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The Lisbon Agreement on Femoroacetabular Impingement Imaging—part 1: overview

Authors
  • Mascarenhas, Vasco V.1
  • Castro, Miguel O.2
  • Rego, Paulo A.3
  • Sutter, Reto4
  • Sconfienza, Luca Maria5, 6
  • Kassarjian, Ara7
  • Schmaranzer, Florian8
  • Ayeni, Olufemi R.9
  • Dietrich, Tobias Johannes10
  • Robinson, Philip11, 12, 11
  • Weber, Marc-André13
  • Beaulé, Paul E.14
  • Dienst, Michael15
  • Jans, Lennart16
  • Lalam, Radhesh17
  • Karantanas, Apostolos H.18, 19
  • Sudoł-Szopińska, Iwona20
  • Anderson, Suzanne21, 22
  • Noebauer-Huhmann, Iris23
  • Vanhoenacker, Filip M.16, 24, 25
  • And 11 more
  • 1 Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, Lisbon, 1500-650, Portugal , Lisbon (Portugal)
  • 2 Centro Hospitalar Universitário do Algarve, Portimão, Portugal , Portimão (Portugal)
  • 3 Hospital da Luz, Lisbon, Portugal , Lisbon (Portugal)
  • 4 University of Zurich, Zurich, Switzerland , Zurich (Switzerland)
  • 5 IRCCS Istituto Ortopedico Galeazzi, Milan, Italy , Milan (Italy)
  • 6 Università degli Studi di Milano, Milan, Italy , Milan (Italy)
  • 7 Elite Sports Imaging SL, Madrid, Spain , Madrid (Spain)
  • 8 University of Bern, Bern, Switzerland , Bern (Switzerland)
  • 9 McMaster University, Hamilton, Ontario, Canada , Hamilton (Canada)
  • 10 Kantonsspital St. Gallen, St. Gallen, Switzerland , St. Gallen (Switzerland)
  • 11 Chapel Allerton Hospital, Leeds, UK , Leeds (United Kingdom)
  • 12 University of Leeds, Leeds, UK , Leeds (United Kingdom)
  • 13 University Medical Center, Rostock, Germany , Rostock (Germany)
  • 14 University of Ottawa, Ottawa, Ontario, Canada , Ottawa (Canada)
  • 15 Orthopädische Chirurgie München, Munich, Germany , Munich (Germany)
  • 16 Ghent University Hospital, Gent, Belgium , Gent (Belgium)
  • 17 The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry, UK , Oswestry (United Kingdom)
  • 18 University of Crete, Heraklion, Greece , Heraklion (Greece)
  • 19 ICS/FORTH, Heraklion, Greece , Heraklion (Greece)
  • 20 National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland , Warsaw (Poland)
  • 21 Kantonsspital Baden, Baden, Switzerland , Baden (Switzerland)
  • 22 The University of Notre Dame Australia, Sydney, Australia , Sydney (Australia)
  • 23 Medical University of Vienna, Vienna, Austria , Vienna (Austria)
  • 24 Antwerp University Hospital, Edegem, Belgium , Edegem (Belgium)
  • 25 AZ Sint-Maarten, Mechelen, Belgium , Mechelen (Belgium)
  • 26 Hospital CUF Descobertas, Lisbon, Portugal , Lisbon (Portugal)
  • 27 University Hospital Infanta Leonor, Madrid, Spain , Madrid (Spain)
  • 28 Centro Médico Teknon, Barcelona, Spain , Barcelona (Spain)
  • 29 University Hospital del Mar, Barcelona, Spain , Barcelona (Spain)
  • 30 District Hospital St. Johann, St. Johann, Tyrol, Austria , St. Johann (Austria)
  • 31 Hospital de la Ribera, Valencia, Spain , Valencia (Spain)
  • 32 Clínica Cemtro, Madrid, Spain , Madrid (Spain)
  • 33 Röntgeninstitut am Schillerpark, Rainerstrasse, Linz, Austria , Linz (Austria)
  • 34 Balgrist University Hospital, Zurich, Switzerland , Zurich (Switzerland)
  • 35 Universitair Ziekenhuis Brussel, Brussels, Belgium , Brussels (Belgium)
Type
Published Article
Journal
European Radiology
Publisher
Springer-Verlag
Publication Date
Jul 17, 2020
Volume
30
Issue
10
Pages
5281–5297
Identifiers
DOI: 10.1007/s00330-020-06822-9
Source
Springer Nature
Keywords
License
Yellow

Abstract

ObjectivesImaging assessment for the clinical management of femoroacetabular impingement (FAI) syndrome remains controversial because of a paucity of evidence-based guidance and notable variability in clinical practice, ultimately requiring expert consensus. The purpose of this agreement is to establish expert-based statements on FAI imaging, using formal techniques of consensus building.MethodsA validated Delphi method and peer-reviewed literature were used to formally derive consensus among 30 panel members (21 musculoskeletal radiologists and 9 orthopaedic surgeons) from 13 countries. Forty-four questions were agreed on, and recent relevant seminal literature was circulated and classified in five major topics (‘General issues’, ‘Parameters and reporting’, ‘Radiographic assessment’, ‘MRI’ and ‘Ultrasound’) in order to produce answering statements. The level of evidence was noted for all statements, and panel members were asked to score their level of agreement with each statement (0 to 10) during iterative rounds. Either ‘consensus’, ‘agreement’ or ‘no agreement’ was achieved.ResultsForty-seven statements were generated, and group consensus was reached for 45 (95.7%). Seventeen of these statements were selected as most important for dissemination in advance. There was no agreement for the two statements pertaining to ‘Ultrasound’.ConclusionRadiographic evaluation is the cornerstone of hip evaluation. An anteroposterior pelvis radiograph and a Dunn 45° view are recommended for the initial assessment of FAI although MRI with a dedicated protocol is the gold standard imaging technique in this setting. The resulting consensus can serve as a tool to reduce variability in clinical practices and guide further research for the clinical management of FAI.Key Points• FAI imaging literature is extensive although often of low level of evidence.• Radiographic evaluation with a reproducible technique is the cornerstone of hip imaging assessment.• MRI with a dedicated protocol is the gold standard imaging technique for FAI assessment.

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