Femoroacetabular Impingement In Adolescents Research Articles

Long-Term Outcomes of Arthroscopic Labral Treatment of Femoroacetabular Impingement in Adolescents: A Nested Propensity-Matched Analysis.

Hip arthroscopy has demonstrated effectiveness as a treatment for femoroacetabular impingement (FAI) in adult patients, with promising long-term outcomes. However, there is a paucity of literature regarding the adolescent population. The purposes of our study were to report on survivorship and patient-reported outcomes (PROs) at a minimum 10-year follow-up in adolescent patients who underwent hip arthroscopy for FAI and labral tears and to compare the survivorship and outcomes of this population with those of a nested, propensity-matched adult control group. Data regarding adolescent patients who underwent primary hip arthroscopy between February 2008 and January 2012 were reviewed. Patients with a minimum 10-year follow-up for the modified Harris hip score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score Sport-Specific Subscale (HOS-SSS), International Hip Outcome Tool-12 (iHOT-12), and visual analog scale (VAS) for pain were eligible. The exclusion criteria were previous ipsilateral hip conditions or surgical procedures, a Tönnis grade of >1, or dysplasia. In the subanalysis, adolescent patients were matched to young adult patients with use of a 1:1 ratio on the basis of sex, body mass index, Tönnis grade, lateral center-edge angle (LCEA), labral treatment, capsular treatment, and additional procedures performed during the surgery. A total of 74 patients (61 female and 13 male; 74 hips) with a mean (and standard deviation) age of 16.7 ± 1.4 years and a minimum follow-up of 10 years were included. The latest follow-up occurred at a mean of 125.4 ± 5.3 months (range, 120.0 to 144.1 months). Significant improvement in all PROs from baseline and 100% survivorship were demonstrated at the 10-year follow-up. In the subanalysis, 58 adolescent hips were propensity-matched to 58 young adult hips. The adolescent group had higher postoperative scores for the HOS-SSS (p = 0.021), NAHS (p = 0.021), and iHOT-12 (p = 0.042) than the young adult group. Patient satisfaction at the latest follow-up was also significantly higher in the adolescent group (p = 0.00061). The rate of survivorship free from conversion to THA was similar between the adolescent and control groups (100% versus 96.6%; p = 0.200). Adolescents undergoing hip arthroscopy for the treatment of FAI and labral tears demonstrated excellent outcomes and a high rate of survivorship. These outcomes were superior to those seen in a matched adult group. The results of this study indicate that hip arthroscopy in adolescents is a safe procedure that leads to improvement in outcomes at long-term follow-up. Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Podium Presentation Title: Primary Hip Arthroscopy for Femoroacetabular Impingement in Adolescents had High Clinical Benefit

Podium Presentation Title: Primary Hip Arthroscopy for Femoroacetabular Impingement in Adolescents had High Clinical Benefit

Clinical aspects of imaging the hip in infants, children and adolescents

When achild with ahip problem is clinically evaluated, it is usually possible to make apresumptive diagnosis which is subsequently confirmed. The most important tool for confirmation in pediatric hip disorders is radiological imaging. Vice versa changes on sonogram, native X‑ray or magnetic resonance images (MRI) can often only be interpreted when the history and current clinical findings are known. In this constellation, it is desirable that all colleagues who are confronted with achild's hip problem know the most common and important pediatric hip disorders and use the same terminology. The aim of this article is to present ashort outline of the pathogenesis and clinical aspects of congenital and neurogenic hip dysplasia, coxitis fugax, septic coxitis, Perthes' disease, infantile and adolescent femoroacetabular impingement, apophysiolyses, and slipped capital femoral epiphysis.

