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Published in: Knee Surgery, Sports Traumatology, Arthroscopy 4/2014

01-04-2014 | Hip

A painful squat test provides limited diagnostic utility in CAM-type femoroacetabular impingement

Authors: Olufemi Ayeni, Raymond Chu, Bandar Hetaimish, Liin Nur, Nicole Simunovic, Forough Farrokhyar, Asheesh Bedi, Mohit Bhandari

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 4/2014

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Abstract

Purpose

The purpose of this study is to determine the relationship between a symptomatic maximal squat and the presence of radiographic CAM-type femoroacetabular impingement (FAI) on magnetic resonance imaging (MRI) and to determine the sensitivity and specificity of a maximal squat test for the presence of radiographic CAM-type femoral deformity in an adult population.

Methods

In this pilot study, 76 consecutive patients were recruited from an outpatient clinic at McMaster University. All patients presented with pre-arthritic hip pain and were asked to perform a maximal squat. The results of this test were compared to magnetic resonance imaging and magnetic resonance angiographic (MRI and MRA) findings evaluating and characterizing CAM-type FAI deformity.

Results

The sensitivity and specificity of the maximal squat test were 75 % (56.6–88.5 %) and 41 % (27.0–56.8 %), respectively, for CAM-type FAI deformity. The positive and negative likelihood ratios were modest at 1.3 (0.9–1.7) and 0.6 (0.3–1.2), respectively. This means that a 30 % pre-test probability is improved to 36 % following a positive squat test and reduced to 20 % with a negative squat test.

Conclusion

The maximal squat test was found to have marginal incremental diagnostic ability for CAM-type FAI. Its utility in the diagnostic evaluation of FAI remains limited. This survey elucidates areas of research for future studies relevant to the clinical diagnosis of FAI.

