Correlation between the presence of herniation pit and femoroacetabular impingement: a systematic review and meta-analysis

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PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the correlation between the incidence of herniation pits (HPs) and femoroacetabular impingement (FAI)-related morphologies. METHODS: A systematic search of the MEDLINE, EMBASE, and Cochrane Library databases was performed for studies evaluating the relationship between the incidence of HPs and FAI-related morphologies published up to August 16, 2019. Subgroup analyses were also performed to determine the differences in the relationship between the presence/absence of hip symptoms and cam-/pincer-type FAI. RESULTS: Seven studies involving 7950 hips were included. The pooled odds ratio (OR) for the incidence of HPs in the presence of an FAI-related morphology was 1.64 (95% confidence interval [CI] = 1.09-2.46; P = 0.02). In the subgroup analyses, the ORs for the incidence of HPs in the symptomatic and asymptomatic hips were 1.00 (95% CI 0.40-2.51; P = 1.00) and 1.59 (95% CI 1.42-1.77; P < 0.0001), respectively; the ORs for the incidence of HPs in the cam- and pincer-type FAI were 1.61 (95% CI 1.43-1.81; P < 0.0001) and 1.42 (95% CI 0.77-2.61; P = n.s.), respectively. CONCLUSIONS: The incidence of HPs has a significant relationship with FAI-related morphology, especially in asymptomatic patients and those with cam-type FAI morphology. LEVEL OF EVIDENCE: III.