm the diagnosis of FAI syndrome.

PROSPERO registration number

CRD42018079116.