Skip to main content

Arthroscopic Management of Femoroacetabular Impingement in Athletes

  • Chapter
  • First Online:
Hip and Groin Pain in the Athlete

Abstract

Femoroacetabular impingement (FAI) can lead to significant pain and dysfunction in the young active population. Historically, this condition was managed with open surgery; however, advances in arthroscopic techniques and improved instrumentation have allowed for a more minimally invasive approach. Although our understanding of the pathoanatomy of FAI has evolved, controversies remain regarding optimal surgical strategies to manage chondrolabral pathology, cam- and pincer-type impingement, and indications for capsular closure. The purpose of this book chapter will be to provide an evidence-based approach with the pearls and pitfalls of arthroscopic management of FAI in the young athlete.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Feeley BT, Powell JW, Muller MS, Barnes RP, Warren RF, Kelly BT. Hip injuries and labral tears in the national football league. Am J Sports Med. 2008;36(11):2187–95. https://doi.org/10.1177/0363546508319898.

    Article  PubMed  Google Scholar 

  2. Borowski LA, Yard EE, Fields SK, Comstock RD. The epidemiology of US high school basketball injuries, 2005-2007. Am J Sports Med. 2008;36(12):2328–35. https://doi.org/10.1177/0363546508322893.

    Article  PubMed  Google Scholar 

  3. Ekberg O, Persson NH, Abrahamsson P, Westlin NE, Lilga B. Long-standing groin pain in athletes. Sports Med. 1988;6:56–61.

    Article  CAS  PubMed  Google Scholar 

  4. de Darren SA, Hölmich P, Phillips M, et al. Athletic groin pain: a systematic review of surgical diagnoses, investigations and treatment. Br J Sports Med. 2016;50(19):1181–6. https://doi.org/10.1136/bjsports-2015-095137.

    Article  Google Scholar 

  5. Griffin DR, Dickenson EJ, O’Donnell J, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med. 2016;50(19):1169–76. https://doi.org/10.1136/bjsports-2016-096743.

    Article  CAS  PubMed  Google Scholar 

  6. Clohisy JC, Knaus ER, Hunt DM, Lesher JM, Harris-Hayes M, Prather H. Clinical presentation of patients with symptomatic anterior hip impingement. Clin Orthop Relat Res. 2009;467:638–44. https://doi.org/10.1007/s11999-008-0680-y.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Shanmugaraj A, Shell JR, Horner NS, Duong A, Simunovic N, Uchida S, Ayeni OR. How useful is the flexion-adduction-internal rotation test for diagnosing femoroacetabular impingement: a systematic review. Clin J Sport Med. 2018. https://doi.org/10.1097/JSM.0000.

  8. Gebhart JJ, Weinberg DS, Conry KT, Morris WZ, Sasala LM, Liu RW. Hip-spine syndrome: is there an association between markers for cam deformity and osteoarthritis of the lumbar spine? Arthroscopy. 2016;32(11):2243–8. https://doi.org/10.1016/j.arthro.2016.04.025.

    Article  PubMed  Google Scholar 

  9. Taylor DC, Meyers WC, Moylan JA, Lohnes J, Bassett FH, Garrett WE. Abdominal musculature abnormalities as a cause of groin pain in athletes: inguinal hernias and pubalgia. Am J Sports Med. 1991;19(3):239–42. https://doi.org/10.1177/036354659101900306.

    Article  CAS  PubMed  Google Scholar 

  10. Haldane CE, Ekhtiari S, de Darren SA, Simunovic N, Ayeni OR. Preoperative physical examination and imaging of femoroacetabular impingement prior to hip arthroscopy—a systematic review. J Hip Preserv Surg. 2017;4(3):201–13. https://doi.org/10.1093/jhps/hnx020.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sutter R, Dietrich TJ, Zingg PO, Pfirrmann CWA. Femoral antetorsion: comparing asymptomatic volunteers and patients with femoroacetabular impingement. Radiology. 2012;263(2):475–83. https://doi.org/10.1148/radiol.12111903.

    Article  PubMed  Google Scholar 

  12. Kraeutler MJ, Chadayammuri V, Garabekyan T, Mei-Dan O. Femoral version abnormalities significantly outweigh effect of cam impingement on hip internal rotation. J Bone Joint Surg Am. 2018;100(3):205–10. https://doi.org/10.2106/JBJS.17.00376.

    Article  PubMed  Google Scholar 

  13. Ayeni OR, Farrokhyar F, Crouch S, Chan K, Sprague S, Bhandari M. Pre-operative intra-articular hip injection as a predictor of short-term outcome following arthroscopic management of femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):801–5. https://doi.org/10.1007/s00167-014-2883-y.

