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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Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2009.06.005 · Cited by 19,575

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Background
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Background
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Background
CAM-type femoroacetabular impingement in male elite junior cross-country skiers and non-athlete controls: a cross-sectional MRI study
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Background
Total volume of cam deformity alone predicts outcome in arthroscopy for femoroacetabular impingement
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“The reported prevalence of asymptomatic FAI in radiographs is 23–32% for CAM lesions and 43–67% for pincer lesions (Frank et al. 2015; Diesel et al. 2015).”
Background
The Effect of Pelvic Incidence on Outcomes After Hip Arthroscopy for Femoroacetabular Impingement and Acetabular Labral Tears
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Pålsson, A., Kostogiannis, I., & Ageberg, E. (2021) · Physical Therapy in Sport · doi:10.1016/j.ptsp.2021.09.011 · Cited by 12
Sex differences in the prevalence of radiographic findings of structural hip deformities in patients with symptomatic femoroacetabular impingement
Zhou, J., Melugin, H., Hale, R., Song, B. M., Okoroha, K. R., Levy, B., & Krych, A. (2021) · Journal of Hip Preservation Surgery · doi:10.1093/jhps/hnab050 · Cited by 12
“Previous studies have described the radiographic findings of FAI in athletes [28–32], asymptomatic volunteers [33], adolescents [34] and a general population of patients with hip pain [35].”
Background
The Effect of Resection Size in the Treatment of Cam-Type Femoroacetabular Impingement in the Typical Patient With Hip Arthroscopy: A Biomechanical Analysis
Bonano, J. C., Johannsen, A., Mardones, R., Fithian, A. T., Storaci, H. W., Tam, K., & Safran, M. (2020) · American Journal of Sports Medicine · doi:10.1177/0363546520952774 · Cited by 12
Femoroacetabular Impingement Syndrome
Trigg, S., Schroeder, J. D., & Hulsopple, C. D. (2020) · Current sports medicine reports · doi:10.1249/jsr.0000000000000748 · Cited by 12
“The cammorphology accounts for 37% of the morphologies seen in FAI syndrome, and its prevalence is three times more likely in athletes than the general population, and more commonly described in men (9).”
Hip Imaging: Normal Variants and Asymptomatic Findings
Omoumi, P., & Berg, B. V. (2017) · Seminars in Musculoskeletal Radiology · doi:10.1055/s-0037-1606136 · Cited by 12
Avoiding Failure in Hip Arthroscopy: Complications, Pearls, and Pitfalls.
Burrus, M., Cowan, J. B., & Bedi, A. (2016) · Clinics in Sports Medicine · doi:10.1016/j.csm.2016.02.011 · Cited by 12
Prevalência da morfologia de impacto femoroacetabular em jogadores de futebol juvenil assintomáticos: estudo de ressonância magnética com correlação clínica
Yépez, A. K., Abreu, M., Germani, B. L., & Galia, C. R. (2017) · doi:10.1016/j.rbo.2017.06.003 · Cited by 12
What's New in Sports Medicine.
Christensen, J., Trask, D., & Dunn, W. R. (2016) · Journal of Bone and Joint Surgery. American volume · doi:10.2106/jbjs.16.00055 · Cited by 12
A radiomics approach to the diagnosis of femoroacetabular impingement
Montin, E., Kijowski, R., Youm, T., & Lattanzi, R. (2023) · Frontiers in Radiology · doi:10.3389/fradi.2023.1151258 · Cited by 11
Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Chinese Patients: A Minimum 2-Year Follow-up Study
Maimaitimin, M., Yang, F., Huang, H.-J., Xu, Y., Zhang, X., Ao, Y., & Wang, J.-Q. (2022) · Orthopaedic Journal of Sports Medicine · doi:10.1177/23259671221135218 · Cited by 11
Male Gender and Competitive Athlete Status Are Associated With Better Outcomes Following Hip Arthroscopy In Patients With Global Acetabular Retroversion
O’Reilly, O. C., Day, M., Seiffert, K., Fritts, H., An, Q., Westermann, R., & Larson, C. (2022) · Arthroscopy, Sports Medicine, and Rehabilitation · doi:10.1016/j.asmr.2022.06.019 · Cited by 11
“5% of athlete hips had asymptomatic pincer deformity (often referred to interchangeably as acetabular retroversion), and asymptomatic cam morphology was 3 times more common in athletes than nonathletes.(29) Review of previous studies examining athlete PROs suggest athletes tend to have greater PROs than nonathletes af…”
Background
BMP-2 Modified Electrospun Scaffold for Acetabular Labral Reconstruction Promotes Collagen Fiber Regeneration in a Porcine Model
Wu, R., Gao, G., Zhang, S., Liu, R., Dong, H., & Xu, Y. (2022) · The American Journal of Sports Medicine · doi:10.1177/03635465211066948 · Cited by 11
Hip joint range of motion is restricted by pain rather than mechanical impingement in individuals with femoroacetabular impingement syndrome
Naili, J., Stålman, A., Valentin, A., Skorpil, M., & Weidenhielm, L. (2021) · Archives of Orthopaedic and Trauma Surgery · doi:10.1007/s00402-021-04185-4 · Cited by 11
Cam Morphology is Associated with Increased Femoral Version: Findings from a Collection of 1,321 Cadaveric Femurs.
