Subscribe to RSS
DOI: 10.1055/s-0045-1805079
Sports-related Hip Injuries

Abstract
Sports-related injuries of the hip joint and surrounding structures are frequently encountered in athletes, encompassing a wide spectrum of osseous, intra-articular, and extra-articular pathologies. Early and accurate detection of typical injury patterns across various sports can expedite recovery. Delayed diagnosis often leads to prolonged return to play and progression of low grade to more severe injuries. These injuries, caused by repetitive stress or acute trauma, include fractures, hip dislocations, and intra-articular abnormalities, such as femoroacetabular impingement, labral tears, cartilage defects, and ligamentum teres tears. Extra-articular pathologies include apophyseal injuries, muscle strains, athletic pubalgia, greater trochanteric pain syndrome, or snapping hip syndrome, all of which can substantially impair athletic performance. Familiarity with hip anatomy and biomechanics, as well as the strengths of different imaging modalities, with magnetic resonance imaging often the preferred choice for many injuries, is essential for an efficient diagnostic work-up of the painful hip and reducing long-term complications.
Keywords
sport injury hip - femoroacetabular impingement - imaging - hip magnetic resonance imaging - return to playPublication History
Article published online:
20 May 2025
© 2025. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Armstrong CG, Gardner DL. Thickness and distribution of human femoral head articular cartilage. Changes with age. Ann Rheum Dis 1977; 36 (05) 407-412
- 2 Tsutsumi M, Nimura A, Akita K. Clinical anatomy of the musculoskeletal system in the hip region. Anat Sci Int 2022; 97 (02) 157-164
- 3 Jawetz ST, Fox MG, Blankenbaker DG. et al; Expert Panel on Musculoskeletal Imaging. ACR Appropriateness Criteria® chronic hip pain: 2022 update. J Am Coll Radiol 2023; 20 (5S): S33-S48
- 4 Schmaranzer F, Kheterpal AB, Bredella MA. Best practices: hip femoroacetabular impingement. AJR Am J Roentgenol 2021; 216 (03) 585-598
- 5 Le J. Snapping hip syndrome: imaging diagnosis. Magn Reson Imaging Clin N Am 2025; 33 (01) 75-82
- 6 Vajapey S, Ghenbot S, Baria MR, Magnussen RA, Vasileff WK. Utility of percutaneous ultrasonic tenotomy for tendinopathies: a systematic review. Sports Health 2021; 13 (03) 258-264
- 7 Baffour FI, Glazebrook KN, Ferrero A. et al. Photon-counting detector CT for musculoskeletal imaging: a clinical perspective. AJR Am J Roentgenol 2023; 220 (04) 551-560
- 8 Henak CR, Abraham CL, Peters CL, Sanders RK, Weiss JA, Anderson AE. Computed tomography arthrography with traction in the human hip for three-dimensional reconstruction of cartilage and the acetabular labrum. Clin Radiol 2014; 69 (10) e381-e391
- 9 Chuang CA, Sheu H, Yang CP. et al. Combined 3-dimensional CT and multidirectional CT arthrography for femoroacetabular impingement and hip lesions: a cross-sectional study comparing imaging and hip arthroscopic surgery findings. Orthop J Sports Med 2023; 11 (01) 23 259671221143459
- 10 Sneag DB, Abel F, Potter HG. et al. MRI advancements in musculoskeletal clinical and research practice. Radiology 2023; 308 (02) e230531
- 11 Sutter R, Zubler V, Hoffmann A. et al. Hip MRI: how useful is intraarticular contrast material for evaluating surgically proven lesions of the labrum and articular cartilage?. AJR Am J Roentgenol 2014; 202 (01) 160-169
- 12 Meier MK, Wagner M, Brunner A. et al. Can gadolinium contrast agents be replaced with saline for direct MR arthrography of the hip? A pilot study with arthroscopic comparison. Eur Radiol 2023; 33 (09) 6369-6380
- 13 Schmaranzer F, Klauser A, Kogler M. et al. Diagnostic performance of direct traction MR arthrography of the hip: detection of chondral and labral lesions with arthroscopic comparison. Eur Radiol 2015; 25 (06) 1721-1730
- 14 Mascarenhas VV, Castro MO, Rego PA. et al. The Lisbon Agreement on femoroacetabular impingement imaging-part 1: overview. Eur Radiol 2020; 30 (10) 5281-5297
- 15 Sutter R, Dietrich TJ, Zingg PO, Pfirrmann CWA. Assessment of femoral antetorsion with MRI: comparison of oblique measurements to standard transverse measurements. AJR Am J Roentgenol 2015; 205 (01) 130-135
- 16 Robertson GA, Wood AM. Femoral neck stress fractures in sport: a current concepts review. Sports Med Int Open 2017; 1 (02) E58-E68
