What is the Prevalence of Hip Intra-Articular Pathologies and Osteoarthritis in Active Athletes with Hip and Groin Pain Compared with Those Without? A Systematic Review and Meta-Analysis

A Correction to this article was published on 23 April 2019

This article has been updated



In athletes, hip and groin pain is considered to be associated with hip intra-articular pathologies and hip osteoarthritis (OA). A greater understanding of the relationship between hip and groin pain and imaging findings is required.


Our objective was to undertake a systematic review and meta-analysis to determine the prevalence of hip intra-articular pathologies and hip OA in athletes with and without hip and groin pain.


Seven electronic databases were searched on 29 January 2018 for studies investigating the prevalence of hip intra-articular pathologies and hip OA using X-ray, magnetic resonance imaging, magnetic resonance arthrography or computed tomography. The search, study selection, quality appraisal and data extraction were performed by two independent reviewers. When studies were considered homogenous, meta-analysis was undertaken. A strength of evidence was given to pooled results.


Twenty studies reporting on the prevalence of hip intra-articular pathologies and hip OA in athletes were identified. Included studies were considered moderate to high risk of bias, with only three studies adjudged as low risk of bias. In asymptomatic athletes, limited evidence identified a labral tear prevalence of 54% per person and moderate evidence of 33% per hip. In symptomatic athletes, moderate evidence of a labral tear prevalence of 20% per hip was found. Moderate evidence of a cartilage defect prevalence of 10% per person was reported in asymptomatic athletes. In symptomatic athletes, cartilage defect prevalence was 7–40%. In asymptomatic athletes, the prevalence of hip OA was 0–17%, compared with 2% in symptomatic athletes.


The prevalence of hip intra-articular pathologies and hip OA in symptomatic and asymptomatic athletes is variable. Labral tears and cartilage defects appear to be seen often in athletes with and without pain. Hip OA is rarely seen in athletes either with or without hip and groin pain.

Study Registration

PROSPERO registration CRD42017082457.

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Change history

  • 23 April 2019

    The original article can be found online.


  1. 1.

    Mosler AB, Weir A, Eirale C, Farooq A, Thorborg K, Whiteley RJ, et al. Epidemiology of time loss groin injuries in a men’s professional football league: a 2-year prospective study of 17 clubs and 606 players. Br J Sports Med. 2017;52(5):292–7. https://doi.org/10.1136/bjsports-2016-097277.

    Article  PubMed  Google Scholar 

  2. 2.

    Gouttebarge V, Hughes Schwab BA, Vivian A, Kerkhoffs GMMJ. Injuries, matches missed and the influence of minimum medical standards in the A-League professional football: a 5-year prospective study. Asian J Sports Med. 2016;7(1):e31385. https://doi.org/10.5812/asjsm.31385.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Thorborg K, Rathleff MS, Petersen P, Branci S, Holmich P. Prevalence and severity of hip and groin pain in sub-elite male football: a cross-sectional cohort study of 695 players. Scand J Med Sci Sports. 2017;27(1):107–14. https://doi.org/10.1111/sms.12623.

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    Coleman SH, Mayer SW, Tyson JJ, Pollack KM, Curriero FC. The epidemiology of hip and groin injuries in professional baseball players. Am J Orthop (Belle Mead NJ). 2016;45(3):168–75.

    PubMed  Google Scholar 

  5. 5.

    Dalton SL, Zupon AB, Gardner EC, Djoko A, Dompier TP, Kerr ZY. The epidemiology of hip/groin injuries in national collegiate athletic association men’s and women’s ice hockey: 2009-2010 through 2014-2015 academic years. Orthop J Sports Med. 2016;4(3):2325967116632692. https://doi.org/10.1177/2325967116632692.

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Haroy J, Clarsen B, Thorborg K, Holmich P, Bahr R, Andersen TE. Groin problems in male soccer players are more common than previously reported. Am J Sports Med. 2017;45(6):1304–8. https://doi.org/10.1177/0363546516687539.

    Article  PubMed  Google Scholar 

  7. 7.

    Kerr ZY, Kroshus E, Grant J, Parsons JT, Folger D, Hayden R, et al. Epidemiology of national collegiate athletic association men’s and women’s cross-country injuries, 2009-2010 through 2013-2014. J Athl Train. 2016;51(1):57–64. https://doi.org/10.4085/1062-6050-51.1.10.

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Larruskain J, Lekue JA, Diaz N, Odriozola A, Gil SM. A comparison of injuries in elite male and female football players: a five-season prospective study. Scand J Med Sci Sports. 2018;28(1):237–45. https://doi.org/10.1111/sms.12860.

    Article  CAS  PubMed  Google Scholar 

  9. 9.

