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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“In a 2015 systematic review of 26 studies of asymptomatic FAI by Frank et al, 23 the average prevalence of an asymptomatic Cam deformity was found to be 37% with a wide range (7% to 100%).”
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Femoroacetabular impingement
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“11,17,18,37 Although the prevalence of radiographic features of FAIS is high, particularly in athletic populations, 4,16,24,26,31,39,40 only a small portion of individuals go on to become symptomatic.”
Self-citation
Prevalence of femoroacetabular impingement syndrome and related hip morphologies, and its developmental dose-response relationship in professional female football players: a multicentre cohort study (PROFE).
Beddows, T., Munnik-Hagewoud, R., Kluijtmans, L., Zuurmond, R., van der Weegen, W., van Zoest, W. V., Verjans, R., Heuvel, J. O., Welling, R., Hoogeslag, R., et al. (2026) · Journal of Science and Medicine in Sport · doi:10.1016/j.jsams.2026.02.001 · Cited by 2
High Rates of Return to American Football After Primary Hip Arthroscopy for Femoroacetabular Impingement: A 2-Year Minimum Follow-up
Kang, L. S., Okolo, M., Cleary, E. J., Lu, Y.-N., Iyer, S., Levy, B. A., Hevesi, M., Okoroha, K. R., & Krych, A. (2026) · Orthopaedic Journal of Sports Medicine · doi:10.1177/23259671251397513 · Cited by 2
“6,23,26 Frank et al 8 reported a 55% prevalence of cam deformities in athletes versus 23% in the general population.”
Does presence of hip dysplasia affect the prevalence and location of cam morphologies in pediatric hip pain patients?
Ferrell, S. D., Ramirez, S. X., Rosenfeld, S. B., Bawa, P., Sher, A. C., & Kan, J. (2026) · Clinical imaging · doi:10.1016/j.clinimag.2026.110731 · Cited by 2
The Relationship Between the Lumbopelvic Spine and Hip in Femoroacetabular Impingement Patients
Milner, J. E., Morgan, A., Brown, J., Westafer, J., Youm, T., & Kaplan, D. J. (2025) · Current Reviews in Musculoskeletal Medicine · doi:10.1007/s12178-025-09999-y · Cited by 2
Sex-Based Differences Femoroacetabular Impingement and Hip Arthroscopy
Smith, H. E., & Spiker, A. M. (2025) · Current Reviews in Musculoskeletal Medicine · doi:10.1007/s12178-025-09988-1 · Cited by 2
“1) Epidemiological studies report a prevalence of cam morphology in approximately 20–30% of males in the general population, with rates 37% to over 90% observed in athletic cohorts in high risk sports [14–16].”
Differences in isokinetic hip muscle torque between individuals with femoroacetabular impingement syndrome and pain-free controls: A cross-sectional study.
da Costa, G. D., de Castro, M. D., Haupenthal, A., Gomes, D. A., Silva, D. D. O., Canella, R., Fontana, H. D. B., & Ruschel, C. (2025) · Journal of Biomechanics · doi:10.1016/j.jbiomech.2025.112801 · Cited by 2
Association Between Global Overcoverage and Long-term Survivorship, Chondrolabral Junction Breakdown, and Reduced Joint Space Width: Minimum 8-Year Follow-up
Lee, J. S., Gillinov, S. M., Siddiq, B. S., Dowley, K. S., Dean, M. C., Cherian, N., Eberlin, C. T., Kucharik, M., & Martin, S. (2025) · American Journal of Sports Medicine · doi:10.1177/03635465251317738 · Cited by 2
“18 Together, previous literature has established that progressive chondral wear caused by repetitive impingement compromises the labral suction seal and leads to chondrolabral junction (CLJ) breakdown, hip osteoarthritis, groin pain, stiffness, and reduced range of motion.”
The prevalence of primary cam morphology in early adolescents from the general population: a population-based study (Generation R).
