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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)
  1. Lasse Ishøi1,
  2. Mathias Fabricius Nielsen1,
  3. Kasper Krommes1,
  4. Rasmus Skov Husted2,3,
  5. Per Hölmich1,
  6. Lisbeth Lund Pedersen4,
  7. Kristian Thorborg1
  1. 1 Sports Orthopaedic Research Center–Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
  2. 2 Physical Medicine & Rehabilitation Research – Copenhagen (PMR-C), Department of Orthopedic Surgery and Physical Therapy, Copenhagen University Hospital, Hvidovre, Denmark
  3. 3 Department of Clinical Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
  4. 4 Danish Society of Sports Physical Therapy, Odense, Denmark
  1. Correspondence to Lasse Ishøi, Hvidovre Hospital, Sports Orthopaedic Research Center–Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark, Kobenhavn, Denmark; lasse.ishoei{at}


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.

  • hip
  • physical therapy modalities
  • diagnosis
  • evidence based review
  • groin

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  • Twitter @LasseIshoei, @Physiomathias, @krommes, @Husted_RS, @KThorborg

  • Contributors LI and KT conceived the study idea. KK performed the systematic searches with input from LI, MFN, KT, RSH, LLP. LI, MFN and RSH conducted risk of bias assessments, while LI and MFN conducted grade assessments. LI wrote the initial draft. All authors revised the draft critically and agreed on the final version.

  • Funding The Danish Society of Sports Physical Therapy initiated the project and provided financial support to authors (LI, RSH, LLP, KT).

  • Competing interests KT is Deputy Editor in BJSM, and have received grants from the Danish Society of Sports Physical Therapy.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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