    Article  PubMed  Google Scholar 

  14. Nepple JJ, Vigdorchik JM, Clohisy JC. What is the association between sports participation and the development of proximal femoral cam deformity? Am J Sports Med. 2015;43(11):2833–40. https://doi.org/10.1177/0363546514563909.

    Article  PubMed  Google Scholar 

  15. de Silva V, Swain M, Broderick C, McKay D. Does high level youth sports participation increase the risk of femoroacetabular impingement? A review of the current literature. Pediatr Rheumatol Online J. 2016;14(1):16. https://doi.org/10.1186/s12969-016-0077-5.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 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(1):73–95. https://doi.org/10.1016/j.ejrad.2015.10.016.

    Article  PubMed  Google Scholar 

  17. Mair SD, Uhl TL, Robbe RG, Brindle KA. Physeal changes and range-of-motion differences in the dominant shoulders of skeletally immature baseball players. J Shoulder Elb Surg. 2004;13(5):487–91. https://doi.org/10.1016/j.jse.2004.02.008.

    Article  Google Scholar 

  18. DiFiori JP, Caine DJ, Malina RM. Wrist pain, distal radial physeal injury, and ulnar variance in the young gymnast. Am J Sports Med. 2006;34(5):840–9. https://doi.org/10.1177/0363546505284848.

    Article  PubMed  Google Scholar 

  19. Agricola R, Heijboer MP, Ginai AZ, et al. A cam deformity is gradually acquired during skeletal maturation in adolescent and young male soccer players: a prospective study with minimum 2-year follow-up. Am J Sports Med. 2014;42(4):798–806. https://doi.org/10.1177/0363546514524364.

    Article  PubMed  Google Scholar 

  20. Lerebours F, Robertson W, Neri B, Schulz B, Youm T, Limpisvasti O. Prevalence of cam-type morphology in elite ice hockey players. Am J Sports Med. 2015;44(4):1024–30. https://doi.org/10.1177/0363546515624671.

    Article  Google Scholar 

  21. Larson CM, Ross JR, Kuhn AW, et al. Radiographic hip anatomy correlates with range of motion and symptoms in national hockey league players. Am J Sports Med. 2017;45(7):1633–9. https://doi.org/10.1177/0363546517692542.

    Article  PubMed  Google Scholar 

  22. Palmer A, Fernquest S, Gimpel M, et al. Physical activity during adolescence and the development of cam morphology: a cross-sectional cohort study of 210 individuals. Br J Sports Med. 2017;52(9):097626. https://doi.org/10.1136/bjsports-2017-097626.

    Article  Google Scholar 

  23. Matsuda DK, Carlisle JC, Arthurs SC, Wierks CH, Philippon MJ. Comparative systematic review of the open dislocation, mini-open, and arthroscopic surgeries for femoroacetabular impingement. Arthroscopy. 2011;27(2):252–69. https://doi.org/10.1016/j.arthro.2010.09.011.

    Article  PubMed  Google Scholar 

  24. Botser IB, Smith TW, Nasser R, Domb BG. Open surgical dislocation versus arthroscopy for femoroacetabular impingement: a comparison of clinical outcomes. Arthroscopy. 2011;27(2):270–8. https://doi.org/10.1016/j.arthro.2010.11.008.

    Article  PubMed  Google Scholar 

  25. Byrd JW. Lateral impact injury. A source of occult hip pathology. Clin Sports Med. 2001;20(4):801–15. https://doi.org/10.1016/S0278-5919(05)70286-6.

    Article  CAS  PubMed  Google Scholar 

  26. Saberi Hosnijeh F, Zuiderwijk ME, Versteeg M, et al. Cam deformity and acetabular dysplasia as risk factors for hip osteoarthritis. Arthritis Rheumatol. 2017;69(1):86–93. https://doi.org/10.1002/art.39929.

    Article  PubMed  Google Scholar 

  27. 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. Ann Rheum Dis. 2013;72(6):918–23. https://doi.org/10.1136/annrheumdis-2012-201643.

    Article  PubMed  Google Scholar 

  28. Nicholls AS, Kiran A, Pollard TCB, et al. The association between hip morphology parameters and nineteen-year risk of end-stage osteoarthritis of the hip: a nested case-control study. Arthritis Rheum. 2011;63(11):3392–400. https://doi.org/10.1002/art.30523.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Nelson AE, Stiller JL, Shi XA, et al. Measures of hip morphology are related to development of worsening radiographic hip osteoarthritis over 6 to 13 year follow-up: The Johnston County Osteoarthritis Project. Osteoarthr Cartil. 2016;24(3):443–50. https://doi.org/10.1016/j.joca.2015.10.007.

