CAM Impingement: Surgical Management

Abstract

CAM-type femoroacetabular impingement is increasingly recognized as a source of activity-limiting symptom and a contributor to degenerative hip disease. Hip arthroscopy is an effective treatment option for repairing the resulting acetabular chondrolabral junction injury and reshaping the pathologic bony morphology to limit further joint degeneration. Recent randomized controlled trials have confirmed the advantages of surgical management of femoroacetabular impingement with hip arthroscopy over conservative management. Standard technique utilizes 3 portals, anterolateral, mid-anterior, and distal anterolateral accessory. Interportal capsulotomy allows access to the central compartment to resect a concomitant pincer lesion, refixate a torn labrum, and treat articular cartilage injury. The mid-anterior portal is used for arthroscopic visualization, while suture anchors are placed through the distal anterolateral accessory portal and the anterolateral portal is a working portal. T-capsulotomy provides extensile exposure of the entire CAM lesion, and viewing from the mid-anterior portal further improves arthroscopic visualization. Fluoroscopy is essential for intraoperative mapping of the CAM lesion and to confirm appropriate resection. Capsular closure is performed routinely to repair both the T-capsulotomy and the interportal capsulotomy. This review provides a comprehensive description of the surgical technique for CAM impingement, as well as the postoperative rehabilitation and outcomes.