Level of evidence

III.
Literature
1.
go back to reference Anderson SE, Siebenrock KA, Mamisch TC, Tannast M (2009) Femoroacetabular impingement magnetic resonance imaging. Top Magn Reson Imaging 20(3):123–128PubMedCrossRef Anderson SE, Siebenrock KA, Mamisch TC, Tannast M (2009) Femoroacetabular impingement magnetic resonance imaging. Top Magn Reson Imaging 20(3):123–128PubMedCrossRef
2.
go back to reference Beck M, Kalhor M, Leunig M, Ganz R (2005) Hip morphology influences the pattern of damage to the acetabular cartilage—femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br 87B(7):1012–1018CrossRef Beck M, Kalhor M, Leunig M, Ganz R (2005) Hip morphology influences the pattern of damage to the acetabular cartilage—femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br 87B(7):1012–1018CrossRef
3.
go back to reference Bredella MA, Stoller DW (2005) MR imaging of femoroacetabular impingement. Magn Reson Imaging Clin N Am 13(4):653–664PubMedCrossRef Bredella MA, Stoller DW (2005) MR imaging of femoroacetabular impingement. Magn Reson Imaging Clin N Am 13(4):653–664PubMedCrossRef
4.
go back to reference Burnett RSJ, Della Rocca GJ, Prather H, Curry M, Maloney WJ, Clohisy JC (2006) Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg Am 88A(7):1448–1457CrossRef Burnett RSJ, Della Rocca GJ, Prather H, Curry M, Maloney WJ, Clohisy JC (2006) Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg Am 88A(7):1448–1457CrossRef
5.
go back to reference Clohisy JC, Knaus ER, Hunt DM, Lesher JM, Harris-Hayes M, Prather H (2009) Clinical presentation of patients with symptomatic anterior hip impingement. Clin Orthop Relat Res 467:638–644PubMedCentralPubMedCrossRef Clohisy JC, Knaus ER, Hunt DM, Lesher JM, Harris-Hayes M, Prather H (2009) Clinical presentation of patients with symptomatic anterior hip impingement. Clin Orthop Relat Res 467:638–644PubMedCentralPubMedCrossRef
6.
go back to reference Domb BG, Brooks AG, Byrd JW (2009) Clinical examination of the hip joint in athletes. J Sport Rehabil 18(1):3–23PubMed Domb BG, Brooks AG, Byrd JW (2009) Clinical examination of the hip joint in athletes. J Sport Rehabil 18(1):3–23PubMed
7.
go back to reference Fitzgerald RH (1995) Acetabular labrum tears: diagnosis and treatment. Clin Orthop Relat Res 311:60–68PubMed Fitzgerald RH (1995) Acetabular labrum tears: diagnosis and treatment. Clin Orthop Relat Res 311:60–68PubMed
8.
go back to reference Ganz R, Leunig M, Leunig-Ganz K, Harris WH (2008) The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res 466(2):264–272PubMedCentralPubMedCrossRef Ganz R, Leunig M, Leunig-Ganz K, Harris WH (2008) The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res 466(2):264–272PubMedCentralPubMedCrossRef
9.
go back to reference Hack K, Di Primio G, Rakhra K, Beaule PE (2010) Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers. J Bone Joint Surg Am 92A(14):2436–2444CrossRef Hack K, Di Primio G, Rakhra K, Beaule PE (2010) Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers. J Bone Joint Surg Am 92A(14):2436–2444CrossRef
10.
go back to reference Ito K, Minka-II MA, Leunig M, Werlen S, Ganz R (2001) Femoroacetabular impingement and the cam-effect a MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br 83B(2):171–176CrossRef Ito K, Minka-II MA, Leunig M, Werlen S, Ganz R (2001) Femoroacetabular impingement and the cam-effect a MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br 83B(2):171–176CrossRef
11.
go back to reference Kapron AL, Anderson AE, Aoki SK et al (2011) Radiographic prevalence of femoroacetabular impingement in collegiate football players: AAOS exhibit selection. J Bone Joint Surg Am 93(19):e111-1–e111-10CrossRef Kapron AL, Anderson AE, Aoki SK et al (2011) Radiographic prevalence of femoroacetabular impingement in collegiate football players: AAOS exhibit selection. J Bone Joint Surg Am 93(19):e111-1–e111-10CrossRef
12.
go back to reference Kassarjian A (2006) Hip MR arthrography and femoroacetabular impingement. Semin Musculoskelet Radiol 10(3):208–219PubMedCrossRef Kassarjian A (2006) Hip MR arthrography and femoroacetabular impingement. Semin Musculoskelet Radiol 10(3):208–219PubMedCrossRef
13.
go back to reference Kubiak-Langer M, Tannast M, Murphy SB, Siebenrock KA, Langlotz F (2007) Range of motion in anterior femoroacetabular impingement. Clin Orthop Relat Res 458:117–124PubMed Kubiak-Langer M, Tannast M, Murphy SB, Siebenrock KA, Langlotz F (2007) Range of motion in anterior femoroacetabular impingement. Clin Orthop Relat Res 458:117–124PubMed
14.
go back to reference Lamontagne M, Brisson N, Kennedy MJ, Beaule PE (2011) Preoperative and postoperative lower-extremity joint and pelvic kinematics during maximal squatting of patients with cam femoro-acetabular impingement. J Bone Joint Surg Am 93A:40–45CrossRef Lamontagne M, Brisson N, Kennedy MJ, Beaule PE (2011) Preoperative and postoperative lower-extremity joint and pelvic kinematics during maximal squatting of patients with cam femoro-acetabular impingement. J Bone Joint Surg Am 93A:40–45CrossRef
15.
16.
