Anterior impingement test for labral lesions has high positive predictive value

Clin Orthop Relat Res. 2012 Dec;470(12):3524-9. doi: 10.1007/s11999-012-2450-0. Epub 2012 Jul 6.


Background: The anterior impingement test is intended to detect anterosuperior acetabular labral lesions. In patients treated for labral lesions its sensitivity is reportedly 95% to 100%, and in a small group of patients undergoing periacetabular osteotomy, its sensitivity was 59% and specificity 100%. However, the sensitivity, specificity, positive predictive value, and negative predict value of this test to detect these labral lesions in unselected patients with hip pain are unknown.

Questions/purposes: We investigated these four parameters (1) in unselected patients with hip pain, and (2) in three subgroups of patients with dysplasia, femoroacetabular impingement (FAI), and with an intact joint space.

Methods: We prospectively studied 69 patients (15 men and 54 women) with a mean age of 57.2 years (range, 27-81 years). One observer performed the anterior impingement test in all patients. We determined the presence or absence of an anterosuperior labral lesion with radial MRI in 107 hips (38 patients in both hips: 14 with pain, and 24 without pain). We also investigated the parameters in the three subgroups which consisted of 60 cases of dysplasia, 27 cases of FAI, and 80 cases with intact joint space; the third subgroup partially overlapped the first and second subgroups.

Results: The four parameters in all hips were 50.6% (45/89), 88.9% (16/18), 95.7% (45/47), and 26.7% (16/60), respectively. Parameters in the three subgroups were similar to those of all cases.

Conclusions: Although the sensitivity of the anterior impingement test did not reach a sufficient level for detecting anterosuperior labral lesions, we believe the high positive predictive value makes the test useful.

Level of evidence: Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetabulum / abnormalities
  • Acetabulum / pathology*
  • Adult
  • Aged
  • Aged, 80 and over
  • Arthralgia / diagnosis*
  • Arthralgia / pathology
  • Arthralgia / physiopathology
  • Biomechanical Phenomena
  • Female
  • Femoracetabular Impingement / diagnosis*
  • Femoracetabular Impingement / pathology
  • Femoracetabular Impingement / physiopathology
  • Hip Dislocation, Congenital / diagnosis*
  • Hip Dislocation, Congenital / pathology
  • Hip Dislocation, Congenital / physiopathology
  • Hip Joint / abnormalities
  • Hip Joint / physiopathology*
  • Humans
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Pain Measurement*
  • Physical Examination*
  • Predictive Value of Tests
  • Prospective Studies
  • Range of Motion, Articular
  • Sensitivity and Specificity