Impingement In Athletes Research Articles

Relationship between the morphology of osteophytes and cartilage lesions in anterior ankle impingement in athletes: a cross-sectional study

BackgroundThe present study aimed to describe the frequency and severity of tram-track lesions in anterior ankle impingement in athletes and to evaluate the association between osteophyte morphology and severity of tram-track lesions, the distinctive cartilage lesions associated with tibial osteophytes in anterior ankle impingement syndrome.MethodsWe evaluated 34 athletes who underwent arthroscopic osteophyte resection for anterior ankle impingement between January 2017 and March 2021.ResultsWe found tram-track lesions in 26 athletes (76.5%). Arthroscopic findings revealed the distribution of the International Cartilage Repair Society grades of tram-track lesions (grade 0, eight; grade 1, seven; grade 2, ten; grade 3, nine; grade 4, zero). These findings indicate that athletes with anterior ankle impingement syndrome may have more severe cartilage lesions than non-athletes. There was a positive correlation between the International Cartilage Repair Society grade and osteophyte size (r = 0.393, p = 0.021). We divided athletes into two groups according to the presence or absence of osteophyte protrusion into the joint space. Osteophyte protrusion was present in 14 athletes (41.2%). All athletes in the protrusion-type group had tram-track lesions; seven (50%) had International Cartilage Repair Society grade 3. The protrusion-type group’s International Cartilage Repair Society grade was significantly higher than that of the non-protrusion-type group (p = 0.008). The osteophyte sizes in the two groups were not significantly different (p = 0.341).ConclusionsBased on these findings, osteophyte protrusion should be assessed when an indication of arthroscopic treatment for anterior ankle impingement syndrome is considered, particularly in athletes.

Primary and Revision Circumferential Labral Reconstruction for Femoroacetabular Impingement in Athletes: Return to Sport and Technique

To determine return-to-play rates and hip-specific outcomes in athlete hips with femoroacetabular impingement syndrome treated with circumferential labral reconstruction (CLR). All consecutive patients who underwent CLR from January through December 2016 performed by the senior surgeon with complete 2-year outcome scores were identified. The hips of 57 non-athletes who underwent CLR were excluded from analysis, as were 165 patients who underwent labral repair and 4 patients who underwent labral debridement. Outcome measures were completed by patients within 1 week prior to surgery and between 22 and 26 months postoperatively. Thirty patients met the inclusion criteria for this study. All 30 participated in regular, competitive athletic events and had magnetic resonance arthrogram-confirmed labral tears, and nonsurgical measures had failed. Of the 30 patients, 5 (16.7%) participated in cutting sports; 5 (16.7%), asymmetrical or overhead sports; 4 (13.3%), contact sports; 13 (43.3%), endurance sports; and 3 (10.0%), flexibility sports. Moreover, 25 of 30 (83.3%) were high-level athletes. Both primary (n= 23) and revision (n= 7) procedures were included. As determined by the International Hip Outcome Tool 12 score, 28 of 30 patients (93.3%) met the patient acceptable symptomatic state whereas 30 of 30 (100%) achieved substantial clinical benefit and exceeded the minimal clinically important difference for their operative hip. In addition, 23 of 30 patients (76.6%) met the patient acceptable symptomatic state whereas 30 of 30 (100%) achieved substantial clinical benefit and exceeded the minimal clinically important difference for the operative hip as determined by the visual analog scale pain score. Of 30 patients, 26 (86.7%) were able to return to play. The mean time to return to play was 6.6 months (standard deviation, 2.4 months). Two-year outcomes in this population of athletes undergoing CLR for femoroacetabular impingement syndrome show a statistically and clinically significant improvement in patient-reported outcomes, a statistically and clinically significant decrease in pain, and an overall return-to-play rate of 86.7%. Level IV, therapeutic case series.

Capsular management in the arthroscopic treatment of the femoro-acetabular impingement in athletes: our experience.