    Trentacosta N, Sugimoto D, Micheli LJ. Hip and groin injuries in dancers: a systematic review. Sports Health. 2017;9(5):422–7. https://doi.org/10.1177/1941738117724159.

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Walden M, Hagglund M, Ekstrand J. The epidemiology of groin injury in senior football: a systematic review of prospective studies. Br J Sports Med. 2015;49(12):792–7. https://doi.org/10.1136/bjsports-2015-094705.

    Article  PubMed  Google Scholar 

  11. 11.

    Werner J, Hagglund M, Walden M, Ekstrand J. UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons. Br J Sports Med. 2009;43(13):1036–40. https://doi.org/10.1136/bjsm.2009.066944.

    Article  CAS  PubMed  Google Scholar 

  12. 12.

    Orchard JW, Seward H, Orchard JJ. Results of 2 decades of injury surveillance and public release of data in the Australian Football League. Am J Sports Med. 2013;41(4):734–41. https://doi.org/10.1177/0363546513476270.

    Article  PubMed  Google Scholar 

  13. 13.

    Werner J, Hägglund M, Ekstrand J, Waldén M. Hip and groin time-loss injuries decreased slightly but injury burden remained constant in men’s professional football: the 15-year prospective UEFA elite club injury study. Br J Sports Med. 2018. https://doi.org/10.1136/bjsports-2017-097796 (Epub 2018 Apr 24).

    Article  PubMed  Google Scholar 

  14. 14.

    Weir A, Brukner P, Delahunt E, Ekstrand J, Griffin D, Khan KM, et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med. 2015;49(12):768–74. https://doi.org/10.1136/bjsports-2015-094869.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Rankin AT, Bleakley CM, Cullen M. Hip joint pathology as a leading cause of groin pain in the sporting population: a 6-year review of 894 cases. Am J Sports Med. 2015;43(7):1698–703. https://doi.org/10.1177/0363546515582031.

    Article  PubMed  Google Scholar 

  16. 16.

    Thorborg K, Reiman MP, Weir A, Kemp JL, Serner A, Mosler AB, et al. Clinical examination, diagnostic imaging, and testing of athletes with groin pain: an evidence-based approach to effective management. J Orthop Sports Phys Ther. 2018;48(4):239–49. https://doi.org/10.2519/jospt.2018.7850.

    Article  PubMed  Google Scholar 

  17. 17.

    Holmich P. Long-standing groin pain in sportspeople falls into three primary patterns, a “clinical entity” approach: a prospective study of 207 patients. Br J Sports Med. 2007;41(4):247–52. https://doi.org/10.1136/bjsm.2006.033373.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Keogh MJ, Batt ME. A review of femoroacetabular impingement in athletes. Sports Med. 2008;38(10):863–78. https://doi.org/10.2165/00007256-200838100-00005.

    Article  PubMed  Google Scholar 

  19. 19.

    Zadpoor AA. Etiology of femoroacetabular impingement in athletes: a review of recent findings. Sports Med. 2015;45(8):1097–106. https://doi.org/10.1007/s40279-015-0339-2.

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Tranovich MJ, Salzler MJ, Enseki KR, Wright VJ. A review of femoroacetabular impingement and hip arthroscopy in the athlete. Phys Sportsmed. 2014;42(1):75–87. https://doi.org/10.3810/psm.2014.02.2050.

    Article  PubMed  Google Scholar 

  21. 21.

    Griffin DR, Dickenson EJ, O’Donnell J, Agricola R, Awan T, Beck M, et al. The Warwick agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med. 2016;50(19):1169–76. https://doi.org/10.1136/bjsports-2016-096743.

    Article  CAS  PubMed  Google Scholar 

  22. 22.

    Frank JM, Harris JD, Erickson BJ, Slikker W, Bush-Joseph CA, Salata MJ, et al. Prevalence of femoroacetabular impingement imaging findings in asymptomatic volunteers: a systematic review. Arthroscopy. 2015;31(6):1199–204. https://doi.org/10.1016/j.arthro.2014.11.042.

    Article  PubMed  Google Scholar 

  23. 23.

    Mascarenhas VV, Rego P, Dantas P, Morais F, McWilliams J, Collado D, et al. Imaging prevalence of femoroacetabular impingement in symptomatic patients, athletes, and asymptomatic individuals: a systematic review. Eur J Radiol. 2016;85(1):73–95. https://doi.org/10.1016/j.ejrad.2015.10.016.

    Article  PubMed  Google Scholar 

  24. 24.

    Nepple JJ, Vigdorchik JM, Clohisy JC. What Is the association between sports participation and the development of proximal femoral cam deformity? A systematic review and meta-analysis. Am J Sports Med. 2015;43(11):2833–40. https://doi.org/10.1177/0363546514563909.