    Article  CAS  Google Scholar 

  30. Kowalczuk M, Yeung M, Simunovic N, Ayeni OR. Does femoroacetabular impingement contribute to the development of hip osteoarthritis? A systematic review. Sports Med Arthrosc. 2015;23(4):174–9. https://doi.org/10.1097/JSA.0000000000000091.

    Article  PubMed  Google Scholar 

  31. Nepple JJ, Carlisle JC, Nunley RM, Clohisy JC. Clinical and radiographic predictors of intra-articular hip disease in arthroscopy. Am J Sports Med. 2011;39(2):296–303. https://doi.org/10.1177/0363546510384787.

    Article  PubMed  Google Scholar 

  32. Thomas GER, Palmer AJR, Batra RN, et al. Subclinical deformities of the hip are significant predictors of radiographic osteoarthritis and joint replacement in women. A 20 year longitudinal cohort study. Osteoarthr Cartil. 2014;22(10):1504–10. https://doi.org/10.1016/j.joca.2014.06.038.

    Article  CAS  Google Scholar 

  33. Reichenbach S, Leunig M, Werlen S, et al. Association between cam-type deformities and magnetic resonance imaging-detected structural hip damage: a cross-sectional study in young men. Arthritis Rheum. 2011;63(12):4023–30. https://doi.org/10.1002/art.30589.

    Article  PubMed  Google Scholar 

  34. Wyles CC, Norambuena GA, Howe BM, et al. Cam deformities and limited hip range of motion are associated with early osteoarthritic changes in adolescent athletes: a prospective matched cohort study. Am J Sports Med. 2017;45(13):3036–43. https://doi.org/10.1177/0363546517719460.

    Article  PubMed  Google Scholar 

  35. Beck M. 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-B(7):1012–8. https://doi.org/10.1302/0301-620X.87B7.15203.

    Article  Google Scholar 

  36. Crawford K, Philippon MJ, Sekiya JK, Rodkey WG, Steadman JR. Microfracture of the Hip in Athletes. Clin Sports Med. 2006;25(2):327–35. https://doi.org/10.1016/j.csm.2005.12.004.

    Article  PubMed  Google Scholar 

  37. Suarez-Ahedo C, Gui C, Rabe SM, Chandrasekaran S, Lodhia P, Domb BG. Acetabular chondral lesions in hip arthroscopy: relationships between grade, topography, and demographics. Am J Sports Med. 2017;45(11):2501–6. https://doi.org/10.1177/0363546517708192.

    Article  PubMed  Google Scholar 

  38. Mankin HJ. The response of articular cartilage to mechanical injury. J Bone Joint Surg Am. 1982;64:460–6.

    Article  CAS  PubMed  Google Scholar 

  39. Sekiya JK, Martin RL, Lesniak BP. Arthroscopic repair of delaminated acetabular articular cartilage in femoroacetabular impingement. Orthopedics. 2009;32(9):692–6. https://doi.org/10.3928/01477447-20090728-44.

    Article  Google Scholar 

  40. Stafford GH, Bunn JR, Villar RN. Arthroscopic repair of delaminated acetabular articular cartilage using fibrin adhesive. Results at one to three years. Hip Int. 2011;21(6):744–50. https://doi.org/10.5301/HIP.2011.8843.

    Article  PubMed  Google Scholar 

  41. Fontana A, Bistolfi A, Crova M, Rosso F, Massazza G. Arthroscopic treatment of hip chondral defects: autologous chondrocyte transplantation versus simple debridement-A pilot study. Arthroscopy. 2012;28(3):322–9. https://doi.org/10.1016/j.arthro.2011.08.304.

    Article  PubMed  Google Scholar 

  42. Steadman JR, Briggs KK, Rodrigo JJ, Kocher MS, Gill TJ, Rodkey WG. Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy. 2003;19(5):477–84. https://doi.org/10.1053/jars.2003.50112.

    Article  PubMed  Google Scholar 

  43. Gudas R, Gudaite A, Pocius A, et al. Ten-year follow-up of a prospective, randomized clinical study of mosaic osteochondral autologous transplantation versus microfracture for the treatment of osteochondral defects in the knee joint of athletes. Am J Sports Med. 2012;40(11):2499–508. https://doi.org/10.1177/0363546512458763.

    Article  PubMed  Google Scholar 

  44. Byrd JWT, Jones KS. Arthroscopic femoroplasty in the management of cam-type femoroacetabular impingement. Clin Orthop Relat Res. 2009;467:739–46. https://doi.org/10.1007/s11999-008-0659-8.

    Article  PubMed  Google Scholar 

  45. McDonald JE, Herzog MM, Philippon MJ. Return to play after hip arthroscopy with microfracture in elite athletes. Arthroscopy. 2013;29(2):330–5. https://doi.org/10.1016/j.arthro.2012.08.028.

