Prueba para el ligamento redondo : una prueba nueva y efectiva en el diagnóstico de desgarres del ligamente redondoThe ligamentum teres test: a novel and effective test in diagnosing tears of the ligamentum teres

#teres test #ligamento redondo

Fuente
Este artículo es originalmente publicado en:
http://www.ncbi.nlm.nih.gov/pubmed/24280307
http://ajs.sagepub.com/content/42/1/138.long
De:
O’Donnell J1, Economopoulos K, Singh P, Bates D, Pritchard M.
Am J Sports Med. 2014 Jan;42(1):138-43. doi: 10.1177/0363546513510683. Epub 2013 Nov 26.
Todos los derechos reservados para:
Copyright © 2015 by The American Orthopaedic Society for Sports Medicine

Abstract

BACKGROUND:

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.

PURPOSE:

To report a new clinical examination to assess the presence of an LT tear: the LT test.

STUDY DESIGN:

Cohort study (diagnosis); Level of evidence, 2.

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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.
Resumen

 
ANTECEDENTES:Una lesión en el ligamento redondo (LT) es un hallazgo frecuente en el momento de la cirugía artroscópica de cadera en pacientes con la ingle crónica y dolor en la cadera; Sin embargo, los desgarres LT  han sido difíciles de identificar antes de la cirugía. No ha habido características únicas identificadas en la evaluación de la historia, la exploración física o de imágenes que identifican de forma fiable las lesiones de la LT antes de la operación. 
PROPÓSITO:Para informar de un nuevo examen clínico para evaluar la presencia de un desgarro LT: la prueba de LT. 
DISEÑO DEL ESTUDIO:Estudio de cohortes (diagnóstico); Nivel de evidencia, 2. 
MÉTODOS:El estudio consistió en 75 pacientes sometidos a cirugía artroscópica de cadera para lesiones múltiples. Cada paciente fue evaluado por 2 examinadores independientes utilizando la prueba de LT, dando lugar a un total de 150 pruebas que se realiza. La prueba LT se realiza con la cadera flexionada a 70 ° y 30 ° por debajo de la abducción completa; la cadera es entonces internamente y externamente girar a sus límites de movimiento. Dolor en la rotación, ya sea interna o externa es consistente con un resultado de prueba positivo LT. A continuación, se realizó la cirugía artroscópica de cadera y todas las anormalidades intraarticulares señaló. Imágenes Artroscópicas fueron tomadas de cada LT y examinadas por un tercer examinador independiente, que determina la presencia o ausencia de un desgarre. Los hallazgos del examen clínico se compararon con los hallazgos artroscópicos para determinar la sensibilidad, especificidad y valores predictivos positivos y negativos. Además, la presencia de lesiones patológicas intra-articulares se comparó con los resultados de la prueba para determinar si existía una correlación entre la presencia de una anormalidad patológica intra-articular y un resultado de prueba positivo LT. 
RESULTADOS:De los 150 exámenes realizados, el resultado de la prueba fue positivo 55% del tiempo (77 exámenes). La sensibilidad y especificidad de la prueba fueron 90% y 85%, respectivamente. El valor predictivo positivo fue del 84%, y el valor predictivo negativo del 91%. La presencia de un desgarro LT, lesión de pinza y desgarre en el labrum que requiere reparación se asoció con un resultado positivo LT. El coeficiente κ para la fiabilidad interobservador fue 0,80. 
CONCLUSIÓN:La prueba LT es una manera eficaz de evaluar la presencia de desgarres en LT  con moderada a alta fiabilidad entre observadores. Además de un desgarro LT, la presencia de una lesión o de pinza del labrum desgarre que requiere reparación también se asocian con un resultado de prueba positivo LT.

KEYWORDS:

LT test; groin pain; ligamentum teres; tears
PMID:

 

24280307

 

[PubMed – indexed for MEDLINE]
 
 
 
 

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