- 17 Hoenig T, Eissele J, Strahl A. et al. Return to sport following low-risk and high-risk bone stress injuries: a systematic review and meta-analysis. Br J Sports Med 2023; 57 (07) 427-432
- 18 Hoenig T, Tenforde AS, Strahl A, Rolvien T, Hollander K. Does magnetic resonance imaging grading correlate with return to sports after bone stress injuries? A systematic review and meta-analysis. Am J Sports Med 2022; 50 (03) 834-844
- 19 Chona DV, Minetos PD, LaPrade CM. et al. Hip dislocation and subluxation in athletes: a systematic review. Am J Sports Med 2022; 50 (10) 2834-2841
- 20 Kellam P, Ostrum RF. Systematic review and meta-analysis of avascular necrosis and posttraumatic arthritis after traumatic hip dislocation. J Orthop Trauma 2016; 30 (01) 10-16
- 21 Kolo FC, Charbonnier C, Pfirrmann CWA. et al. Extreme hip motion in professional ballet dancers: dynamic and morphological evaluation based on magnetic resonance imaging. Skeletal Radiol 2013; 42 (05) 689-698
- 22 Mascarenhas VV, Rego P, Dantas P. et al. Imaging prevalence of femoroacetabular impingement in symptomatic patients, athletes, and asymptomatic individuals: a systematic review. Eur J Radiol 2016; 85 (01) 73-95
- 23 Pettit M, Doran C, Singh Y, Saito M, Sunil Kumar KH, Khanduja V. How does the cam morphology develop in athletes? A systematic review and meta-analysis. Osteoarthritis Cartilage 2021; 29 (08) 1117-1129
- 24 Agricola R, Heijboer MP, Bierma-Zeinstra SMA, Verhaar JAN, Weinans H, Waarsing JH. Cam impingement causes osteoarthritis of the hip: a nationwide prospective cohort study (CHECK). Ann Rheum Dis 2013; 72 (06) 918-923
- 25 Mascarenhas VV, Castro MO, Afonso PD. et al. The Lisbon Agreement on femoroacetabular impingement imaging-part 2: general issues, parameters, and reporting. Eur Radiol 2021; 31 (07) 4634-4651
- 26 Sutter R, Dietrich TJ, Zingg PO, Pfirrmann CWA. How useful is the alpha angle for discriminating between symptomatic patients with cam-type femoroacetabular impingement and asymptomatic volunteers?. Radiology 2012; 264 (02) 514-521
- 27 Sutter R, Dietrich TJ, Zingg PO, Pfirrmann CWA. Femoral antetorsion: comparing asymptomatic volunteers and patients with femoroacetabular impingement. Radiology 2012; 263 (02) 475-483
- 28 Lerch TD, Boschung A, Todorski IAS. et al. Femoroacetabular impingement patients with decreased femoral version have different impingement locations and intra- and extraarticular anterior subspine FAI on 3D-CT-based impingement simulation: implications for hip arthroscopy. Am J Sports Med 2019; 47 (13) 3120-3132
- 29 Schmaranzer F, Kallini JR, Miller PE, Kim YJ, Bixby SD, Novais EN. The effect of modality and landmark selection on MRI and CT femoral torsion angles. Radiology 2020; 296 (02) 381-390
- 30 Kwee RM, Kavanagh EC, Adriaensen MEAPM. Normal anatomical variants of the labrum of the hip at magnetic resonance imaging: a systematic review. Eur Radiol 2013; 23 (06) 1694-1710
- 31 Markhardt BK, Hund S, Rosas HG. et al. Comparison of MRI and arthroscopy findings for transitional zone cartilage damage in the acetabulum of the hip joint. Skeletal Radiol 2024; 53 (07) 1303-1312
- 32 Saddik D, Troupis J, Tirman P, O'Donnell J, Howells R. Prevalence and location of acetabular sublabral sulci at hip arthroscopy with retrospective MRI review. AJR Am J Roentgenol 2006; 187 (05) W507-W511
- 33 Matcuk Jr GR, Price SE, Patel DB, White EA, Cen S. Acetabular labral tear description and measures of pincer and cam-type femoroacetabular impingement and interobserver variability on 3 T MR arthrograms. Clin Imaging 2018; 50: 194-200
- 34 Mayer SW, Skelton A, Flug J. et al. Comparison of 2D, 3D, and radially reformatted MR images in the detection of labral tears and acetabular cartilage injury in young patients. Skeletal Radiol 2021; 50 (02) 381-388
- 35 Lerch TD, Nanavati AK, Heimann AF. et al. Are degenerative findings detected on traction MR arthrography of the hip associated with failure of arthroscopic femoroacetabular impingement surgery?. Eur Radiol 2024; 34 (06) 3555-3565
- 36 Stetzelberger VM, Nishimura H, Hollenbeck JFM. et al. How strong is the ligamentum teres of the hip? A biomechanical analysis. Clin Orthop Relat Res 2024; 482 (09) 1685-1695
- 37 Botser IB, Martin DE, Stout CE, Domb BG. Tears of the ligamentum teres: prevalence in hip arthroscopy using 2 classification systems. Am J Sports Med 2011; 39 (1, Suppl): 117S-125S
- 38 Shakoor D, Farahani SJ, Hafezi-Nejad N. et al. Lesions of ligamentum teres: diagnostic performance of MRI and MR arthrography—a systematic review and meta-analysis. AJR Am J Roentgenol 2018; 211 (01) W52-W63
