title: Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis.
abstract: 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.
  
  
  BACKGROUND
  PROSPERO Registration # CRD42014010144.
authors.affiliation: Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, USA Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: M P
authors.initials: MP
authors.lastname: Reiman
authors.affiliation: Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: A P
authors.initials: AP
authors.lastname: Goode
authors.affiliation: Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: C E
authors.initials: CE
authors.lastname: Cook
authors.affiliation: Sports Orthopedic Research Centre-Copenhagen (SORC-C), Arthroscopic Center Amager, Copenhagen University Hospital, Copenhagen, Denmark. Aspetar Sports Groin Pain Center, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
authors.forename: P
authors.initials: P
authors.lastname: Hölmich
authors.affiliation: Sports Orthopedic Research Centre-Copenhagen (SORC-C), Arthroscopic Center Amager, Copenhagen University Hospital, Copenhagen, Denmark. Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), and Departments of Orthopaedic Surgery and Physical Therapy, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: K
authors.initials: K
authors.lastname: Thorborg
mesh_terms: D057925:Femoracetabular Impingement / Q000175:diagnosis*; D006801:Humans; D022125:Lacerations / Q000175:diagnosis; D010808:Physical Examination / Q000379:methods / Q000592:standards; D012372:ROC Curve; D012015:Reference Standards; D012421:Rupture / Q000175:diagnosis
keywords: Evaluation; Evidence based review; Groin; Hip; Injury