Hip arthroscopy improves symptoms associated with FAI in selected adolescent athletes

Abstract

Background: 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.

Questions/purposes: 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.

Methods: 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).

Results: 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.

Conclusions: 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.

Fig. 1

A coronal proton density noncontrast MRI sequence shows a full-thickness degenerative labral tear at the site of impingement (triangle). The osseous cam deformity also is seen (arrow). * = hip capsule.

Fig. 2A–B

Three-dimensional CT reconstructions show (A) an anteromedial oblique view of a right femoral neck cam lesion (arrow), and (B) a frontal view of a combined lesion in the left hip of another patient. Arrow = cam; * = pincer.

Fig. 3A–B

Intraoperative fluoroscopy of cam decompression in the hip of a 19-year-old male is shown. (A) Before decompression, a cam lesion was identified (arrow). (B) After recontouring the femoral neck with a 3.5-mm arthroscopic burr, femoral head-neck offset was reestablished (arrow).