Nonoperative Management of Femoroacetabular Impingement in Adolescents: Clinical Outcomes at a Mean of 5 Years: A Prospective Study

Background: There is a lack of midterm or long-term outcome data on nonoperative management of femoroacetabular impingement (FAI) syndrome in adolescents despite expanding research mostly focused on arthroscopic management. Purpose: To present 5-year outcome data utilizing a nonoperative protocol on a consecutive series of patients presenting to our clinic with FAI syndrome. Study Design: Cohort study, Level of evidence, 2. Methods: A total of 100 patients (62% female; mean age 15 years) who presented to the clinic for evaluation of hip pain and had at least 1 hip with a positive impingement sign were prospectively recruited. The management protocol consisted of an initial trial of rest, physical therapy, and activity modification. Patients who remained symptomatic were offered an intra-articular steroid injection. Patients with recurrent symptoms were then offered arthroscopic treatment. Patient-reported outcomes (PROs), including the modified Harris Hip Score (mHHS) and the Nonarthritic Hip Score (NAHS) were then collected at a mean 1, 2, and 5 years after the initial evaluation. Results: At enrollment, the mean mHHS and NAHS were 69.6 ± 12.9 and 75.5 ± 15.2, respectively. A total of 51 patients (n = 69 hips) were available at a mean 5-year follow-up, with the mean mHHS and NAHS of 89.5 ± 10.8 and 88.1 ± 12, respectively. There was no significant difference in the mHHS or the NAHS between activity modification and physical therapy, injection, or arthroscopic surgery groups at 5-year follow-up (P > .6) and no difference in the proportion of hips meeting the minimal clinically important difference (MCID) for the mHHS based on treatment course (P = .99). There was no significant difference in the mHHS or the NAHS between FAI types at any time point, or in the proportion of hips that met the MCID among FAI types (P = .64). Also, 11 out of 12 hips that required surgery had surgery in less than 2 years. One hip underwent surgery at 5 years after the initial visit. There was no significant drop-off in the mHHS or the NAHS between the 2-year and 5-year time periods (P > .3). Conclusion: Nonoperative management of FAI syndrome is effective in a majority of adolescent patients, with significant improvements in PROs persisting at a mean 5-year follow-up.

Arthroscopic Management of Femoroacetabular Impingement in Adolescents: A Systematic Review

Background: Femoroacetabular impingement (FAI) is highly prevalent in adolescent athletes. There has been an increasing trend for arthroscopic surgery for FAI, and the results of several clinical studies on outcome after arthroscopic surgery for FAI are available. Purpose: To conduct a systematic review to investigate the role of arthroscopic management for FAI in adolescents. Study Design: Systematic review. Methods: This systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In August 2020, PubMed, Scopus, Google Scholar, and EMBASE were accessed. All clinical trials concerning the arthroscopic treatment for adolescents with FAI were identified. Only studies on patients aged less than 18 years at the time of surgery reporting data over a minimum follow-up of 12 months were considered. Results: Data from 406 adolescents (470 procedures; mean age at surgery, 15.9 years; mean follow-up, 30.4 months) with FAI were retrieved. At a mean of 28.0 months of follow-up, 94% of the adolescents had already returned to sport. All the scores of interest were improved at the final follow-up: visual analog scale (P = .01), modified Harris Hip Score (P < .0001), Non-Arthritic Hip Score (P = .03), Hip Outcome Score–Activities of Daily Living (P = .01), Hip Outcome Score–Sport-Specific Subscale (P < .0001), and Tegner score (P < .0001). Complications occurred in 1.1% (5/470) of procedures, and revision arthroscopy was performed in 4.7% (22/470) of procedures. Conclusion: Arthroscopic surgery in adolescents with FAI achieves excellent outcomes and a high rate of return to sport, with rates of complication and revision surgery of 1% and 5%, respectively.

Hip Arthroscopy for Femoroacetabular Impingement in Adolescents: 10-Year Patient-Reported Outcomes