Background and aim of the work:In the last decade, thanks to the improvement of the surgical techniques, arthroscopic treatment of hip diseases has significantly spread and evolved and currently it represents the gold standard for the treatment of femoral-acetabular impingement. In the recent years, the function of the joint capsule (and therefore the results of an arthroscopic capsulotomy) has been better understood, opening a heated debate. The Literature is still torn about a proper capsular management and the need for a capsular suture, but latest studies are more oriented to its execution at the end of the surgical procedure. According to these recent studies, the joint capsule performs an essential function on primary stability, so a conservative capsulotomy and its final closure are therefore reccomended to restore the native anatomy and physiology. Although capsular management remains a controversial topic, in recent years we have developed a new conservative capsulotomy technique associated with a final capsular suture. The aim of the present retrospective study is to assess the influence of different capsulotomy techniques and a possible capsular suture role on the patient’s functional outcome in a cohort of patients with femoral-acetabular impingement arthroscopically treated.Hypothesis:Our hypothesis is that a conservative “longitudinal” capsulotomy with a proper capsular suture positively influences the patient’s functional outcome in athletes.Methods:36 patients (competitive athletes) treated with hip arthroscopy for femoral-acetabular impingement have been retrospectively enrolled at the Orthopaedic Clinic of Academic Hospital of Udine during a period of two years (2016-2018); collected data have been analyzed and compared with a retrospective model. Patients have been divided into three equivalent groups, 12 without a suitable capsular management (T-Capsulotomy technique), 12 performing a Longitudinal Capsulotomy but without a final suture and 12 treated with a conservative Longitudinal Capsulotomy and a capsular suture. Patient’s post-operative functional outcome has been analysed using the modified Harris Hip Score (mHHS), the Hip Outcome Score-Activity of Daily Living (HOS-ADL) and the Hip Outcome Score-Sport Scale (HOS-SS). Return to sport.Results:In our series there was no statistically significant difference in functional scores, however longitudinal capsulotomy seems to be associated with a higher percentage of return to sports activity (91,6% vs 75%).Conclusions:The new longitudinal shape capsulotomy technique and a capsular suture with a single side-to-side stitch at the end of the procedure in athletes can positively influence the patient’s functional outcome. (www.actabiomedica.it)

Non-arthroplasty iliopsoas impingement in athletes: a narrative literature review.

Iliopsoas impingement occurs secondary to a tight iliopsoas tendon that causes impingement during movement. This review presents current aspects regarding the diagnosis of iliopsoas impingement and also exposes the readers to the possible anatomic and clinical variations together with the available treatment options. We conducted a narrative literature review with regard to non-arthroplasty iliopsoas impingement. Iliopsoas impingement is characterised by a distinct pattern of labral pathology, with anteriorly localised labral damage, that does not extend to the anterosuperior portion of the acetabulum. Anterior groin pain and intermittent catching, snapping or popping of the hip are common symptoms. Non-specific focal tenderness is often found over the iliopsoas tendon at the level of the anterior aspect of the joint. The 'C-sign' and Impingment test are usually positive. Dynamic ultrasonography is also useful for confirming the diagnosis. Initial management of painful iliopsoas impingement should be conservative. When patients continue to have pain, an ultrasound-guided injection can provide relief and predict the response to the surgical release. For patients who have recurrent pain after local injection of steroids, arthroscopic release has shown to achieve effective results. Although different treatment options for iliopsoas impingement are emerging, the current standard of therapy is conservative followed by an arthroscopic tenotomy if necessary. Young adult hip surgeons should always keep this differential in mind in a patient presenting with groin pain and mechanical symptoms.

Arthroscopic treatment of anterolateral ankle soft-tissue impingement in athletes

