Prevalence of Femoroacetabular Impingement Imaging Findings in Asymptomatic Volunteers: A Systematic Review

Frank, Jonathan M.; Harris, Joshua D.; Erickson, Brandon J.; Slikker, William; Bush‐Joseph, Charles A.; Salata, Michael J.; Nho, Shane J.

doi:10.1016/j.arthro.2014.11.042

Cited by 476Hip disorders and treatmentsLower Extremity Biomechanics and PathologiesShoulder Injury and Treatment

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Prevalence of Femoroacetabular Impingement Imaging Findings in Asymptomatic Volunteers: A Systematic Review

Frank, Jonathan M., Harris, Joshua D., Erickson, Brandon J., Slikker, William, Bush‐Joseph, Charles A., Salata, Michael J., Nho, Shane J.·2015·Arthroscopy

DOI 10.1016/j.arthro.2014.11.042

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Abstract

Purpose: The aim of this study was to determine the prevalence of radiographic findings suggestive of femoroacetabular impingement (FAI) in asymptomatic individuals. Methods: A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Studies reporting radiographic, computed tomographic, or magnetic resonance imaging (MRI) findings that were suggestive of FAI in asymptomatic volunteers were included. Cam, pincer, and combined pathologic conditions were investigated. Results: We identified 26 studies for inclusion, comprising 2,114 asymptomatic hips (57.2% men; 42.8% women). The mean participant age was 25.3 ± 1.5 years. The mean alpha angle in asymptomatic hips was 54.1° ± 5.1°. The prevalence of an asymptomatic cam deformity was 37% (range, 7% to 100% between studies)—54.8% in athletes versus 23.1% in the general population. Of the 17 studies that measured alpha angles, 9 used MRI and 9 used radiography (1 study used both). The mean lateral and anterior center edge angles (CEAs) were 31.2° and 30°, respectively. The prevalence of asymptomatic hips with pincer deformity was 67% (range 61% to 76% between studies). Pincer deformity was poorly defined (4 studies [15%]; focal anterior overcoverage, acetabular retroversion, abnormal CEA or acetabular index, coxa profunda, acetabular protrusio, ischial spine sign, crossover sign, and posterior wall sign). Only 7 studies reported on labral injury, which was found on MRI without intra‐articular contrast in 68.1% of hips. Conclusions: FAI morphologic features and labral injuries are common in asymptomatic patients. Clinical decision making should carefully analyze the association of patient history and physical examination with radiographic imaging. Level of Evidence: Level IV, systematic review if Level II‐IV studies.

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Tissue disruption alone is not enough to explain pain or dysfunction.
“In physical medicine, a large body of research supports the perspective that tissue disruption alone is not enough to explain pain or dysfunction (Beecher, 1946;Brinjikji et al., 2015;Frank et al., 2015;Teunis et al., 2014).”
From Beyond yellow flags: The Big‐Five personality traits and psychologically informed musculoskeletal rehabilitation. (2023) · cites this paper as Frank et al., 2015

