Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression

Abstract

Femoroacetabular impingement (FAI) occurs when an osseous abnormality of the proximal femur (cam) or acetabulum (pincer) triggers damage to the acetabular labrum and articular cartilage in the hip. Although the precise etiology of FAI is not well understood, both types of FAI are common in athletes presenting with hip pain, loss of range-of-motion, and disability in athletics. An open surgical approach to decompressing FAI has shown good clinical outcomes; however, this highly invasive approach inherently may delay or preclude a high level athlete's return to play. The purpose of this study was to define associated pathologies and determine if an arthroscopic approach to treating FAI can allow professional athletes to return to high-level sport. Hip arthroscopy for the treatment of FAI allows professional athletes to return to professional sport. Between October 2000 and September 2005, 45 professional athletes underwent hip arthroscopy for the decompression of FAI. Operative and return-to-play data were obtained from patient records. Average time to follow-up was 1.6 years (range: 6 months to 5.5 years). Forty two (93%) athletes returned to professional competition following arthroscopic decompression of FAI. Three athletes did not return to play; however, all had diffuse osteoarthritis at the time of arthroscopy. Thirty-five athletes (78%) remain active in professional sport at an average follow-up of 1.6 years. Arthroscopic treatment of FAI allows professional athletes to return to professional sport.

Fig. 1

A 27-year-old professional hockey player was evaluated for right hip pain. a A pre-operative cross-table lateral radiograph demonstrated convexity at the anterior femoral head–neck junction. b The presence of a cam lesion was verified arthroscopically. The femoral head (FH) and acetabulum (Ac) are visualized in the peripheral hip compartment with the camera in the anterior portal. c A motorized burr was used to restore anterior concavity at the head–neck junction. This was visualized at the superior acetabular (Ac) position (12:00) with the camera in the anterior portal. d A post-operative film verified successful decompression of the cam impingement and restoration of the femoral head–neck junction concavity

Fig. 2

A 22-year-old professional football player was evaluated for right hip pain. a A pre-operative AP radiograph demonstrated a cross-over sign of the right acetabulum, indicating acetabular retroversion. b The presence of a pincer lesion was verified arthroscopically with the camera in the anterolateral portal with excessive bone along the anterior–superior acetabulum (Ac). c A motorized burr in the anterior portal resected the lesion with the burr shield placed against the labrum (L) for protection. d The labrum was fixed back to the rim using two suture anchors. e A post-operative film verified the successful removal of pincer impingement and lack of retroversion in the superior region of the acetabulum