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Skeletal Radiology

, Volume 44, Issue 6, pp 831–837 | Cite as

Ischiofemoral impingement syndrome: a meta-analysis

  • Adam D. SingerEmail author
  • Ty K. Subhawong
  • Jean Jose
  • Jonathan Tresley
  • Paul D. Clifford
Scientific Article

Abstract

Objective

The aims of this article are to review the imaging characteristics of ischiofemoral impingement (IFI), summarize measurement thresholds for radiologic diagnosis based on a meta-analysis of the literature and raise awareness among radiologists and clinicians of this entity.

Materials and methods

A PubMed search restricted to the English language containing the keywords “ischiofemoral impingement” and “quadratus femoris MRI” was performed, and citations in these articles were also used to identify a total of 27 studies discussing ischiofemoral impingement. After excluding case reports and non-representative studies, there were five remaining articles including 193 hip MRIs of IFI in 154 subjects (133 female, 21 male) and 135 asymptomatic control hip MRIs from 74 subjects (55 female, 19 male). Additionally, we performed a retrospective database search of pelvic and hip MRI reports from our institution including the terms “quadratus femoris” or “ischiofemoral impingement” from a 9-year period and 24 hip MRIs from 21 patients (18 female, 3 male) with IFI with 5 asymptomatic contralateral control hip MRIs identified. In all, 217 hip MRIs of IFI and 140 control cases were included. A meta-analysis of these hip MRIs was conducted to determine optimal thresholds of the ischiofemoral space (IFS) and quadratus femoris space (QFS) for identifying IFI.

Results

Cases of IFI showed significantly smaller IFS and QFS compared to controls (14.91 ± 4.8 versus 26.01 ± 7.98 and 9.57 ± 3.7 versus 15.97 ± 6.07, measured in mm, respectively, p < 0.0001 for both). Pooled analysis revealed that for IFS, using a cutoff of ≤15 mm yielded a sensitivity of 76.9 %, specificity of 81.0 % and overall accuracy of 78.3 %. For QFS, a cutoff of ≤ 10.0 mm resulted in 78.7 % sensitivity, 74.1 % specificity and 77.1 % overall accuracy.

Conclusion

IFI is a potential cause of hip pain that can be accurately diagnosed with MRI in conjunction with clinical findings. Using the proposed measurement thresholds may better identify patients with this impingement syndrome so that optimal treatment options can be pursued.

Keywords

Ischiofemoral impingement IFS QFS Quadratus femoris MRI Hip pain 

Abbreviations

IFS

ischiofemoral space

QFS

quadratus femoris space

mm

millimeter

QF

quadratus femoris

MRI

magnetic resonance imaging

IFI

ischiofemoral impingement

Notes

Acknowledgments

The authors express their gratitude to Drs. Özgür Tosun and Athanasios Papavasiliou for generously sharing raw data from their studies to facilitate this meta-analysis.

Conflicts of interest

The authors have no conflicts of interest.

Consent

A waiver for informed consent was obtained from the University of Miami Institutional Review Board for the onsite case series contributing to the meta-analysis.

