Femoroacetabular impingement syndrome and labral injuries: grading the evidence on diagnosis and non-operative treatment—a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF)

Abstract

This statement summarises and appraises the evidence on diagnostic tests and clinical information, and non-operative treatment of femoroacetabular impingement (FAI) syndrome and labral injuries. We included studies based on the highest available level of evidence as judged by study design. We evaluated the certainty of evidence using the Grading of Recommendations Assessment Development and Evaluation framework. We found 29 studies reporting 23 clinical tests and 14 different forms of clinical information, respectively. Restricted internal hip rotation in 0° hip flexion with or without pain was best to rule in FAI syndrome (low diagnostic effectiveness; low quality of evidence; interpretation of evidence: may increase post-test probability slightly), whereas no pain in Flexion Adduction Internal Rotation test or no restricted range of motion in Flexion Abduction External Rotation test compared with the unaffected side were best to rule out (very low to high diagnostic effectiveness; very low to moderate quality of evidence; interpretation of evidence: very uncertain, but may reduce post-test probability slightly). No forms of clinical information were found useful for diagnosis. For treatment of FAI syndrome, 14 randomised controlled trials were found. Prescribed physiotherapy, consisting of hip strengthening, hip joint manual therapy techniques, functional activity-specific retraining and education showed a small to medium effect size compared with a combination of passive modalities, stretching and advice (very low to low quality of evidence; interpretation of evidence: very uncertain, but may slightly improve outcomes). Prescribed physiotherapy was, however, inferior to hip arthroscopy (small effect size; moderate quality of evidence; interpretation of evidence: hip arthroscopy probably increases outcome slightly). For both domains, the overall quality of evidence ranged from very low to moderate indicating that future research on diagnosis and treatment may alter the conclusions from this review.

Pain provocation tests and clinical entities in male football players with longstanding groin pain are associated with pain intensity and disability

“…Supporting this, each clinical entity seems to have distinct anatomical representations in patients with only one type of clinical entity (Serner et al, 2022). However, clear relationships between tissue injuries/pathology and longstanding groin pain classified into clinical entities using pain provocation tests are still lacking (Drew et al, 2014;Ishøi et al, 2021). Furthermore, the associations between longstanding groin pain and abnormal radiological findings lack robustness, temporal validity, and consistency (Branci et al, 2013Heerey et al, 2020;Massa et al, 2020;Paajanen et al, 2019;Robinson et al, 2015;Saito et al, 2021;Serner et al, 2021;Tsukada et al, 2018).…”

The Effect of a Formal Nonoperative Management Program Combining a Hip Injection With Structured Adjunctive Exercise Rehabilitation in Patients With Symptomatic Femoroacetabular Impingement Syndrome

“…18 A recent Danish Society of Sports Physical Therapy statement reported that physical therapy demonstrated a small to medium effect size as compared with passive modalities in patients with symptoms associated with FAIS and labral injuries; however, physical therapy was inferior to hip arthroscopy (although the quality of evidence for either was very low to moderate). 13 This was supported by Griffin et al, 10 who found that hip arthroscopy led to greater improvement at 12 months than nonoperative management in patients with FAIS. Nonetheless, a systematic review and meta-analysis revealed that despite the lack of high-quality randomized controlled trials (RCTs), physical therapist-led interventions (of 3 months) may improve pain and function in young and middle-aged adults with hip-related pain.…”

First-line treatment for femoroacetabular impingement syndrome and hip-related quality of life: study protocol for a multicentre randomised controlled trial comparing a 6-month supervised strength exercise intervention to usual care (the Better Hip Trial)

“…2 The radiographic findings include cam, pincer or mixed morphology, and these morphological changes, especially cam, may lead to labral and cartilage lesions, and subsequently early hip osteoarthritis. [1][2][3][4][5][6][7][8] Furthermore, it is increasingly recognised that FAIS might account for previously undiagnosed hip pain in young adults. 5 9 Patients with FAIS usually present with hip pain, limiting activities of daily living, sports participation and hip-related quality of life (QoL).…”