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Fernquest, S., Arnold, C., Palmer, A., Broomfield, J., Denton, J., Taylor, A., & Glyn-Jones, S. (2017) · The Bone & Joint Journal · doi:10.1302/0301-620x.99b4.bjj-2016-1274.r1 · Cited by 37
Advanced Imaging in Femoroacetabular Impingement: Current State and Future Prospects
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Pain Neuroscience Education: Teaching People About Pain
Louw, A., & Riera-Gilley, V. (2024) · Journal of Pain & Palliative Care Pharmacotherapy · doi:10.1080/15360288.2024.2424853 · Cited by 36
“• femoroacetabular impingement is equally frequent in pain-free and painful individuals (35).”
Computer-based estimation of the hip joint reaction force and hip flexion angle in three different sitting configurations.
Houcke, J. V., Schouten, A., Steenackers, G., Vandermeulen, D., Pattyn, C., & Audenaert, E. (2017) · Applied Ergonomics · doi:10.1016/j.apergo.2017.04.008 · Cited by 34
Internationale Studienergebnisse
(2022) · physiopraxis · doi:10.1055/a-1660-9213 · Cited by 33
What is the Prevalence of Hip Intra-Articular Pathologies and Osteoarthritis in Active Athletes with Hip and Groin Pain Compared with Those Without? A Systematic Review and Meta-Analysis
Heerey, J., Kemp, J., Mosler, A., Jones, D. M., Pizzari, T., Scholes, M., Agricola, R., & Crossley, K. (2019) · Sports Medicine · doi:10.1007/s40279-019-01092-y · Cited by 31
Prevalence and Consistency in Surgical Outcome Reporting for Femoroacetabular Impingement Syndrome: A Scoping Review
Reiman, M. P., Peters, S., Sylvain, J., Hagymasi, S., & Ayeni, O. R. (2018) · Arthroscopy The Journal of Arthroscopic and Related Surgery · doi:10.1016/j.arthro.2017.11.037 · Cited by 39
Trunk and lower limb biomechanics during stair climbing in people with and without symptomatic femoroacetabular impingement
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Primary cam morphology; bump, burden or bog-standard? A concept analysis
Dijkstra, H. P., Ardern, C. L., Serner, A., Mosler, A., Weir, A., Roberts, N. W., Auliffe, S. M., Oke, J. L., Khan, K. M., Clarke, M. J., et al. (2021) · British Journal of Sports Medicine · doi:10.1136/bjsports-2020-103308 · Cited by 38
“This is an ideal opportunity for experts to now work towards agreement.”
Background
Surgery is no more effective than conservative treatment for Femoroacetabular impingement syndrome: Systematic review and meta-analysis of randomized controlled trials
Bastos, R. M., de Carvalho, J. G., da Silva, S. A. M., Campos, S., Rosa, M. V., & Prianti, B. D. M. (2020) · Clinical Rehabilitation · doi:10.1177/0269215520966694 · Cited by 29
The Diagnostic Value of Ultrasound in Anterosuperior Acetabular Labral Tear.
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Professional soccer is associated with radiographic cam and pincer hip morphology
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Hip-Spine Syndrome in the Non-Arthritic Patient.
Vaswani, R., White, A. E., Feingold, J. D., & Ranawat, A. (2022) · Arthroscopy: The Journal of Arthroscopy And Related · doi:10.1016/j.arthro.2022.04.015 · Cited by 28
Hip Arthroscopy for Femoroacetabular Impingement Syndrome Shows Good Outcomes and Low Revision Rates, with Young Age and Low Postoperative Pain Score Predicting Excellent 5-Year Outcomes.
Huang, H.-J., Dang, H.-H., Mamtimin, M., Gang, Y., Zhang, X., & Wang, J.-Q. (2022) · Arthroscopy: The Journal of Arthroscopy And Related · doi:10.1016/j.arthro.2022.03.024 · Cited by 28
The effectiveness of hip arthroscopic surgery for the treatment of femoroacetabular impingement syndrome: A systematic review and meta-analysis.
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Performance and Return to Sport After Hip Arthroscopy in the National Basketball Association.
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Self-citation
Return to Sport Following Arthroscopic Management of Femoroacetabular Impingement: A Systematic Review
Lucenti, L., Maffulli, N., Bardazzi, T., Saggini, R., Memminger, M., Simeone, F., & Migliorini, F. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13175219 · Cited by 27
“FAI is a common finding on imaging [6,7].”
Background
Effectiveness of Hip Arthroscopy on Treatment of Femoroacetabular Impingement Syndrome: A Meta‐Analysis of Randomized Controlled Trials
Casartelli, N. C., Valenzuela, P. L., Maffiuletti, N., & Leunig, M. (2020) · Arthritis care & research · doi:10.1002/acr.24234 · Cited by 27
“Approximately 25% of the White population presents FAISrelated morphology (2), and up to 25% of these”
Background
Posterior acetabular uptake on 18F-fluoride positron emission tomography/computed tomography reveals a putative contrecoup region in patients with femoroacetabular impingement
Oishi, T., Kobayashi, N., Choe, H., Tezuka, T., Kobayashi, D., Higashihira, S., & Inaba, Y. (2019) · Journal of Orthopaedic Surgery · doi:10.1177/2309499019868929 · Cited by 27
“67%, respectively).(23) The authors concluded that cam impingement may predispose hip joint to instability to a greater extent than pincer impingement.”
Trunk, pelvis and hip biomechanics in individuals with femoroacetabular impingement syndrome: Strategies for step ascent
Diamond, L. E., Bennell, K. L., Wrigley, T. V., Hinman, R. S., Hall, M., O’Donnell, J., & Hodges, P. W. (2018) · Gait & Posture · doi:10.1016/j.gaitpost.2018.01.005 · Cited by 30
Prevalence of femoro-acetabular impingement in non-arthritic patients with hip pain: a meta-analysis
Jauregui, J., Salmons, H., Meredith, S. J., Oster, B., Gopinath, R., & Adib, F. (2020) · International Orthopaedics · doi:10.1007/s00264-020-04857-7 · Cited by 26
Current trends in sport and exercise hip conditions: Intra-articular and extra-articular hip pain, with detailed focus on femoroacetabular impingement (FAI) syndrome.
