Question
A 28 year old male footballer has 9 months of groin pain with deep flexion and a clicking sensation. Flexion, adduction and internal rotation reproduce his pain.
- What is the likely diagnosis and what are the morphological types?
- What imaging and measurements would you request?
- Outline your management.
Answer
Diagnosis and morphology
- Femoroacetabular impingement syndrome with symptoms, signs and imaging findings
- Cam morphology, an aspherical head neck junction, common in young male athletes
- Pincer morphology, acetabular overcoverage from retroversion, coxa profunda or protrusio
- Mixed morphology is most common
- Leads to labral tears and chondral delamination
Imaging and measurements
- AP pelvis and Dunn lateral views
- Alpha angle over about 55 to 60 degrees for cam morphology
- Lateral centre edge angle over 40 degrees, crossover sign and posterior wall sign for pincer morphology
- MRI arthrogram for labral and cartilage damage
- Exclude dysplasia (centre edge angle under 20 to 25 degrees) and arthritis, which predicts poor outcome
Management
- Activity modification and physiotherapy focusing on hip and core strength
- Intra-articular injection for diagnosis
- Arthroscopic osteochondroplasty with labral repair for persistent symptoms without arthritis, which improves outcomes over physiotherapy (FASHIoN, Lancet 2018)
- Surgical dislocation for complex deformity
- Hip replacement for established arthritis
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.