Hip Arthroscopy Improves Symptoms Associated with FAI in Selected Adolescent Athletes
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Femoroacetabular impingement (FAI) is increasingly diagnosed in young and middle-aged patients. Although arthroscopic procedures are becoming frequently used in the treatment of FAI, there are little data regarding rates of complications or the ability of hip arthroscopy to improve hip function specifically in the adolescent athlete population. Because arthroscopic treatment is being used in the treatment of FAI, it is vital to know what, if any, improvements in hip function can be expected and the potential complications.
We asked (1) whether validated measures of hip function improve after arthroscopic treatment of FAI in adolescent athletes, and (2) what complications might be expected during and after arthroscopic treatment of FAI in these patients.
We retrospectively reviewed the records of 27 hips in 21 patients 19 years of age or younger who underwent arthroscopic treatment for FAI between 2007 and 2008. From the records we extracted demographic data, operative details, complications, and preoperative and postoperative modified Harris hip scores (HHS) and the Hip Outcome Score (HOS). The minimum followup was 1 year (average, 1.5 years; range, 1–2.5 years).
Modified HHS improved by an average of 21 points, the activities of daily living subset of the HOS improved by an average of 16 points, and the sports outcome subset of the HOS improved by an average of 32 points. All patients’ self-reported ability to engage in their preoperative level of athletic competition improved. In 24 hips that underwent cam decompression, the mean alpha-angle improved from 64° ± 16° to 40° ± 5.3° postoperatively.
We found short-term improvements in HOS and HHS with no complications for arthroscopic treatment of FAI in our cohort of adolescent athletes. We believe arthroscopic treatment of FAI by an experienced hip arthroscopist should be considered in selected patients when treating athletically active adolescents for whom nonoperative management fails.
Level of Evidence
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
- Adler RS, Buly R, Ambrose R, Sculco T. Diagnostic and therapeutic use of sonography-guided iliopsoas peritendinous injections. AJR Am J Roentgenol. 2005;85:940–943. CrossRef
- Alpert JM, Kozanek M, Li G, Kelly BT, Asnis PD. Cross-sectional analysis of the iliopsoas tendon and its relationship to the acetabular labrum: an anatomic study. Am J Sports Med. 2009;37:1594–1598. CrossRef
- Anderson SA, Keene JS. Results of arthroscopic iliopsoas tendon release in competitive and recreational athletes. Am J Sports Med. 2008;36:2363–2371. CrossRef
- Bartlett CS, DiFelice GS, Buly RL, Quinn TJ, Green DS, Helfet DL. Cardiac arrest as a result of intraabdominal extravasation of fluid during arthroscopic removal of a loose body from the hip joint of a patient with an acetabular fracture. J Orthop Trauma. 1998;12:294–299. CrossRef
- Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87:1012–1018. CrossRef
- Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R. Anterior femoroacetabular impingement: Part II. Midterm results of surgical treatment. Clin Orthop Relat Res. 2004;418:67–73. CrossRef
- Berend KR, Vail TP. Hip arthroscopy in the adolescent and pediatric athlete. Clin Sports Med. 2001;20:763–778. CrossRef
- Boykin RE, Anz AW, Bushnell BD, Kocher MS, Stubbs AJ, Philippon MJ. Hip instability. J Am Acad Orthop Surg. 2011;19:340–349.
- Byers PD, Contepomi CA, Farkas TA. A post mortem study of the hip joint: including the prevalence of the features of the right side. Ann Rheum Dis. 1970;29:15–31. CrossRef
- Byrd JW. Hip arthroscopy utilizing the supine position. Arthroscopy. 1994;10:275–280. CrossRef
- Byrd JW, ed. Operative Hip Arthroscopy. New York, NY: Thieme; 1998.
- Byrd JW, Jones KS. Prospective analysis of hip arthroscopy with 2-year follow-up. Arthroscopy. 2000;16:578–587. CrossRef
- Byrd JW, Jones KS. Arthroscopic femoroplasty in the management of cam-type femoroacetabular impingement. Clin Orthop Relat Res. 2009;467:739–746. CrossRef
- Byrd JW, Jones KS. Prospective analysis of hip arthroscopy with 10-year followup. Clin Orthop Relat Res. 2010;468:741–746. CrossRef
- Clarke MT, Arora A, Villar RN. Hip arthroscopy: complications in 1054 cases. Clin Orthop Relat Res. 2003;406:84–88. CrossRef
- Clohisy JC, Carlisle JC, Beaule PE, Kim YJ, Trousdale RT, Sierra RJ, Leunig M, Schoenecker PL, Millis MB. A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am. 2008;90(suppl 4):47–66. CrossRef
- Clohisy JC, Zebala LP, Nepple JJ, Pashos G. Combined hip arthroscopy and limited open osteochondroplasty for anterior femoroacetabular impingement. J Bone Joint Surg Am. 2010;92:1697–1706. CrossRef
- Dolan MM, Heyworth BE, Bedi A, Duke G, Kelly BT. CT reveals a high incidence of osseous abnormalities in hips with labral tears. Clin Orthop Relat Res. 2011;469:831–838. CrossRef
- Dunn DM. The treatment of adolescent slipping of the upper femoral epiphysis. J Bone Joint Surg Br. 1964;46:621–629.
