Femoroacetabular Impingement In Adolescents Research Articles

Results of Treatment of Femoroacetabular Impingement in Adolescents with a Surgical Hip Dislocation Approach

The literature contains few studies of open treatment with an open surgical hip dislocation approach for treatment of femoroacetabular impingement (FAI) in adolescents. The average age and associated disorders in adolescents with FAI reveal a critical need to study younger patients whose hip disorder has not had time to progress. We assessed (1) how validated measures of patient-oriented assessment of hip function and quality of life change after surgical hip dislocation; (2) whether any patient-related or technique variables correlated with changes in the outcome scores; and (3) what the complications of treatment are and how many reoperations we performed on these patients. We retrospectively reviewed a consecutive series of 71 hips in adolescents younger than 21 years who underwent surgical hip dislocation for FAI. The final cohort consisted of 44 patients (52 hips) with a mean age of 16 years. We analyzed changes in outcome variables after surgical hip dislocation and recorded reoperations during the study period. The minimum followup was 12 months (average, 27 months; range, 12-60 months). Modified Harris hip scores increased from a mean of 57.7 preoperatively to a mean of 85.8 postoperatively. Mean SF-12 scores increased from 42.3 to 50.6. Mean preoperative hip flexion increased from 97.5° to 106.2°. Mean internal rotation of the affected hip at 90° flexion increased from 18.19° to 34°. Early results revealed improvements in hip function, patient quality of life, and ROM after surgical hip dislocation for the majority of this group of adolescents with FAI. However, 10% of the patients did not improve, and an additional 15% improved but still did not consider their hips good or excellent. This points toward the need for further studies in this population of patients.

Current concepts in the treatment of adolescent femoroacetabular impingement.

There is growing evidence that symptomatic femoroacetabular impingement leads to intra-articular damage and the development of early-onset osteoarthritis. Symptoms of femoroacetabular impingement often do not manifest until adulthood, but have been increasingly recognised in the paediatric and adolescent population. The surgical treatment of femoroacetabular impingement is aimed at restoring a more normal femoral head-neck offset in order to increase the clearance and prevent femoral abutment against the acetabular edge. Current methods include open and arthroscopic techniques. The latter has been combined with an open approach to gain access to the head-neck junction for osteochondroplasty. Proximal femoral and/or periacetabular osteotomies are used to treat femoroacetabular impingement associated with deformity secondary to childhood hip conditions, such as slipped capital femoral epiphysis and Legg-Calvé-Perthes disease. Some adolescents have severe degenerative joint disease at the time of presentation and may require arthroplasty or arthrodesis. The aim of this review is to identify the major trends and advancements in the management of femoroacetabular impingement in adolescents, including the outcome of studies of the surgical treatment modalities used.

Outcome of arthroscopic treatment for cam type femoroacetabular impingement in adolescents

Hip arthroscopy has become an established procedure in adults with well-published results. These techniques have been extended to the teenage population, but the literature remains limited in regard to indications, efficacy, outcomes and complications specific to the paediatric population. The purpose of this study was to report the short-term outcome of the arthroscopic treatment of cam-type femoroacetabular impingement (FAI) in the skeletally immature adolescent population with open growth plates, with the hypothesis that it is a safe procedure, with good clinical outcomes and low complication rates. The study design of this article was a multicentre prospective longitudinal case series. From 2008-2009, 34 consecutive patients who were 18 years or younger at the date of operation (41 hips) with open proximal femoral growth plates had arthroscopic hip surgery for treatment of cam-type FAI and associated lesions by use of the lateral decubitus position by two surgeons. Data were collected prospectively including the modified Harris hip score (MHHS), nonarthritic hip score (NAHS), satisfaction survey and complications. Mean follow-up was 14 months (range 1-2 years). All hips were available for review. The mean age of patients was 15.7 years with the most common sport activity being Australian Football League, netball and rugby. All patients had cam-type impingement, with the most common associated lesions being acetabular rim lesions (82.9%) and pincer impingement (22%). The labrum underwent debridement in 31.7% of cases, and was repaired in 17.1%. The MHHS and NAHS improved in all patients post-operatively, 77.39-94.15 and 76.34-93.18, respectively. A percentage of 78.1 were able to return to full sporting activity and 88.2% were satisfied with the operation. There were no complications. Using hip arthroscopy to treat cam-type impingement and associated lesions in the adolescent population, we confirmed our hypothesis with observed high satisfaction levels, return to sports, significant improvement in post-operative hip scores (MHHS and NAHS) and no complications.

