The Femoral Head Divot Sign: A Useful Arthroscopic Sign of Hip Microinstability
Authors: Rosinsky PJ, Mayo BC, Kyin C, Shapira J, Maldonado DR, Meghpara MB, Lall AC, Domb BG
DOI: 10.1177/2325967120917919
Background
Microinstability of the hip is a challenging diagnosis. The femoral head “divot” sign—a linear indentation in the femoral head cartilage seen during arthroscopy—may provide a visual clue for instability.
Methods
From 690 hip arthroscopies, cases with the divot sign were analyzed for associations with preoperative findings like ligamentous laxity, labral tears, and radiographic signs of instability.
Key Findings
- The divot sign was present in 2% of patients, predominantly younger females.
- All cases showed clinical and/or radiologic evidence of microinstability.
- Associated pathology included labral tears and iliopsoas bursitis.
Conclusions
The femoral head divot sign is a reliable intraoperative marker for hip microinstability and may guide treatment strategies, particularly the need for capsular plication.
What Does This Mean for Providers?
During hip arthroscopy, identification of a femoral head divot should raise concern for microinstability, especially in young, hypermobile females. This finding supports a more aggressive stabilization approach, such as capsular repair or plication, to improve joint stability and outcomes.