Femoroacetabular impingement (FAI) is a cause of chronic hip pain in athletic individuals. Usually it is not an injury that occurs after an acute event, but instead it often manifests as hip pain that develops over time. The problem results from abnormal contact between the femoral head or neck and the acetabulum. Bony prominence on either the femoral head and neck or the acetabulum can be the source of problems. Why this problem develops in some athletes is often difficult to determine.

Signs and symptoms of FAI

An athlete with femoroacetabular impingement often complains of pain deep in the groin with certain maneuvers. Often squatting and deep hip flexion cause groin pain. Occasionally the athlete will complain of pain in the groin with cutting and pivoting maneuvers and changing directions.

Tests for FAI

In the office, the sports medicine physician will perform a physical examination to try to determine the location of the pain. Often there is no specific bony or soft tissue tenderness to palpation as is often present with strains of the muscles and tendons around the hip. Often range of motion of the hip, especially full flexion with internal or external rotation of the hip, reproduces the patient’s pain. X-rays often show the problem, especially when there is a deformity of the femoral neck or abnormal positioning of the acetabulum. An MRI is often performed to look for other sources of pain such as a hip labral tear or cartilage injury within the joint.

Femoroacetabular impingement - FAI - of the hip
This x-ray of a left hip shows bony prominence (white arrow) of the femoral head and neck consistent with cam-type femoroacetabular impingement.

Treatment options for FAI

Unfortunately nonsurgical treatment, such as physical therapy and anti-inflammatory medications, is usually unsuccessful. If the athlete is unable to perform the sports or exercises that he or she wants to play off, surgical treatment is a reasonable option. Surgery usually consists of arthroscopic or even open procedures to remove the abnormal contact between the femoral neck and head and acetabulum. Which procedures are done depend on the location of the problem and how extensive the bony impingement is. Also labral debridement, repair of labral tears, and treatment of cartilaginous injuries can be performed at the same time. Usually the athlete is made nonweightbearing for up to six weeks before instituting progressive weightbearing, range of motion, and strength in. Return to sports can be slow, often taking many months, but athletes with this problem often get back to competitive athletics.

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