Background: Previous studies have demonstrated hip arthroscopy to be an effective treatment for femoroacetabular impingement (FAI) in individuals 18 years of age and older. Long-term outcome data in the adolescent population, however, are limited. Purpose: To report 10-year outcomes after hip arthroscopy in adolescents with symptomatic FAI. Study Design: Case series; Level of evidence, 4. Methods: Prospectively collected data were analyzed on adolescent patients younger than 18 years of age who had hip arthroscopy between March 2005 and 2009 with a minimum 10-year follow-up. Patients were included if they were diagnosed with symptomatic FAI and an associated labral tear that was treated with repair. Patients were excluded if they had previous hip procedures, acetabular dysplasia (lateral center-edge angle, <20°), avascular necrosis, previous hip fracture or dislocation, or Legg-Calve-Perthes disease, or refused to participate. The primary patient-reported outcome measure was the Hip Outcome Score (HOS) Activities of Daily Living (ADL) subscale. In addition, the HOS—Sport, modified Harris Hip Score (mHHS), 12-Item Short Form Health Survey (SF-12), and patient satisfaction were collected. Failure was defined as patients having to undergo revision arthroscopy. Results: There were 60 patients (70 hips) who met inclusion criteria and had a 10-year follow-up. The mean age of the cohort was 16 ± 1.2 years, with 21 male and 49 female hips. Seven hips (10%) required revision hip arthroscopy. All revisions occurred in female patients and were associated with global laxity as well as longer duration of symptoms before time of surgery. At a mean follow-up of 12 years (range, 10-14 years), patients who did not undergo revision surgery had significant improvements from preoperatively to postoperatively in HOS-ADL (from 64 to 92; P < .01), HOS–Sport (from 40 to 86; P < .01), mHHS (from 56 to 88; P < .01), and SF-12 Physical Component Summary (from 41 to 54; P < .01). The median patient satisfaction was 10 out of 10 (very satisfied). Conclusion: Hip arthroscopy for FAI with labral repair resulted in excellent patient-reported outcomes and satisfaction at a minimum of 10 years of follow-up. There was a 10% rate of revision surgery, which was associated with global laxity and longer duration of symptoms before surgery, which should be considered in patient selection.

The Association of α Angle on Disease Severity in Adolescent Femoroacetabular Impingement.

Background:Femoroacetabular Impingement (FAI) is a common cause of hip pain in adolescent patients. Clinical exam and radiographic markers, such as α angle and lateral center edge angle (LCEA), are commonly used to aid in the diagnosis of this condition. The purpose of this study was to correlate preoperative α angle and LCEA with preoperative symptoms, intraoperative findings, and preoperative and postoperative patient reported outcomes (PROs) in the adolescent patient.Methods:A retrospective analysis of prospectively collected data was conducted for all patients who underwent operative intervention for FAI at an academic institution over an 11-year period. Preoperative imaging was obtained and measured for LCEA and α angle. PROs (modified Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score, and UCLA score) were collected preoperatively, as well as 1, 2, and 5 years postoperatively. Operative intervention was either open surgical hip dislocation or arthroscopic, and intraoperative disease was graded using the Beck Classification system. Patients with minimum 1-year follow-up were included in statistical analysis.Results:There were 86 hips (64 female hips) included with an average age of 16.3 years (range, 10.4 to 20.5 y), with an average of 37 months of follow-up. There was no correlation between severity of preoperative symptoms or difference between pre and postoperative PROs for both α angle and LCEA. Overall, significant improvement was noted in modified Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score, and UCLA Score (P<0.001 for each). Independent of preoperative symptoms, increased α angle correlated with more severe intraoperative labral disease (P<0.001), and longer length of labral tear (Corr 0.295, P<0.01). Femoral head and acetabular articular cartilage damage did not correlate with α angle or LCEA, nor did overall severity of disease.Conclusions:In adolescent patients with FAI, increased α angle was found to significantly correlate with labral pathology, including increased length of tear and severity of disease, irrespective of preoperative symptoms or postoperative patient reported outcomes.Level of Evidence:Level III—retrospective.

Arthroscopic Surgery for Femoroacetabular Impingement in Skeletally Immature Athletes: Radiographic and Clinical Analysis

