The LT test is a new clinical examination test for assessing the ligamentum teres, and we are presenting the details of how to perform the test,and its validation.
Ligamentum teres (LT) pathology has been identified as a significant cause of hip pain in patients undergoing hip arthroscopy. However, there has been no reliable clinical test available to predict the presence of LT pathology prior to surgery. We have developed The LT test (a new clinical test) to assess LT pathology. Our hypothesis is that this test will reliably predict the presence of LT pathology.
A prospective study was performed on 29 consecutive patients. Prior to undergoing hip arthroscopy, each patient was examined independently by two experienced hip surgeons using this test. The examiners were blinded to the patients' histories and imaging findings. The test was performed with the patients' hip flexed to full flexion without tilting of the pelvis. The hip was then extended by 30 degrees. From this position, the hip was moved into full abduction and then adducted 30 degrees. The hip was then internally and externally rotated through full range. The presence of pain is considered a positive test.
The clinical examination results were recorded in our hip arthroscopy database.
At the time of arthroscopic surgery, the ligamentum teres was examined in neutral position, full internal and external rotation. The ligament was carefully probed to assess for the presence of any tears during these manoeuvres. Any pathology identified, including tears and synovitis were recorded.
Of the 29 patients examined, 18 had a positive test. 14 were confirmed at surgery to have LT pathology:
- -Grade 1 tear 0
- -Grade 2 tear 7
- -Grade 3 tear 2
- -Synovitis 5
11 patients had a negative test, and of these, 9 had a normal intact LT.
- -Synovitis 1
- -Grade 2 tear 1
The sensitivity of the test was 83%, and specificity 90%. The positive predictive value was 93%, and negative predictive value was 77%. The kappa coefficient for interobserver reliability was 0.72.
The PODS test is an effective way to assess the presence of LT pathology with moderate to high interobserver reliability.
© 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.