To determine the prevalence of athletic pubalgia imaging findings on MRI in patients with femoroacetabular impingement and assess for correlative risk factors.
Materials and methods
A retrospective search identified 156 hips with femoroacetabular impingement and a control group of 113 without femoroacetabular impingement that had an MRI performed between January 1, 2015, and January 1, 2018. Two fellowship-trained musculoskeletal radiologists reviewed studies for the presence of acute osteitis pubis, chronic osteitis pubis, adductor tendinosis, and tendon tear; rectus abdominis tendinosis and tendon tear; and aponeurotic plate tear. Findings were correlated with various clinical and imaging risk factors. Univariate and multivariate statistical analyses were performed.
Imaging findings of adductor tendinosis (p = 0.02) and chronic osteitis pubis (p = 0.01) were more prevalent in FAI patients than controls. Univariate analyses in FAI patients showed that an alpha angle ≥ 60° had a higher prevalence of aponeurotic plate tears (p = 0.02) and adductor tendinosis (p = 0.049). Multivariate analyses showed that an alpha angle ≥ 60° had a higher prevalence of chronic osteitis pubis (OR = 2.27, p = 0.031), sports participation had a higher prevalence of adductor tendon tears (OR = 4.69, p = 0.013) and chronic osteitis pubis (OR = 2.61, p = 0.0058), and males had a higher prevalence of acute osteitis pubis (OR = 5.17, p = 0.032).
Sports participation, alpha angle ≥ 60°, and male sex predict a higher prevalence of athletic pubalgia imaging findings in patients with femoroacetabular impingement.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Byrd JWT. Femoroacetabular impingement in athletes: current concepts. Am J Sports Med. 2014;42(3):737–51.
Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–20.
Wyles CC, Norambuena GA, Howe BM, Larson DR, Levy BA, Yuan BJ, et al. Cam deformities and limited hip range of motion are associated with early osteoarthritic changes in adolescent athletes: a prospective matched cohort study. Am J Sports Med. 2017;45(13):3036–43.
Cohen B, Kleinhenz D, Schiller J, Tabaddor R. Understanding athletic pubalgia: a review. R I Med J. 2016;99(10):31–5.
Strosberg DS, Ellis TJ, Renton DB. The role of femoroacetabular impingement in core muscle injury/athletic pubalgia: diagnosis and management. Front Surg. 2016;3:6.
Poor AE, Roedl JB, Zoga AC, Meyers WC. Core muscle injuries in athletes. Curr Sports Med Rep. 2018;17(2):54–8.
McSweeney SE, Naraghi A, Salonen D, Theodoropoulos J, White LM. Hip and groin pain in the professional athlete. Can Assoc Radiol J. 2012;63(2):87–99.
Zoga AC, Kavanagh EC, Omar IM, Morrison WB, Koulouris G, Lopez H, et al. Athletic pubalgia and the “sports hernia”: MR imaging findings. Radiology. 2008;247(3):797–807.
Omar IM, Zoga AC, Kavanagh EC, Koulouris G, Bergin D, Gopez AG, et al. Athletic pubalgia and “sports hernia”: optimal MR imaging technique and findings. Radiographics. 2008;28(5):1415–38.
Birmingham PM, Kelly BT, Jacobs R, McGrady L, Wang M. The effect of dynamic femoroacetabular impingement on pubic symphysis motion: a cadaveric study. Am J Sports Med. 2012;40(5):1113–8.
Larson CM, Pierce BR, Giveans MR. Treatment of athletes with symptomatic intra-articular hip pathology and athletic pubalgia/sports hernia: a case series. Arthroscopy. 2011;27(6):768–75.
Saito M, Utsunomiya H, Hatakeyama A, Nakashima H, Nishimura H, Matsuda DK, et al. Hip arthroscopic management can improve osteitis pubis and bone marrow edema in competitive soccer players with femoroacetabular impingement. Am J Sports Med. 2019;47(2):408–19.
Sansone M, Ahldén M, Jonasson P, Thomeé R, Falk A, Swärd L, et al. Can hip impingement be mistaken for tendon pain in the groin? A long-term follow-up of tenotomy for groin pain in athletes. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):786–92.