To evaluate radiographic and clinical outcomes after arthroscopic femoroacetabular impingement (FAI) correction in symptomatic adolescent athletes with open physes. We retrospectively reviewed radiographic and clinical outcomes in patients treated with a non-physeal-sparing arthroscopic approach for symptomatic FAI with open physes and a minimum 1-year follow-up. Specific plain radiographic and computed tomography parameters were determined, and preoperative and postoperative outcomes were prospectively evaluated with modified Harris Hip Score (mHHS), 12-Item Veterans-Rand, and pain on a visual analog scale. Thirty-seven hips (28 patients; 75% male) with a mean age of 15.9years (range, 12.8-18.3years) had imaging studies consistent with open femoral neck and iliac crest physes. The ischial tuberosity and greater trochanteric physes were open in 95% and 54% of the hips, respectively. All patients participated in organized athletics, and 50% were in multiple sports year-round. Mean follow-up was 39.8months post-arthroscopic FAI correction. There was a mean 27.7-point improvement in the mHHS (P < .001), a 4.8-point decrease in the visual analog scale for pain (P < .001), and a 15.2-point improvement in the 12-Item Veterans-Rand physical component (P < .001). Ninety-three percent of patients returned to their preinjury level of sports participation without limitations. Thirty (81.1%) patients demonstrated improvements in mHHS greater than the minimally clinically important difference (of mHHS 8 points). Two patients could not reach minimally clinically important difference because of a preoperative mHHS of > 92. There were no postoperative physeal growth arrests, growth disturbances, physeal instability, or avascular necrosis. A non-physeal-sparing arthroscopic approach for FAI in adolescents with open physes is safe and effective with no evidence of clinically relevant complication of growth arrest-related deformity or physeal instability in patients with a minimum of 1year (mean, 39.8months) of follow-up after surgery. Young, highly athletic adolescent patients with larger FAI deformities demonstrated greater outcomes improvement after arthroscopy. Level IV, therapeutic case series.

Editorial on ‘Functional outcomes and cam recurrence after arthroscopic treatment of femoroacetabular impingement in adolescents’

Femoroacetabular impingement (FAI) syndrome is defined as having symptoms, clinical signs and diagnostic imaging findings of pincer and/or cam morphology (1). The treatment of FAI syndrome can be conservative by physiotherapy or surgically, mostly by arthroscopy. Functional outcome after hip arthroscopy can be quantified in several ways. Patient-reported outcome measures (PROMs) via hip specific questionnaires and return-to-play (RTP) time or percentage for athletes are most often used.

Outcomes of intra-articular corticosteroid injections for adolescents with hip pain.

ABSTRACTIntra-articular injection of corticosteroid and anesthetic (CSI) is a useful diagnostic tool for hip pain secondary to labral tears or femoroacetabular impingement (FAI). However, the effectiveness of CSI as a stand-alone treatment for hip pain in adolescents is unknown. The purpose of this study is to evaluate the use of CSI for the treatment of hip pain and determine factors that may affect outcomes after injection. Retrospective analysis of 18 patients and 19 hips that underwent fluoroscopic guided hip injection for the treatment of pain at a single institution from 2012 to 2015 was carried out in this study. Mean age at the time of injection was 15.1 years (range 13–17) with mean follow-up of 29.4 months. Fifty-two percent (10/19 hips) went on to surgery after the injection. Average time to surgical conversion was 12.8 months after CSI. Cam or pincer morphologies were present in 90% (9/10 hips) of the operative group. Patients with FAI were more likely to need surgery than patients without bony abnormalities (RR= 10, 95% CI 1.6–64.2, P = 0.0001). There was no difference in the presence of labral tears in the operative and non-operative groups (100% versus 89%, P = 0.47). For adolescents without bony abnormalities, 90% improved with CSI alone and did not require further treatment within 2.4 years. Fluoroscopic guided corticosteroid hip injection may have limited efficacy for the treatment of hip pain secondary to FAI in adolescents. However, for patients without osseous deformity, CSI may offer prolonged improvement of symptoms even in the presence of labral tears.

Surgery for Femoroacetabular Impingement in Skeletally Immature Patients: Radiographic and Clinical Analysis