    Article  PubMed  Google Scholar 

  25. 25.

    Reichenbach S, Leunig M, Werlen S, Nuesch E, Pfirrmann CW, Bonel H, et al. Association between cam-type deformities and magnetic resonance imaging-detected structural hip damage: a cross-sectional study in young men. Arthritis Rheum. 2011;63(12):4023–30. https://doi.org/10.1002/art.30589.

    Article  PubMed  Google Scholar 

  26. 26.

    Register B, Pennock AT, Ho CP, Strickland CD, Lawand A, Philippon MJ. Prevalence of abnormal hip findings in asymptomatic participants: a prospective, blinded study. Am J Sports Med. 2012;40(12):2720–4. https://doi.org/10.1177/0363546512462124.

    Article  PubMed  Google Scholar 

  27. 27.

    Grace T, Samaan MA, Souza RB, Link TM, Majumdar S, Zhang AL. Correlation of patient symptoms with labral and articular cartilage damage in femoroacetabular impingement. Orthop J Sports Med. 2018;6(6):2325967118778785. https://doi.org/10.1177/2325967118778785.

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Agricola R, Heijboer MP, Bierma-Zeinstra SM, Verhaar JA, Weinans H, Waarsing JH. Cam impingement causes osteoarthritis of the hip: a nationwide prospective cohort study (CHECK). Ann Rheum Dis. 2013;72(6):918–23. https://doi.org/10.1136/annrheumdis-2012-201643.

    Article  PubMed  Google Scholar 

  29. 29.

    Armfield DR, Towers JD, Robertson DD. Radiographic and MR imaging of the athletic hip. Clin Sports Med. 2006;25(2):211–239, viii. https://doi.org/10.1016/j.csm.2005.12.009.

    Article  PubMed  Google Scholar 

  30. 30.

    Reiman MP, Thorborg K. Clinical examination and physical assessment of hip joint-related pain in athletes. Int J Sports Phys Ther. 2014;9(6):737–55.

    PubMed  PubMed Central  Google Scholar 

  31. 31.

    Heerey JJ, Kemp JL, Mosler AB, Jones DM, Pizzari T, Souza RB, et al. What is the prevalence of imaging-defined intra-articular hip pathologies in people with and without pain? A systematic review and meta-analysis. Br J Sports Med. 2018;52(9):581–93. https://doi.org/10.1136/bjsports-2017-098264.

    Article  PubMed  Google Scholar 

  32. 32.

    Lohkamp M, Kromer TO, Schmitt H. Osteoarthritis and joint replacements of the lower limb and spine in ex-professional soccer players: a systematic review. Scand J Med Sci Sports. 2017;27(10):1038–49. https://doi.org/10.1111/sms.12846.

    Article  CAS  PubMed  Google Scholar 

  33. 33.

    Gouttebarge V, Inklaar H, Backx F, Kerkhoffs G. Prevalence of osteoarthritis in former elite athletes: a systematic overview of the recent literature. Rheumatol Int. 2015;35(3):405–18. https://doi.org/10.1007/s00296-014-3093-0.

    Article  PubMed  Google Scholar 

  34. 34.

    Hoy D, Brooks P, Woolf A, Blyth F, March L, Bain C, et al. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol. 2012;65(9):934–9. https://doi.org/10.1016/j.jclinepi.2011.11.014.

    Article  PubMed  Google Scholar 

  35. 35.

    Taylor JB, Goode AP, George SZ, Cook CE. Incidence and risk factors for first-time incident low back pain: a systematic review and meta-analysis. Spine J. 2014;14(10):2299–319. https://doi.org/10.1016/j.spinee.2014.01.026.

    Article  PubMed  Google Scholar 

  36. 36.

    Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74. https://doi.org/10.2307/2529310.

    Article  CAS  PubMed  Google Scholar 

  37. 37.

    Beals CT, Magnussen RA, Graham WC, Flanigan DC. The prevalence of meniscal pathology in asymptomatic athletes. Sports Med. 2016;46(10):1517–24. https://doi.org/10.1007/s40279-016-0540-y.

    Article  PubMed  Google Scholar 

  38. 38.

    Nawabi DH, Bedi A, Tibor LM, Magennis E, Kelly BT. The demographic characteristics of high-level and recreational athletes undergoing hip arthroscopy for femoroacetabular impingement: a sports-specific analysis. Arthroscopy. 2014;30(3):398–405. https://doi.org/10.1016/j.arthro.2013.12.010.

    Article  PubMed  Google Scholar 

  39. 39.

    Shibata KR, Matsuda S, Safran MR. Arthroscopic hip surgery in the elite athlete: comparison of female and male competitive athletes. Am J Sports Med. 2017;45(8):1730–9. https://doi.org/10.1177/0363546517697296.

    Article  PubMed  Google Scholar 

  40. 40.

    Gold GE, Cicuttini F, Crema MD, Eckstein F, Guermazi A, Kijowski R, et al. OARSI clinical trials recommendations: hip imaging in clinical trials in osteoarthritis. Osteoarthr Cartil. 2015;23(5):716–31. https://doi.org/10.1016/j.joca.2015.03.004.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. 41.

    Tonnis D, Legal H, Graf R. Congenital dysplasia and dislocation of the hip in children and adults. Berlin: Springer; 1987.

    Google Scholar 

  42. 42.

    Chandrasekaran S, Gui C, Darwish N, Lodhia P, Suarez-Ahedo C, Domb BG. Outcomes of hip arthroscopic surgery in patients with tönnis grade 1 osteoarthritis with a minimum 2-year follow-up: evaluation using a matched-pair analysis with a control group with tönnis grade 0. Am J Sports Med. 2016;44(7):1781–8. https://doi.org/10.1177/0363546516638087.

    Article  PubMed  Google Scholar 

  43. 43.

    Weir A, Rabia S, Ardern C. Trusting systematic reviews and meta-analyses: all that glitters is not gold! Br J Sports Med. 2016;50(18):1100–1. https://doi.org/10.1136/bjsports-2015-095896.

    Article  PubMed  Google Scholar 

  44. 44.

    Higgins J, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration; 2011. http://handbook.cochrane.org. Accessed 14 May 2018.

  45. 45.

    Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60. https://doi.org/10.1136/bmj.327.7414.557.

    Article  PubMed  PubMed Central  Google Scholar 

  46. 46.

    Rathleff MS, Rathleff CR, Crossley KM, Barton CJ. Is hip strength a risk factor for patellofemoral pain? A systematic review and meta-analysis. Br J Sports Med. 2014;48(14):1088. https://doi.org/10.1136/bjsports-2013-093305.

    Article  CAS  PubMed  Google Scholar 

  47. 47.

    van Tulder M, Furlan A, Bombardier C, Bouter L. Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine. 2003;28(12):1290–9. https://doi.org/10.1097/01.brs.0000065484.95996.af.

    Article  PubMed  Google Scholar 

  48. 48.

    Ayeni OR, Banga K, Bhandari M, Maizlin Z, Golev D, et al. Femoroacetabular impingement in elite ice hockey players. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):920–5. https://doi.org/10.1007/s00167-013-2598-5.

    Article  PubMed  Google Scholar 

  49. 49.

    Kapron AL, Anderson AE, Aoki SK, Phillips LG, Petron DJ, Toth R, et al. Radiographic prevalence of femoroacetabular impingement in collegiate football players. J Bone Jt Surg Am. 2011;93(19):e111(1–10). https://doi.org/10.2106/jbjs.K.00544.

    Article  Google Scholar 

  50. 50.

    Kolo FC, Charbonnier C, Pfirrmann CWA, Duc SR, Lubbeke A, Duthon VB, et al. Extreme hip motion in professional ballet dancers: dynamic and morphological evaluation based on magnetic resonance imaging. Skelet Radiol. 2013;42(5):689–98. https://doi.org/10.1007/s00256-012-1544-9.

    Article  Google Scholar 

  51. 51.

    Mariconda M, Cozzolino A, Di Pietto F, Ribas M, Bellotti V, Soldati A. Radiographic findings of femoroacetabular impingement in capoeira players. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):874–81. https://doi.org/10.1007/s00167-014-2850-7.

    Article  PubMed  Google Scholar 

  52. 52.

    Mayes S, Ferris AR, Smith P, Garnham A, Cook J. Atraumatic tears of the ligamentum teres are more frequent in professional ballet dancers than a sporting population. Skelet Radiol. 2016;45(7):959–67. https://doi.org/10.1007/s00256-016-2379-6.

    Article  Google Scholar 

  53. 53.

    Yépez AK, Abreu M, Germani B, Galia CR. Prevalence of femoroacetabular impingement morphology in asymptomatic youth soccer players: magnetic resonance imaging study with clinical correlation. Rev Bras Ortop. 2017;52:14–20. https://doi.org/10.1016/j.rboe.2017.06.005.

    Article  PubMed  PubMed Central  Google Scholar 

  54. 54.

    Anderson L, Anderson M, Kapron A, Aoki S, Erickson J, Chrastil J, et al. Radiographic abnormalities common in senior athletes with well-functioning hips but not associated with osteoarthritis. Clin Orthop Relat Res. 2016;474(2):342–52. https://doi.org/10.1007/s11999-015-4379-6.

    Article  PubMed  Google Scholar 

  55. 55.

    Farrell G, McGrath F, Hogan B, Logan M, Denvir K, O’Connell B, et al. 95% prevalence of abnormality on hip MRI in elite academy level rugby union: a clinical and imaging study of hip disorders. J Sci Med Sport. 2016;19(11):893–7. https://doi.org/10.1016/j.jsams.2016.01.005.

    Article  PubMed  Google Scholar 

  56. 56.

    Lahner M, Bader S, Walter PA, Duif C, von Schulze Pellengahr C, Lukas C, et al. Prevalence of femoro-acetabular impingement in international competitive track and field athletes. Int Orthop. 2014;38(12):2571–6. https://doi.org/10.1007/s00264-014-2486-8.

    Article  PubMed  Google Scholar 

  57. 57.

    Lahner M, Walter PA, von Schulze Pellengahr C, Hagen M, von Engelhardt LV, Lukas C. Comparative study of the femoroacetabular impingement (FAI) prevalence in male semiprofessional and amateur soccer players. Arch Orthop Trauma Surg. 2014;134(8):1135–41. https://doi.org/10.1007/s00402-014-2008-6.

    Article  PubMed  Google Scholar 

  58. 58.

    Philippon MJ, Ho CP, Briggs KK, Stull J, Laprade RF. Prevalence of increased alpha angles as a measure of cam-type femoroacetabular impingement in youth ice hockey players. Am J Sports Med. 2013;41(6):1357–62. https://doi.org/10.1177/0363546513483448.

    Article  PubMed  Google Scholar 

  59. 59.

    Silvis ML, Mosher TJ, Smetana BS, Chinchilli VM, Flemming DJ, Walker EA, et al. High prevalence of pelvic and hip magnetic resonance imaging findings in asymptomatic collegiate and professional hockey players. Am J Sports Med. 2011;39(4):715–21. https://doi.org/10.1177/0363546510388931.

    Article  PubMed  Google Scholar 

  60. 60.

    Yuan BJ, Bartelt RB, Levy BA, Bond JR, Trousdale RT, Sierra RJ. Decreased range of motion is associated with structural hip deformity in asymptomatic adolescent athletes. Am J Sports Med. 2013;41(7):1519–25. https://doi.org/10.1177/0363546513488748.

    Article  PubMed  Google Scholar 

  61. 61.

    Narvani AA, Tsiridis E, Kendall S, Chaudhuri R, Thomas P. A preliminary report on prevalence of acetabular labrum tears in sports patients with groin pain. Knee Surg Sports Traumatol Arthrosc. 2003;11(6):403–8. https://doi.org/10.1007/s00167-003-0390-7.

    Article  CAS  PubMed  Google Scholar 

  62. 62.

    Nepple JJ, Brophy RH, Matava MJ, Wright RW, Clohisy JC. Radiographic findings of femoroacetabular impingement in national football league combine athletes undergoing radiographs for previous hip or groin pain. Arthroscopy. 2012;28(10):1396–403. https://doi.org/10.1016/j.arthro.2012.03.005.

    Article  PubMed  Google Scholar 

  63. 63.

    Harris JD, Gerrie BJ, Varner KE, Lintner DM, McCulloch PC. Radiographic prevalence of dysplasia, cam, and pincer deformities in elite ballet. Am J Sports Med. 2016;44(1):20–7. https://doi.org/10.1177/0363546515601996.

    Article  PubMed  Google Scholar 

  64. 64.

    Larson CM, Ross JR, Kuhn AW, Fuller D, Rowley DM, Giveans MR, et al. Radiographic hip anatomy correlates with range of motion and symptoms in national hockey league players. Am J Sports Med. 2017;45(7):1633–9. https://doi.org/10.1177/0363546517692542.

    Article  PubMed  Google Scholar 

  65. 65.

    Mayes S, Ferris AR, Smith P, Garnham A, Cook J. Similar prevalence of acetabular labral tear in professional ballet dancers and sporting participants. Clin J Sports Med. 2016;26(4):307–13. https://doi.org/10.1097/JSM.0000000000000257.

    Article  Google Scholar 

  66. 66.

    Mayes S, Ferris AR, Smith P, Garnham A, Cook J. Professional ballet dancers have a similar prevalence of articular cartilage defects compared to age- and sex-matched non-dancing athletes. Clin Rheumatol. 2016;35(12):3037–43. https://doi.org/10.1007/s10067-016-3389-4.

    Article  PubMed  Google Scholar 

  67. 67.

    Dickenson E, O’Connor P, Robinson P, Campbell R, Ahmed I, Fernandez M, et al. Hip morphology in elite golfers: asymmetry between lead and trail hips. Br J Sports Med. 2016;50(17):1081–6. https://doi.org/10.1136/bjsports-2016-096007.

    Article  PubMed  Google Scholar 

  68. 68.

    Feeley BT, Powell JW, Muller MS, Barnes RP, Warren RF, Kelly BT. Hip injuries and labral tears in the national football league. Am J Sports Med. 2008;36(11):2187–95. https://doi.org/10.1177/0363546508319898.

    Article  PubMed  Google Scholar 

  69. 69.

    Lewis CL, Sahrmann SA. Acetabular labral tears. Phys Ther. 2006;86(1):110–21.

    Article  PubMed  Google Scholar 

  70. 70.

    Epstein DM, McHugh M, Yorio M, Neri B. Intra-articular hip injuries in national hockey league players: a descriptive epidemiological study. Am J Sports Med. 2013;41(2):343–8. https://doi.org/10.1177/0363546512467612.

    Article  PubMed  Google Scholar 

  71. 71.

    Kumar D, Wyatt CR, Lee S, Nardo L, Link TM, Majumdar S, et al. Association of cartilage defects, and other MRI findings with pain and function in individuals with mild-moderate radiographic hip osteoarthritis and controls. Osteoarthr Cartil. 2013;21(11):1685–92. https://doi.org/10.1016/j.joca.2013.08.009.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. 72.

    Lee S, Nardo L, Kumar D, Wyatt CR, Souza RB, Lynch J, et al. Scoring hip osteoarthritis with MRI (SHOMRI): a whole joint osteoarthritis evaluation system. J Magn Reson Imaging. 2015;41(6):1549–57. https://doi.org/10.1002/jmri.24722.

    Article  PubMed  Google Scholar 

  73. 73.

    Ayeni OR, Adamich J, Farrokhyar F, Simunovic N, Crouch S, Philippon MJ, et al. Surgical management of labral tears during femoroacetabular impingement surgery: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):756–62. https://doi.org/10.1007/s00167-014-2886-8.

    Article  CAS  PubMed  Google Scholar 

  74. 74.

    Ayeni OR, Alradwan H, de Sa D, Philippon MJ. The hip labrum reconstruction: indications and outcomes—a systematic review. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):737–43. https://doi.org/10.1007/s00167-013-2804-5.

    Article  PubMed  Google Scholar 

  75. 75.

    Forster-Horvath C, von Rotz N, Giordano BD, Domb BG. Acetabular labral debridement/segmental resection versus reconstruction in the comprehensive treatment of symptomatic femoroacetabular impingement: a systematic review. Arthroscopy. 2016;32(11):2401–15. https://doi.org/10.1016/j.arthro.2016.04.035.

    Article  PubMed  Google Scholar 

  76. 76.

    Reiman MP, Peters S, Sylvain J, Hagymasi S, Mather RC, Goode AP. Femoroacetabular impingement surgery allows 74% of athletes to return to the same competitive level of sports participation but their level of performance remains unreported: a systematic review with meta-analysis. Br J Sports Med. 2018;52(15):972–81. https://doi.org/10.1136/bjsports-2017-098696.

    Article  PubMed  Google Scholar 

  77. 77.

    O’Sullivan K, Darlow B, O’Sullivan P, Forster BB, Reiman MP, Weir A. Imaging for hip-related groin pain: don’t be hip-notised by the findings. Br J Sports Med. 2018;52(9):551. https://doi.org/10.1136/bjsports-2017-097889.

    Article  PubMed  Google Scholar 

  78. 78.

    Roemer FW, Hunter DJ, Winterstein A, Li L, Kim YJ, Cibere J, et al. Hip osteoarthritis MRI scoring system (HOAMS): reliability and associations with radiographic and clinical findings. Osteoarthr Cartil. 2011;19(8):946–62. https://doi.org/10.1016/j.joca.2011.04.003.

    Article  CAS  PubMed  Google Scholar 

  79. 79.

    Bennell K, Hunter DJ, Vicenzino B. Long-term effects of sport: preventing and managing OA in the athlete. Nat Rev Rheumatol. 2012;8(12):747–52. https://doi.org/10.1038/nrrheum.2012.119.

    Article  PubMed  Google Scholar 

  80. 80.

    Tveit M, Rosengren BE, Nilsson JA, Karlsson MK. Former male elite athletes have a higher prevalence of osteoarthritis and arthroplasty in the hip and knee than expected. Am J Sports Med. 2012;40(3):527–33. https://doi.org/10.1177/0363546511429278.

    Article  PubMed  Google Scholar 

  81. 81.

    Hunter DJ, Guermazi A, Roemer F, Zhang Y, Neogi T. Structural correlates of pain in joints with osteoarthritis. Osteoarthr Cartil. 2013;21(9):1170–8. https://doi.org/10.1016/j.joca.2013.05.017.

    Article  CAS  PubMed  Google Scholar 

  82. 82.

    Culvenor AG, Oiestad BE, Hart HF, Stefanik JJ, Guermazi A, Crossley KM. Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. Br J Sports Med. 2018. https://doi.org/10.1136/bjsports-2018-099257 (Epub 2018 Jun 9).

    Article  PubMed  Google Scholar 

  83. 83.

    Pereira D, Peleteiro B, Araujo J, Branco J, Santos RA, Ramos E. The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review. Osteoarthr Cartil. 2011;19(11):1270–85. https://doi.org/10.1016/j.joca.2011.08.009.

    Article  CAS  PubMed  Google Scholar 

  84. 84.

    Kim C, Nevitt MC, Niu J, Clancy MM, Lane NE, Link TM, et al. Association of hip pain with radiographic evidence of hip osteoarthritis: diagnostic test study. BMJ. 2015;351:h5983. https://doi.org/10.1136/bmj.h5983.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  85. 85.

    Pollard TC, Gwilym SE, Carr AJ. The assessment of early osteoarthritis. J Bone Jt Surg Br. 2008;90(4):411–21. https://doi.org/10.1302/0301-620x.90b4.20284.

    Article  CAS  Google Scholar 

  86. 86.

    Teichtahl AJ, Wang Y, Smith S, Wluka AE, Giles GG, Bennell KL, et al. Structural changes of hip osteoarthritis using magnetic resonance imaging. Arthritis Res Ther. 2014;16(5):466. https://doi.org/10.1186/s13075-014-0466-4.

    Article  PubMed  PubMed Central  Google Scholar 

  87. 87.

    Haversath M, Hanke J, Landgraeber S, Herten M, Zilkens C, Krauspe R, et al. The distribution of nociceptive innervation in the painful hip: a histological investigation. Bone Jt J. 2013;95-B(6):770–6. https://doi.org/10.1302/0301-620x.95b6.30262.

    Article  CAS  Google Scholar 

  88. 88.

    Gerhardt M, Johnson K, Atkinson R, Snow B, Shaw C, Brown A, et al. Characterisation and classification of the neural anatomy in the human hip joint. Hip Int. 2012;22(1):75–81. https://doi.org/10.5301/hip.2012.9042.

    Article  PubMed  Google Scholar 

  89. 89.

    Martin RL, Palmer I, Martin HD. Ligamentum teres: a functional description and potential clinical relevance. Knee Surg Sports Traumatol Arthrosc. 2012;20(6):1209–14. https://doi.org/10.1007/s00167-011-1663-1.

    Article  PubMed  Google Scholar 

  90. 90.

    van Arkel RJ, Amis AA, Cobb JP, Jeffers JR. The capsular ligaments provide more hip rotational restraint than the acetabular labrum and the ligamentum teres: an experimental study. Bone Jt J. 2015;97-b(4):484–91. https://doi.org/10.1302/0301-620x.97b4.34638.

    Article  Google Scholar 

  91. 91.

    Martin HD, Hatem MA, Kivlan BR, Martin RL. Function of the ligamentum teres in limiting hip rotation: a cadaveric study. Arthroscopy. 2014;30(9):1085–91. https://doi.org/10.1016/j.arthro.2014.04.087.

    Article  PubMed  Google Scholar 

  92. 92.

    Roemer FW, Kassim Javaid M, Guermazi A, Thomas M, Kiran A, Keen R, et al. Anatomical distribution of synovitis in knee osteoarthritis and its association with joint effusion assessed on non-enhanced and contrast-enhanced MRI. Osteoarthr Cartil. 2010;18(10):1269–74. https://doi.org/10.1016/j.joca.2010.07.008.

    Article  CAS  PubMed  Google Scholar 

  93. 93.

    Ahedi HG, Aitken DA, Blizzard LC, Ding CH, Cicuttini FM, Jones G. Correlates of hip cartilage defects: a cross-sectional study in older adults. J Rheumatol. 2016;43(7):1406–12. https://doi.org/10.3899/jrheum.151001.

    Article  PubMed  Google Scholar 

  94. 94.

    Domb BG, Jackson TJ, Carter CC, Jester JR, Finch NA, Stake CE. Magnetic resonance imaging findings in the symptomatic hips of younger retired national football league players. Am J Sports Med. 2014;42(7):1704–9. https://doi.org/10.1177/0363546514531551.

    Article  PubMed  Google Scholar 

  95. 95.