Schaver, A. L., Oshodi, A., Glass, N., Duchman, K. R., Willey, M., & Westermann, R. (2021) · Arthroscopy: The Journal of Arthroscopy And Related · doi:10.1016/j.arthro.2021.07.032 · Cited by 11
Association between severity of hip chondrolabral injuries, dynamic hip muscle strength and quality of life: A cross-sectional study in patients with femoroacetabular impingement syndrome scheduled for hip arthroscopy.
Gomes, D., Ribeiro, D. C., Canella, R., Ferreira, T., da Costa, G. D., Okubo, R., & de Castro, M. D. (2021) · Clinical Biomechanics · doi:10.1016/j.clinbiomech.2021.105348 · Cited by 11
Prevalence of CAM deformity and its influence on therapy success in patients with osteonecrosis of the femoral head
Serong, S., Haversath, M., Jäger, M., & Landgraeber, S. (2019) · Journal of Tissue Engineering and Regenerative Medicine · doi:10.1002/term.2794 · Cited by 11
Hip Hype: FAI Syndrome, Amara's Law, and the Hype Cycle
Kassarjian, A. (2019) · Seminars in Musculoskeletal Radiology · doi:10.1055/s-0039-1677695 · Cited by 11
Influence of evolution on cam deformity and its impact on biomechanics of the human hip joint
Anwander, H., Beck, M., & Büchler, L. (2018) · Journal of Orthopaedic Research® · doi:10.1002/jor.23863 · Cited by 11
“In the general male population at age 20, the prevalence of cam-type FAI is up to 23%.(5) In females at the same age a cam deformity generally is not present.”
Background
Imaging evaluation of the hip after arthroscopic surgery for femoroacetabular impingement
Crim, J. (2017) · Skeletal Radiology · doi:10.1007/s00256-017-2665-y · Cited by 11
“It cannot be overemphasized that patients may have morphological findings associated with impingement without having the clinical syndrome [4, 5].”
Background
The Horsens-Aarhus Femoro Acetabular Impingement (HAFAI) cohort: outcome of arthroscopic treatment for femoroacetabular impingement. Protocol for a prospective cohort study
Kierkegaard, S., Lund, B., Dalgas, U., Sørensen, H., Søballe, K., & Mechlenburg, I. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-008952 · Cited by 11
“Asymptomatic pincer deformities were seen in 67% of the population, although they were less well defined in the literature.(4) It is unknown why only some deformities become symptomatic, although the symptomatic deformities seem to be linked to a combination of lifestyle factors and genetics.”
BackgroundResult
Results of Endoscopic Labral Repair With Concomitant Gluteus Medius and/or Minimus Repair Compared With Outcomes of Labral Repair Alone: A Matched Comparative Cohort Analysis at Minimum 2-Year Follow-up
Horner, N., Chapman, R. S., Larson, J. H., & Nho, S. (2023) · American Journal of Sports Medicine · doi:10.1177/03635465231166708 · Cited by 10
“Studies have also reported high rates of asymptomatic labral injury in the general population and particularly high rates in physically active individuals.(1,7,25-27) In 1 study that examined a random sample of pelvic magnetic resonance imaging (MRI) scans, gluteus medius tears were identified in 11% of hips among pat…”
BackgroundSelf-citation
Hip pain and its correlation with cam morphology in young skiers—a minimum of 5 years follow-up
Abrahamson, J., Jonasson, P., Sansone, M., Aminoff, A., Todd, C., Karlsson, J., & Baranto, A. (2020) · Journal of Orthopaedic Surgery and Research · doi:10.1186/s13018-020-01952-8 · Cited by 10
“Additionally, the prevalence of cam morphology has been reported rather high (37%) in asymptomatic populations [26].”
Background
The prevalence of femoroacetabular impingement anatomy in Division 1 aquatic athletes who tread water
Langner, J. L., Black, M. S., MacKay, J., Hall, K. E., Safran, M., Kogan, F., & Gold, G. (2020) · Journal of Hip Preservation Surgery · doi:10.1093/jhps/hnaa009 · Cited by 10
Analysis of the referral pattern and wait time for hip arthroscopy in a single payer publicly funded health care system.
Petrera, M., Yañez-Siller, F., Whelan, D. B., Hoit, G., Mahjoob, M., Chahal, J., & Dwyer, T. (2020) · Journal of Evaluation In Clinical Practice · doi:10.1111/jep.13192 · Cited by 10
Imaging characteristics of hip joint microinstability: a case–control study of hip arthroscopy patients
Vesey, R., MacDonald, A. A., Brick, M. J., Bacon, C. J., Foo, G. L., Lu, M., Lightfoot, N., Blankenbaker, D. G., & Woodward, R. (2024) · Skeletal Radiology · doi:10.1007/s00256-024-04802-4 · Cited by 9
“Cross-sectional studies of labral tears on MR have reported highly variable prevalence rates, but most have reported labral tears to be present in a majority of asymptomatic people, one systematic review reported this to be 68% [39].”
Associations between type and severity of hip pathology with pre-operative patient reported outcome measures.
Freke, M., Crossley, K., Russell, T., Sims, K., & Semciw, A. (2019) · Brazilian Journal of Physical Therapy · doi:10.1016/j.bjpt.2018.09.008 · Cited by 9
Minimal Clinically Important Differences in Conservative Treatment Versus Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Frequentist Meta‐Analysis of RCTs
Ramadanov, N., Lettner, J., Voss, M., Prill, R., Hable, R., Dimitrov, D., & Becker, R. (2025) · Orthopaedic Surgery · doi:10.1111/os.70097 · Cited by 8
Efficacy and safety of arthroscopy in femoroacetabular impingement syndrome: a systematic review and meta-analysis of randomized clinical trials
Lamo-Espinosa, J., Mariscal, G., Gómez-Álvarez, J., & San-Julián, M. (2025) · Scientific Reports · doi:10.1038/s41598-025-91788-1 · Cited by 8
Cross-cultural adaptation, and validation of the Turkish version of the Nonarthritic Hip Score.
Kanik, Z. H., Sozlu, U., Olmez, S., Başar, S., & Kanatlı, U. (2020) · Acta Orthopaedica et Traumatologica Turcica · doi:10.5152/j.aott.2020.19177 · Cited by 8
“/ Acta Orthop Traumatol Turc 2020; 54(4): 414-22”
BackgroundInfluential
Outcomes After Arthroscopic Repair in Patients With Tears of Hypertrophic Versus Morphologically Normal Acetabular Labra
Lim, J.-Y., Jang, Y.-H., Yoo, J., Lee, Y.-K., Koo, K., & Ha, Y. (2020) · American Journal of Sports Medicine · doi:10.1177/0363546520907106 · Cited by 8
“Patients with asymptomatic labral tears are not recommended to undergo surgery, including prophylactic arthroscopic preservation, and the prevalence of asymptomatic labral injury in these patients may be as high as 68%.(4,6) Recently, we found that a hypertrophic acetabular labrum was an important causal factor of tea…”
Background
Femoroacetabular Impingement in Pediatric Patients
Sheppard, E., Read, C. R., Wills, B., & Estes, A. R. (2019) · Pediatrics in review · doi:10.1542/pir.2017-0137 · Cited by 8
Editorial Commentary: Excessive Femoral Retroversion and Increased Femoral Anteversion Has a Negative Effect on Hip Arthroscopy Outcomes: Symptomatic Extremes of Version Require an Osteotomy.