Objectives:The improved recognition of symptomatic femoroacetabular impingement (FAI) has lead to an emphasis of early diagnosis and treatment in the adolescent population. The purpose of this study was to evaluate the radiographic and clinical outcomes in patients with open physes that underwent hip arthroscopy for the treatment of symptomatic FAI. Additionally, we describe the three-dimensional (3D) pathomorphology in this unique population.Methods:We retrospectively reviewed 39 hips (28 patients; 75% male) with a mean age 15.8 years (range, 12.8-19.3 years) with FAI, who additionally demonstrated open physes on pre-operative radiographs. Radiographic parameters included the lateral center edge (LCE), Tonnis angle, AP and lateral alpha angle and head-neck offset ratio (HNOr). Each patient also underwent a pre-operative CT scan, which was utilized for the evaluation for femoral and acetabular measurements and simulated range of motion (ROM) to impingement. Preoperative and post-operative functions were evaluated prospectively using the modified Harris Hip Score (mHHS) and pain on a visual analogue scale (VAS). All patients participated in organized athletics and 50% were in multiple sports year round.Results:All patients (100%) within this cohort had open femoral neck and iliac crest physis. The ischial tuberosity and greater trochanteric physes were open in 95% and 54% of the hips respectively. Although there was no significant difference between pre-operative and post-operative LCE and Tonnis angles, the alpha angle and HNOr were significantly improved (39.7° vs. 61.7°; p<0.001 and 0.19 vs. 0.17; p<0.001). Mean femoral version was 17.6°±7.4°, while the acetabular version at the 1:30 and 3:00 positions were 1.0°±6.7° and 14.0°±4.1°. The mean maximum alpha angle was 72.0°±12.1° and was located on average at the 1:15 position. Simulated ROM to bony impingement was 121.6°±12.1° for flexion, 33.8°±13.3° for internal rotation in 90 degrees of flexion. Mean follow-up was 18.6 months (range, 6.3 - 55.8 months). There was a mean 23.0-point improvement in the mHHS (pre-operative 69.4, post-operative 92.4; p<0.001) and a mean decrease of 3.5 points in the VAS for pain (pre-operative 5.2, post-operative 1.7; p<0.001). 93% percent of patients returned to their preinjury level of sports participation and did not feel limited by their hip. Multivariate analysis demonstrated that a greater pre-operative LCEA correlated with a greater change in the mHHS score (r=0.374, p=0.038). Similarly, a greater pre-operative AP alpha angle and change in the AP alpha angle also correlated with a greater change in the VAS pain score (r=0.411, p=0.038 and r=0.426,p=0.019, respectively). No major complications were noted, but 3 hips (2 patients) underwent revision hip arthroscopy during the follow-up period secondary to further development of cam-type FAI. There were no cases physeal growth arrest, growth disturbance, avascular necrosis.Conclusion:The arthroscopic approach for the treatment of FAI in adolescents with open physes is a safe and effective and has a high return to sports rate. Risk for recurrent FAI in the presence of open growth plates was noted. Young, highly athletic adolescent patients with a larger FAI pathomorphology demonstrate the most predictable improvement in clinical outcomes after arthroscopicy.

Arthroscopic Treatment of Femoroacetabular Impingement in Adolescents Provides Clinically Significant Outcome Improvement

To define minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for adolescents undergoing arthroscopic femoroacetabular impingement (FAI) surgery. A prospective institutional hip preservation registry was reviewed to identify hip arthroscopies performed for FAI. Patients with pre-existing hip conditions such as slipped capital femoral epiphysis and Legg-Calve-Perthese were excluded. Included patients were 18years and younger. The modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS), and the international Hip Outcome Tool (iHOT-33) were administered as part of the registry. MCID was calculated using a distribution-based method, and SCB was calculated using a physical function anchor question. Receiver operating characteristic analysis with area under the curve (AUC) was used for psychometric analyses. Forty-seven adolescents were identified. The majority of patients were female (n= 32, 68.1%) with a mean age of 16.5 (±1.1) years. The MCID (% achieving) for the mHHS, HOS activities of daily living (ADL), HOS Sport, and iHOT-33 was 9.5 (85%), 9.8 (79%), 12.1 (85%), and 10.7 (94%), respectively. Ninety-two percent of adolescents reported some form of improved hip physical ability on the anchor question. The following 1-year absolute outcome scores were significantly representative of an SCB state on the mHHS, HOS ADL, HOS Sport, and mHHS, respectively (AUC): 93.5 (0.79), 98.5 (0.84), 96.9 (0.81), and 85.9 (0.76). Adolescents undergoing arthroscopic FAI surgery achieve clinically significant outcome improvement. We found that the vast majority of adolescents achieve MCID on hip-specific patient-reported outcome tools. However, although adolescents readily achieve MCID, a considerable improvement in postoperative outcome score is often needed to perceive a substantial benefit (SCB). The available hip outcome tools may be subject to ceiling effects for measuring clinically significant outcome improvement in adolescents. Level IV, case series.

