A Clinician's Guide to Femoacetabular Impingement in Athletes

Femoroacetabular impingement (FAI) is the most common cause of hip pain in both professional and recreational athletes. It is caused by abnormal bone development on both the acetabulum and proximal femur as a result of genetic factors and in reaction to high-volume athletics participation. Athletes typically become symptomatic after reaching skeletal maturity and commonly describe deep groin pain that worsens with activities such as squatting, cutting, or pivoting motions. For this reason, sports such as hockey, football, and soccer can be particularly irritating to an athlete with FAI. Moreover, the athlete with FAI often presents with contaminant hip and pelvis pathologies such as athletic pubalgia and iliopsoas tendinopathy that must also be addressed. While this pain often limits performance or participation in sports, perhaps the most significant ramification of FAI is the role it plays in driving early onset osteoarthritis. Fortunately, FAI can be reliably diagnosed through careful history taking, appropriate provocative physical exam maneuvers, and familiarity with hallmark radiographic features. The aims of this review are to provide clinicians with information regarding the pathogenesis of FAI, to thoroughly describe the classic history and physical exam elements, and to introduce various management strategies for athletes suffering from FAI.