Article Review:

Diagnostic accuracy of clinical tests for cam or pincer morphology in individuals with suspected FAI

What is known:

There is only limited evidence on diagnostic test accuracy for clinical tests to diagnose cam, pincer or mixed morphologies. The most current systematic reviews on clinical tests searched studies up to August 2014 and one review on flexion-adductioninternal rotation searched up to January 2017.

New findings:

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

Study in a nutshell:

This systematic review examined the current literature on clinical tests for the detection of cam or pincer morphology in individuals suspected of having FAI syndrome. Eight out of 4091 studies were included, and these reported on 17 clinical tests and two test combinations. Because of the insufficient number of studies per test, a meta-analysis could not be performed. There are three main findings: (1) there is only low-quality evidence; (2) no single test effectively rules in a cam or mixed morphology; (3) the FADIR, FPAW and the maximal squat test showed the best sensitivities and should be combined to cautiously rule out a cam or mixed morphology, but the validity of this combination should be tested with a multivariable regression model. Specificity could only be calculated for nine tests. Overall results showed low specificity for all tests, ranging from 0.11 to 0.56.

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