- 39 Stetzelberger VM, Zurmühle CA, Hanauer M. et al. Reliability and reproducibility of a novel grading system for lesions of the ligamentous-fossa-foveolar complex in young patients undergoing open hip preservation surgery. Orthop J Sports Med 2022; 10 (06) 23 259671221098750
- 40 Grissom LE, Harty MP, Guo GW, Kecskemethy HH. Maturation of pelvic ossification centers on computed tomography in normal children. Pediatr Radiol 2018; 48 (13) 1902-1914
- 41 Calderazzi F, Nosenzo A, Galavotti C, Menozzi M, Pogliacomi F, Ceccarelli F. Apophyseal avulsion fractures of the pelvis. A review. Acta Biomed 2018; 89 (04) 470-476
- 42 Roedl JB, Morrison WB, Ciccotti MG, Zoga AC. Acromial apophysiolysis: superior shoulder pain and acromial nonfusion in the young throwing athlete. Radiology 2015; 274 (01) 201-209
- 43 Eberbach H, Hohloch L, Feucht MJ, Konstantinidis L, Südkamp NP, Zwingmann J. Operative versus conservative treatment of apophyseal avulsion fractures of the pelvis in the adolescents: a systematical review with meta-analysis of clinical outcome and return to sports. BMC Musculoskelet Disord 2017; 18 (01) 162
- 44 Grassi A, Quaglia A, Canata GL, Zaffagnini S. An update on the grading of muscle injuries: a narrative review from clinical to comprehensive systems. Joints 2016; 4 (01) 39-46
- 45 Patel A, Chakraverty J, Pollock N, Chakraverty R, Suokas AK, James SL. British athletics muscle injury classification: a reliability study for a new grading system. Clin Radiol 2015; 70 (12) 1414-1420
- 46 Kumaravel M, Bawa P, Murai N. Magnetic resonance imaging of muscle injury in elite American football players: predictors for return to play and performance. Eur J Radiol 2018; 108: 155-164
- 47 van der Made AD, Almusa E, Whiteley R. et al. Intramuscular tendon involvement on MRI has limited value for predicting time to return to play following acute hamstring injury. Br J Sports Med 2018; 52 (02) 83-88
- 48 Isern-Kebschull J, Mechó S, Pedret C. et al. Muscle healing in sports injuries: MRI findings and proposed classification based on a single institutional experience and clinical observation. Radiographics 2024; 44 (08) e230147
- 49 De Maeseneer M, Forsyth R, Provyn S. et al. MR imaging-anatomical-histological evaluation of the abdominal muscles, aponeurosis, and adductor tendon insertions on the pubic symphysis: a cadaver study. Eur J Radiol 2019; 118: 107-113
- 50 Verrall GM, Slavotinek JP, Fon GT. Incidence of pubic bone marrow oedema in Australian rules football players: relation to groin pain. Br J Sports Med 2001; 35 (01) 28-33
- 51 Calcei JG, Safran MR. Evaluation of athletes with hip pain. Clin Sports Med 2021; 40 (02) 221-240
- 52 Long SS, Surrey DE, Nazarian LN. Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis. AJR Am J Roentgenol 2013; 201 (05) 1083-1086
- 53 Cvitanic O, Henzie G, Skezas N, Lyons J, Minter J. MRI diagnosis of tears of the hip abductor tendons (gluteus medius and gluteus minimus). AJR Am J Roentgenol 2004; 182 (01) 137-143
- 54 Gazendam A, Ekhtiari S, Axelrod D. et al. Comparative efficacy of nonoperative treatments for greater trochanteric pain syndrome: a systematic review and network meta-analysis of randomized controlled trials. Clin J Sport Med 2022; 32 (04) 427-432
- 55 Vanhegan IS, Dala-Ali B, Verhelst L, Mallucci P, Haddad FS. The Morel-Lavallée lesion as a rare differential diagnosis for recalcitrant bursitis of the knee: case report and literature review. Case Rep Orthop 2012; 2012 (01) 593193
- 56 Bansal A, Bhatia N, Singh A, Singh AK. Doxycycline sclerodesis as a treatment option for persistent Morel-Lavallée lesions. Injury 2013; 44 (01) 66-69
- 57 Lee KS, Rosas HG, Phancao JP. Snapping hip: imaging and treatment. Semin Musculoskelet Radiol 2013; 17 (03) 286-294
- 58 Sugrañes J, Jackson GR, Warrier AA, Allahabadi S, Chahla J. Snapping hip syndrome: pathoanatomy, diagnosis, nonoperative therapy, and current concepts in operative management. JBJS Rev 2023; 11 (06) e23
- 59 Hwang A, Martinez M, Cora Jones CM, Giordano B. Multifid iliopsoas tendons are more common in patients with painful snapping iliopsoas tendons. Arthrosc Sports Med Rehabil 2023; 5 (05) 100780
- 60 Kim CH, Lee SK, Kim JH, Yoon PW. External snapping hip: classification based on magnetic resonance imaging features and clinical correlation. Hip Int 2022; 32 (01) 118-123