Original article Br J Sports Med 2011;45:6–9. doi:10.1136/bjsm.2009.060434 6 1 Sports Medicine Department, The Hague Medical Centre, Antoniushove Hospital, Leidschendam, The Netherlands 2 Department of Sports Medicine, Rijnland Hospital, Leiderdorp, The Netherlands 3 Department of Orthopaedic Surgery, Amager Hospital, Faculty of Health Sciences, University of Copenhagen, Denmark Correspondence to Dr A Weir, Sports Medicine Department, The Hague Medical Centre Antoniushove, PO Box 411, Burgemeester Banninglaan 1, 2260 AK Leidschendam, The Netherlands; a.weir@mchaaglanden.nl Accepted 03 July 2009 Published Online First 11 June 2010 Prevalence of radiological signs of femoroacetabular impingement in patients presenting with long-standing adductor-related groin pain A Weir, 1 R J de Vos, 1 M Moen, 2 P Hölmich, 3 J L Tol 1 ABSTRACT Objective A decreased range of motion (ROM) of the hip joint is known to predispose to athletic groin injury. Femoroacetabular impingement (FAI) of the hip leads to a reduced ROM. This study examined the prevalence of radiological signs of FAI in patients presenting with long- standing adductor-related groin pain (LSARGP). Design Prospective case series. Setting Outpatient Sports Medicine Department. Patients 34 athletes with LSARGP defined as pain on palpation of the proximal insertion of adductor muscle and a painful, resisted adduction test. Assessment A clinician blinded to the results of the radiological assessment performed a physical examination: iliopsoas length, hip ROM and anterior hip impingement test. Anteroposterior pelvic radiographs were examined by a second blinded clinician for the presence of: pistol grip deformity, centrum-collum- diaphyseal angle, femoral head neck ratio, coxa profunda, protrusio acetabuli, lateral centre edge angle, acetabular index and cross-over sign. Results The prevalence of radiological signs of FAI was 94% (64/68). The mean number of radiological signs in hips with LSARGP was 1.84 (range 0–4, SD 1.05) and 1.96 (range 0–5, SD 1.12) in asymptomatic groins (p=0.95). The anterior hip impingement test was positive in nine cases. There was no relationship with the number of radiological signs (p=0.95). There was no correlation between hip ROM and the number of radiological signs (p=0.37). Conclusion Radiological signs of FAI are frequently observed in patients presenting with LSARGP. Clinicians should be aware of this fact and the possible lack of correlation when assessing athletes with groin pain. Long-standing adductor-related groin pain (LSARGP) is common in sports such as soccer and rugby involving cutting and kicking. The annual frequency of groin injuries is 8% to 18% in foot- ball. 1 2 LSARGP can be difficult to treat, and there is a lack of consensus as to the diagnostic criteria that apply in groin pain. Many authors have noted that multiple diagnoses are common. 3–5a LSARGP is a diagnostic term used to describe pain at the proximal attachment of the adductor muscles on the pubic bone on sporting activities. 5a The pain can be felt on palpating the proximal attachment of the adductor muscles and can de reproduced when resisted hip adduction is performed. It is termed long standing when symptoms have been present for more than 2 months. 5b It has long been noted that patients with long-standing groin pain appeared to have a reduced hip joint range of motion (ROM). 6 Recent prospective studies confi rmed this association. 7 8 The cause of this reduced ROM is unclear. 7 One possible explana- tion may be that the reduced ROM could be due to a hip disorder. Femoroacetabular impingement (FAI) is a hip condition which is considered by some authors to be due to subtle developmental disorders of the hip. 9 FAI is caused by abnormal contact between the femur and the acetabulum. It is clinically char- acterised by a reduced hip joint ROM and pain when the hip impingement test is performed. 10 FAI has two subtypes: cam and pincer impingement. In cam impingement, there is an abnormality of the femoral head or neck, and pincer impingement occurs when the acetabulum is abnormal. At the time of writing, at least eight different radiological signs have been reported to show the presence of FAI. 11–15 The natural history of this condition is unknown, although population studies are being performed to evaluate this. 9 The current suggested treatment for FAI is conservative with activity modification, analgesia of anti-inflammatories and possibly modification of technique. 10 If conservative ther- apy is unsuccessful, then surgical treatment with correction of the abnormal shape of the femur (cam impingement), acetabulum (pincer impinge- ment) or both can be performed. 9 11 This study aims to examine the relationship between LSARGP and FAI. First, the clinical fi nd- ings of the hip joint ROM, the hip impingement test and the length of the iliopsoas muscle were examined in athletes presenting with LSARGP. Second, the prevalence of radiological signs of FAI in these athletes was examined. Third, the rela- tionship between physical and radiological fi nd- ings of FAI was examined. METHODS Patients Patients with groin pain were seen at the Sports Medicine Department of a large general hospi- tal. Patients were referred by their general prac- titioner or a physical therapist. The diagnosis was made based on history and a standardised clin- ical examination. 16 All patients who presented were included in the study after they gave their informed consent. The regional medical ethics committee approved the study. The type of sport, frequency of sports activities and Tegner activity score were recorded. The inclusion and exclusion criteria are shown in table 1. group.bmj.com on April 4, 2017 - Published by http://bjsm.bmj.com/ Downloaded from