Kostas Economopoulos, The Orthopedic Clinic Association, 2222 East Highland Avenue, #300, Phoenix, AZ 85016.
Am J Sports Med. 2014 Jan;42(1):138-43. doi: 10.1177/0363546513510683. Epub 2013 Nov 26.
A ligamentum teres (LT) injury is a common finding at the time of hip arthroscopic surgery in patients with chronic groin and hip pain; however, LT tears have been difficult to identify before surgery. There have been no unique features identified on history assessment, physical examination, or imaging that reliably identify injuries of the LT preoperatively.
To report a new clinical examination to assess the presence of an LT tear: the LT test.
Cohort study (diagnosis); Level of evidence, 2.
The study consisted of 75 patients undergoing hip arthroscopic surgery for multiple lesions. Each patient was evaluated by 2 independent examiners using the LT test, leading to a total of 150 tests being performed. The LT test is conducted with the hip flexed at 70° and 30° short of full abduction; the hip is then internally and externally rotated to its limits of motion. Pain on either internal or external rotation is consistent with a positive LT test result. Hip arthroscopic surgery was then performed and all intra-articular abnormalities noted. Arthroscopic images were taken of each LT and examined by a third independent examiner who determined the presence or absence of a tear. Clinical examination findings were compared with the arthroscopic findings to determine the sensitivity, specificity, and positive and negative predictive values. In addition, the presence of intra-articular pathological lesions was compared with the test results to determine if there was a correlation between the presence of an intra-articular pathological abnormality and a positive LT test result.
Of the 150 examinations performed, the test result was positive 55% of the time (77 examinations). The sensitivity and specificity of the test were 90% and 85%, respectively. The positive predictive value was 84%, and the negative predictive value was 91%. The presence of an LT tear, pincer lesion, and labral tear that required repair was associated with a positive LT test result. The κ coefficient for interobserver reliability was .80.
The LT test is an effective way of assessing the presence of LT tears with moderate to high interobserver reliability. In addition to an LT tear, the presence of a pincer lesion or labral tear requiring repair are also associated with a positive LT test result.
在慢性腹股沟和髋关节疼痛患者的髋关节镜手术中，经常会发现圆韧带（LT）损伤；然而，LT 撕裂在手术前很难识别。在病史评估、体格检查或影像学检查中，尚未发现任何独特的特征可以可靠地术前识别 LT 损伤。
报告一种新的临床检查方法来评估 LT 撕裂的存在：LT 试验。
队列研究（诊断）；证据水平，2 级。
该研究包括 75 例接受髋关节镜手术治疗多种病变的患者。每位患者由 2 位独立的检查者使用 LT 试验进行评估，共进行了 150 次试验。LT 试验在髋关节屈曲 70°和外展 30°时进行；然后髋关节内旋和外旋至运动极限。内旋或外旋时疼痛与 LT 试验阳性结果一致。然后进行髋关节镜手术，并记录所有关节内异常。对每个 LT 进行关节镜检查，并由第三位独立检查者检查，以确定是否存在撕裂。将临床检查结果与关节镜检查结果进行比较，以确定敏感性、特异性、阳性和阴性预测值。此外，还比较了关节内病理性病变的存在与试验结果，以确定关节内病理性异常的存在与 LT 试验阳性结果之间是否存在相关性。
在进行的 150 次检查中，试验结果阳性的次数为 55%（77 次检查）。该试验的敏感性和特异性分别为 90%和 85%。阳性预测值为 84%，阴性预测值为 91%。LT 撕裂、钳夹病变和需要修复的盂唇撕裂的存在与 LT 试验阳性结果相关。观察者间可靠性的 κ 系数为.80。
LT 试验是一种评估 LT 撕裂的有效方法，具有中度至高度的观察者间可靠性。除 LT 撕裂外，钳夹病变或需要修复的盂唇撕裂的存在也与 LT 试验阳性结果相关。