Retracted Article: Clinical effectiveness of continuous passive motion (CPM) following femoroacetabular impingement surgery in adolescents

This study hypothesizes that the use of continuous passive motion (CPM) following open femoroacetabular impingement (FAI) surgery in the adolescent population improves clinical outcomes in terms of the modified Harris hip score (mHHS). Twenty-nine symptomatic adolescent FAI patients were postoperatively divided into one of three groups; no CPM, twodays of inpatient CPM, and twoweeks of CPM. mHHS was used preoperatively and postoperatively at sixweeks, threemonths, six months, and ninemonths in all cases. Kruskal-Wallis (KW) analysis was performed to determine statistical differences in mHHS. mHHS was then re-evaluated using the Mann-Whitney test. There were no statistically significant differences in hip scores between the three groups preoperatively (p=0.158). There were statistically significant differences (p<0.001) in mHHS between the three groups at all postoperative time periods. The group that received twoweeks of CPM had the best outcome scores. The results of this study suggest that postoperative CPM use following open hip preservation surgery for symptomatic FAI in adolescents improves clinical outcomes. These benefits seem to be related to the duration of CPM. Retrospective comparative study, Level III. Patients treated one way compared with patients treated another way at the same institution.

Paper 20: The Outcome of Arthroscopic Treatment for Cam Type Femoroacetabular Impingement in Adolescents

Paper 20: The Outcome of Arthroscopic Treatment for Cam Type Femoroacetabular Impingement in Adolescents

Adolescent Femoroacetabular Impingement From Malunion of the Anteroinferior Iliac Spine Apophysis Treated With Arthroscopic Spinoplasty

This article describes a case of an acute anterior inferior iliac spine apophyseal avulsion fracture in an adolescent athlete progressing to secondary symptomatic femoroacetabular impingement from an inferiorly displaced malunion and its arthroscopic management. A 13-year-old boy with an acute minimally displaced avulsion fracture of the anterior inferior iliac spine apophysis had initial symptomatic improvement with conservative treatment and a 3-month symptom-free period but then developed flexion-induced deep anterior groin pain and mechanical symptoms. Radiographs confirmed an inferiorly displaced malunion of the ipsilateral anterior inferior iliac spine apophysis in addition to acetabular retroversion and cam deformity. Surgical treatment, including arthroscopic spinoplasty, was performed. Despite some nonrestrictive heterotopic ossification, the patient had a successful clinical outcome at 18 months, with return to football, and a nonarthritic hip score of 98. Although anterior inferior iliac spine avulsion fractures have historically been considered relatively self-limiting injuries, their malunion may be a previously missed cause of unrelenting or bimodal pain from secondary femoroacetabular impingement with possible degenerative consequences in young athletic patients. Anterior inferior iliac spine avulsion fractures may merit a lower degree of tolerance for displacement in the acute setting and a higher degree of clinical and radiographic scrutiny with surgical intervention, possibly in the form of arthroscopic spinoplasty in the more chronic one.

Clinical Outcomes Following Hip Arthroscopy for Femoroacetabular Impingement in Adolescents (SS-36)

