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Evaluating the Association Between Core Muscle Injury Symptom Pattern and Concomitant Femoroacetabular Impingement

Allison R Garden1,2, Andrea M E Palazzolo Ray1, Adam Alakhras1

  • 1Indiana University School of Medicine, Department of Orthopaedic Surgery, Indianapolis, Indiana, USA.

Orthopaedic Journal of Sports Medicine
|April 10, 2026
PubMed
Summary

Femoroacetabular impingement (FAI) morphology is highly prevalent in athletes with core muscle injury (CMI). Symptomatic FAI is more common in athletes with isolated adductor longus (AL) symptoms than combined rectus abdominis-adductor longus (RA-AL) symptoms.

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athletic pubalgiacore muscle injuryfemoroacetabular impingementsports hernia

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Area of Science:

  • Orthopedics
  • Sports Medicine
  • Athletic Training

Background:

  • Femoroacetabular impingement (FAI) morphology may predispose athletes to core muscle injury (CMI) due to abnormal loading of the adductor-rectus abdominis (RA) aponeurosis.
  • The relationship between FAI morphology and CMI, specifically comparing combined RA-AL symptoms versus isolated AL symptoms, requires further investigation.

Purpose of the Study:

  • To determine if athletes with CMI presenting with combined RA-AL symptoms have a different prevalence of FAI syndrome (FAIS) compared to those with isolated AL symptoms.
  • To assess if the prevalence or severity of FAI morphology differs between these two CMI symptom groups.

Main Methods:

  • A case series design was employed, analyzing data from athletes undergoing surgical treatment for CMI between 2021 and 2025.
  • Athletes were classified into RA-AL or AL symptom groups. FAI status was confirmed by symptomatic impingement morphology and surgical treatment. Radiographic assessments evaluated various FAI parameters.

Main Results:

  • Out of 65 athletes with CMI, 98% exhibited FAI morphology. Symptomatic FAIS prevalence was 38% overall, being lower in the RA-AL group (29%) compared to the AL group (57%) (P = .03).
  • No significant differences were found in radiographic measurements or impingement types between the RA-AL and AL groups.
  • Cam-type morphology was present in 95% of athletes, pincer-type in 40%, and mixed in 38%.

Conclusions:

  • FAI morphology, particularly cam-type, is highly prevalent in athletes with CMI, suggesting a significant role in CMI development.
  • Symptomatic FAI is more prevalent in athletes with isolated AL symptoms than in those with combined RA-AL symptoms.
  • The specific type or severity of radiographic FAI morphology did not correlate with distinct CMI symptom patterns.