References

  1. 1.
    Johnson KA. Impingement of the lesser trochanter on the ischial ramus after total hip arthroplasty. Report of three cases. J Bone Joint Surg Am. 1977;59(2):268–9.PubMedGoogle Scholar
  2. 2.
    Hayat Z, Konan S, Pollock R. Ischiofemoral impingement resulting from a chronic avulsion injury of the hamstrings. BMJ Case Rep. 2014;25:2014.Google Scholar
  3. 3.
    Viala P, Vanel D, Larbi A, Cyteval C, Laredo JD. Bilateral ischiofemoral impingement in a patient with hereditary multiple exostoses. Skelet Radiol. 2012;41(12):1637–40.CrossRefGoogle Scholar
  4. 4.
    Tosun Ö, Çay N, Bozkurt M, Arslan H. Ischiofemoral impingement in an 11-year-old girl. Diagn Interv Radiol. 2012;18(6):571–3.PubMedGoogle Scholar
  5. 5.
    Ali AM, Whitwell D, Ostlere SJ. Case report: imaging and surgical treatment of a snapping hip due to ischiofemoral impingement. Skelet Radiol. 2011;40(5):653–6.CrossRefGoogle Scholar
  6. 6.
    López-Sánchez MC, Armesto Pérez V, Montero Furelos LÁ, Vázquez-Rodríguez TR, Calvo Arrojo G, et al. Ischiofemoral impingement: hip pain of infrequent cause. Reumatol Clin. 2013;9(3):186–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Ali AM, Teh J, Whitwell D, Ostlere S. Ischiofemoral impingement: a retrospective analysis of cases in a specialist orthopaedic centre over a four-year period. Hip Int. 2013;23(3):263–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Yoong P, Mansour R, Teh JL. Multiple hereditary exostoses and ischiofemoral impingement: a case–control study. Skelet Radiol. 2014;5.Google Scholar
  9. 9.
    Papavasiliou A, Siatras T, Bintoudi A, Milosis D, Lallas V, Sykaras E, et al. The gymnasts’ hip and groin: a magnetic resonance imaging study in asymptomatic elite athletes. Skelet Radiol. 2014;43(8):1071–7.CrossRefGoogle Scholar
  10. 10.
    Tosun O, Algin O, Yalcin N, Cay N, Ocakoglu G, et al. Ischiofemoral impingement: evaluation with new MRI parameters and assessment of their reliability. Skelet Radiol. 2012;41(5):575–87.CrossRefGoogle Scholar
  11. 11.
    Torriani M, Souto SC, Thomas BJ, Ouellette H, Bredella MA. Ischiofemoral impingement syndrome: an entity with hip pain and abnormalities of the quadratus femoris muscle. AJR Am J Roentgenol. 2009;193(1):186–90.CrossRefPubMedGoogle Scholar
  12. 12.
    Sussman WI, Han E, Schuenke MD. Quantitative assessment of the ischiofemoral space and evidence of degenerative changes in the quadratus femoris muscle. Surg Radiol Anat. 2013;35(4):273–81.CrossRefPubMedGoogle Scholar
  13. 13.
    de Sa D, Alradwan H, Cargnelli S, Thawer Z, Simunovic N, et al. Extra-articular hip impingement: a systematic review examining operative treatment of psoas, subspine, ischiofemoral, and greater trochanteric/pelvic impingement. Arthroscopy. 2014;5(14):00203.Google Scholar
  14. 14.
    Taneja AK, Bredella MA, Torriani M. Ischiofemoral impingement. Magn Reson Imaging Clin N Am. 2013;21(1):65–73.CrossRefPubMedGoogle Scholar
  15. 15.
    Kim WJ, Shin HY, Koo GH, Park HG, Ha YC, Park YH. Ultrasound-guided prolotherapy with polydeoxyribonucleotide sodium in ischiofemoral impingement syndrome. Pain Pract. 2014.Google Scholar
  16. 16.
    Safran M, Ryu J. Ischiofemoral impingement of the hip: a novel approach to treatment. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):781–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Ganz R, Slongo T, Turchetto L, Masse A, Whitehead D, et al. The lesser trochanter as a cause of Hip impingement: pathophysiology and treatment options. Hip Int. 2013;23 Suppl 9:S35–41.CrossRefPubMedGoogle Scholar
  18. 18.
    Singer A, Clifford P, Tresley J, Jose J, Subhawong T. Ischiofemoral impingement and the utility of full range of motion MRI in its detection. Am J Orthop (Belle Mead NJ). 2014;43(12):548–51.Google Scholar
  19. 19.
    Ata AM, Yavuz H, Kaymak B, Ozcan HN, Ergen B, Ozçakar L. Ischiofemoral impingement revisited: what physiatrists need to know in short. Am J Phys Med Rehabil. 2014.Google Scholar
  20. 20.
    Wilson JJ, Furukawa M. Evaluation of the patient with hip pain. Am Fam Physician. 2014;89(1):27–34.PubMedGoogle Scholar
  21. 21.
    Sutter R, Pfirrmann CW. Atypical hip impingement. AJR Am J Roentgenol. 2013;201(3):W437–42.CrossRefPubMedGoogle Scholar
  22. 22.
    Blankenbaker DG, Tuite MJ. Non-femoroacetabular impingement. Semin Musculoskelet Radiol. 2013;17(3):279–85.CrossRefPubMedGoogle Scholar
  23. 23.
    Lee S, Kim I, Lee SM, Lee J. Ischiofemoral impingement syndrome. Ann Rehabil Med. 2013;37(1):143–6.CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    Stafford GH, Villar RN. Ischiofemoral impingement. J Bone Joint Surg (Br). 2011;93(10):1300–2.CrossRefGoogle Scholar
  25. 25.
    Backer MW, Lee KS, Blankenbaker DG, Kijowski R, Keene JS. Correlation of ultrasound-guided corticosteroid injection of the quadratus femoris with MRI findings of ischiofemoral impingement. AJR Am J Roentgenol. 2014;203(3):589–93.CrossRefPubMedGoogle Scholar
  26. 26.
    Hatem MA, Palmer IJ, Martin HD. Diagnosis and 2-year outcomes of endoscopic treatment for ischiofemoral impingement. Arthroscopy. 2014. S0749-8063(14)00704-X.Google Scholar
  27. 27.
    Bredella MA, Azevedo DC, Oliveira AL, Simeone FJ, Chang CY, et al. Pelvic morphology in ischiofemoral impingement. Skelet Radiol. 2014.Google Scholar
  28. 28.
    Chan WP, Liu GC. MR imaging of primary skeletal muscle diseases in children. AJR Am J Roentgenol. 2002;179(4):989–97.CrossRefPubMedGoogle Scholar
  29. 29.
    Dion E, Cherin P, Payan C, Fournet JC, Papo T, et al. Magnetic resonance imaging criteria for distinguishing between inclusion body myositis and polymyositis. J Rheumatol. 2002;29(9):1897–906.PubMedGoogle Scholar

Copyright information

© ISS 2015

Authors and Affiliations

  • Adam D. Singer
    • 1
    Email author
  • Ty K. Subhawong
    • 1
  • Jean Jose
    • 1
  • Jonathan Tresley
    • 1
  • Paul D. Clifford
    • 1
  1. 1.Department of Diagnostic Radiology, Section of Musculoskeletal ImagingJackson Memorial HospitalMiamiUSA

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