Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 25, Issue 6, pp 1951–1957 | Cite as

No difference in prevalence of radiographic subspinal impingement of the hip between symptomatic and asymptomatic subjects

  • Jun-Il Yoo
  • Yong-Chan HaEmail author
  • Han-Jun Lee
  • Jung-Yeop Lee
  • Young-Kyun Lee
  • Kyung-Hoi Koo



The study determined the prevalence of subspinal impingement (SSI) in symptomatic and asymptomatic individuals, morphologic characteristics in symptomatic patients, and risk factors for SSI.


The study cohort consisted of 427 patients (427 hips; median age 33.4 years; range 19–50 years) with mechanical symptoms who underwent multi-detector computed tomography arthrography (symptomatic patients) and 259 control (asymptomatic) patients who underwent abdominopelvic three-dimensional CT because of a ureter stone or minor trauma. Two orthopaedic surgeons reviewed the images to evaluate the prevalence of SSI and the relationship with morphologic abnormalities. Radiologic parameters were further compared between the SSI and non-SSI groups in symptomatic patients using the Chi-squared test or two-sample t test. Variables with p values <0.10 (sex and age) were included in the multi-variate analysis. Logistic regression analysis was carried out to identify independent risk factors for SSI.


The prevalence of SSI in symptomatic and asymptomatic patients was 65/427 (15.2%) and 40/259 (15.4%), respectively (n.s.). Structural bony abnormalities in symptomatic patients were not associated with the presence of SSI (n.s.). Binary logistic regression analysis revealed that youth (odds ratio 0.952, 95% CI 0.922–0.984) was the only significant factor for SSI.


SSI had a similar prevalence in symptomatic and asymptomatic patients and was not rare in either group. Therefore, clinical implication of SSI in symptomatic patient should be re-evaluated through further study.

Level of evidence

Level IV.


Subspinal Extra-articular Femoroacetabular impingement Prevalence 


Compliance with ethical standards

Conflict of interest

Jun-Il Yoo, Yong-Chan Ha, Han-Jun Lee, Jung-Yeop Lee, Young-Kyun Lee, and Kyung-Hoi Koo declare that they have no conflict of interest.


No funding was received for this study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Formal consent is not required for the study.


