Arthroscopic Management of Femoroacetabular Impingement (FAI) in Adolescents

Abstract

Objectives: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.Methods: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 achieved 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.Results:Follow-up averaged 29 months for both groups (range 12-60 months). For the study group, the average age was 16 years (range 12-17 years). There were 49 males and 59 females. For the control group, the average age was 36 years (range 18-50 years) with 71 males and 51 females. The average 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 (42 Grade I, 18 Grade II, 47 Grade III and 4 Grade IV) with 4 microfractures. There were 3 femoral chondral lesions (1 Grade II, 2 Grade III). 7 loose bodies were removed and 19 lesions of the ligamentum teres were debrided. Concomitant extraarticular 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 (9 Grade I, 11 Grade II, 59 Grade III, 33 Grade IV) with 20 microfractures. There were 17 femoral chondral lesions (1 Grade II, 11 Grade III, 5 Grade IV). 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.Conclusion:This study reports favorable outcomes of arthroscopic management of FAI in adolescents with improvement more than comparable to those of an adult population and higher absolute scores. Concomitant extraarticular procedures and revision were both more common among adolescents. This data supports that arthroscopy does have a role in the management of FAI in adolescents.