    Article  PubMed  Google Scholar 

  46. McDonald JE, Herzog MM, Philippon MJ. Performance outcomes in professional hockey players following arthroscopic treatment of FAI and microfracture of the hip. Knee Surg Sports Traumatol Arthrosc. 2014;22(4):915–9. https://doi.org/10.1007/s00167-013-2691-9.

    Article  PubMed  Google Scholar 

  47. Espinosa N, Beck M, Rothenfluh DA, Ganz R, Leunig M. Treatment of femoro-acetabular impingement: preliminary results of labral refixation. Surgical technique. J Bone Joint Surg Am. 2007;89(Pt 1 Suppl):36–53. https://doi.org/10.2106/JBJS.F.01123.

    Article  PubMed  Google Scholar 

  48. Philippon MJ, Wolff AB, Briggs KK, Zehms CT, Kuppersmith DA. Acetabular rim reduction for the treatment of femoroacetabular impingement correlates with preoperative and postoperative center-edge angle. Arthroscopy. 2010;26(6):757–61. https://doi.org/10.1016/j.arthro.2009.11.003.

    Article  PubMed  Google Scholar 

  49. Richards PJ, Pattison JM, Belcher J, DeCann RW, Anderson S, Wynn-Jones C. A new tilt on pelvic radiographs: a pilot study. Skelet Radiol. 2009;38(2):113–22. https://doi.org/10.1007/s00256-008-0481-0.

    Article  CAS  Google Scholar 

  50. Tannast M, Fritsch S, Zheng G, Siebenrock KA, Steppacher SD. Which radiographic hip parameters do not have to be corrected for pelvic rotation and tilt? Clin Orthop Relat Res. 2015;473(4):1255–66. https://doi.org/10.1007/s11999-014-3936-8.

    Article  PubMed  Google Scholar 

  51. Ross JR, Nepple JJ, Philippon MJ, Kelly BT, Larson CM, Bedi A. Effect of changes in pelvic tilt on range of motion to impingement and radiographic parameters of acetabular morphologic characteristics. Am J Sports Med. 2014;42(10):2402–9. https://doi.org/10.1177/0363546514541229.

    Article  PubMed  Google Scholar 

  52. Gross CE, Salata MJ, Manno K, et al. New radiographic parameters to describe anterior acetabular rim trimming during hip arthroscopy. Arthroscopy. 2012;28(10):1404–9. https://doi.org/10.1016/j.arthro.2012.03.001.

    Article  PubMed  Google Scholar 

  53. Hellman MD, Gross CE, Hart M, et al. Radiographic comparison of anterior acetabular rim morphology between pincer femoroacetabular impingement and control. Arthroscopy. 2016;32(3):468–72. https://doi.org/10.1016/j.arthro.2015.08.035.

    Article  PubMed  Google Scholar 

  54. Bhatia S, Lee S, Shewman E, et al. Effects of acetabular rim trimming on hip joint contact pressures: how much is too much? Am J Sports Med. 2015;43(9):2138–45. https://doi.org/10.1177/0363546515590400.

    Article  PubMed  Google Scholar 

  55. Kapron AL, Peters CL, Aoki SK, et al. The prevalence of radiographic findings of structural hip deformities in female collegiate athletes. Am J Sports Med. 2015;43(6):1324–30. https://doi.org/10.1177/0363546515576908.

    Article  PubMed  Google Scholar 

  56. Ross JR, Bedi A, Stone RM, Sibilsky Enselman E, Kelly BT, Larson CM. Characterization of symptomatic hip impingement in butterfly ice hockey goalies. Arthroscopy. 2015;31(4):635–42. https://doi.org/10.1016/j.arthro.2014.10.010.

    Article  PubMed  Google Scholar 

  57. Gosvig KK, Jacobsen S, Sonne-Holm S, Palm H, Troelsen A. Prevalence of malformations of the hip joint and their relationship to sex, groin pain, and risk of osteoarthritis: a population-based survey. J Bone Joint Surg Am. 2010;92(5):1162–9. https://doi.org/10.2106/JBJS.H.01674.

    Article  PubMed  Google Scholar 

  58. Matsuda DK, Gupta N, Burchette RJ, Sehgal B. Arthroscopic surgery for global versus focal pincer femoroacetabular impingement: are the outcomes different? J Hip Preserv Surg. 2015;2(1):42–50. https://doi.org/10.1093/jhps/hnv010.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Narvani AA, Tsiridis E, Kendall S, Chaudhuri R, Thomas P. A preliminary report on prevalence of acetabular labrum tears in sports patients with groin pain. Knee Surg Sport Traumatol Arthrosc. 2003;11(6):403–8. https://doi.org/10.1007/s00167-003-0390-7.