Functional Outcomes and Cam Recurrence After Arthroscopic Treatment of Femoroacetabular Impingement in Adolescents

To compare the functional outcomes after arthroscopic treatment of femoroacetabular impingement (FAI) in adolescent patients and non-adolescent patients, and to report on the rate of cam recurrence within 2years after femoral osteoplasty in a limited sample of the adolescent group. From 2010 to 2014, patients younger than 18years with symptomatic FAI (alpha angle >50°) who underwent hip arthroscopy with minimum 2-year follow-up or reoperation were identified. A group of non-adolescent patients with identical inclusion criteria, except age of 18years or older, was also identified for comparison. In addition, a separate group of adolescent patients with 2-year postoperative radiographs was reviewed for cam recurrence. Demographic data, operative data, and radiographic and clinical outcomes (modified Harris Hip Score [mHHS], Hip Outcome Score-Activities of Daily Living [HOS-ADL], Hip Outcome Score-Sport-Specific Subscale [HOS-SSS], and International Hip Outcome Tool 33 [iHOT-33] score) were collected. We identified 34 adolescent patients (38 hips) with an average age of 16years (range, 13-17years). The mean clinical follow-up period was 36.1 ± 11.6months (range, 24.1-71.7months) and 29.6 ± 2.4months (range, 27.9-31.3months) without and with reoperation, respectively. A control group of 296 non-adolescent patients (306 hips), with a mean age of 31years (range, 18-59years), was identified as our non-adolescent group. The mean clinical follow-up period was 34.1 ± 11months (range, 24.0-77.4months) and 15.1 ± 9.1months (range, 3.6-34.6months) without and with reoperation, respectively. Significant improvement was noted in adolescents in the changes in outcome scores (mHHS, 22.2 [95% confidence interval (CI), 15.4-29.0]; HOS-ADL, 18.6 [95% CI, 11.9-25.2]; HOS-SSS, 33.5 [95% CI, 24.5-42.5]; and iHOT-33 score, 30.5 [95% CI, 21.8-39.2]; P < .001). Similar improvements were observed in non-adolescents (mHHS, 21.0 [95% CI, 19.0-23.0]; HOS-ADL, 16.6 [95% CI, 14.6-18.6]; HOS-SSS, 30.1 [95% CI, 26.6-33.6]; and iHOT-33 score, 34.9 [95% CI, 31.5-38.3]; P < .001). There was no evidence of a difference in follow-up survey scores between groups (P > .203). Revision surgery was required in 2 adolescent hips (5.3% [95% CI, 1.5%-17.3%]) and 19 non-adolescent hips (6.2% [95% CI, 4.0%-9.5%]). Minimum 2-year radiographs were available for review in 24 adolescent patients (30 hips). The alpha angle (mean ± standard deviation) was reduced from 55.4° ± 12.1° preoperatively to 38.7° ± 4.9° at 6weeks postoperatively (mean difference,-16.4° [95% CI,-19.8° to-12.9°]; P < .001). At 2years, the alpha angle remained at 39.2° ± 11.2°, which did not differ from 6-week measurements (mean difference, 0.5° [95% CI,-2.9° to 3.9°]; P= .784). There were no cases of cam recurrence (0% [95% CI, 0%-11.4%]). Significant improvement in clinical outcomes can be anticipated after arthroscopic treatment of FAI in adolescents. From a limited sample of our adolescent population, the risk of cam recurrence appears low; however, further follow-up is needed to ensure this does not represent a biased sample of the initial population. Level III, retrospective comparative study.

Does Hip Arthroscopy Provide Meaningful Outcome Improvement for Adolescent Femoroacetabular Impingement

Objectives:Arthroscopic treatment of femoroacetabular impingement (FAI) produces meaningful outcome improvement in adults. Hip arthroscopy for pediatric FAI is now established as a safe procedure however there is a paucity of evidence reporting on outcome improvement after arthroscopic treatment of FAI in this population.Methods:A prospective institutional hip preservation registry was reviewed to identify hip arthroscopies performed for pediatric FAI. Patients with pre-existing hip conditions such as slipped capital femoral epiphysis and Legg-Calve-Perthese were excluded. Included patients were 18 years and younger. The modified Harris Hip Score (mHHS), the Hip Outcome Score (HOS) and the international Hip Outcome Tool (iHOT-33) are routinely collected as part of the registry. Minimal clinically important difference (MCID) was calculated using a distribution based method and substantial clinical benefit (SCB) was calculated using the an anchor question. Receiver operating characteristic (ROC) analysis with area under the curve was used. AUC > 0.7 was considered significantly predictive.Results:Forty-seven children and adolescents were identified. The majority of patients were female (N=32, 68.1%) with a mean age of 16.5 (+ 1.1) years. The MCID (% achieving) for the mHHS, HOS activities of daily living (ADL), HOS Sport and iHOT-33 was 9.5 (85%), 9.8 (79%), 12.1 (85%) and 10.7 (94%) respectively. MCID values on these outcome tools were comparable to adult patients within the registry however for each outcome measure pediatric patients were more likely to achieve MCID. In univariate analysis acetabular version was the only predictive variable for achieving MCID in pediatric FAI (p<0.05). The majority of children (91%) reported improved physical ability based on the anchor question and 53% (compared to 40% in adult registry patients) were classified as achieving SCB. The following one-year raw outcome scores were significantly predictive of SCB on the mHHS, HOS ADL, HOS Sport and mHHS respectively (AUC): 93.5 (0.79), 98.5 (0.84), 96.9 (0.81), 85.9 (0.76). These pediatric SCB values were all higher than SCB values for adult registry patients (82.5, 93.3, 84.4, 63.5 respectively)Conclusion:Pediatric patients undergoing arthroscopic FAI treatment can achieve meaningful outcome improvement and compared to adults, a larger proportion of children achieve meaningful outcome improvement. Additionally, while MCID values are comparable in children and adults, children appear to require substantially higher overall post-operative scores to perceive SCB. These findings highlight that commonly administered adult FAI outcome tools may have a relative ceiling effect in capturing outcome after treatment of pediatric FAI.

Adolescent Femoroacetabular Impingement: Gender Differences in Hip Morphology

To compare the hip morphology of adolescent male patients and female patients who underwent hip arthroscopy for femoroacetabular impingement (FAI) and determine if gender differences exist. We retrospectively reviewed the records of 177 adolescents, aged 13 to 18years, who were treated for FAI with hip arthroscopy. We examined and analyzed preoperative magnetic resonance imaging (MRI) scans and plain radiographs, measuring the lateral center-edge angle, Tönnis angle, and alpha angle. The intraclass correlation coefficient between readers was calculated. We created multiple linear regression models incorporating age, gender, and body mass index (BMI) with the radiographic measurements. Intraoperative findings using the Outerbridge grading system, as well as procedure performed, were documented. We compared these findings with our preoperative imaging measurements using the χ2 test and the Wilcoxon rank sum test. The intraclass correlation coefficient showed moderate to strong agreement between the 3 image readers. The BMI- and age-adjusted mean alpha angle was higher in male patients than female patients on both plain radiographs (55.9° vs 45.2°, P < .0001) and axial oblique MRI scans (54.1° vs 42.5°, P < .0001). An alpha angle greater than 55° was found in 38.9% of male patients compared with only 1% of female patients (P < .0001). The lateral center-edge angle and Tönnis angle on MRI scans and plain radiographs displayed no statistically significant differences between genders after we controlled for BMI and age. Male patients were more likely to have chondral damage intraoperatively than female patients (56.3% vs 32.5%, P= .0041). Distinct differences between genders were seen both on preoperative imaging and at the time of hip arthroscopy. We found that male patients with FAI displayed a larger mean alpha angle, and therefore a more severe cam-type deformity, than female patients. Our study also found that male patients were more likely to show evidence of chondral damage than female patients at the time of surgery. Level IV.