Chen, D., Boel, F., van Klij, P., van Buuren, M. V., Bierma-Zeinstra, S., & Agricola, R. (2025) · Osteoarthritis and Cartilage · doi:10.1016/j.joca.2025.02.775 · Cited by 2
Asymptomatic female softball pitchers have altered hip morphology and cartilage composition
Warden, S. J., Coburn, S., Fuchs, R. K., Surowiec, R., Carballido-Gamio, J., Kemp, J. L., Jalaie, P., Hanff, D., Palmer, A., Fernquest, S., et al. (2025) · Scientific Reports · doi:10.1038/s41598-025-87839-2 · Cited by 2
Six-month rehabilitation following surgical hip dislocation for femoroacetabular impingement restores the preoperative strength of most hip muscles, except for external rotators
Servant, G., Bothorel, H., Pernoud, A., Mayes, S., Fourchet, F., & Christofilopoulos, P. (2024) · Journal of Hip Preservation Surgery · doi:10.1093/jhps/hnae042 · Cited by 2
“The prevalence of FAIS is as high as one fifth of the general population and tends to affect young and active individuals, potentially contributing to cartilage degeneration and early osteoarthritis of the hip joint [2, 3].”
Sex differences in the anatomy of the anterior–superior acetabular rim in relation to pincer-type femoroacetabular impingement in Koreans: a three-dimensional quantitative analysis
Cho, B., Kwon, H., Park, J. Y., Park, K., Kim, T., & Lee, W.-S. (2023) · Journal of Orthopaedic Surgery and Research · doi:10.1186/s13018-023-03526-w · Cited by 2
Anterior and lateral femoroacetabular excursion angles are helpful for assessing femoroacetabular impingement syndrome: a cross-sectional cohort study.
Kim, H., Park, J., Park, J. W., Ha, Y., Lee, Y.-K., Lee, Y.-J., & Koo, K. (2023) · Arthroscopy: The Journal of Arthroscopy And Related · doi:10.1016/j.arthro.2023.03.007 · Cited by 2
Patients with Low-Grade Lumbosacral Transitional Vertebrae Demonstrate No Difference in Achievement of Clinical ThresholdsFollowing Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome.
Montgomery, S. R., Li, Z. I., Shankar, D. S., Samim, M. M., & Youm, T. J. (2023) · Arthroscopy: The Journal of Arthroscopy And Related · doi:10.1016/j.arthro.2023.01.099 · Cited by 2
Olympic fencer with femoroacetabular impingement syndrome uses active rehabilitation to avoid surgery: A case report
Abdelkader, N., Leonardelli, C., & Howitt, S. D. (2022) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2022.09.002 · Cited by 2
Hip Preservation Surgery in Osteoarthritis Prevention: Potential Benefits of the Radiographic Angular Correction
Lamo-Espinosa, J., Alfonso, A., Pascual, E., García-Ausín, J., Sánchez-Gordoa, M., Blanco, A., Gómez-Álvarez, J., & San-Julián, M. (2022) · Diagnostics · doi:10.3390/diagnostics12051128 · Cited by 2
“, in a study of 2114 hips of asymptomatic patients with a mean age of 25 years, observed the presence of the Pincer-type form in 67% of cases [12].”
Background
Increased prevalence of femoroacetabular impingement on the elderly with fractures of the proximal femur
Busato, T., Baggio, M., Morozowski, M., Matioski, G. R., Godoi, L., & Capriotti, J. R. V. (2021) · SICOT-J · doi:10.1051/sicotj/2021033 · Cited by 2
“We adopted the following reference values for the definition of cam deformity: alpha angle > 55 [13] on AP or lateral view.”
Method
Return to Sports After Joint Preservation Hip Surgery.
Yacovelli, S., & Parvizi, J. (2020) · The Orthopedic cllinics of North America · doi:10.1016/j.ocl.2020.06.001 · Cited by 2
Evidence-based Risk Stratification for Sport Medicine Procedures During the COVID-19 Pandemic
Hinckel, B., Baumann, C. A., Ejnisman, L., Cavinatto, L. M., Martusiewicz, A., Tanaka, M. J., Tompkins, M. E., Sherman, S., Chahla, J., Frank, R. M., et al. (2020) · Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · doi:10.5435/jaaosglobal-d-20-00083 · Cited by 2
Running with Femoral Acetabular Impingement: Operative vs Nonoperative Treatment.