    Article  CAS  Google Scholar 

  60. Ferguson SJ, Bryant JT, Ganz R, Ito K. The acetabular labrum seal: a poroelastic finite element model. Clin Biomech. 2000;15(6):463–8. https://doi.org/10.1016/S0268-0033(99)00099-6.

    Article  CAS  Google Scholar 

  61. 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(2):171–8. https://doi.org/10.1016/S0021-9290(02)00365-2.

    Article  CAS  PubMed  Google Scholar 

  62. Philippon MJ, Schenker ML. A new method for acetabular rim trimming and labral repair. Clin Sports Med. 2006;25(2):293–7. https://doi.org/10.1016/j.csm.2005.12.005.

    Article  PubMed  Google Scholar 

  63. Mohan R, Johnson NR, Hevesi M, Gibbs CM, Levy BA, Krych AJ. Return to sport and clinical outcomes after hip arthroscopic labral repair in young amateur athletes: minimum 2-year follow-up. Arthroscopy. 2017;33(9):1679–84. https://doi.org/10.1016/j.arthro.2017.03.011.

    Article  PubMed  Google Scholar 

  64. Ayeni OR, Adamich J, Farrokhyar F, et al. Surgical management of labral tears during femoroacetabular impingement surgery: a systematic review. Knee Surg Sport Traumatol Arthrosc. 2014;22(4):756–62. https://doi.org/10.1007/s00167-014-2886-8.

    Article  CAS  Google Scholar 

  65. Sawyer GA, Briggs KK, Dornan GJ, Ommen ND, Philippon MJ. Clinical outcomes after arthroscopic hip labral repair using looped versus pierced suture techniques. Am J Sports Med. 2015;43(7):1683–8. https://doi.org/10.1177/0363546515581469.

    Article  PubMed  Google Scholar 

  66. Philippon MJ, Briggs KK, Hay CJ, Kuppersmith DA, Dewing CB, Huang MJ. Arthroscopic labral reconstruction in the hip using iliotibial band autograft: technique and early outcomes. Arthroscopy. 2010;26(6):750–6. https://doi.org/10.1016/j.arthro.2009.10.016.

    Article  PubMed  Google Scholar 

  67. Ejnisman L, Philippon MJ, Lertwanich P. Acetabular labral tears: diagnosis, repair, and a method for labral reconstruction. Clin Sports Med. 2011;30(2):317–29. https://doi.org/10.1016/j.csm.2010.12.006.

    Article  PubMed  Google Scholar 

  68. Boykin RE, Patterson D, Briggs KK, Dee A, Philippon MJ. Results of arthroscopic labral reconstruction of the hip in elite athletes. Am J Sports Med. 2013;41(10):2296–301. https://doi.org/10.1177/0363546513498058.

    Article  PubMed  Google Scholar 

  69. Robertson WJ, Kelly BT. The safe zone for hip arthroscopy: a cadaveric assessment of central, peripheral, and lateral compartment portal placement. Arthroscopy. 2008;24(9):1019–26. https://doi.org/10.1016/j.arthro.2008.05.008.

    Article  PubMed  Google Scholar 

  70. Hernandez JD, McGrath BE. Safe angle for suture anchor insertion during acetabular labral repair. Arthroscopy. 2008;24(12):1390–4. https://doi.org/10.1016/j.arthro.2008.08.007.

    Article  PubMed  Google Scholar 

  71. Nho SJ, Freedman RL, Federer AE, et al. Computed tomographic analysis of curved and straight guides for placement of suture anchors for acetabular labral refixation. Arthroscopy. 2013;29(10):1623–7. https://doi.org/10.1016/j.arthro.2013.07.262.

    Article  PubMed  Google Scholar 

  72. Stanton M, Banffy M. Safe angle of anchor insertion for labral repair during hip arthroscopy. Arthroscopy. 2016;32(9):1793–7. https://doi.org/10.1016/j.arthro.2016.02.013.

    Article  PubMed  Google Scholar 

  73. Degen RM, O’Sullivan E, Sink EL, Kelly BT. Psoas tunnel perforation—an unreported complication of hip arthroscopy. J Hip Preserv Surg. 2015;2(3):272–9. https://doi.org/10.1093/jhps/hnv043.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Arnason A, Sigurdsson SB, Gudmundsson A, Holme I, Engebretsen L, Bahr R. Risk factors for injuries in football. Am J Sports Med. 2004;32(Suppl. 1):5S–16S. https://doi.org/10.1177/0363546503258912.

    Article  PubMed  Google Scholar 

  75. García VV, Duhrkop DC, Seijas R, Ares O, Cugat R. Surgical treatment of proximal ruptures of the rectus femoris in professional soccer players. Arch Orthop Trauma Surg. 2012;132(3):329–33. https://doi.org/10.1007/s00402-011-1372-8.