Femoroacetabular Impingement in Adolescent Athletes

Background: Adolescent athletes with symptomatic femoroacetabular impingement (FAI) may respond well to arthroscopic intervention. Purpose: This study reports the outcomes of arthroscopic treatment for symptomatic FAI in adolescents. Study Design: Case series; Level of evidence, 4. Methods: Included in this study were 104 consecutive athletes (116 hips) younger than 18 years who underwent arthroscopic correction of symptomatic FAI with a minimum 2-year follow-up. All patients were prospectively assessed with the modified Harris Hip Score (mHHS). Pincer lesions were defined by acetabular overcoverage or retroversion with an accompanying labral injury, and cam lesions were defined by loss of sphericity of the femoral head with associated acetabular articular failure. Results: The average follow-up was 38 months (range, 24-120 months), and the average patient age was 16 years (range, 12-17 years), with 47 male and 57 female patients. There were 67 combined, 33 cam, and 16 pincer lesions. The average improvement on the mHHS was 25 points (average score: 69 preoperatively, 94 postoperatively), with 97% improved and 94% good and excellent results. Athletes returned to their sport after 100 procedures (86%). After 16 procedures, 5 patients were unable to return to sport, 6 chose not to, and 5 had completed their high school athletic careers. There were 2 complications, both transient pudendal nerve neurapraxias, that resolved within 2 weeks. Four patients underwent repeat arthroscopic surgery, and 1 underwent periacetabular osteotomy. Conclusion: This study reports favorable outcomes of arthroscopic treatment of FAI among adolescent athletes. A high proportion improved, although only 87% actually returned to their sport. Return to sport may be influenced by factors other than just the success of the procedures.

Arthroscopic Management of Femoroacetabular Impingement in Adolescents

To report the outcomes of hip arthroscopy for adolescent patients with symptomatic femoroacetabular impingement (FAI) in relation to a control group of adult patients treated arthroscopically for FAI. All patients undergoing hip arthroscopy were assessed with a modified Harris Hip Score preoperatively and postoperatively at 3, 12, 24, and 60months. Inclusion criteria were all patients less than 18years of age who underwent arthroscopic surgery for symptomatic FAI and had achieved minimum 1-year follow-up. These cases were gathered over an 8-year period. The study group consisted of 122 consecutive hips (108 patients), and the control group consisted of 122 hips. Follow-up averaged 30months (range 12 to 60months). For the study group, the average age was 16years, with 55 males and 65 females; control group average age was 36years, with 71 males and 51 females. In the study group, the average scores were preoperative 68.3 and postoperative 93.6, with a 25.4-point improvement. The duration of symptoms averaged 16.6months, and 95.9% participated in athletic activities. The study group included 36 cam, 17 pincer, and 69 combined lesions. One hundred eleven labral tears underwent 85 refixations and 26 debridements; there were 101 acetabular chondral lesions (51 grade 3 or 4), with 4 microfractures and 3 femoral chondral lesions. Among the control group, the average scores were preoperative 63.3 and postoperative 85.5, with a 22.2-point improvement. The duration of symptoms averaged 31.2months, and 61.5% participate in athletic activities. The control group consisted of 53 cam, 5 pincer, and 64 combined FAI lesions. One hundred three labral tears underwent 52 refixations and 51 debridements; there were 112 acetabular lesions (92 grade 3 or 4), with 20 microfractures and 17 femoral chondral lesions. The study group included 15 concomitant extra-articular procedures, and there were 5 in the control group. In the study group, 4 underwent repeat arthroscopy and 1 periacetabular osteotomy; in the control group, 1 patient underwent repeat arthroscopy. Favorable outcomes of arthroscopic management of FAI in adolescents are reported compared with an adult control group. The present data support that arthroscopy does have a role in the management of FAI in adolescents. Level III, case control study.

Arthroscopic Management of Femoroacetabular Impingement (FAI) in Adolescents

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.

Arthroscopic Management of Femoroacetabular Impingement (FAI) in Adolescents

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.

Arthroscopic Management of Femoroacetabular Impingement (FAI) in Adolescents

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.