Kemp, J., Grimaldi, A., Heerey, J., Jones, D. M., Scholes, M., Lawrenson, P., Coburn, S., & King, M. (2019) · Baillière's Best Practice & Research : Clinical Rheumatology · doi:10.1016/j.berh.2019.02.006 · Cited by 26
Advanced Imaging Adds Little Value in the Diagnosis of Femoroacetabular Impingement Syndrome
Cunningham, D. J., Paranjape, C. S., Harris, J. D., Nho, S. J., Olson, S. A., & Mather, R. C. “. (2017) · Journal of Bone and Joint Surgery · doi:10.2106/jbjs.16.00963 · Cited by 22
Self-citation
The Effect of a Formal Nonoperative Management Program Combining a Hip Injection With Structured Adjunctive Exercise Rehabilitation in Patients With Symptomatic Femoroacetabular Impingement Syndrome
Ebert, J. R., Raymond, A., Aujla, R. S., & D’Alessandro, P. A. (2023) · The American Journal of Sports Medicine · doi:10.1177/03635465221148744 · Cited by 26
Conservative vs. Surgical Management for Femoro-Acetabular Impingement: A Systematic Review of Clinical Evidence
Anzillotti, G., Iacomella, A., Grancagnolo, M., Bertolino, E., Marcacci, M., Sconza, C., Kon, E., & Matteo, B. D. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11195852 · Cited by 25
“First described during the 1990s [2–4], the incidence of FAI morphology, which could induce the syndrome, is estimated to be up to 37% and 67% in asymptomatic patients for cam and pincer, respectively [5].”
Background
The interface between periacetabular osteotomy, hip arthroscopy and total hip arthroplasty in the young adult hip
Jakobsen, S., Overgaard, S., Søballe, K., Ovesen, O., Mygind-Klavsen, B., Dippmann, C., Jensen, M. U., Sturup, J., & Retpen, J. (2018) · EFORT Open Reviews · doi:10.1302/2058-5241.3.170042 · Cited by 25
The management of symptomatic femoroacetabular impingement: what is the rationale for non-surgical treatment?
Casartelli, N. C., Maffiuletti, N., Bizzini, M., Kelly, B., Naal, F., & Leunig, M. (2016) · British Journal of Sports Medicine · doi:10.1136/bjsports-2015-095722 · Cited by 25
Is There an Association Between Noncontact Anterior Cruciate Ligament Injuries and Decreased Hip Internal Rotation or Radiographic Femoroacetabular Impingement? A Systematic Review.
Boutris, N., Byrne, R. A., Delgado, D. A., Hewett, T., Mcculloch, P., Lintner, D., & Harris, J. (2018) · Arthroscopy: The Journal of Arthroscopy And Related · doi:10.1016/j.arthro.2017.08.302 · Cited by 25
Self-citation
A Systematic Summary of Systematic Reviews on the Topic of Hip Arthroscopic Surgery
de Sa, D., Lian, J., Sheean, A. J., Inman, K., Drain, N. P., Ayeni, O., & Mauro, C. (2018) · Orthopaedic Journal of Sports Medicine · doi:10.1177/2325967118796222 · Cited by 24
Hip Arthroscopy: Common Problems and Solutions.
Casp, A., & Gwathmey, F. W. (2018) · Clinics in Sports Medicine · doi:10.1016/j.csm.2017.12.005 · Cited by 24
Hip Arthroscopy for Femoroacetabular Impingement-Associated Labral Tears: Current Status and Future Prospects
Buzin, S., Shankar, D. S., Vasavada, K. D., & Youm, T. J. (2022) · Orthopedic Research and Reviews · doi:10.2147/orr.s253762 · Cited by 23
“In female athletes, a higher rate of pincer FAI and hip instability is seen, whereas in male athletes, a higher rate of combined FAI, larger alpha angles, and more extensive acetabular cartilage damage and concomitant microfracture treatment has been observed.(2,15) These differences in pathology may be attributable t…”
BackgroundInfluential
Persistent or recurrent symptoms after arthroscopic surgery for femoroacetabular impingement: A review of imaging findings
Woodward, R., & Philippon, M. (2018) · Journal of Medical Imaging and Radiation Oncology · doi:10.1111/1754-9485.12822 · Cited by 23
Relationship between physical activity and hip pain in persons with and without cam or pincer morphology: a population-based case–control study
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Femoroacetabular Impingement Surgery Is on the Rise-But What Is the Next Step?
Reiman, M., Thorborg, K., & Hölmich, P. (2016) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2016.0605 · Cited by 23
Atraumatic Hip Instability
Canham, C. D., Domb, B., & Giordano, B. (2016) · JBJS Reviews · doi:10.2106/jbjs.rvw.15.00045 · Cited by 23
Imaging in Hip Arthroscopy for Femoroacetabular Impingement: A Comprehensive Approach.
Griffin, J., Weber, A., Kuhns, B. D., Lewis, P. B., & Nho, S. (2016) · Clinics in Sports Medicine · doi:10.1016/j.csm.2016.02.002 · Cited by 23
“The literature suggests a high number of asymptomatic patients have radiographic measurements indicating FAI.6,7”
BackgroundInfluentialSelf-citation
Risk Factors for Long-term Hip Osteoarthritis in Patients With Femoroacetabular Impingement Without Surgical Intervention
Melugin, H., Hale, R., Zhou, J., LaPrade, M. D., Bernard, C. D., Leland, D. P., Levy, B., & Krych, A. (2020) · American Journal of Sports Medicine · doi:10.1177/0363546520949179 · Cited by 22
Prevalence of Femoroacetabular Impingement Syndrome among Young and Middle-aged White Adults
Kopec, J., Hong, Q., Wong, H., Zhang, C., Ratzlaff, C., Cibere, J., Li, L. C., Prlic, H., Wilson, D., Forster, B., et al. (2019) · Journal of Rheumatology · doi:10.3899/jrheum.190345 · Cited by 22
NON-OPERATIVE MANAGEMENT OF INDIVIDUALS WITH NON-ARTHRITIC HIP PAIN: A LITERATURE REVIEW.
McGovern, R. P., Martin, R. L., Kivlan, B., & Christoforetti, J. (2019) · International Journal of Sports Physical Therapy · doi:10.26603/ijspt20190135 · Cited by 22
Should Acetabular Retroversion Be Treated Arthroscopically? A Systematic Review of Open Versus Arthroscopic Techniques.
Litrenta, J., Mu, B. H., Ortiz-Declet, V., Chen, A. W., Perets, I., & Domb, B. (2018) · Arthroscopy: The Journal of Arthroscopy And Related · doi:10.1016/j.arthro.2017.09.013 · Cited by 22