Munegato D, Bigoni M, Gridavilla G, Olmi S, Cesana G, Zatti G. Sports hernia and femoroacetabular impingement in athletes: a systematic review. World J Clin Cases. 2015;3(9):823–30.
Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br. 2002;84(4):556–60.
Tallroth K, Lepistö J. Computed tomography measurement of acetabular dimensions: normal values for correction of dysplasia. Acta Orthop. 2006;77(4):598–602.
Hernandez RJ, Tachdjian MO, Poznanski AK, Dias LS. CT determination of femoral torsion [Internet]. Am J Roentgenol. 1981;137:97–101. https://doi.org/10.2214/ajr.137.1.97.
Anda S, Terjesen T, Kvistad KA. Computed tomography measurements of the acetabulum in adult dysplastic hips: which level is appropriate? Skelet Radiol. 1991;20(4):267–71.
Brennan D, O’Connell MJ, Ryan M, Cunningham P, Taylor D, Cronin C, et al. Secondary cleft sign as a marker of injury in athletes with groin pain: MR image appearance and interpretation. Radiology. 2005;235(1):162–7.
Hammoud S, Bedi A, Magennis E, Meyers WC, Kelly BT. High incidence of athletic pubalgia symptoms in professional athletes with symptomatic femoroacetabular impingement. Arthroscopy. 2012;28(10):1388–95.
Larson CM, Sikka RS, Sardelli MC, Byrd JWT, Kelly BT, Jain RK, et al. Increasing alpha angle is predictive of athletic-related “hip” and “groin” pain in collegiate National Football League prospects. Arthroscopy. 2013;29(3):405–10.
Verrall GM, Slavotinek JP, Barnes PG, Esterman A, Oakeshott RD, Spriggins AJ. Hip joint range of motion restriction precedes athletic chronic groin injury. J Sci Med Sport. 2007;10(6):463–6.
Verrall GM, Hamilton IA, Slavotinek JP, Oakeshott RD, Spriggins AJ, Barnes PG, et al. Hip joint range of motion reduction in sports-related chronic groin injury diagnosed as pubic bone stress injury. J Sci Med Sport. 2005;8(1):77–84.
Weir A, de Vos RJ, Moen M, Hölmich P, Tol JL. Prevalence of radiological signs of femoroacetabular impingement in patients presenting with long-standing adductor-related groin pain. Br J Sports Med. 2011;45(1):6–9.
Feeley BT, Powell JW, Muller MS, Barnes RP, Warren RF, Kelly BT. Hip injuries and labral tears in the national football league. Am J Sports Med. 2008;36(11):2187–95.
Kavroudakis E, Karampinas PK, Evangelopoulos DS, Vlamis J. Treatment of osteitis pubis in non-athlete female patients. Open Orthop J. 2011;5:331–4.
Angoules AG. Osteitis pubis in elite athletes: diagnostic and therapeutic approach. World J Orthop. 2015;6(9):672–9.
Kennedy MJ, Lamontagne M, Beaulé PE. Femoroacetabular impingement alters hip and pelvic biomechanics during gait walking biomechanics of FAI. Gait Posture. 2009;30(1):41–4.
Hammoud S, Bedi A, Voos JE, Mauro CS, Kelly BT. The recognition and evaluation of patterns of compensatory injury in patients with mechanical hip pain. Sports Health. 2014;6(2):108–18.
Conflict of interest
The authors declare that they have no conflict of interest.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
The prevalence of athletic pubalgia imaging findings on MRI in patients with femoroacetabular impingement
About this article
Cite this article
Varada, S., Moy, M.P., Wu, F. et al. The prevalence of athletic pubalgia imaging findings on MRI in patients with femoroacetabular impingement. Skeletal Radiol 49, 1249–1258 (2020). https://doi.org/10.1007/s00256-020-03405-z
- Femoroacetabular impingement
- Athletic pubalgia
- Osteitis pubis
- Rectus abdominis
- Aponeurotic plate