    Dickenson E, Wall PD, Robinson B, Fernandez M, Parsons H, Buchbinder R, et al. Prevalence of cam hip shape morphology: a systematic review. Osteoarthr Cartil. 2016;24(6):949–61. https://doi.org/10.1016/j.joca.2015.12.020.

    Article  CAS  PubMed  Google Scholar 

  96. 96.

    Mosler AB, Crossley KM, Waarsing JH, Jomaah N, Weir A, Holmich P, et al. Ethnic differences in bony hip morphology in a cohort of 445 professional male soccer players. Am J Sports Med. 2016;44(11):2967–74. https://doi.org/10.1177/0363546516656163.

    Article  PubMed  Google Scholar 

  97. 97.

    Smith TO, Hilton G, Toms AP, Donell ST, Hing CB. The diagnostic accuracy of acetabular labral tears using magnetic resonance imaging and magnetic resonance arthrography: a meta-analysis. Eur Radiol. 2011;21(4):863–74. https://doi.org/10.1007/s00330-010-1956-7.

    Article  PubMed  Google Scholar 

  98. 98.

    Reiman MP, Thorborg K, Goode AP, Cook CE, Weir A, Holmich P. Diagnostic accuracy of imaging modalities and injection techniques for the diagnosis of femoroacetabular impingement/labral tear. Am J Sports Med. 2017;45(11):2665–77. https://doi.org/10.1177/0363546516686960.

    Article  PubMed  Google Scholar 

  99. 99.

    Saied AM, Redant C, El-Batouty M, El-Lakkany MR, El-Adl WA, Anthonissen J, et al. Accuracy of magnetic resonance studies in the detection of chondral and labral lesions in femoroacetabular impingement: systematic review and meta-analysis. BMC Musculoskelet Disord. 2017;18:83. https://doi.org/10.1186/s12891-017-1443-2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  100. 100.

    Smith TO, Simpson M, Ejindu V, Hing CB. The diagnostic test accuracy of magnetic resonance imaging, magnetic resonance arthrography and computer tomography in the detection of chondral lesions of the hip. Eur J Orthop Surg Traumatol. 2013;23(3):335–44. https://doi.org/10.1007/s00590-012-0972-5.

    Article  PubMed  Google Scholar 

  101. 101.

    Linda DD, Naraghi A, Murnaghan L, Whelan D, White LM. Accuracy of non-arthrographic 3T MR imaging in evaluation of intra-articular pathology of the hip in femoroacetabular impingement. Skelet Radiol. 2017;46(3):299–308. https://doi.org/10.1007/s00256-016-2551-z.

    Article  Google Scholar 

  102. 102.

    Schleich C, Hesper T, Hosalkar HS, Rettegi F, Zilkens C, Krauspe R, et al. 3D double-echo steady-state sequence assessment of hip joint cartilage and labrum at 3 Tesla: comparative analysis of magnetic resonance imaging and intraoperative data. Eur Radiol. 2017;27(10):4360–71. https://doi.org/10.1007/s00330-017-4834-8.

    Article  PubMed  Google Scholar 

  103. 103.

    Crossley KM, Pandy MG, Majumdar S, Smith AJ, Agricola R, Semciw AI, et al. Femoroacetabular impingement and hip OsteoaRthritis Cohort (FORCe): protocol for a prospective study. J Physiother. 2018;64(1):55. https://doi.org/10.1016/j.jphys.2017.10.004.

    Article  PubMed  Google Scholar 

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JJH, JLK, ABM, DMJ, TP, MJS, RA and KMC were responsible for the creation and planning of the review. JJH and JLK were responsible for the search strategy utilised. JJH, JLK and DMJ developed the strategy to evaluate study quality. JJH, ABM and KMC were involved in the data extraction process. JJH wrote the final manuscript, with all authors assisting in revising content.

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Correspondence to Kay M. Crossley.

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Joshua J. Heerey, Joanne L. Kemp, Andrea B. Mosler, Denise M. Jones, Tania Pizzari, Mark J. Scholes and Rintje Agricola declare they have no competing interests. Kay Crossley is a recipient of an NHMRC (National Health and Medical Research Council; Australia) Project Grant (GNT1088683), which provided funding to support this research.


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The original version of this article was revised due to a Figures 2 and 3 interchange.

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Heerey, J.J., Kemp, J.L., Mosler, A.B. et al. What is the Prevalence of Hip Intra-Articular Pathologies and Osteoarthritis in Active Athletes with Hip and Groin Pain Compared with Those Without? A Systematic Review and Meta-Analysis. Sports Med 49, 951–972 (2019). https://doi.org/10.1007/s40279-019-01092-y

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