    Article  PubMed  Google Scholar 

  76. Rossi F, Dragoni S. Acute avulsion fractures of the pelvis in adolescent competitive athletes: prevalence, location and sports distribution of 203 cases collected. Skelet Radiol. 2001;30(3):127–31. https://doi.org/10.1007/s002560000319.

    Article  CAS  Google Scholar 

  77. Irving MH. Exostosis formation after traumatic avulsion of the anterior inferior iliac spine. J Bone Joint Surg Br. 1964;46-B(4):720–2.

    Article  Google Scholar 

  78. Pan H, Kawanabe K, Akiyama H, Goto K, Onishi E, Nakamura T. Operative treatment of hip impingement caused by hypertrophy of the anterior inferior iliac spine. J Bone Joint Surg Br. 2008;90-B(5):677–9. https://doi.org/10.1302/0301-620X.90B5.20005.

    Article  Google Scholar 

  79. Larson CM, Kelly BT, Stone RM. Making a case for anterior inferior iliac spine/subspine hip impingement: three representative case reports and proposed concept. Arthroscopy. 2011;27(12):1732–7. https://doi.org/10.1016/j.arthro.2011.10.004.

    Article  PubMed  Google Scholar 

  80. Hetsroni I, Larson CM, Dela Torre K, Zbeda RM, Magennis E, Kelly BT. Anterior inferior iliac spine deformity as an extra-articular source for hip impingement: a series of 10 patients treated with arthroscopic decompression. Arthroscopy. 2012;28(11):1644–53. https://doi.org/10.1016/j.arthro.2012.05.882.

    Article  PubMed  Google Scholar 

  81. Ilizaliturri VM, Byrd JWT, Sampson TG, et al. A geographic zone method to describe intra-articular pathology in hip arthroscopy: cadaveric study and preliminary report. Arthroscopy. 2008;24(5):534–9. https://doi.org/10.1016/j.arthro.2007.11.019.

    Article  PubMed  Google Scholar 

  82. Amar E, Warschawski Y, Sharfman ZT, Martin HD, Safran MR, Rath E. Pathological findings in patients with low anterior inferior iliac spine impingement. Surg Radiol Anat. 2016;38(5):569–75. https://doi.org/10.1007/s00276-015-1591-8.

    Article  PubMed  Google Scholar 

  83. Devitt BM, Smith B, Stapf R, O’Donnell JM. Avulsion of the direct head of rectus femoris following arthroscopic subspine impingement resection: a case report. J Hip Preserv Surg. 2016;3(1):56–60. https://doi.org/10.1093/jhps/hnv072.

    Article  PubMed  Google Scholar 

  84. Hapa O, Bedi A, Gursan O, et al. Anatomic footprint of the direct head of the rectus femoris origin: cadaveric study and clinical series of hips after arthroscopic anterior inferior iliac spine/subspine decompression. Arthroscopy. 2013;29:1932–40.

    Article  PubMed  Google Scholar 

  85. Nawabi DH, Degen RM, Fields KG, Wentzel CS, Adeoye O, Kelly BT. Anterior inferior iliac spine morphology and outcomes of hip arthroscopy in soccer athletes: a comparison to nonkicking athletes. Arthroscopy. 2017;33(4):758–65. https://doi.org/10.1016/j.arthro.2016.10.019.

    Article  PubMed  Google Scholar 

  86. Seldinger SI. Catheter replacement of the needle in percutaneous arteriography: a new technique. Acta Radiol. 2008;49(suppl. 434):47–52. https://doi.org/10.1080/02841850802133386.

    Article  Google Scholar 

  87. Ross JR, Bedi A, Stone RM, et al. Intraoperative fluoroscopic imaging to treat cam deformities: correlation with 3-dimensional computed tomography. Am J Sports Med. 2014;42(6):1370–6. https://doi.org/10.1177/0363546514529515.

    Article  PubMed  Google Scholar 

  88. Larson CM, Giveans MR, Samuelson KM, Stone RM, Bedi A. Arthroscopic hip revision surgery for residual femoroacetabular impingement (FAI): surgical outcomes compared with a matched cohort after primary arthroscopic fai correction. Am J Sports Med. 2014;42(8):1785–90. https://doi.org/10.1177/0363546514534181.

    Article  PubMed  Google Scholar 

  89. Budd H, Patchava A, Khanduja V. Establishing the radiation risk from fluoroscopic-assisted arthroscopic surgery of the hip. Int Orthop. 2012;36(9):1803–6. https://doi.org/10.1007/s00264-012-1557-y.

    Article  PubMed  PubMed Central  Google Scholar 

  90. Gaymer CE, Achten J, Auckett R, Cooper L, Griffin D. Fluoroscopic radiation exposure during hip arthroscopy. Arthroscopy. 2013;29(5):870–3. https://doi.org/10.1016/j.arthro.2013.01.024.

