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· DOS Abstracts
Predicting MRI injury location using clinical
examination in athletes with acute groin injuries.
Andreas Serner, Adam Weir, Johannes L Tol, Kristian Thorborg, Frank Roemer, Ali
Guermazi, Per Hölmich
Sports Groin Pain Center, Aspetar Orthopaedic and Sports Medicine Hospital, Doha,
Qatar; Sports Groin Pain Center, Aspetar Orthopaedic and Sports Medicine Hospital,
Doha, Qatar; Sports Groin Pain Center, Aspetar Orthopaedic and Sports Medicine
Hospital, Doha, Qatar; Sports Orthopaedic Research Center–Copenhagen (SORC-C),
Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre,
Denmark; Department of Radiology, University of Erlangen-Nuremberg, Erlangen,
Germany; Quantitative Imaging Center (QIC), Department of Radiology, Boston
University School of Medicine, Boston, MA, USA; Sports Orthopaedic Research Center–
Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University
Hospital, Amager-Hvidovre, Denmark
Background:
MRI can be used in the diagnosis of acute groin injuries in athletes, how-
ever, as MRI is not readily available for many clinicians, further investigation of the as-
sociation between clinical examination tests and the presence of MRI injuries and their
location is required.
Purpose / Aim of Study:
To investigate whether clinical examination tests predict a
positive or negative MRI result (MRI+/-), and to assess accuracy of clinical tests to lo-
calise injury in MRI+ cases.
Materials and Methods:
We consecutively included 81 male athletes with acute groin
injuries. Standardized clinical examination (palpation, resistance, and stretch tests) and
MRI were performed within 7 days of injury. Diagnostic statistics including positive and
negative predictive values (PPV/NPV) were calculated.
Findings / Results:
85 acute injuries were found on MRI in 64 athletes with 17(21%)
athletes having MRI- injuries. Palpation had highest NPV (91-96%, [95%CI 69-99]).
Three specific adductor examination tests (resisted outer-range adduction, squeeze test
- hip neutral and long lever, and passive adductor stretch) showed 80-81% (95%CI
63-91) probability of an MRI+ adductor lesion when positive, all with high accuracy of
a correct MRI location (PPV 93-97% [95%CI 76-100]). Hip flexor tests showed poor
ability to predict MRI+ lesions (PPV 34-63% [95%CI 20-84]), and low accuracy (PPV
17-71% [95%CI 7-85]).
Conclusions:
21% of athletes had negative imaging and the absence of palpation pain
was best at predicting an MRI- result. Specific adductor examination tests were accurate
for confirming MRI+ adductor injuries. Hip flexor clinical tests were poor at predicating
and localising MRI+ injuries in the hip flexors. Clinical examination therefore appears suf-
ficient to diagnose acute adductor injuries, whereas MRI could assist in accurately locat-
ing acute hip flexor injuries.
No conflicts of interest reported
79.