Arthroscopic appearance and treatment of impingement cysts at femoral head-neck junction

Abstract

Purpose: To study the arthroscopic appearance and treatment of impingement cysts and to propose their potential intraoperative value for correct femoral osteochondroplasty in femoroacetabular impingement (FAI).

Methods: We performed a single-surgeon, retrospective study of 152 consecutive hip arthroscopies in 141 patients treated for FAI due to cam, localized pincer, or mixed FAI. Radiographic (conventional radiographs and magnetic resonance arthrography) cyst sizes and locations as well as the arthroscopic appearance were recorded.

Results: On the preoperative radiographs, impingement cysts were radiographically visible in 18% of treated FAI patients (26 of 141); 15% of these patients (4 of 26) had more than 1 cyst. Age was the only independent predictor of cysts, with a 7-year shift to a mean age of 42 years. The majority of cysts were located in the anterosuperior quadrant of the femoral head-neck junction (93%), the mean diameter of cysts was 7.0 mm, with a range from 3.7 to 15.1 mm. During surgery, only a few were arthroscopically identifiable, with a pit-like (3 of 26) or crater-like appearance (3 of 26) (i.e., surface alterations) for the larger cysts. The majority of cysts (20 of 26) became evident, however, after unroofing of the area of cam FAI. Cysts were associated with labral (25 of 26) and/or chondral lesions (23 of 26). Small cysts were completely removed during femoral osteochondroplasty, whereas larger cysts were only resected until impingement-free range of motion was reached. No neck fractures occurred in this series.

Conclusions: Impingement cysts were present on 1 in 6 radiographs in patients undergoing hip arthroscopy for FAI and were found most commonly in older patients. The cysts predictably occur within the epicenter of the femoral-induced impingement. Whereas surface alterations are rare (6 of 26), the content and base of the unroofed cyst are consistent. Most cysts are completely excised as part of the femoral impingement correction and may be used as a confirmation that arthroscopic cam resection has been performed at the correct site.

Level of evidence: Level IV, therapeutic case series.