- Espinosa N, Rothenfluh DA, Beck M, Ganz R, Leunig M. Treatment of femoro-acetabular impingement: preliminary results of labral refixation. J Bone Joint Surg Am. 2006;88:925–935. CrossRef
- Ferguson SJ, Bryant JT, Ganz R, Ito K. The acetabular labrum seal: a poroelastic finite element model. Clin Biomech (Bristol, Avon). 2000;15:463–468. CrossRef
- Ferguson SJ, Bryant JT, Ganz R, Ito K. The influence of the acetabular labrum on hip joint cartilage consolidation: a poroelastic finite element model. J Biomech. 2000;33:953–960. CrossRef
- Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech. 2003;36:171–178. CrossRef
- Fowler J, Owens BD. Abdominal compartment syndrome after hip arthroscopy. Arthroscopy. 2010;26:128–130. CrossRef
- Ganz R, Leunig M, Leunig-Ganz K, Harris WH. The etiology of osteoarthritis of the hip: an integrated mechanical concept. Clin Orthop Relat Res. 2008;466:264–272. CrossRef
- Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–120.
- Heyworth BE, Shindle MK, Voos JE, Rudzki JR, Kelly BT. Radiologic and intraoperative findings in revision hip arthroscopy. Arthroscopy. 2007;23:1295–1302. CrossRef
- Ilizaliturri VM Jr. Complications of arthroscopic femoroacetabular impingement treatment: a review. Clin Orthop Relat Res. 2009;467:760–768. CrossRef
- Ilizaliturri VM Jr, Orozco-Rodriguez L, Acosta-Rodriguez E, Camacho-Galindo J. Arthroscopic treatment of cam-type femoroacetabular impingement: preliminary report at 2 years minimum follow-up. J Arthroplasty. 2008;23:226–234. CrossRef
- Ilizaliturri VM Jr, Villalobos FE Jr, Chaidez PA, Valero FS, Aguilera JM. Internal snapping hip syndrome: treatment by endoscopic release of the iliopsoas tendon. Arthroscopy. 2005;21:1375–1380. CrossRef
- Imhauser G. [Late results of Imhauser’s osteotomy for slipped capital femoral epiphysis (author’s transl)] [in German]. Z Orthop Ihre Grenzgeb. 1977;115:716–725.
- Ito K, Leunig M, Ganz R. Histopathologic features of the acetabular labrum in femoroacetabular impingement. Clin Orthop Relat Res. 2004;429:262–271. CrossRef
- Kelly BT, Philippon MJ. Arthroscopic hip anatomy. In: Callaghan JJ, Rosenberg AG, Rubash HE, eds. The Adult Hip. Ed 2. Philadelphia, PA: Lippincott Williams & Wilkins; 2007:68.
- Kelly BT, Williams RJ 3rd, Philippon MJ. Hip arthroscopy: current indications, treatment options, and management issues. Am J Sports Med. 2003;31:1020–1037.
- Kocher MS, Kim YJ, Millis MB, Mandiga R, Siparsky P, Micheli LJ, Kasser JR. Hip arthroscopy in children and adolescents. J Pediatr Orthop. 2005;25:680–686. CrossRef
- Kocher MS, Tucker R. Pediatric athlete hip disorders. Clin Sports Med. 2006;25:241–253, viii. CrossRef
- Kohnlein W, Ganz R, Impellizzeri FM, Leunig M. Acetabular morphology: implications for joint-preserving surgery. Clin Orthop Relat Res. 2009;467:682–691. CrossRef
- Larson CM, Giveans MR. Arthroscopic management of femoroacetabular impingement: early outcomes measures. Arthroscopy. 2008;24:540–546. CrossRef
- Lavigne M, Parvizi J, Beck M, Siebenrock KA, Ganz R, Leunig M. Anterior femoroacetabular impingement: Part I. Techniques of joint preserving surgery. Clin Orthop Relat Res. 2004;418:61–66. CrossRef
- Leunig M, Beaule PE, Ganz R. The concept of femoroacetabular impingement: current status and future perspectives. Clin Orthop Relat Res. 2009;467:616–622. CrossRef
- Leunig M, Beck M, Dora C, Ganz R. [Femoroacetabular impingement: trigger for the development of coxarthrosis] [in German]. Orthopade. 2006;35:77–84. CrossRef
- Leunig M, Beck M, Kalhor M, Kim YJ, Werlen S, Ganz R. Fibrocystic changes at anterosuperior femoral neck: prevalence in hips with femoroacetabular impingement. Radiology. 2005;236:237–246. CrossRef
- Leunig M, Beck M, Woo A, Dora C, Kerboull M, Ganz R. Acetabular rim degeneration: a constant finding in the aged hip. Clin Orthop Relat Res. 2003;413:201–207. CrossRef
- Leunig M, Ganz R. [Femoroacetabular impingement: a common cause of hip complaints leading to arthrosis] [in German]. Unfallchirurg. 2005;108:9–10, 12–17.
