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Important clinical descriptors to include in the examination and assessment of patients with femoroacetabular impingement syndrome: an international and multi-disciplinary Delphi survey

  • Hip
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Determine which examination findings are key clinical descriptors of femoroacetabular impingement syndrome (FAIS) through use of an international, multi-disciplinary expert panel.

Methods

A three-round Delphi survey utilizing an international, multi-disciplinary expert panel operationally defined from international publications and presentations was utilized.

Results

All six domains (subjective examination, patient-reported outcome measures, physical examination, special tests, physical performance measures, and diagnostic imaging) had at least one descriptor with 75% consensus agreement for diagnosis and assessment of FAIS. Diagnostic imaging was the domain with the highest level of agreement. Domains such as patient-reported outcome measures (PRO’s) and physical examination were identified as non-diagnostic measures (rather as assessments of disease impact).

Conclusion

Although it also had the greatest level of variability in description of examination domains, diagnostic imaging continues to be the preeminent diagnostic measure for FAIS. No single domain should be utilized as the sole diagnostic or assessment parameter for FAIS. While not all investigated domains provide diagnostic capability for FAIS, those that do not are able to serve purpose as a measure of disease impact (e.g., impairments and activity limitations). The clinical relevance of this Delphi survey is the understanding that a comprehensive assessment measuring both diagnostic capability and disease impact most accurately reflects the patient with FAIS.

Level of evidence

V.

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Abbreviations

CT:

Computed tomography

FABER:

Flexion, abduction, external rotation

FADIR:

Flexion, adduction, internal rotation

HAGOS:

Copenhagen Hip and Groin Outcome Score

HOS:

Hip Outcome Score

HOOS:

Hip Disability and Osteoarthritis Outcome Score

iHOT-12:

International Hip Outcome Tool-12 items

iHOT-33:

International Hip Outcome Tool-33 items

FAI:

Femoroacetabular impingement

FAIS:

Femoroacetabular impingement syndrome

mHHs:

Modified Harris Hip Score

MRI:

Magnetic Resonance Imaging

MRA:

Magnetic resonance arthrogram

PPM’s:

Physical performance measures

PROs:

Patient-reported outcome measures

T:

Tesla

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Author contributions

MPR planned the review, participated in all steps of data collection/abstraction, attaining IRB approval, and initial and subsequent drafting of Delphi questionnaire, analyzed the results, and performed the initial drafting and subsequent drafts of manuscript. All authors participated in editing and subsequent drafting of Delphi survey and reviewing of the initial and subsequent drafts of manuscript. KT and PH assisted in the initial formulation of Delphi planning, drafting of Delphi survey, editing of subsequent drafts of survey, and editing of all manuscript drafts. KC and CEC assisted in the initial formulation of actual Delphi survey, scoring, and coding of each round of Delphi and tabulation of each round results. KC drafted actual electronic Delphi survey. CEC ran statistical analyses on each round of Delphi survey results. All authors verified survey results and edited each draft of manuscript.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Duke University Medical Center, Duke University School of Medicine, Durham, NC, USA

    M. P. Reiman, K. Covington & C. E. Cook

  2. Sports Orthopedic Research Centre-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark

    M. P. Reiman, K. Thorborg & P. Hölmich

  3. Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), and Departments of Orthopedic Surgery and Physical Therapy, Copenhagen University Hospital, Amager-Hvidovre, Denmark

    K. Thorborg

  4. Aspetar Sports Groin Pain Center, Qatar Orthopedic and Sports Medicine Hospital, Doha, Qatar

    P. Hölmich

  5. Doctor of Physical Therapy Division, Department of Medicine, Duke University School of Medicine, DUMC 104002, Durham, NC, 27710, USA

    M. P. Reiman

Authors
  1. M. P. Reiman
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Correspondence to M. P. Reiman.

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None of the authors have any competing interests in the authorship or publication of this contribution. We declare that we have no conflicts of interest in the authorship or publication of this contribution.

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Reiman, M.P., Thorborg, K., Covington, K. et al. Important clinical descriptors to include in the examination and assessment of patients with femoroacetabular impingement syndrome: an international and multi-disciplinary Delphi survey. Knee Surg Sports Traumatol Arthrosc 25, 1975–1986 (2017). https://doi.org/10.1007/s00167-017-4484-z

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