    Article  PubMed  Google Scholar 

  91. 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(9):1571–80. https://doi.org/10.1177/0363546507300258.

    Article  PubMed  Google Scholar 

  92. Neumann M, Cui Q, Siebenrock KA, Beck M. Impingement-free hip motion: the “normal” angle alpha after osteochondroplasty. Clin Orthop Relat Res. 2009;467:699–703. https://doi.org/10.1007/s11999-008-0616-6.

    Article  PubMed  Google Scholar 

  93. Ilizaliturri VM. Complications of arthroscopic femoroacetabular impingement treatment: a review. Clin Orthop Relat Res. 2009;467:760–8. https://doi.org/10.1007/s11999-008-0618-4.

    Article  PubMed  Google Scholar 

  94. de Darren SA, Urquhart N, Philippon M, Ye JE, Simunovic N, Ayeni OR. Alpha angle correction in femoroacetabular impingement. Knee Surg Sport Traumatol Arthrosc. 2014;22(4):812–21. https://doi.org/10.1007/s00167-013-2678-6.

    Article  Google Scholar 

  95. Brunner A, Horisberger M, Herzog RF. Evaluation of a computed tomography-based navigation system prototype for hip arthroscopy in the treatment of femoroacetabular cam impingement. Arthroscopy. 2009;25(4):382–91. https://doi.org/10.1016/j.arthro.2008.11.012.

    Article  PubMed  Google Scholar 

  96. Heyworth BE, Shindle MK, Voos JE, Rudzki JR, Kelly BT. Radiologic and intraoperative findings in revision hip arthroscopy. Arthroscopy. 2007;23(12):1295–302. https://doi.org/10.1016/j.arthro.2007.09.015.

    Article  PubMed  Google Scholar 

  97. Sardana V, Philippon MJ, de Darren SA, et al. Revision hip arthroscopy indications and outcomes: a systematic review. Arthroscopy. 2015;31(10):2047–55. https://doi.org/10.1016/j.arthro.2015.03.039.

    Article  PubMed  Google Scholar 

  98. McCormick F, Nwachukwu BU, Alpaugh K, Martin SD. Predictors of hip arthroscopy outcomes for labral tears at minimum 2-year follow-up: the influence of age and arthritis. Arthroscopy. 2012;28(10):1359–64. https://doi.org/10.1016/j.arthro.2012.04.059.

    Article  PubMed  Google Scholar 

  99. Philippon M, Schenker M, Briggs K, Kuppersmith D. Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression. Knee Surg Sport Traumatol Arthrosc. 2007;15(7):908–14. https://doi.org/10.1007/s00167-007-0332-x.

    Article  Google Scholar 

  100. Benali Y, Katthagen BD. Hip subluxation as a complication of arthroscopic debridement. Arthroscopy. 2009;25(4):405–7. https://doi.org/10.1016/j.arthro.2009.01.012.

    Article  PubMed  Google Scholar 

  101. Matsuda DK. Acute iatrogenic dislocation following hip impingement arthroscopic surgery. Arthroscopy. 2009;25(4):400–4. https://doi.org/10.1016/j.arthro.2008.12.011.

    Article  PubMed  Google Scholar 

  102. Levy DM, Kuhns BD, Frank RM, et al. High rate of return to running for athletes after hip arthroscopy for the treatment of femoroacetabular impingement and capsular plication. Am J Sports Med. 2017;45(1):127–34. https://doi.org/10.1177/0363546516664883.

    Article  PubMed  Google Scholar 

  103. Frank RM, Lee S, Bush-Joseph CA, Kelly BT, Salata MJ, Nho SJ. Improved outcomes after hip arthroscopic surgery in patients undergoing t-capsulotomy with complete repair versus partial repair for femoroacetabular impingement: a comparative matched-pair analysis. Am J Sports Med. 2014;42(11):2634–42. https://doi.org/10.1177/0363546514548017.

    Article  PubMed  Google Scholar 

  104. Steinberg N, Hershkovitz I, Peleg S, et al. Range of joint movement in female dancers and nondancers aged 8 to 16 years: anatomical and clinical implications. Am J Sports Med. 2006;34(5):814–23. https://doi.org/10.1177/0363546505281805.

    Article  PubMed  Google Scholar 

  105. Hamilton D, Aronsen P, Løken JH, et al. Dance training intensity at 11-14 years is associated with femoral torsion in classical ballet dancers. Br J Sports Med. 2006;40(4):299–303. https://doi.org/10.1136/bjsm.2005.020941.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  106. Ekhtiari S, de Darren SA, Haldane CE, et al. Hip arthroscopic capsulotomy techniques and capsular management strategies: a systematic review. Knee Surg Sport Traumatol Arthrosc. 2017;25(1):9–23. https://doi.org/10.1007/s00167-016-4411-8.