- Leunig M, Ganz R. [FAI: concept and etiology] [in German]. Orthopade. 2009;38:394–401. CrossRef
- Leunig M, Huff TW, Ganz R. Femoroacetabular impingement: treatment of the acetabular side. Instr Course Lect. 2009;58:223–229.
- Martin RL, Philippon MJ. Evidence of reliability and responsiveness for the hip outcome score. Arthroscopy. 2008;24:676–682. CrossRef
- Matsuda DK. Acute iatrogenic dislocation following hip impingement arthroscopic surgery. Arthroscopy. 2009;25:400–404. CrossRef
- Meyer DC, Beck M, Ellis T, Ganz R, Leunig M. Comparison of six radiographic projections to assess femoral head/neck asphericity. Clin Orthop Relat Res. 2006;445:181–185.
- Mintz DN, Hooper T, Connell D, Buly R, Padgett DE, Potter HG. Magnetic resonance imaging of the hip: detection of labral and chondral abnormalities using noncontrast imaging. Arthroscopy. 2005;21:385–393. CrossRef
- Murphy S, Tannast M, Kim YJ, Buly R, Millis MB. Debridement of the adult hip for femoroacetabular impingement: indications and preliminary clinical results. Clin Orthop Relat Res. 2004;429:178–181. CrossRef
- Notzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br. 2002;84:556–560. CrossRef
- Parvizi J, Leunig M, Ganz R. Femoroacetabular impingement. J Am Acad Orthop Surg. 2007;15:561–570.
- Peters CL, Erickson JA. Treatment of femoro-acetabular impingement with surgical dislocation and debridement in young adults. J Bone Joint Surg Am. 2006;88:1735–1741. CrossRef
- Philippon MJ. The role of arthroscopic thermal capsulorrhaphy in the hip. Clin Sports Med. 2001;20:817–829. CrossRef
- Philippon MJ. New frontiers in hip arthroscopy: the role of arthroscopic hip labral repair and capsulorrhaphy in the treatment of hip disorders. Instr Course Lect. 2006;55:309–316.
- Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA. Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Joint Surg Br. 2009;91:16–23. CrossRef
- Philippon MJ, Stubbs AJ, Schenker ML, Maxwell RB, Ganz R, Leunig M. Arthroscopic management of femoroacetabular impingement: osteoplasty technique and literature review. Am J Sports Med. 2007;35:1571–1580. CrossRef
- Philippon MJ, Yen YM, Briggs KK, Kuppersmith DA, Maxwell RB. Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient: a preliminary report. J Pediatr Orthop. 2008;28:705–710. CrossRef
- Potter HG, Schachar J. High resolution noncontrast MRI of the hip. J Magn Reson Imaging. 2010;31:268–278. CrossRef
- Ranawat AS, McClincy M, Sekiya JK. Anterior dislocation of the hip after arthroscopy in a patient with capsular laxity of the hip: a case report. J Bone Joint Surg Am. 2009;91:192–197. CrossRef
- Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum: a cause of hip pain. J Bone Joint Surg Br. 1999;81:281–288. CrossRef
- Sampson TG. Complications of hip arthroscopy. Clin Sports Med. 2001;20:831–835. CrossRef
- Seldes RM, Tan V, Hunt J, Katz M, Winiarsky R, Fitzgerald RH Jr. Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Relat Res. 2001;382:232–240. CrossRef
- Sharma A, Sachdev H, Gomillion M. Abdominal compartment syndrome during hip arthroscopy. Anaesthesia. 2009;64:567–569. CrossRef
- Sink EL, Gralla J, Ryba A, Dayton M. Clinical presentation of femoroacetabular impingement in adolescents. J Pediatr Orthop. 2008;28:806–811. CrossRef
- Siparsky PN, Kocher MS. Current concepts in pediatric and adolescent arthroscopy. Arthroscopy. 2009;25:1453–1469. CrossRef
- Smith MV, Sekiya JK. Hip instability. Sports Med Arthrosc. 2010;18:108–112. CrossRef
- Smith-Petersen MN. Treatment of malum coxae senilis, old slipped upper femoral epiphysis, intrapelvic protrusion of the acetabulum, and coxa plana by means of acetabuloplasty. J Bone Joint Surg Am. 1936;18:869–880.
- Southwick WO. Osteotomy through the lesser trochanter for slipped capital femoral epiphysis. J Bone Joint Surg Am. 1967;48:807–835.
- Yen YM, Kocher MS. Chondral lesions of the hip: microfracture and chondroplasty. Sports Med Arthrosc. 2010;18:83–89. CrossRef
- Hip Arthroscopy Improves Symptoms Associated with FAI in Selected Adolescent Athletes
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