title: Sonographic prevalence of groin hernias and adductor tendinopathy in patients with femoroacetabular impingement.
abstract: BACKGROUND
  Femoroacetabular impingement (FAI) is a common debilitating condition that is associated with groin pain and limitation in young and active patients. Besides FAI, various disorders such as hernias, adductor tendinopathy, athletic pubalgia, lumbar spine affections, and others can cause similar symptoms.
  
  
  OBJECTIVE
  To determine the prevalence of inguinal and/or femoral herniation and adductor insertion tendinopathy using dynamic ultrasound in a cohort of patients with radiographic evidence of FAI.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  This retrospective study consisted of 74 patients (36 female and 38 male; mean age, 29 years; 83 symptomatic hips) with groin pain and radiographic evidence of FAI. In addition to the usual diagnostic algorithm, all patients underwent a dynamic ultrasound examination for signs of groin herniation and tendinopathy of the proximal insertion of the adductors.
  
  
  RESULTS
  Evidence of groin herniation was found in 34 hips (41%). There were 27 inguinal (6 female, 21 male) and 10 femoral (9 female, 1 male) hernias. In 3 cases, inguinal and femoral herniation was coexistent. Overall, 5 patients underwent subsequent hernia repair. Patients with groin herniation were significantly older than those without (33 vs 27 years, respectively; P = .01). There were no significant differences for any of the radiographic or clinical parameters. Tendinopathy of the proximal adductor insertion was detected in 19 cases (23%; 11 female, 8 male). Tendinopathy was coexistent with groin herniation in 8 of the 19 cases. There were no significant differences for any of the radiographic or clinical parameters between patients with or without tendinopathy. Patients with a negative diagnostic hip injection result were more likely to have a concomitant groin hernia than those with a positive injection result (80% vs 27%, respectively). Overall, 38 hips underwent FAI surgery with satisfactory outcomes in terms of score values and subjective improvement.
  
  
  CONCLUSIONS
  The results demonstrate that groin herniation and adductor insertion tendinopathy coexist frequently in patients with FAI. Although the clinical effect is yet unclear, 5 patients underwent hernia repair. Dynamic ultrasound is a useful tool to detect such pathological abnormalities. Diagnostic hip injections can be helpful to differentiate between the sources of pain.
authors.affiliation: Department of Orthopaedic Surgery, Schulthess Clinic, Zurich, Switzerland Department of Orthopaedic Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany florian.naal@gmail.com.
authors.forename: Florian D
authors.initials: FD
authors.lastname: Naal
authors.affiliation: Department of Orthopaedic Surgery, Schulthess Clinic, Zurich, Switzerland.
authors.forename: Francesco
authors.initials: F
authors.lastname: Dalla Riva
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Wuerz
authors.affiliation: Sonografie-Institut Glattpark GmbH, Zurich, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Dubs
authors.affiliation: Department of Orthopaedic Surgery, Schulthess Clinic, Zurich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Leunig
mesh_terms: D015746:Abdominal Pain / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D057925:Femoracetabular Impingement / Q000000981:diagnostic imaging* / Q000601:surgery; D006119:Groin / Q000601:surgery; D006552:Hernia, Inguinal / Q000000981:diagnostic imaging* / Q000601:surgery; D059685:Herniorrhaphy / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010808:Physical Examination / Q000379:methods; D012189:Retrospective Studies; D013177:Sports / Q000502:physiology; D052256:Tendinopathy / Q000000981:diagnostic imaging* / Q000601:surgery; D014463:Ultrasonography
keywords: FAI; adductor tendinopathy; diagnostic hip injection; femoroacetabular impingement; groin pain; hernia