Introduction There are many etiologies of adolescent hip impingement that, once symptomatic, can progress to labral tears or chondral lesions. As the teenager grows and engages sooner in competitive sports, more sport-induced hip pain is seen in this young athletic population, including femoroacetabular impingement (FAI). There are very few large studies with greater than one year outcomes of adolescent hip arthroscopy for hip impingement. The goal of this study is to report clinical outcomes and revision rates in the adolescent population after hip arthroscopy for FAI with subsequent labral tear and chondral lesions with a minimum 2 years follow-up. Methods After IRB approval was obtained, prospectively collected data on 70 consecutive adolescents who were 16 years of age or younger and underwent hip arthroscopy for FAI were retrospectively reviewed. All patients had either isolated cam impingement, isolated pincer impingement, or mixed pathology. Surgical treatment for FAI in this adolescent population was with hip arthroscopic acetabular or femoral head-neck osteoplasty, labral debridement versus suture anchor repair, or a chondroplasty for articular cartilage defects. A limited osteoplasty was performed on cam lesion with an open physis. Data analyzed included patient demographics, radiographic parameters, intra-operative findings, and clinical outcomes at a minimum of 2 years. Clinical outcomes measurements included the modified Harris Hip Score (mHHS), and patient satisfaction with outcome (10=very satisfied, 1=very unsatisfied). Results Mean age at time of surgery was 15 years (range, 13 to 16 years) with 22 males and 48 females. CAM impingement was found in 10% of cases, pincer type in 15%, and mixed-type in 75%. Femoral head-neck osteoplasty was performed in 56 patients and rim trimming was performed in 55 patients. Labral tears were identified in all patients, and 83% of these were repaired. The remaining labral tears were debrided. 7 had grade 3-4 chondral defect on the femoral head and 3 on the acetabulum. All were treated with chondroplasty. The mean time of follow up was 3 years (range, 2 to 5 years). Mean preoperative mHHS was 60 (range, 31 to 85), and it improved to an average of 93 (range, 68 to 100). The median patient satisfaction was 10 (range, 5 to 10). After the index procedure, 8 patients needed revision arthroscopy for adhesions at the capsule/labral junction. All revision were females. Median satisfaction following revision was 9 (range 7 to 10). Conclusion Arthroscopic treatment of FAI, labral tears, and chondral lesions in the adolescent population is a safe procedure with excellent clinical outcomes. Females had a higher revision rate but with improved satisfaction after revision surgery.

Femoroacetabular Impingement in Adolescents and Young Adults

Femoroacetabular impingement (FAI) is a recently described hip disorder resulting from an abnormal morphology between the proximal femur and acetabulum (socket). It is now recognized as a cause of hip pain in adolescents and young adults, and research has shown that it may also lead to early degenerative changes and osteoarthritis. Femoroacetabular impingement as a cause of precocious hip arthrosis was originally described by Ganz et al. in 2001, and a quick literature search on this topic will confirm that it has become a topic of cutting edge research within the orthopaedic community. The abnormal morphology in FAI results in increased hip contact forces with hip motion, especially flexion. This results in abnormal contact that can lead to acetabular labral tears and cartilaginous injury. Early diagnosis and treatment may possibly delay the future onset of hip arthritis. Although the precise cause of FAI is not well understood, the condition has become increasingly recognized as a cause of hip pain in active adolescents and young adults. The purpose of this article is to outline the history, physical examination and radiographic findings, and current conservative and surgical treatment modalities for FAI.

Femoroacetabular Impingement in Adolescents and Young Adults

Femoroacetabular Impingement in Adolescents and Young Adults

Clinical Presentation of Femoroacetabular Impingement in Adolescents

Femoroacetabular impingement (FAI) is a recently recognized hip disorder resulting from an abnormal morphology of the proximal femur and acetabulum. This morphology results in increased hip contact forces with hip motion, specifically flexion. This may lead to labral-cartilage injury and pain. The purpose of this study is to describe the clinical presentation and diagnosis of FAI as a cause of hip pain in adolescents.Thirty-five patients with FAI as the etiology of chronic hip pain from one institution were reviewed. The common symptoms, physical examination, and radiographic findings were analyzed.The age range was 13 to 18 years. There were 30 girls and 5 boys. All patients complained of anterior groin pain. All patients performed a sport/activity that contributed to the symptoms such as dancing. Patients had decreased flexion and limited internal rotation on physical examination. All patients had a positive impingement test. Fifteen patients (43%) had primarily pincer impingement with a crossover sign or acetabular retroversion. Cam impingement was the primary type in 2 patients (6%). There were findings of cam and pincer in 18 patients (51%). Sixteen of 28 patients had a positive labral tear on magnetic resonance imaging (57%). Femoroacetabular impingement is a cause of hip pain in the adolescent population. The diagnosis can be derived from reproducible history, physical examination, and radiographic findings. It is more common in female adolescents, and pincer type is more prevalent.