Kollmorgen, R. (2023) · Arthroscopy: The Journal of Arthroscopy And Related · doi:10.1016/j.arthro.2022.08.030 · Cited by 7
Morphological Parameters of the Hip Joint and Its Relation to Gender, Joint Side and Age—A CT-Based Study
Hawellek, T., Meier, M., Seitz, M.-T., Uhlig, J., Hosseini, A. S. A., Beil, F., Lehmann, W., & Hubert, J. (2022) · Diagnostics · doi:10.3390/diagnostics12081774 · Cited by 7
“Other studies published a prevalence of up to 53% in asymptomatic hip joints [13,44].”
Background
Teamwork in hip preservation: the ISHA 2019 Annual Scientific Meeting
Lall, A. C., Walsh, J., Maldonado, D. R., Pinto, L. E., Ashberg, L. J., Lodhia, P., Radha, S., Correia, A., Domb, B., Perez-Carro, L., et al. (2020) · Journal of Hip Preservation Surgery · doi:10.1093/jhps/hnaa037 · Cited by 7
“He cautioned to avoid linear reasoning and blindly treating imaging [50]—know where the impingement is occurring.”
Background
Ultrasound Alpha Angles and Hip Pain and Function in Female Elite Adolescent Ballet Dancers
Biernacki, J. L., d'Hemecourt, P., Stracciolini, A., Owen, M., & Sugimoto, D. (2020) · Journal of Dance Medicine & Science · doi:10.12678/1089-313x.24.3.99 · Cited by 7
Hypermobile Hip Syndrome
Harris, J. (2019) · Operative techniques in sports medicine · doi:10.1053/j.otsm.2019.04.002 · Cited by 7
Self-citation
Relationship Between Hip Morphology and Hip‐Related Patient‐Reported Outcomes in Young and Middle‐Aged Individuals: A Population‐Based Study
Kopec, J., Qian, H., Cibere, J., Wong, H., Li, L. C., Barber, M., Prlic, H., Zhang, C., Ratzlaff, C., Forster, B., et al. (2019) · Arthritis care & research · doi:10.1002/acr.23774 · Cited by 7
“The LCE distribution in our study was symmetric, with a mean similar to that found in other studies (25).”
Result
Prospective evaluation of sport activity and the development of femoroacetabular impingement in the adolescent hip (PREVIEW): results of the pilot study
Ayeni, O. R., PREVIEW Pilot Investigators, Jean, P.-O., Simunovic, N., Duong, A., Foster, G., Musahl, V., Sim, Y., Thabane, L., MacLeay, C., et al. (2022) · Pilot and Feasibility Studies · doi:10.1186/s40814-022-01164-3 · Cited by 9
Adolescent spine patients have an increased incidence of acetabular overcoverage
Nielsen, E., & Goldstein, R. (2018) · Journal of Hip Preservation Surgery · doi:10.1093/jhps/hny004 · Cited by 7
“This discrepancy may be due to varying parameters used to diagnose and define pincer deformity across studies, and actual incidence in the general population may be lower [16].”
Background
Correlation Between Femoroacetabular Impingement and Hamstring Tendon Pathology on Magnetic Resonance Imaging and Arthrography.
Talathi, N. S., LaValva, S., Lopez-Garib, A. J., Kelly, J., & Khoury, V. (2017) · Orthopedics · doi:10.3928/01477447-20171020-04 · Cited by 7
Imaging for hip-related groin pain: don’t be hip-notised by the findings
O'Sullivan, K., Darlow, B., O'Sullivan, P., Forster, B., Reiman, M., & Weir, A. (2017) · British Journal of Sports Medicine · doi:10.1136/bjsports-2017-097889 · Cited by 7
Evolución de los procedimientos artroscópicos de cadera en el País Vasco entre 2008 y 2013
Ayestarán, A. C., Gutiérrez, R., Etxebarría-Foronda, Í., Sobrino, A. S., & Ruiz-Ibán, M. A. (2015) · doi:10.1016/j.reaca.2015.05.003 · Cited by 7
“Hay estudios recientes que concuerdan con nuestro resultados en cuanto al predominio masculino en el choque femoroacetabular 12 .”
High bone mass and cam morphology are independently related to hip osteoarthritis: findings from the High Bone Mass cohort
Zucker, B., Ebsim, R., Lindner, C., Hardcastle, S., Cootes, T., Tobias, J., Whitehouse, M., Gregson, C., Faber, B., & Hartley, A. (2022) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-022-05603-3 · Cited by 6

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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