Clinical Orthopaedics and Related Research®

, Volume 468, Issue 12, pp 3160–3167 | Cite as

In Situ Pinning With Arthroscopic Osteoplasty for Mild SCFE: A Preliminary Technical Report

  • Michael Leunig
  • Kevin Horowitz
  • Hannes Manner
  • Reinhold Ganz
Symposium: Papers Presented at the 2009 Closed Meeting of the International Hip Society

Abstract

Background

There is emerging evidence that even mild slipped capital femoral epiphysis leads to early articular damage. Therefore, we have begun treating patients with mild slips and signs of impingement with in situ pinning and immediate arthroscopic osteoplasty.

Description of Techniques

Surgery was performed using the fracture table. After in situ pinning and diagnostic arthroscopy, peripheral compartment access was obtained and head-neck osteoplasty was completed.

Methods

Between March 2008 and August 2009, three male patients (age range, 11–15 years; BMI, 22–31 kg/m2) presented with slip angles between 15º and 30º. All were ambulatory without assistance but had 2 to 12 weeks of hip and/or knee pain, limited motion and a positive impingement test. Postoperatively, patients were assessed at 6 weeks; 3 and 6 months; then every 6 months for the first two years. Hip motion, epiphyseal-metaphyseal offsets and alpha angles were determined. Patients completed the UCLA activity scale at latest followup that ranged from 6 to 23 months.

Results

Arthroscopic evaluation revealed labral fraying, acetabular chondromalacia, and a prominent metaphyseal ridge. At last followup, each was pain-free and had returned to unrestricted activities. Hip motion improved in all and none demonstrated clinical impingement. Radiographs showed normalized epiphyseal-metaphyseal offsets and alpha angles.

Conclusions

In situ pinning with arthroscopic osteoplasty can limit impingement after mild slipped capital femoral epiphysis. Due to limited followup, we are unable to say whether this protocol reduces subsequent articular damage. Although we recommend performing these procedures concomitantly, they can be performed in a staged fashion, especially since hip arthroscopy following an epiphyseal slip can be challenging.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Notes

Acknowledgements

We thank James Voos, M.D. for his contribution to the design of this study and to the initial preparation of this manuscript.

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Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Michael Leunig
    • 1
    • 2
  • Kevin Horowitz
    • 1
    • 3
  • Hannes Manner
    • 1
  • Reinhold Ganz
    • 2
  1. 1.Department of OrthopedicsSchulthess ClinicZürichSwitzerland
  2. 2.University of BerneBerneSwitzerland
  3. 3.Department of Orthopaedic SurgeryBaylor College of MedicineHoustonUSA

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