    Article  Google Scholar 

  107. Alradwan H, Philippon MJ, Farrokhyar F, et al. Return to preinjury activity levels after surgical management of femoroacetabular impingement in athletes. Arthroscopy. 2012;28(10):1567–76. https://doi.org/10.1016/j.arthro.2012.03.016.

    Article  PubMed  Google Scholar 

  108. Domb BG, Stake CE, Finch NA, Cramer TL. Return to sport after hip arthroscopy: aggregate recommendations from high-volume hip arthroscopy centers. Orthopedics. 2014;37(10):e902–5. https://doi.org/10.3928/01477447-20140924-57.

    Article  PubMed  Google Scholar 

  109. Murata Y, Uchida S, Utsunomiya H, Hatakeyama A, Nakamura E, Sakai A. A comparison of clinical outcome between athletes and nonathletes undergoing hip arthroscopy for femoroacetabular impingement. Clin J Sport Med. 2017;27(4):349–56. https://doi.org/10.1097/JSM.0000000000000367.

    Article  PubMed  Google Scholar 

  110. Malviya A, Paliobeis CP, Villar RN. Do professional athletes perform better than recreational athletes after arthroscopy for femoroacetabular impingement? Hip. Clin Orthop Relat Res. 2013;471:2477–83. https://doi.org/10.1007/s11999-013-2787-z.

    Article  PubMed  PubMed Central  Google Scholar 

  111. Byrd JWT, Jones KS. Arthroscopic management of femoroacetabular impingement in athletes. Am J Sports Med. 2011;39(suppl_1):7S–13S. https://doi.org/10.1177/0363546511404144.

    Article  PubMed  Google Scholar 

  112. Nho SJ, Magennis EM, Singh CK, Kelly BT. Outcomes after the arthroscopic treatment of femoroacetabular impingement in a mixed group of high-level athletes. Am J Sports Med. 2011;39(suppl_1):14S–9S. https://doi.org/10.1177/0363546511401900.

    Article  PubMed  Google Scholar 

  113. Deaner RO, Geary DC, Puts DA, et al. A Sex difference in the predisposition for physical competition: males play sports much more than females even in the contemporary US. PLoS One. 2012;7(11):e49168. https://doi.org/10.1371/journal.pone.0049168.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  114. Clohisy JC, Baca G, Beaulé PE, et al. Descriptive epidemiology of femoroacetabular impingement: a North American cohort of patients undergoing surgery. Am J Sports Med. 2013;41(6):1348–56. https://doi.org/10.1177/0363546513488861.

    Article  PubMed  Google Scholar 

  115. Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–20. https://doi.org/10.1097/01.blo.0000096804.78689.c2.

    Article  Google Scholar 

  116. Leunig M, Jüni P, Werlen S, et al. Prevalence of cam and pincer-type deformities on hip MRI in an asymptomatic young Swiss female population: a cross-sectional study. Osteoarthr Cartil. 2013;21(4):544–50. https://doi.org/10.1016/j.joca.2013.01.003.

    Article  CAS  Google Scholar 

  117. Shibata KR, Matsuda S, Safran MR. Arthroscopic hip surgery in the elite athlete: comparison of female and male competitive athletes. Am J Sports Med. 2017;45(8):1730–9. https://doi.org/10.1177/0363546517697296.

    Article  PubMed  Google Scholar 

  118. Aprato A, Jayasekera N, Villar R. Timing in hip arthroscopy: does surgical timing change clinical results? Int Orthop. 2012;36(11):2231–4. https://doi.org/10.1007/s00264-012-1655-x.

    Article  PubMed  PubMed Central  Google Scholar 

  119. Claßen T, Körsmeier K, Kamminga M, et al. Is early treatment of cam-type femoroacetabular impingement the key to avoiding associated full thickness isolated chondral defects? Knee Surg Sport Traumatol Arthrosc. 2016;24(7):2332–7. https://doi.org/10.1007/s00167-014-3332-7.

    Article  Google Scholar 

  120. Menge TJ, Briggs KK, Philippon MJ. Predictors of length of career after hip arthroscopy for femoroacetabular impingement in professional hockey players. Am J Sports Med. 2016;44:2286–91. https://doi.org/10.1177/0363546516650649.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

None

Conflicts of Interest

None

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Olufemi R. Ayeni .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 ISAKOS

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Coughlin, R.P., Ayeni, O.R. (2019). Arthroscopic Management of Femoroacetabular Impingement in Athletes. In: Safran, M., Karahan, M. (eds) Hip and Groin Pain in the Athlete . Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-58699-0_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-58699-0_8

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-58698-3

  • Online ISBN: 978-3-662-58699-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics