Discussion

FAI has recently been recognized as a major source of hip pain, labral tears, reduced range of motion, and decreased performance in the athlete. In the past, labral tears were regarded as isolated pathologies, and proposed treatment involved simple resection of the tears [27]. Although labral debridement may yield immediate postoperative pain relief, long-term outcomes of this procedure can be improved [27]. As a result, Ganz et al [5,6] have sought a cause for labral tears; they have proposed FAI as an underlying mechanism in a significant proportion of labral tears. Further, FAI has been shown to be a significant cause of early osteoarthritis in the hip [2-4,8,9]. As a result, treatment of the impingement as well as the associated pathology is thought to improve patient outcome following hip arthroscopy.

Historically, an open surgical dislocation procedure for FAI decompression has been advocated to provide an unobstructed 360° view of both the femoral head and acetabulum [6,16]. Although a study has shown good midterm results with this technique [28], the surgical trauma sustained during the open dislocation may make it difficult for high-level athletes to return to play. Proponents of the open technique have argued that the "constrained hip renders [arthro-scopic] access to the underlying cause of impingement technically challenging, if not impossible" [6]. However, with the combined use of long and flexible arthroscopic instrumentation, and controlled intra-operative manipulation of the lower extremity, we believe that 360° access to the femoral head-neck junction is definitely possible with arthroscopy. The senior author has performed over 516 hip arthroscopies for decompression of FAI between September 2000 and April 2005. In a review, 45 of these patients were professional athletes who each experienced symptomatic improvement and all returned to play (Philippon MJ, unpublished data, 73rd Annual Meeting of the American Academy of Orthopaedic Surgeons, 2006).

In conclusion, athletes presenting with hip pain should be evaluated for the signs and symptoms of FAI in addition to those of labral and chondral injuries. The increasing popularity of hip arthroscopy has led to the development of this new technique. Advantages to the arthroscopic approach seem to be a reduction in postoperative morbidity and a more prompt postoperative return to play for athletes. By treating FAI in athletes at an early stage, it is hopeful that osteo-arthritis progression in the years following competition will be delayed or completely prevented.

References

[1] Philippon MJ, Schenker ML. Athletic hip injuries and capsular laxity. Op Tech Orthop 2005;15(3):261-6.

[2] Beck M, Kalhor M, Leunig M, et al. Hip morphology influences the pattern of damage to the acetabular cartilage. J Bone Joint Surg Br 2005;87-B(7):1012-8.

[3] Ganz R, Parvizi J, Beck M, et al. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop 2003;417:112-20.

[4] Wagner S, Hofstetter W, Chiquet, et al. Early osteoarthritic changes of human femoral head cartilage subsequent to femoro-acetabular impingement. Osteoarthritis Cartilage 2003;11(7):508-18.

[5] Ito K, Minka MA, Leunig M, et al. Femoroacetabular impingement and the cam-effect: a MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br 2001;83-B(2):171-6.

Lavigne M, Parvizi J, Beck M, et al. Anterior femoroacetabular impingement: part 1: techniques of joint preserving surgery. Clin Orthop 2004;418:61-6. Notzli HP, Wyss TF, Steocklin CH, et al. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 2002;84-B(4):556-60. Goodman DA, Feighan JE, Smith AD, et al. Subclinical slipped capital femoral epiphysis: relationship to osteoarthrosis of the hip. J Bone Joint Surg 1997;79:1489-97. Leunig M, Casillas MM, Hamlet M, et al. Slipped capital femoral epiphysis: early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis. Acta Orthop Scand 2000;71(4):370-5.

Siebenrock KA, Wahab KH, Werlen S, et al. Abnormal extension of the femoral head epiphysis as a cause of cam impingement. Clin Orthop 2004;418:54-60. Eijer H, Myers SR, Ganz R. Anterior femoroacetabular impingement after femoral neck fractures. J Orthop Trauma 2001;15(7):475-81.

Tonnis D, Heinecke A. Acetabular and femoral anteversion: relationship with osteoarthritis of the hip. J Bone Joint Surg 1999;81-A(12):1747-70.

Reynolds D, Lucas J, Klaue K. Retroversion of the acetabulum: a cause of hip pain. J Bone Joint Surg 1999;81-B(2):281 -8.

Siebenrock KA, Schoeniger R, Ganz R. Anterior femoroacetabular impingement due to acetabular retroversion: treatment with periacetabular osteotomy. J Bone Joint Surg 2003;85-A(2):278-86.

Giori NJ, Trousdale RT. Acetabular retroversion is associated with osteoarthritis of the hip. Clin Orthop 2003;417:263-9.

Ganz R, Gill TJ, Gautier E, et al. Surgical dislocation of the adult hip a technique with full access to the femoral head and acetabulum without the risk of avascular necrosis. J Bone Joint Surg Br 2001;83(8):1119-24.

Kim YT, Azuma H. The nerve endings of the acetabular labrum. Clin Orthop 1995;320: 176-81.

Kelly BT, Williams RJ, Philippon MJ. Hip arthroscopy: current indications, treatment options, and management issues. Am J Sports Med 2003;31(6):1020-37.

Siebenrock KA, Kalbermatten DF, Ganz R. Effect of pelvic tilt on acetabular retroversion:

a study of pelves from cadavers. Clin Orthop 2003;407:241-8.

Eijer H, Leunig M, Mahomed N, et al. Cross-table lateral radiographs for screening of anterior femoral head-neck offset in patients with femoroacetabular impingement. Hip

Int 2001;11:37-41.

Kassarjian A, Yoon LS, Belzile E, et al. Triad of MR arthrographic findings in patients with cam-type femoroacetabular impingement. Radiology 2005;236(2):588-92.

Kelly BT, Weiland DE, Schenker ML, et al. Arthroscopic labral repair in the hip: surgical technique and review of the literature. Arthroscopy 2005;21(12):1496-504.

Schenker ML, Martin RR, Weiland DE, et al. Current trends in hip arthroscopy: a review of injury diagnosis, techniques, and outcome scoring. Curr Opin Orthop 2005;16:89-94.

Gautier E, Ganz K, Krugel N, et al. Anatomy of the medial femoral circumflex artery and its surgical im-plications. J Bone Joint Surg Br 2000;82-B(5):679-83.

Lavigne M, Kalhor M, Beck M, et al. Distribution of vascular foramina around the femoral head and neck junction: relevance for conservative intracapsular procedures of the hip.

Orthop Clin N Am 2005;36:171-6.

Mardones RM, Gonzalez C, Chen Q, et al. Surgical treatment of femoroacetabular impingement: evaluation of the effect of the size of resection. J Bone Joint Surg 2005; 87-A(2):273-9.

Farjo LA, Glick JM, Sampson TG. Hip arthroscopy for acetabular labral tears. Arthroscopy 1999;15(2):132-7.

Beck M, Leunig M, Parvizi J, et al. Anterior femoroacetabular impingement: part II: midterm results of surgical treatment. Clin Orthop 2004;418:67-73.

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