Background Ankle sprains are the most common musculoskeletal injuries that occur in athletes. Although often considered minor, they can lead to development of chronic anterolateral soft-tissue ankle impingement. This ankle sprain if left untreated, owing to repetitive actions, can lead to development of thickenings ‘pathological synovial or capsular tissue’ within the ankle joint, which causes persistent painful limitation of ankle movement as a result of entrapment of this pathological tissues in the anterolateral aspect of the joint. As impingement progresses, movements essential to athletes may become impossible; therefore, successful arthroscopic ankle debridement and impinged-soft tissue excision is the procedure of choice, allowing athletes to return fast to their previous preinjury sports activities level. Patients and methods A total of 25 elite athletes complaining of persistent anterolateral ankle pain during sports participation, who were diagnosed by history, physical examination, and magnetic resonance imaging to have anterolateral ankle impingement with unsuccessful conservative management for at least 6 months, underwent arthroscopic debridement and excision of the anterolateral impinged hypertrophic, inflamed, and scarred soft tissue. Any athlete diagnosed to have associated ankle instability or tibial or talar chondral lesion was excluded from this study. Results There were 13 right ankles and 12 left ankles. There were 14 male and 11 female patients. No bilateral cases existed. The mean duration of symptoms till operation was 8.9 months. The mean postoperative follow-up was 15 months. At the final postoperative evaluation, 23 athletes were satisfied and reparticipated in the same preinjury sports activities level without complaints, whereas two (8%) athletes were unsatisfied and retired from high-level sports activities. The mean time to return to full sports activities with high performance was 8 weeks. According to American Orthopaedic Foot and Ankle Society (AOFAS) at the final postoperative follow-up evaluation, nine patients had excellent results, 14 patients had good results, and two patients had fair results. A significant improvement of the AOFAS (P Conclusion Ankle arthroscopy is a useful and safe method in diagnosis and treatment of anterolateral soft tissue ankle impingement in elite athletes, with early return to full sports activities. Final outcome may be affected negatively with new inversion injuries during the early postoperative period.

Posterior ankle impingement in athletes: Epidemiology and results of operative treatment

Lateral ankle ligament injury is among the most common orthopedic injuries. The objective of this study is to present the preliminary prospective results of treatment using the “Inside-Out” variant of the fully arthroscopic Broström–Gould technique.Twenty six patients were included: 20 male and 6 female, aged 19–60 years, mean 41 years. All patients had positive “anterior drawer” and “talar tilt” tests. When necessary, cartilage injuries were treated with microfracture and arthroscopic resection for anterior impingement; three patients had hindfoot varus, on whom Dwyer osteotomy was performed; one patient had peroneal tendinopathy and was treated with tendoscopic debridement and another one had partial injury of the deltoid ligament, which was treated by direct repair.Two arthroscopic surgery portals were used; the anteromedial and anterolateral. After careful inspection of the joint, the anterior surface of the fibula was cleaned to resect the remains of the anterior talo-fibular ligament. An anchor with two sutures was placed on the anterior aspect of the fibula, 1 cm from the distal apex of the malleolus. The sutures were passed through the remnant of the anterior talo-fibular ligament as well as the extensor retinaculum using special curved needles. Duncan knots were used to tie the ligament and the inferior extensor retinaculum while the ankle was kept in a neutral position. Patients were kept immobilized non-weight bearing for 2 weeks and were then allowed to start weight bearing in a removable protective boot for 4 weeks. The patients were able to return to sporting activities 6 months after surgery.After a mean follow-up of 27 months (range 21–36 months), patients were functionally evaluated using the American Orthopedics Foot and Ankle Society (AOFAS) ankle score. The mean preoperative value was 58 points, while the mean postoperative value increased to 90 points. One patient had paresthesia in the superficial fibular nerve area, which resolved spontaneously.Despite the limited cohort and the relatively short follow-up period, the use of the “inside-out” arthroscopic technique may be considered as a valid option for the treatment of chronic ankle instability.

Posterior ankle impingement in athletes: Pathogenesis, imaging features and differential diagnoses

Posterior ankle impingement is a clinical diagnosis which can be seen following a traumatic hyper-plantar flexion event and may lead to painful symptoms in athletes such as female dancers (‘en pointe’), football players, javelin throwers and gymnasts. Symptoms of posterior ankle impingement are due to failure to accommodate the reduced interval between the posterosuperior aspect of the talus and tibial plafond during plantar flexion, and can be due to osseous or soft tissue lesions. There are multiple causes of posterior ankle impingement. Most commonly, the structural correlates of impingement relate to post-traumatic synovitis and intra-articular fibrous bands-scar tissue, capsular scarring, or bony prominences. The aims of this pictorial review article is to describe different types of posterior ankle impingement due to traumatic and non-traumatic osseous and soft tissue pathology in athletes, to describe diagnostic imaging strategies of these pathologies, and illustrate their imaging features, including relevant differential diagnoses.