Authors: Frank, J. M., Harris, J. D., Erickson, B. J., Slikker, W., Bush‐Joseph, C. A., Salata, M. J., & Nho, S. J.
Affiliations: Rush University Medical Center (US)
Corresponding author: Frank, Jonathan M.
ORCID: Frank, Jonathan M.
Harris, Joshua D.
Erickson, Brandon J.
Slikker, William
Salata, Michael J.
Nho, Shane J.
Venue: Arthroscopy
Publisher: Wiley
Published: 2015-01-28
Volume: 31
Issue: 6
Pages: 1199-1204
ISSN: 0749-8063 (ISSN-L)
1526-3231
DOI: 10.1016/j.arthro.2014.11.042
OpenAlex: W2027317771
Cited by: 476
References: 0
Citations by year: 2026: 33 · 2025: 36 · 2024: 35 · 2023: 35 · 2022: 46 · 2021: 42 · 2020: 52 · 2019: 49 · 2018: 47 · 2017: 33 · 2016: 43 · 2015: 24
FWCI: 9.38
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
doi.wiley.com/10.1002/tdm_license_1.1 (tdm)
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Arthroscopy The Journal of Arthroscopic and Related Surgery (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Surgery › Hip disorders and treatments
Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
Health Sciences › Medicine › Surgery › Shoulder Injury and Treatment
Keywords: femoroacetabular impingement, prevalence, cam deformity, alpha angle, center-edge angle, acetabular index, labral lesions, hip morphology, athletes
MeSH terms: Diagnostic Imaging, Hip Joint, Humans, Magnetic Resonance Imaging, Tomography, X-Ray Computed, Global Health, Prevalence, Femoracetabular Impingement, Healthy Volunteers

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Prevalence of Femoroacetabular Impingement Imaging Findings in Asymptomatic Volunteers: A Systematic Review

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