TY - JOUR
T1 - Predictive value of Gagey's hyperabduction test in identifying inferior glenohumeral ligament lesions
AU - van Spanning, Sanne H.
AU - Lafosse, Thibault
AU - Verweij, Lukas P. E.
AU - van Rijn, Sybren K.
AU - Lafosse, Laurent
AU - Buijze, Geert Alexander
N1 - Publisher Copyright: © 2022 Elsevier Masson SAS
PY - 2023/6
Y1 - 2023/6
N2 - Introduction: Clinical tests that can identify inferior glenohumeral ligament (IGHL) complex injuries are indispensable for the diagnosis of shoulder instability. Gagey's hyperabduction test has been developed to diagnose IGHL hyperlaxity, however, it is unclear whether the test is able to accurately diagnose an IGHL lesion. The aim of this study was to (1) determine the diagnostic performance of the Gagey test in identifying an IGHL lesion and (2) determine if a positive Gagey test is more predictive for an anterior or posterior IGHL lesion thanks to the heatmapping of the lesions. It was hypothesized that a Gagey test can accurately predict IGHL lesions, but would not be able to distinguish between anterior and inferior IGHL lesions. Methods: A retrospective diagnostic accuracy study was conducted including all consecutive patients who underwent glenoid labral repair between January 2005 and September 2021 with a documented Gagey test prior to surgery. Using arthroscopic findings as a reference standard, the diagnostic performance characteristics of the Gagey test for each type of IGHL lesion (anterior, posterior and combined) were calculated and labral heatmapping was used to depict its localisation. Results: A total of 167 patients were included, with a mean age of 29 ± 10 years. The sensitivity, specificity and accuracy of the Gagey test on determining an IGHL lesion were 46%, 38% and 46%, respectively. The positive and negative predictive values were 88% and 7%, respectively. Heatmapping of the labral lesions demonstrated that a positive Gagey test was most predictive of anterior IGHL and axillary pouch tears and non-predictive of posterior IGHL lesions. Discussion: The Gagey test demonstrated a low sensitivity and specificity to identify an IGHL lesion and therefore the hypothesis could not be confirmed. However, the Gagey test has a high positive predictive value to diagnose anterior IGHL lesions. Further prospective research with a more evenly distribution of lesions is needed to investigate the clinical value of the Gagey test to identify these lesions. Based on this data, the Gagey test seems especially important to support the results of other clinical tests such as the apprehension, relocation and surprise tests. Level of evidence: III, retrospective case-control study.
AB - Introduction: Clinical tests that can identify inferior glenohumeral ligament (IGHL) complex injuries are indispensable for the diagnosis of shoulder instability. Gagey's hyperabduction test has been developed to diagnose IGHL hyperlaxity, however, it is unclear whether the test is able to accurately diagnose an IGHL lesion. The aim of this study was to (1) determine the diagnostic performance of the Gagey test in identifying an IGHL lesion and (2) determine if a positive Gagey test is more predictive for an anterior or posterior IGHL lesion thanks to the heatmapping of the lesions. It was hypothesized that a Gagey test can accurately predict IGHL lesions, but would not be able to distinguish between anterior and inferior IGHL lesions. Methods: A retrospective diagnostic accuracy study was conducted including all consecutive patients who underwent glenoid labral repair between January 2005 and September 2021 with a documented Gagey test prior to surgery. Using arthroscopic findings as a reference standard, the diagnostic performance characteristics of the Gagey test for each type of IGHL lesion (anterior, posterior and combined) were calculated and labral heatmapping was used to depict its localisation. Results: A total of 167 patients were included, with a mean age of 29 ± 10 years. The sensitivity, specificity and accuracy of the Gagey test on determining an IGHL lesion were 46%, 38% and 46%, respectively. The positive and negative predictive values were 88% and 7%, respectively. Heatmapping of the labral lesions demonstrated that a positive Gagey test was most predictive of anterior IGHL and axillary pouch tears and non-predictive of posterior IGHL lesions. Discussion: The Gagey test demonstrated a low sensitivity and specificity to identify an IGHL lesion and therefore the hypothesis could not be confirmed. However, the Gagey test has a high positive predictive value to diagnose anterior IGHL lesions. Further prospective research with a more evenly distribution of lesions is needed to investigate the clinical value of the Gagey test to identify these lesions. Based on this data, the Gagey test seems especially important to support the results of other clinical tests such as the apprehension, relocation and surprise tests. Level of evidence: III, retrospective case-control study.
KW - Gagey
KW - IGHL
KW - Instability
KW - Shoulder
UR - http://www.scopus.com/inward/record.url?scp=85153385440&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.rcot.2022.11.025
DO - https://doi.org/10.1016/j.rcot.2022.11.025
M3 - Article
SN - 1877-0517
VL - 109
SP - 604
JO - Revue de Chirurgie Orthopedique et Traumatologique
JF - Revue de Chirurgie Orthopedique et Traumatologique
IS - 4
ER -