go back to reference Martin HD, Kelly BT, Leunig M et al (2010) The pattern and technique in the clinical evaluation of the adult hip: the common physical examination tests of hip specialists. Arthroscopy 26(2):161–172PubMedCrossRef Martin HD, Kelly BT, Leunig M et al (2010) The pattern and technique in the clinical evaluation of the adult hip: the common physical examination tests of hip specialists. Arthroscopy 26(2):161–172PubMedCrossRef
17.
go back to reference Martin RL, Irrgang JJ, Sekiya JK (2008) The diagnostic accuracy of a clinical examination in determining intra-articular hip pain for potential hip arthroscopy candidates. Arthroscopy 24(9):1013–1018PubMedCrossRef Martin RL, Irrgang JJ, Sekiya JK (2008) The diagnostic accuracy of a clinical examination in determining intra-articular hip pain for potential hip arthroscopy candidates. Arthroscopy 24(9):1013–1018PubMedCrossRef
18.
go back to reference Martin RL, Kelly BT, Leunig M et al (2010) Reliability of clinical diagnosis in intraarticular hip diseases. Knee Surg Sports Traumatol Arthrosc 18(5):685–690PubMedCrossRef Martin RL, Kelly BT, Leunig M et al (2010) Reliability of clinical diagnosis in intraarticular hip diseases. Knee Surg Sports Traumatol Arthrosc 18(5):685–690PubMedCrossRef
19.
go back to reference Martin RL, Sekiya JK (2008) The interrater reliability of 4 clinical tests used to assess individuals with musculoskeletal hip pain. J Orthop Sports Phys Ther 38(2):71–77PubMedCrossRef Martin RL, Sekiya JK (2008) The interrater reliability of 4 clinical tests used to assess individuals with musculoskeletal hip pain. J Orthop Sports Phys Ther 38(2):71–77PubMedCrossRef
20.
go back to reference Maslowski E, Sullivan W, Harwood JF, Gonzalez P, Kaufman M, Vidal A, Akuthota V (2010) The diagnostic validity of hip provocation maneuvers to detect intra-articular hip pathology. PM R 2(3):182–186CrossRef Maslowski E, Sullivan W, Harwood JF, Gonzalez P, Kaufman M, Vidal A, Akuthota V (2010) The diagnostic validity of hip provocation maneuvers to detect intra-articular hip pathology. PM R 2(3):182–186CrossRef
21.
go back to reference Ng KCG, Rouhi G, Lamontagne M, Beaulé PE (2012) Finite element analysis examining the effects of cam FAI on hip joint mechanical loading using subject-specific geometries during standing and maximum squat. HSS J 8(3):206–212PubMedCentralPubMedCrossRef Ng KCG, Rouhi G, Lamontagne M, Beaulé PE (2012) Finite element analysis examining the effects of cam FAI on hip joint mechanical loading using subject-specific geometries during standing and maximum squat. HSS J 8(3):206–212PubMedCentralPubMedCrossRef
22.
go back to reference Notzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J (2002) The contour of the femoral head-neck junction as a predictor for the rick of anterior impingement. J Bone Joint Surg Br 84B(4):556–560CrossRef Notzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J (2002) The contour of the femoral head-neck junction as a predictor for the rick of anterior impingement. J Bone Joint Surg Br 84B(4):556–560CrossRef
23.
go back to reference Philippon MJ, Briggs KK, Yen Y-, Kuppersmith DA (2009) Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up. J Bone Joint Surg Br 91B(1):16–23CrossRef Philippon MJ, Briggs KK, Yen Y-, Kuppersmith DA (2009) Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction minimum two-year follow-up. J Bone Joint Surg Br 91B(1):16–23CrossRef
24.
go back to reference Sink EL, Gralla J, Ryba A, Dayton M (2008) Clinical presentation of femoroacetabular impingement in adolescents. J Pediatr Orthop 28(8):806–811PubMedCrossRef Sink EL, Gralla J, Ryba A, Dayton M (2008) Clinical presentation of femoroacetabular impingement in adolescents. J Pediatr Orthop 28(8):806–811PubMedCrossRef
25.
go back to reference Strayer RJ, Lang ES (2006) Does this patient have a torn meniscus or ligament of the knee? Ann Emerg Med 47:499–501PubMedCrossRef Strayer RJ, Lang ES (2006) Does this patient have a torn meniscus or ligament of the knee? Ann Emerg Med 47:499–501PubMedCrossRef
26.
go back to reference Tannast M, Siebenrock KA, Anderson SE (2007) Femoroacetabular impingement: radiographic diagnosis—what the radiologist should know. AJR Am J Roentgenol 188(6):1540–1552PubMedCrossRef Tannast M, Siebenrock KA, Anderson SE (2007) Femoroacetabular impingement: radiographic diagnosis—what the radiologist should know. AJR Am J Roentgenol 188(6):1540–1552PubMedCrossRef
27.
go back to reference Tijssen M, van Cingel R, Willemsen L, de Visser E (2012) Diagnostics of femoroacetabular impingement and labral pathology of the hip: a systematic review of the accuracy and validity of physical tests. Arthroscopy 28(6):860–871PubMedCrossRef Tijssen M, van Cingel R, Willemsen L, de Visser E (2012) Diagnostics of femoroacetabular impingement and labral pathology of the hip: a systematic review of the accuracy and validity of physical tests. Arthroscopy 28(6):860–871PubMedCrossRef
Metadata
Title
A painful squat test provides limited diagnostic utility in CAM-type femoroacetabular impingement
Authors
Olufemi Ayeni
Raymond Chu
Bandar Hetaimish
Liin Nur
Nicole Simunovic
Forough Farrokhyar
Asheesh Bedi
Mohit Bhandari
Publication date
01-04-2014
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 4/2014
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-013-2668-8

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