Ischiofemoral impingement syndrome: a meta-analysis
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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.
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.
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.
KeywordsIschiofemoral impingement IFS QFS Quadratus femoris MRI Hip pain
quadratus femoris space
magnetic resonance imaging
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.
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.
- 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
- 8.Yoong P, Mansour R, Teh JL. Multiple hereditary exostoses and ischiofemoral impingement: a case–control study. Skelet Radiol. 2014;5.Google Scholar
- 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
- 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
- 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.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
- 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.Bredella MA, Azevedo DC, Oliveira AL, Simeone FJ, Chang CY, et al. Pelvic morphology in ischiofemoral impingement. Skelet Radiol. 2014.Google Scholar