The diagnosis of hip joint pathology is complicated by the high incidence of hip joint pathology (including articular cartilage defects and labral changes). This is important as the presence of radiological findings is often concerning for a patient and can be the ‘catalyst’ for surgical intervention. A recent systematic review and meta-analysis has evaluated the incidence of these changes (on imaging studies) in individuals with and without hip pain.1
A total of 29 studies were included (2573 participants and 4410 hips) in this review. The quality and methodology used in these studies was variable which does impact the review’s findings. For example a range of imaging modalities, including MRI, MRA and CT imaging was used to diagnose hip pathology. Despite this the review does present some clinically useful findings.
Consistent with previous studies, labral tears were common in both patient groups, limiting the usefulness of this radiological finding. Labral tears were seen in 62% of individuals who had a painful hip and in 54% of those with asymptomatic hips. Herniation pits (seen in association with FAI) and paralabral cysts were also seen at similar rates in those with and without pain.
The presence of an articular cartilage defect was far more likely to be associated with hip pain and as a result may be a more useful finding. A total of 64% of symptomatic individuals had a cartilage lesion as compared with 12% of asymptomatic individuals. Ligamentum teres tears and bone marrow lesions were also more common in those with symptomatic hips.
The results of this study illustrate that labral tears are common in patients who do not have hip pain. This is an important consideration when treating a player with groin pain. It is important that the player understands that this is a common incidental findings and that this radiological finding is correlated with the general picture. In contrast the presence of an articular cartilage defect, bone marrow lesion or ligamentum teres tear might be more significant. Again clinical correlation is clearly needed.
1.Heerey JJ, Kemp JL, Mosler AB et al. What is the prevalence of imaging-defined intra-articular hip pathologies in people with and without pain? A systematic review and meta-analysis. Br J Sports Med 2018;52:581-593.