Arthroscopic Management of Femoroacetabular Impingement (FAI) in Adolescents

Abstract

Arthroscopic management of symptomatic femoroacetabular impingement (FAI) is a well-accepted treatment. FAI is known to lead to early-age onset osteoarthritis in middle-aged adults and can result in significant secondary joint damage in young adults. Few studies report on the role of arthroscopy for FAI in adolescents, and none provide comparative data. The purpose of this study is to report the outcomes of hip arthroscopy for adolescents with symptomatic FAI in relation to a control group. All patients undergoing arthroscopy are prospectively assessed with a modified Harris Hip Score. 122 consecutive hips among 108 adolescents less than 18 years of age were identified who had undergone arthroscopic surgery for FAI and had minimum 1-year follow-up. A chronologically matched control group of 122 patients 18-50 years of age was identified who had also undergone arthroscopic surgery for FAI contemporaneous with the study group. These cohorts represent the substance of this report. Follow-up averaged 20 months for both groups (range, 12-60 months). For the study group, the ave. age was 16 years (range, 12-17 years). There were 49 males and 59 females. For the control group, the ave. age was 36 years (range, 18-50 years) with 71 males and 51 females. The ave. improvement of the study group was 23 points (preop 69; postop 92) and, for the control group, 21 points (preop 63; postop 84). For the study group, FAI correction was performed for 36 cam, 17 pincer, and 69 combined lesions. 111 labral tears underwent 85 refixations and 26 debridements. There were 101 acetabular chondral lesions with 4 microfxs. There were 3 femoral chondral lesions. 7 loose bodies were removed and 19 lesions of the ligamentum teres were debrided. Comcomitant extra-articular procedures included 13 iliopsoas tendon releases and 2 iliotibial band tendoplasties. Among the control group, FAI correction was performed for 53 cam, 5 pincer, and 64 combined lesions. 103 labral tears underwent 52 refixations and 50 debridements. There were 112 acetabular chondral lesions with 20 microfxs. There were 17 femoral chondral lesions. 17 loose bodies were removed and 21 lesions of the ligamentum teres debrided. Concomitant extraarticular procedures included 4 iliopsoas tendon releases and 1 abductor repair. There were 2 complications in the study group: transient perineal neurapraxias that resolved within 2 weeks. In the control group, 1 patient had a transient perineal neurapraxia and lateral thigh numbness, both of which resolved. In the study group, 4 patients underwent repeat arthroscopy and 1 a PAO. In the control group, 1 patient underwent repeat arthroscopy. This study reports favorable outcomes of arthroscopic management of FAI in adolescents with results more than comparable to those of an adult population. Concomitant extra-articular procedures and revision were both more common among adolescents. These data support that arthroscopy does have a role in the management of FAI in adolescents.