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

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 ultra-sound as compared with MR arthrography

Patient-reported outcome and muscle-tendon pain after periacetabular osteotomy are related:1-year follow-up in 82 patients with hip dysplasia

Background and purpose — Larger prospective studies investigating periacetabular osteotomy (PAO) with patient-reported outcome measures developed for young patients are lacking. We investigated changes in patient-reported outcome (PRO), changes in muscle–tendon pain, and any associations between them from before to 1 year after PAO. Patients and methods — Outcome after PAO was investigated in 82 patients. PRO was investigated with the Copenhagen Hip and Groin Outcome Score (HAGOS). Muscle–tendon pain in the hip and groin region was identified with standardized clinical tests, and any associations between them were analyzed with multivariable linear regressions. Results — HAGOS subscales improved statistically significantly from before to 1 year after PAO with effect sizes ranging from medium to very large (0.66–1.37). Muscle–tendon pain in the hip and groin region showed a large decrease in prevalence from 74% (95% CI 64–83) before PAO to 35% (95% CI 25–47) 1 year after PAO. Statistically significant associations were observed between changes in HAGOS and change in the sum of muscle–tendon pain, ranging from –4.7 (95% CI –8.4 to –1.0) to –8.2 (95% CI –13 to –3.3) HAGOS points per extra painful entity across all subscales from before to 1 year after PAO. Interpretation — Patients with hip dysplasia experience medium to very large improvements in PRO 1 year after PAO, associated with decreased muscle–tendon pain. The understanding of hip dysplasia as solely a joint disease should be reconsidered since muscle–tendon pain seems to play an important role in relation to the outcome after PAO. Trial registration: ClinicalTrials.gov identifier: 20140401PAO

Does the physical activity profile change in patients with hip dysplasia from before to 1 year after periacetabular osteotomy?

Background and purpose — Knowledge of physical activity profiles among patients with hip dysplasia is lacking. We investigated whether patients with hip dysplasia change physical activity profile from before to 1 year after periacetabular osteotomy. Furthermore, we investigated associations between change in accelerometer-based physical activity and change in self-reported participation in preferred physical activities (PA). Patients and methods — Physical activity was objectively measured at very low to high intensity levels with accelerometer-based sensors. Subjectively, PA was recorded with Copenhagen Hip and Groin Outcome Score (HAGOS) in 77 patients. Associations between the 2 were analyzed with simple linear regression analyses. Results — Changes in accelerometer-based physical activity ranged from –2.2 to 4.0% points at all intensity levels from baseline to 1-year follow-up. These changes represent very small effect sizes (–0.16 to 0.14). In contrast, self-reported PA showed a statistically and clinically relevant increase of 22 (CI 14–29) HAGOS PA points 1 year post-surgery. Associations between change in accelerometer-based physical activity and change in self-reported PA were, however, not statistically significant and correspond to a percentage change in physical activity of only –0.87% to 0.65% for a change of 10 HAGOS PA points. Interpretation — Patients with hip dysplasia do not seem to change physical activity profile 1 year post-surgery if measured with objective accelerometer-based sensors. This is interesting as self-reported PA indicates that patients’ ability to participate in physical activity increases, suggesting that this increased self-reported participatory capacity is not manifested as increased objectively measured physical activity

The Use of Ultrasound to Exclude Extremity Fractures in Adults

Background:. The purpose of the present study was to investigate whether ultrasonography can be used as a diagnostic tool to exclude extremity fractures in adults. Methods:. This prospective comparative study involved 91 patients (age, ≥18 years) who had been referred by general practitioners for a conventional radiographic examination of a suspected extremity fracture. No additional clinical examination was performed. Ultrasound examination was consistently carried out prior to conventional radiographic examination, which was regarded as the gold standard. At the end of the study, the positive scans were confirmed by a specialist who was highly skilled in ultrasonography. Results:. The prevalence of fractures in the study population was 27%. Ultrasonography had a sensitivity of 92%, a specificity of 94%, a positive predictive value of 85%, a negative predictive value of 97%, a positive likelihood ratio of 15.33, and a negative likelihood ratio of 0.085. There seemed to be no association between the anomalous results and patient age or the specific anatomical region of the fracture. Conclusions:. The present study indicates that ultrasonography, when performed and interpreted by experienced ultrasonographers, has high accuracy for the diagnosis of a suspected extremity fracture. No systematic differences were found between the results of radiography and ultrasonography, and ultrasonography showed a high sensitivity and specificity. Level of Evidence:. Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence