Femoroacetabular impingement in sports medicine: a narrative review

Abstract

Femoroacetabular impingement (FAI) is a pathomechanical process of the hip, which can occur in every individual but has a higher prevalence in physically active subjects such as athletes. It is mainly due to bony deformities at the proximal femur and/or acetabulum in conjunction with rigorous or supraphysiological hip ranges of motion. FAI may lead to chondrolabral lesions, hip pain and development of early hip osteoarthritis. Symptomatic FAI patients may present functional limitations during daily activities and sports, reduced hip muscle strength as well as hip joint kinematic and kinetic alterations during weight-bearing activities. Hip surgery whether open or arthroscopic is currently the mainstay for the management of symptomatic FAI. It consists of the treatment of FAI-related intra-articular pathologies, such as acetabular labral tears and articular cartilage lesions, and the surgical correction of the underlying bony deformities. Hip surgery demonstrated to reduce hip pain and improve hip function of symptomatic FAI patients in most case series. In addition, relatively high rates of return to sport were reported for FAI athletes after hip surgery. Nevertheless, incomplete recovery of hip muscle strength and hip joint kinematics and kinetics during functional tasks were shown after hip surgery for FAI. Non-surgical treatments aimed at restoring normal hip muscle and physical function have not been considered as a valid alternative to hip surgery for the management of symptomatic FAI so far. Future research should propose standardized physical therapy protocols for the non-surgical management of symptomatic FAI, and investigate their effectiveness in reducing hip pain and improving hip function. In addition, randomized controlled trials should compare surgical with non-surgical treatments for FAI so as to provide knowledge about the optimal conditions and time point for hip surgery.