Moley, P. J., Tatka, J., & Singh, J. (2020) · PM & R : the journal of injury, function, and rehabilitation · doi:10.1002/pmrj.12438 · Cited by 2
β-Angles of hips with femoroacetabular impingement versus asymptomatic normal hips in a Japanese population: A CT-based observational clinical study.
Mimura, T., Mori, K., Okumura, N., Kumagai, K., Maeda, T., Kagei, Y., Yayama, T., & Imai, S. (2020) · Journal of Orthopaedic Science · doi:10.1016/j.jos.2019.04.011 · Cited by 2
Detection of Acetabular and Proximal Femoral Radiographic Abnormalities Showed by Hip Digital Tomosynthesis in Special Functional Position Compared with Conventional Radiography
Wu, H.-Z., Latif, M., Zhong, Z.-W., Yu, B.-H., Wu, W.-J., Zhang, F., Han, S.-M., & Zhang, Z. (2016) · doi:10.5812/iranjradiol.36009 · Cited by 2
Editorial Commentary: Radiographic Inclusion and Exclusion Diagnostic Criteria for Femoroacetabular Impingement Require Confirmation.
Lubowitz, J. (2015) · Arthroscopy: The Journal of Arthroscopy And Related · doi:10.1016/j.arthro.2015.04.104 · Cited by 2
Hip and Groin Injuries in Basketball
Laver, L., Okohara, K., Nwachukwu, B. U., Mei-Dan, O., & Nho, S. (2020) · doi:10.1007/978-3-662-61070-1_28 · Cited by 2
Self-citation
Treatment of Femoroacetabular Impingement and Labral Injuries in Tennis Players
Safran, M., & Costantini, A. (2018) · doi:10.1007/978-3-319-71498-1_24 · Cited by 2
Surgical Treatment of Femoroacetabular Impingement
Mardones, R., Gonzalez, C., Chen, Q.-S., Zobitz, M., Kaufman, K., & Trousdale, R. (2013) · doi:10.2106/00004623-200502000-00006 · Cited by 2
Editorial Commentary: Platelet-Rich Plasma Improves Knee Pain and Function in Patients With Knee Osteoarthritis
Lubowitz, J. (2015) · Arthroscopy: The Journal of Arthroscopy And Related · doi:10.1016/j.arthro.2015.08.022 · Cited by 1
Hip and groin pain in physically active adults with a focus on terminology, clinical examination and imaging: A formal ESSKA‐EHPA‐ESMA Consensus
Hölmich, P., Weir, A., Papadopoulou, T., Papavasiliou, A., Thorborg, K., Canata, G., Villa, F. D., Laver, L., Marín-Peña, O., Paajanen, H., et al. (2026) · Knee Surgery, Sports Traumatology, Arthroscopy · doi:10.1002/ksa.70565 · Cited by 1
“…patients with normal imaging and asymptomatic individuals with positive imaging ﬁ ndings necessitates judicious use and cautious interpretation [1, 15, 19, 38] Radiographs remain the ﬁ rst ‐ line imaging modality for assessing hip morphology, with reported sensitivities between 71% and 96% for…”
Estimation of safe zones for suture anchor placement in arthroscopic hip labral repair
Han, X.-K., Tang, X.-Y., Li, L., Zhang, Y., Fu, H.-T., & Qi, C. (2026) · Frontiers in Surgery · doi:10.3389/fsurg.2026.1681289 · Cited by 1
“When conservative measures—rest, physiotherapy, and pharmacotherapy—fail to relieve function-limiting symptoms of labral tears, arthroscopic suture repair is indicated ( 5).”
Midterm Outcomes of Staged Bilateral Hip Arthroscopy for Femoroacetabular Impingement Syndrome Show Comparable Outcomes Between Time Interval More or Less Than 12 Months of Bilateral Procedures.
Cao, Z.-H., Gao, G.-Y., Zhu, Y.-C., Zhou, X., Wang, J.-Q., & Xu, Y. (2026) · Arthroscopy: The Journal of Arthroscopy And Related · doi:10.1002/arj.70069 · Cited by 1
Lower limb biomechanics in femoroacetabular impingement syndrome, asymptomatic cam morphology, and controls during bilateral and single-leg squatting.
