Patients with sports hernia display high rate of radiographic FAI

Issue: August 2012

BALTIMORE — The biomechanical changes associated with femoroacetabular impingement may lead to increased stresses across the lower abdominal musculature culminating in a sports hernia, according to a presenter at the American Orthopaedic Society for Sports Medicine Annual Meeting, here.

Perspective from J. W. Thomas Byrd, MD

In addition, it was noted, underlying femoroacetabular impingement (FAI) may be a cause of continued groin pain after sports hernia repair.

“A high prevalence of patients treated for sports hernia have FAI. These results strengthen the idea that FAI and sports hernia may be related,” researcher Kostas Economopoulos, MD said.

Researchers conducted a retrospective review of 43 patients who underwent 56 sports hernia repairs at the University of Virginia from 1999 to 2011. MRI, CT scans or X-rays were performed to look for radiological signs of FAI. Alpha angle was measured using axial cuts to identify cam lesions. Researchers identified pincer lesions by measuring the acetabular coverage and acetabular retroversion using axial cuts on the MRI.

Kostas Economopoulos

Radiographic evidence of FAI was identified in at least one hip in 37 of 43 patients (86%). Additionally, 29 patients (67%) had isolated cam lesions, two patients (5%) had isolated pincer lesions, and six patients (14%) had combined cam and pincer lesions. Cam lesions were identified in 42 (75%) hips on the ipsilateral side of the hernia and 13 (46%) cam lesions were found in hips without associated hernia. The average alpha angle of hips on the side of the hernia was 75° and 61° in hips without an associated hernia on its side. Forty-two of 56 hips (75%) with associated hernia with alpha angle greater than 55°, and 13 of 28 hips (46%) without associated hernia had an alpha angle greater than 55°. Pincer lesions were identified in 9 (16.1%) hernias and 2 (7.14%) hips without associated hernias.

Economopoulos said the team conducted phone follow-up with 28 patients and found 22 were able to return to sport at an average time of 14.4 weeks. Four patients had revision hernia surgery, and no patients had hip arthroscopy.

“Underlying FAI may be a cause of continued groin pain after sports hernia repair surgery and should be evaluated for patients who do not improve,” Economopoulos said.

Reference:

Economopoulos KJ, Diduch DR, Hanks JB, et al. Radiographic evidence of FAI in athletes with sports hernias. Paper #26. Presented at the American Orthopaedic Society for Sports Medicine Annual Meeting 2012. July 12-15. Baltimore.

Disclosure: Economopoulos has no relevant financial disclosures.

Perspective

J. W. Thomas Byrd, MD

Dr. Economopolous and his colleagues present a concise observational study on the prevalence of radiographic findings of femoroacetabular impingement (FAI) among athletes who underwent surgery for sports hernia. Its value is most substantially that it reminds us to maintain a sense of awareness regarding the relationship of these two entities. They represent no causal relationship between the two. Others have postulated that athletes with FAI and reduced hip rotational motion compensate by increased pelvic motion and thus stress the pelvic stabilizers resulting in some of the sports hernia problems. However, as a backdrop to this current report, other studies have shown a high prevalence of radiographic findings of FAI just as part of the normal screening of athletes with rates of 72 and 95%.

It is hard to compare these studies to the report of Dr. Economopolous and colleagues, but it is not clear whether the 86% prevalence they report is any higher than what might normally be encountered among athletes. A final point of their study is well taken that athletes with continued groin pain following sports hernia repair should be closely assessed for FAI.

J. W. Thomas Byrd, MD

Nashville Sports Medicine & Orthopaedic Center

Nashville, Tenn.

Disclosures: Byrd is a consultant for A2Surgical and Smith & Nephew Endoscopy, receives research support from Smith & Nephew Endoscopy, and is a stockholder for A2 Surgical.