Etiology of Femoroacetabular Impingement in Athletes: A Review of Recent Findings.

The relationship between hip deformities and osteoarthritis has recently received a lot of attention. In particular, it has been shown that both osteoarthritis and its precursors, such as the hip deformities that lead to femoroacetabular impingement (FAI), are more prevalent in elite athletes compared with the general population. However, the etiology of the above-mentioned types of hip deformity is not currently well understood. Many recent studies have attempted to shed light on the etiology of this disease. In this article, the main clinical, radiological, mechanobiological, and biomechanical findings of relevance to understanding the etiology of hip deformities leading to FAI are reviewed. Based on these findings, a consistent biomechanical theory explaining the development of hip deformities in athletes is then presented. According to the presented theory, the repetitive, impact-like musculoskeletal loads that athletes experience, particularly when they undertake extreme ranges of hip motion, cause the development of hip deformities. According to this theory, these musculoskeletal loads trigger abnormal growth patterns during the years of skeletal development and cause the formation of hip deformities. A number of hypotheses based on the proposed theory are then formulated that could be tested in future studies to ascertain whether the proposed theory could sufficiently describe the development of hip deformities in athletes.

Sports hernia and femoroacetabular impingement in athletes: A systematic review

To investigate the association between sports hernias and femoroacetabular impingement (FAI) in athletes. PubMed, MEDLINE, CINAHL, Embase, Cochrane Controlled Trials Register, and Google Scholar databases were electronically searched for articles relating to sports hernia, athletic pubalgia, groin pain, long-standing adductor-related groin pain, Gilmore groin, adductor pain syndrome, and FAI. The initial search identified 196 studies, of which only articles reporting on the association of sports hernia and FAI or laparoscopic treatment of sports hernia were selected for systematic review. Finally, 24 studies were reviewed to evaluate the prevalence of FAI in cases of sports hernia and examine treatment outcomes and evidence for a common underlying pathogenic mechanism. FAI has been reported in as few as 12% to as high as 94% of patients with sports hernias, athletic pubalgia or adductor-related groin pain. Cam-type impingement is proposed to lead to increased symphyseal motion with overload on the surrounding extra-articular structures and muscle, which can result in the development of sports hernia and athletic pubalgia. Laparoscopic repair of sports hernias, via either the transabdominal preperitoneal or extraperitoneal approach, has a high success rate and earlier recovery of full sports activity compared to open surgery or conservative treatment. For patients with FAI and sports hernia, the surgical management of both pathologies is more effective than sports pubalgia treatment or hip arthroscopy alone (89% vs 33% of cases). As sports hernias and FAI are typically treated by general and orthopedic surgeons, respectively, a multidisciplinary approach for diagnosis and treatment is recommended for optimal treatment of patients with these injuries. The restriction in range of motion due to FAI likely contributes to sports hernias; therefore, surgical treatment of both pathologies represents an optimal therapy.

Femoroacetabular Impingement in Athletes

Orthopaedic Nursing: May/June 2014 - Volume 33 - Issue 3 - p 140-141 doi: 10.1097/NOR.0000000000000058

Femoroacetabular impingement in athletes.

Besides professional sports, what do Alex Rodriguez, Michelle Kwan, and Greg Norman have in common? They all suffered from a condition called femoroacetabular impingement, or FAI. First identified by Dr. Reinhold Ganz, an orthopaedic surgeon in the mid-1990s, FAI has gained recognition in recent years as more professional athletes have been diagnosed with this condition. Characterized as a condition involving an abnormal morphological shape of the femoral head (cam type deformity) or acetabulum (pincer type deformity) of the hip joint, FAI is commonly diagnosed after the athlete complains of hip or groin pain and restricted range of motion (, p. 8). Femoroacetabular impingement is often diagnosed in young, active individuals, such as athletes, and can be successfully managed and treated. In this article, types and diagnosis and management of FAI in athletes, as well as measures to successfully return athletes to participation in sports, are discussed.

