Hip arthroscopy following slipped capital femoral epiphysis fixation: chondral damage and labral tears findings

Abstract

Purpose: This study investigated the association between chondrolabral damage and time to arthroscopic surgery for slipped capital femoral epiphysis (SCFE).

Methods: This was a descriptive retrospective study that enrolled patients with SCFE who underwent hip arthroscopy for femoral osteochondroplasty after SCFE fixation. SCFE type, time from SCFE symptom onset or slip fixation surgery to hip arthroscopy and intraarticular arthroscopic findings were recorded. Acetabular chondrolabral damage was evaluated according to the Konan and Outerbridge classification systems. Nested analysis of variance and the chi-squared test were used for statistical analyses.

Results: We analyzed 22 cases of SCFE in 17 patients (five bilateral). The mean age at the time of hip arthroscopy was 13.6 years-old (8-20), and mean time from SCFE fixation to arthroscopy was 25.1 months (3 weeks to 8 years). Labral frying was present in 20 cases, labral tears in 16 and acetabular chondral damage in 17. The most frequent lesion was type 3 (41%) (Konan classification). Two cases had a grade III and 1 had a grade II acetabular chondral lesion (Outerbridge classification). Positive associations were observed between time from SCFE to hip arthroscopy and hip intraarticular lesions evaluated using Konan (p = 0.004) and Outerbridge (p = 0.000) classification systems. There was no association between SCFE severity (chi-squared = 0.315), stability (chi-squared = 0.558) or temporality (chi-squared = 0.145) type and hip intraarticular lesions.

Conclusion: A longer time from SCFE symptom onset and fixation to hip arthroscopy is associated with greater acetabular chondrolabral damage.

Level of evidence: IV.

Keywords: epiphysiolysis; femoroacetabular impingement; hip arthroscopy; hip preservation surgery; slipped capital femoral epiphysis; slipped upper femoral epiphysis.

Fig. 1

Synovial hyperemia: arthroscopic view of central (a) and peripheral (b) compartments of the hip joint in a patient with slipped capital femoral epiphysis (AC, acetabular cartilage; FH, femoral head; L, labrum; S, synovial tissue in chondrolabral junction; SC, synovial capsule).

Fig. 2

Direct arthroscopic view of the labrum: fibrillated and stable (a) and unstable (b) labrum and severe intrasubstance tissue damage in the labrum (c) (AC, acetabular cartilage; FH, femoral head; L: labrum).

Fig. 3

Acetabular cartilage under direct arthroscopic view: Konan type 1 (a), type 2 (b) and type 3 (c) acetabular chondral lesions. Arrowheads in (a) delineate the area of loss of fixation of peripheral acetabular cartilage (AC, acetabular cartilage; CL, chondrolabral junction; FH, femoral head; L, labrum; TC, triradiate cartilage).

Fig. 4

Direct arthroscopic view of femoral head cartilage with grade I chondromalacia (Outerbridge classification).

Fig. 5

Arthroscopic view of peripheral compartment of the hip joint in a patient with slipped capital femoral epiphysis (SCFE), showing femoroacetabular impingement by inclusion (arrowhead) from the metaphyseal bump of the proximal femur against the acetabular labrum (L, labrum; MB, metaphyseal bump; S, slip zone of SCFE).

Fig. 6

Arthroscopic view of peripheral compartment of the hip joint in a patient with slipped capital femoral epiphysis after osteochondroplasty (E, proximal femur epiphysis; L, labrum; M, proximal femur metaphysis; Ph, proximal femur physis).

Fig. 7

Mean joint range of movement values in slipped capital femoral epiphysis cases pre- and post-hip arthroscopy: a) flexion; b) internal rotation (IR); c) external rotation (ER); d) abduction.

Fig. 8

Dunn 90° radiograph views pre- (a, c) and post- (b, d) arthroscopic femoral osteochondroplasty with α angle measurements in two slipped capital femoral epiphysis cases.

Fig. 9

α Angle measured pre- and post-arthroscopic femoral osteochondroplasty in slipped capital femoral epiphysis cases.

Fig. 10

Correlation analysis: time from onset of slipped capital femoral epiphysis (SCFE) symptoms (a) and slip fixation surgery (b) to hip arthroscopy and Konan-type lesions. Time from onset of SCFE symptoms (c) and slip fixation surgery (d) to hip arthroscopy and Outerbridge grade of acetabular cartilage lesions.