title: Radiographic evidence of femoroacetabular impingement in athletes with athletic pubalgia.
abstract: BACKGROUND
  Two of the most common causes of groin pain in athletes are femoroacetabular impingement (FAI) and athletic pubalgia. An association between the 2 is apparent, but the prevalence of radiographic signs of FAI in patients undergoing athletic pubalgia surgery remains unknown. The purpose of this study was to determine the prevalence of radiologic signs of FAI in patients with athletic pubalgia.
  
  
  OBJECTIVE
  We hypothesized that patients with athletic pubalgia would have a high prevalence of underlying FAI.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Level 4.
  
  
  METHODS
  A retrospective review of all patients evaluated at our institution with athletic pubalgia who underwent surgical treatment (ie, for sports hernia) from 1999 to 2011 was performed. The radiographs of patients with athletic pubalgia were reviewed for radiographic signs of FAI. Alpha angles were measured using frog-leg lateral radiographs. Pincer lesions were identified by measuring the lateral center-edge angle and identifying the presence of a "crossover" sign on anteroposterior radiographs. Phone follow-up was performed 2 years or more after the initial sports hernia surgery to evaluate recurrent symptoms.
  
  
  RESULTS
  Forty-three patients underwent 56 athletic pubalgia surgeries. Radiographic evidence of FAI was identified in at least 1 hip in 37 of 43 patients (86%). Cam lesions were identified in 83.7% of the population; the alpha angle averaged 66.7° ± 17.9° for all hips. Pincer lesions were present in 28% of the hips. Eight patients had recurrent groin pain, 3 patients had revision athletic pubalgia surgery, and 1 had hip arthroscopy.
  
  
  CONCLUSIONS
  The study demonstrates a high prevalence of radiographic FAI in patients with athletic pubalgia.
  
  
  CONCLUSIONS
  Underlying FAI may be a cause of continued groin pain after athletic pubalgia surgery. Patients with athletic pubalgia should be evaluated closely for FAI.
authors.affiliation: The Orthopedic Clinic Association, Phoenix, Arizona.
authors.forename: Kostas J
authors.initials: KJ
authors.lastname: Economopoulos
authors.affiliation: Elite Sports Medicine, Connecticut Children's Medical Center, Farmington, Connecticut.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Milewski
authors.affiliation: Department of General Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: John B
authors.initials: JB
authors.lastname: Hanks
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Hart
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: David R
authors.initials: DR
authors.lastname: Diduch
keywords: alpha angle; athletic pubalgia; center-edge angle; femoroacetabular impingement; sports hernia