  1. 1.
    Ali AM, Teh J, Whitwell D, Ostlere SJ (2013) Ischiofemoral impingement: a retrospective analysis of cases in a specialist orthopaedic centre over a four-year period. Hip Int 23(3):263–268CrossRefPubMedGoogle Scholar
  2. 2.
    Ali AM, Whitwell D, Ostlere SJ (2011) Case report: imaging and surgical treatment of a snapping hip due to ischiofemoral impingement. Skelet Radiol 40(5):653–656CrossRefGoogle Scholar
  3. 3.
    Amar E, Warschawski Y, Sharfman ZT, Martin HD, Safran MR, Rath E (2016) Pathological findings in patients with low anterior inferior iliac spine impingement. Surg Radiol Anat 38(5):569–575CrossRefPubMedGoogle Scholar
  4. 4.
    Ayeni OR, Adamich J, Farrokhyar F, Simunovic N, Crouch S, Philippon MJ, Bhandari M (2014) Surgical management of labral tears during femoroacetabular impingement surgery: a systematic review. Knee Surg Sports Traumatol Arthrosc 22(4):756–762CrossRefPubMedGoogle Scholar
  5. 5.
    Cadet ER, Babatunde OM, Gorroochurn P, Chan AK, Stancato-Pasik A, Brown M, Johnson S, Kaiser PB, Gardner TR, Ayeni OR (2016) Inter- and intra-observer agreement of femoroacetabular impingement (FAI) parameters comparing plain radiographs and advanced, 3D computed tomographic (CT)-generated hip models in a surgical patient cohort. Knee Surg Sports Traumatol Arthrosc 24(7):2324–2331CrossRefPubMedGoogle Scholar
  6. 6.
    Ha Y-C, Choi J-A, Lee Y-K, Kim JY, Koo K-H, Lee GY, Kang HS (2013) The diagnostic value of direct CT arthrography using MDCT in the evaluation of acetabular labral tear: with arthroscopic correlation. Skelet Radiol 42(5):681–688CrossRefGoogle Scholar
  7. 7.
    Hapa O, Bedi A, Gursan O, Akar MS, Güvencer M, Havitçioğlu H, Larson CM (2013) Anatomic footprint of the direct head of the rectus femoris origin: cadaveric study and clinical series of hips after arthroscopic anterior inferior iliac spine/subspine decompression. Arthroscopy 29(12):1932–1940CrossRefPubMedGoogle Scholar
  8. 8.
    Hetsroni I, Larson CM, Dela Torre K, Zbeda RM, Magennis E, Kelly BT (2012) Anterior inferior iliac spine deformity as an extra-articular source for hip impingement: a series of 10 patients treated with arthroscopic decompression. Arthroscopy 28(11):1644–1653CrossRefPubMedGoogle Scholar
  9. 9.
    Hetsroni I, Poultsides L, Bedi A, Larson CM, Kelly BT (2013) Anterior inferior iliac spine morphology correlates with hip range of motion: a classification system and dynamic model. Clin Orthop Relat Res 471(8):2497–2503CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Ji H-M, Baek J-H, Kim K-W, Yoon J-W, Ha Y-C (2014) Herniation pits as a radiographic indicator of pincer-type femoroacetabular impingement in symptomatic patients. Knee Surg Sports Traumatol Arthrosc 22(4):860–866CrossRefPubMedGoogle Scholar
  11. 11.
    Jung JY, Kim G-U, Lee H-J, Jang E-C, Song IS, Ha Y-C (2013) Diagnostic value of ultrasound and computed tomographic arthrography in diagnosing anterosuperior acetabular labral tears. Arthroscopy 29(11):1769–1776CrossRefPubMedGoogle Scholar
  12. 12.
    Kappe T, Kocak T, Neuerburg C, Lippacher S, Bieger R, Reichel H (2011) Reliability of radiographic signs for acetabular retroversion. Int Orthop 35(6):817–821CrossRefPubMedGoogle Scholar
  13. 13.
    Larson CM, Kelly BT, Stone RM (2011) Making a case for anterior inferior iliac spine/subspine hip impingement: three representative case reports and proposed concept. Arthroscopy 27(12):1732–1737CrossRefPubMedGoogle Scholar
  14. 14.
    Matsuda DK, Calipusan CP (2012) Adolescent femoroacetabular impingement from malunion of the anteroinferior iliac spine apophysis treated with arthroscopic spinoplasty. Orthopedics 35(3):e460–e463PubMedGoogle Scholar
  15. 15.
    Montgomery AA, Graham A, Evans PH, Fahey T (2002) Inter-rater agreement in the scoring of abstracts submitted to a primary care research conference. BMC Health Serv Res 2(1):8CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J (2002) The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 84(4):556–560CrossRefPubMedGoogle Scholar
  17. 17.
    Pan H, Kawanabe K, Akiyama H, Goto K, Onishi E, Nakamura T (2008) Operative treatment of hip impingement caused by hypertrophy of the anterior inferior iliac spine. J Bone Joint Surg Br 90(5):677–679CrossRefPubMedGoogle Scholar
  18. 18.
    Reynolds D, Lucas J, Klaue K (1999) Retroversion of the acetabulum. A cause of hip pain. J Bone Joint Surg Br 81(2):281–288CrossRefPubMedGoogle Scholar
  19. 19.
    Ricciardi BF, Fabricant PD, Fields KG, Poultsides L, Zaltz I, Sink EL (2015) What are the demographic and radiographic characteristics of patients with symptomatic extraarticular femoroacetabular impingement? Clin Orthop Relat Res 473(4):1299–1308CrossRefPubMedGoogle Scholar
  20. 20.
    Stafford GH, Villar RN (2011) Ischiofemoral impingement. J Bone Joint Surg Br 93(10):1300–1302CrossRefPubMedGoogle Scholar
  21. 21.
    Tönnis D, Heinecke A (1999) Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg Am 81(12):1747–1770CrossRefPubMedGoogle Scholar
  22. 22.
    Zhang D, Chen L, Wang G (2016) Hip arthroscopy versus open surgical dislocation for femoroacetabular impingement: a systematic review and meta-analysis. Medicine (Baltimore) 95(41):e5122CrossRefGoogle Scholar
  23. 23.
    Wiberg G (1953) Studies on dysplastic acetabula and congenital subluxation of the hip joint with special reference to the complication of osteoarthritis. Acta Chir Scand 83(Suppl 58):1–135Google Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016

Authors and Affiliations

  • Jun-Il Yoo
    • 1
  • Yong-Chan Ha
    • 2
    Email author
  • Han-Jun Lee
    • 2
  • Jung-Yeop Lee
    • 2
  • Young-Kyun Lee
    • 1
  • Kyung-Hoi Koo
    • 1
  1. 1.Department of Orthopaedic SurgerySeoul National University Bundang HospitalSungnamSouth Korea
  2. 2.Department of Orthopaedic SurgeryChung-Ang University College of MedicineSeoulSouth Korea

Personalised recommendations