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

Abstract

Objectives: Imaging assessment for the clinical management of femoroacetabular impingement syndrome (FAIS) remains controversial because of a paucity of evidencebased guidance and notable variability in clinical practice, ultimately requiring expert consensus. The purpose of this agreement is to establish expert-based statements on FAIS imaging, using formal techniques of consensus building driven by relevant literature review. Methods:The validated Delphi method and peer-reviewed literature were used to formally derive consensus among 30 panel members (21 musculoskeletal radiologists and 9 orthopedic surgeons) from 13 countries.Forty-two 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 evaluation" and "Ultrasound") in order to produce answering statements.The level of evidence was noted for all produced statements and panel members were asked to score their level of agreement with each statement (0 to 10) during iterative rounds. Either "group consensus", "group agreement" or "no agreement" was achieved.Items near consensus were further queried using 4 moderated group sessions and in 4 Delphi rounds.Results: Forty-five statements were generated and group consensus was reached for 43 (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". Conclusion:The first international Delphi-based consensus for the imaging assessment of FAIS was developed. The resulting consensus can serve as a tool to reduce variability in clinical practices and guide further research for the clinical management of FAIS. 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.

Hips With Acetabular Retroversion Can Be Safely Treated With Advanced Arthroscopic Techniques Without Anteverting Periacetabular Osteotomy: Response

“…5 It is key that physicians have protocols for radiographic views as well as standardized parameters for plain radiographic assessment. Mascarenhas et al 7 make this conclusion for femoroacetabular impingement imaging.…”

Benefits of a Specific and Supervised Rehabilitation Program in Femoroacetabular Impingement Patients Undergoing Hip Arthroscopy: A Randomized Control Trial

“…A single-blind study with a blinded evaluator strategy with two parallel groups was conducted. Patients with symptomatic cam FAIS (impingement-related hip or groin pain of greater than 3/10 on a visual analog scale for at least 3 months) and radiographic evidence of cam morphology (an alpha angle of 60° or greater on either anterior/posterior pelvic or Dunn 45° hip radiographs) who were scheduled for HA [ 19 , 20 , 21 ] were recruited from the surgical practices of two orthopedic surgeons in Alicante, Spain. Pincer and mixed types were excluded.…”

Editorial Commentary: Personalized Hip Arthroscopy Outcome Prediction Using Machine Learning—The Future Is Here

“…4 However, the doubling time of medical knowledge was recently estimated at 73 days in 2020 5 ! Now, let's closely examine the hip: If you combine the layered approach to the hip, 6 the Warwick agreement, 7 the Lisbon agreement, 8,9 and the Doha agreement, 10 you will see that across the hip and pelvis, there are the following: 5 joints, 5 bones, 21 crossing musculotendinous units, the lumbosacral nerve plexus and its branches, the aortoiliac-femoral vascular system, dozens of different subjective symptoms and objective physical examination signs variably sensitive and specific for hip disease, 17 different plain radiographic views, 12 different magnetic resonance imaging or computed tomography series, 62 different imaging measurements, and 19 different hip-specific patientreported outcome scores analyzed across 4 different broad measures of clinical relevance. Furthermore, if you acquire the average amount of data of a single patient entered in an electronic medical record, there are up to 32,000 discrete data points available for analysis.…”