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observers. In the next two steps, the DI measurements from the individual observers and the PennHIP evaluation center were compared to the laxity index (LI) measured on the VMBDD view. The results were similar in every comparison: no evidence for bias, a linear relationship and a small variability. Based on these comparisons, it was concluded that the LI (VMBDD) is similar to the DI (PennHIP). Finally, the interobserver agreement of the DI, LI and NA was assessed and compared to classi cation criteria. For the NA, the measurement variability was substantial, consequently a clear measurement protocol is necessary. The DI and LI were equally reproducible and scored much better. Overall, the VMBDD seems a promising alternative for a complete and correct in-house evaluation of the hip.
To conclude, it’s time to change our approach. The methods based on the detection/quanti cation of hip joint laxity have demonstrated their superiority compared to the StVD projection and should be used as well in clinical patients as in screening programs. PennHIP offers a strong scienti c basis but the constraints related to
its use prevent a more extended use, mainly in Europe. Alternative techniques, such as the VMBDD, that allow
a complete and correct in-house evaluation of the hip joint by trained clinicians might increase the popularity of laxity-based radiographic techniques.
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