Luijendijk, C. E., Meinders, E., Goncalves, B., Pizzolato, C., Saxby, D., & Diamond, L. (2026) · Gait & Posture · doi:10.1016/j.gaitpost.2026.110131 · Cited by 1
Associated Factors of Primary Cam Morphology in 4477 Early Adolescents: A Multiethnic, Population-Based, Cross-sectional Study (Generation R)
Chen, D., Boel, F., van Klij, P., Runhaar, J., Rivadeneira, F., Bierma-Zeinstra, S., & Agricola, R. (2025) · Orthopaedic Journal of Sports Medicine · doi:10.1177/23259671251394027 · Cited by 1
“The presence of PCM is common in the general population 11,17 and is known to be a strong and potentially modifiable risk factor for hip osteoarthritis.”
Preoperative Osteoarthritis Severity Influences Quality of Life Trajectories Following Hip Arthroscopy in Individuals with Femoroacetabular Impingement Syndrome.
Halliwell, C., Moyer, R. F., & Wong, I. (2025) · Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine · doi:10.1016/j.jisako.2025.101044 · Cited by 1
Intelligent extraction of CT image landmarks for improving cam-type femoroacetabular impingement assessment
Tayyebinezhad, S., Fatehi, M., Arabalibeik, H., & Ghadiri, H. (2025) · European Radiology · doi:10.1007/s00330-025-11901-w
Spinopelvic Characteristics as Predictors of Cam Morphology: A 2-Year Follow-up of Elite Adolescent Soccer Players
Otti, D. A., Staes, F., Ghijselings, S., Hermans, S., & Scheys, L. (2025) · American Journal of Sports Medicine · doi:10.1177/03635465251353155 · Cited by 1
“2 While it is prevalent in approximately 20% to 30% 16 of the general population, this rate increases to 50% to 60% 11 in patients, particularly male patients, 14 with a history of being highly physically active during adolescence.”
Preliminary observations on the coincidence of femoroacetabular impingement and/or acetabular retroversion with anterior ankle impingement
Bahaeddini, M., Mirzamohammadi, H., Aminian, A., Tabrizian, P., Mohammadyahya, E., Amiri, S., Kadijani, A. A., Tayyebi, H., & Gharanizadeh, K. (2025) · European Journal of Orthopaedic Surgery & Traumatology · doi:10.1007/s00590-025-04348-8 · Cited by 1
Squatting Biomechanics After Femoroacetabular Impingement Surgery: A Systematic Review and Meta-analysis
Generoso, T. O., Pelegrinelli, A. R. M., Gonzalez, F. F., Pallone, L., Locks, R., Guadagnin, E. C., Chahla, J. A., Gustafson, J. A., Metsavaht, L. F., & Leporace, G. (2025) · Clinical Journal of Sport Medicine · doi:10.1097/jsm.0000000000001371 · Cited by 1
Analysis of YouTube content as an information source for femoroacetabular impingement rehabilitation
Sözlü, U., Olmez, S., Akaras, E., & Hazar, Z. (2025) · Turkish Journal of Kinesiology · doi:10.31459/turkjkin.1645880 · Cited by 1
Epidemiology of Femoroacetabular Impingement in Korea
Lee, D.-H., Park, K.-T., Won, J., An, J. H., Park, J., & Lee, Y.-K. (2025) · Journal of Korean medical science · doi:10.3346/jkms.2025.40.e124 · Cited by 1
Femoroacetabular impingement, labral tears, mimics, and ischiofemoral impingement – A comprehensive imaging review
Sethi, S., Narayanaswamy, S., Shah, A., Spalkit, S., Bugata, S. K., & Chari, R. (2025) · Indian Journal of Musculoskeletal Radiology · doi:10.25259/ijmsr_65_2024 · Cited by 1
Incidence, risk factors, and prognostic consequences of femoroacetabular cup impingement following hip resurfacing arthroplasty
Park, C.-W., Jeong, S.-J., Lim, S.-J., & Park, Y.-S. (2024) · International Orthopaedics · doi:10.1007/s00264-024-06386-z · Cited by 1
“These findings are consistent with the frequent asymptomatic cases of radiographic femoroacetabular impingements in natural joints [38].”

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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