Arthroscopic Management of Femoroacetabular Impingement in Adolescents

Abstract

Purpose: To report the outcomes of hip arthroscopy for adolescent patients with symptomatic femoroacetabular impingement (FAI) in relation to a control group of adult patients treated arthroscopically for FAI.

Methods: All patients undergoing hip arthroscopy were assessed with a modified Harris Hip Score preoperatively and postoperatively at 3, 12, 24, and 60 months. Inclusion criteria were all patients less than 18 years of age who underwent arthroscopic surgery for symptomatic FAI and had achieved minimum 1-year follow-up. These cases were gathered over an 8-year period.

Results: The study group consisted of 122 consecutive hips (108 patients), and the control group consisted of 122 hips. Follow-up averaged 30 months (range 12 to 60 months). For the study group, the average age was 16 years, with 55 males and 65 females; control group average age was 36 years, with 71 males and 51 females. In the study group, the average scores were preoperative 68.3 and postoperative 93.6, with a 25.4-point improvement. The duration of symptoms averaged 16.6 months, and 95.9% participated in athletic activities. The study group included 36 cam, 17 pincer, and 69 combined lesions. One hundred eleven labral tears underwent 85 refixations and 26 debridements; there were 101 acetabular chondral lesions (51 grade 3 or 4), with 4 microfractures and 3 femoral chondral lesions. Among the control group, the average scores were preoperative 63.3 and postoperative 85.5, with a 22.2-point improvement. The duration of symptoms averaged 31.2 months, and 61.5% participate in athletic activities. The control group consisted of 53 cam, 5 pincer, and 64 combined FAI lesions. One hundred three labral tears underwent 52 refixations and 51 debridements; there were 112 acetabular lesions (92 grade 3 or 4), with 20 microfractures and 17 femoral chondral lesions. The study group included 15 concomitant extra-articular procedures, and there were 5 in the control group. In the study group, 4 underwent repeat arthroscopy and 1 periacetabular osteotomy; in the control group, 1 patient underwent repeat arthroscopy.

Conclusions: Favorable outcomes of arthroscopic management of FAI in adolescents are reported compared with an adult control group. The present data support that arthroscopy does have a role in the management of FAI in adolescents.

Level of evidence: Level III, case control study.