Radiographic Evidence of Femoroacetabular Impingement in Athletes With Athletic Pubalgia

Background:Two of the most common causes of groin pain in athletes are femoroacetabular impingement (FAI) and athletic pubalgia. An association between the 2 is apparent, but the prevalence of radiographic signs of FAI in patients undergoing athletic pubalgia surgery remains unknown. The purpose of this study was to determine the prevalence of radiologic signs of FAI in patients with athletic pubalgia.Hypothesis:We hypothesized that patients with athletic pubalgia would have a high prevalence of underlying FAI.Study Design:Case series.Level of Evidence:Level 4.Methods:A retrospective review of all patients evaluated at our institution with athletic pubalgia who underwent surgical treatment (ie, for sports hernia) from 1999 to 2011 was performed. The radiographs of patients with athletic pubalgia were reviewed for radiographic signs of FAI. Alpha angles were measured using frog-leg lateral radiographs. Pincer lesions were identified by measuring the lateral center-edge angle and identifying the presence of a “crossover” sign on anteroposterior radiographs. Phone follow-up was performed 2 years or more after the initial sports hernia surgery to evaluate recurrent symptoms.Results:Forty-three patients underwent 56 athletic pubalgia surgeries. Radiographic evidence of FAI was identified in at least 1 hip in 37 of 43 patients (86%). Cam lesions were identified in 83.7% of the population; the alpha angle averaged 66.7° ± 17.9° for all hips. Pincer lesions were present in 28% of the hips. Eight patients had recurrent groin pain, 3 patients had revision athletic pubalgia surgery, and 1 had hip arthroscopy.Conclusion:The study demonstrates a high prevalence of radiographic FAI in patients with athletic pubalgia.Clinical Relevance:Underlying FAI may be a cause of continued groin pain after athletic pubalgia surgery. Patients with athletic pubalgia should be evaluated closely for FAI.

Extensor retinaculum of the wrist: gross anatomical correlation with MR imaging after ultrasound-guided tenography with emphasis on anatomical features in wrist dorsiflexion responsible for tendon impingement

To demonstrate the anatomy of the extensor retinaculum (ER) of the wrist using gross anatomical correlation with magnetic resonance (MR) imaging before and after ultrasound-guided tenography in four different positions, emphasizing the morphological appearance of the ER that occurs with dorsiflexion of the wrist to define the nature of extensor tendon impingement in athletes who perform repetitive wrist dorsiflexion. Institutional policies were followed regarding cadaver use. Ten upper extremities were harvested from fresh cadavers. MR imaging before and after ultrasound-guided tenography of the wrist was performed, followed by gross anatomical correlation. Two radiologists interpreted the MR images and sections by consensus for the anatomical landmarks of the ER, and morphological changes occurring during dorsiflexion of the wrist were analyzed and measured. The ER of the wrist appeared as a band of low signal intensity on T1- and PD-weighted images. Because of its orientation, axial images were best suited to depict the ER anatomy; specifically, localization of the bony landmarks and the septal attachments. On sagittal images, a consistent appearance of the ER was seen: appearing with fusiform morphology in the neutral position, and becoming shortened and thickened at the abutment point where the extensor tendons of the fourth compartment had a curved excursion during dorsiflexion. The width and thickness of the ER in neutral position averaged 13.56mm and 1.67mm respectively. In wrist dorsiflexion, the average width and thickness changed to 8.68mm and 2.15mm respectively. Magnetic resonance imaging is a useful technique to demonstrate the ER of the wrist, the septal attachments, and morphological changes that occur during dorsiflexion of the wrist, which potentially can lead to impingement of the extensor tendons.

Femoroacetabular Impingement in Athletes

Hip disorders are increasingly recognized as a cause of dysfunction and disability among athletes. Femoroacetabular impingement (FAI) is a common source of hip problems. While FAI may sometimes be present as an incidental asymptomatic finding, substantial secondary joint damage may occur. This problem is often observed in young adult, and even adolescent, athletes. FAI morphology results in a breakdown of the labrum and articular surfaces from forces generated during sporting activities that would otherwise be well tolerated by a normal joint. A description of the pathomechanics is included. Detection of pathological FAI is important to minimize its harmful effects. The history, examination findings, and pertinent imaging studies are detailed. Nonoperative measures, including training modifications and pelvic stabilization exercises, may be of some benefit in modulating symptoms. When secondary joint damage has occurred, surgical intervention is usually necessary. While most can be managed with arthroscopic techniques, open and mini-open methods are discussed as well. With proper recognition and treatment, most athletes can expect to return to sports, although the long-term implications of high-level activities must still be considered. These results are summarized.

Femoroacetabular impingement in athletes: A review of the current literature

There are several well-recognized causes of hip and groin pain that commonly affect athletes. Femoroacetabular impingement (FAI), also known as hip impingement, is increasingly recognized as a common; and possibly often overlooked; etiology of hip pain in athletes. FAI is characterized by the abutment of the acetabular rim and the proximal femur, which may occur by two mechanisms known as cam or pincer impingement, although most commonly by a combination of the two. It affects athletes at a young age causing significant pain and disruption to athletic performance and activities of daily living. It injures the labrum and articular cartilage and can lead to early osteoarthritis of the hip if left untreated. Patients often report a groin pain, which is typically reproduced by the use of flexion, adduction and internal rotation of the supine hip. Early diagnosis is crucial in order to avoid the severe secondary damage that can occur. Although, FAI is significant for all patients, in athletic individuals they may bring about the end of their sporting careers. Both open and arthroscopic surgical methods are used, with recent reports in athletes showing excellent results for life-style improvement and frequency of returning to the sport. Whether treatment prevents or delays osteoarthritis of the hip is unknown. This article reviews the latest scientific literature in reference to FAI in athletes. It goes some way to explaining the principles, approach and guidelines for management of FAI in athletes.

Return to Preinjury Activity Levels After Surgical Management of Femoroacetabular Impingement in Athletes

A systematic review was conducted to identify, assess, and summarize the available evidence pertaining to surgical intervention for femoroacetabular impingement (FAI) in athletes. Summary estimates of treatment effect (proportion with 95% confidence interval [CI]) were calculated specifically for the rate of return to sport. Electronic databases (Medline, Embase, and Cochrane Library) were searched from inception to November 2011. The references of included articles were reviewed for eligible studies. The inclusion criteria were clinical studies, studies involving humans, minimum 6 months' follow-up, exclusive FAI treatment, and focus on athletes. Exclusion criteria were review articles, basic science investigations, radiologic studies, arthroplasty, and nonathlete clinical studies. A quality assessment of the included articles was conducted by 2 reviewers using a quality assessment tool developed by Yang et al. We used a random-effects model (DerSimonian-Laird method) to calculate weighted proportions. Percentages with 95% CIs are reported. Nine articles met the inclusion and exclusion criteria in this review. There was 72% agreement (95% CI, 0% to 94%) between the 2 independent reviewers for inclusion and quality assessment of the studies. A total of 418 athletes were surgically treated for FAI and were available for assessment. The rate of return to sport was 92% (95% CI, 87% to 96%), and the rate of return to the previous level of competition was 88% (95% CI, 80% to 94%). Despite the limitations of our systematic review, the findings suggest that surgical treatment for FAI resulted in a high return to preinjury activity levels of sports. Level IV, systematic review of Level IV studies (case series).

Treatment of Femoroacetabular Impingement in Athletes Using a Mini–Direct Anterior Approach

Background: Femoroacetabular impingement (FAI) is an increasingly common diagnosis in active patients with hip pain. Surgical options for FAI include arthroscopy, open surgical dislocation, or mini–direct anterior approaches. Arthroscopic and open treatments of FAI have been commonly performed and have had promising results in athletes. Hypothesis/Purpose: We hypothesized that the mini–direct anterior approach would provide the advantages of a minimally invasive procedure and still allow adequate exposure of the hip joint to successfully treat FAI in an athletic population. The purpose of this study was to determine if a mini-open approach for the treatment of FAI in athletic patients would allow a return to preoperative activity. Study Design: Case series; Level of evidence, 4. Methods: A total of 234 patients (257 hips) with FAI were treated by a mini-open approach; 59 were athletic patients (66 hips) with a preoperative University of California, Los Angeles (UCLA) activity score of 7 or higher or Super Simple Hip (SUSHI) activity score of 70 or greater. Forty-four of the 59 athletic patients (47 hips) have reached 1-year minimum follow-up. No patients were lost to follow-up. The mini-open approach was performed through a 4-cm incision and modified Smith-Peterson approach with no muscle detachment. All patients were prospectively evaluated using the following outcome measures: preoperative and postoperative UCLA activity, Short-Form 36 Health Survey (SF-36), Western Ontario and McMaster Osteoarthritis Index (WOMAC), modified Harris Hip Score (HHS), and SUSHI scores. Results: The average age at the time of surgery was 32 years (range, 17-60 years), with an average follow-up of 22 months. Labral changes—whether tear, detachment, or ossification—were present in all patients, and 84% had chondral lesions. The mean HHS improved from 55 preoperatively to 79 postoperatively (P < .001). The WOMAC scores also improved from 47.9 to 8.3 (P < .001). Mean SF-36 scores improved from 65 to 85 postoperatively (P < .001). The mean preoperative SUSHI general score was 31.1, pain score was 26.6, and limitation score was 28.9. The mean postoperative SUSHI general score was 53.6, pain score was 47.5, and limitation score was 51.6 (P < .001). There was minimal change from preinjury to postoperative UCLA (8.0 to 8.7, respectively; P = .07) or SUSHI activity scores (76.3 to 67.7, respectively; P = .048), indicating a reliable return to preinjury activity levels. Twenty-four of 44 patients (55%) reported a return to their specific preoperative sports. Nine patients (20%) developed meralgia paresthetica postoperatively, which resolved within 1 year. Conclusion: The mini-open approach for the treatment of FAI is a safe and effective procedure that allows surgical treatment of FAI in athletic patients and a successful return to high activity levels. The outcome of the mini-open approach for athletes may be comparable with open and arthroscopic treatment of FAI.

Paper # 62: Arthroscopic Management of Femoroacetabular Impingement (FAI) in Athletes

Arthroscopic management of femoroacetabular impingement in athletes results in high success rates with return to sports and few complications. Hip pathology is a significant source of pain and dysfunction among athletic individuals and FAI is often a causative factor. Arthroscopic intervention has been proposed to address the joint damage and underlying impingement. The purpose of this study is to report our prospectively collected data on arthroscopic management of FAI in an athletic population. All patients undergoing hip arthroscopy are prospectively assessed with a modified Harris hip score obtained preop and postop at 3, 12, 24, 60 and 120 months. This report consists of a cohort of 200 patients identified who underwent arthroscopic management of FAI, participated in athletic activities, and had achieved minimum one-year followup. There was 100% followup at an average of 19 months (range 12-60 months). The average age was 28.6 years (range 11-60 years) with 148 males and 52 females. There were 159 cam, 31 combined, and 10 pincer lesions. There were 23 professional, 56 intercollegiate, 24 high school and 97 recreational athletes. The male/female ratio was 2.8:1 among cam lesions and 1:1 among pincer lesions. The median improvement was 24 points (preop 72; postop 96) which was statistically significant (p<0.001). 95% of professional athletes and 85% of intercollegiate athletes were able to return to their previous level of competition. There were five transient neuropraxias (all resolved) and one minor heterotopic ossification. One athlete (0.5%) underwent conversion to total hip arthroplasty and 4 (2%) underwent repeat arthroscopy. Arthroscopic management of FAI results in successful outcomes with modest complications and most athletes are able to resume activities.

Paper # 59: Treatment of Femoroacetabular Impingement in Athletes Using a Mini-Direct Anterior Approach

ObjectivesFemoroacetabular impingement (FAI) is an increasingly common diagnosis in active patients with hip pain. Surgical options for FAI include arthroscopy, open surgical dislocation, or mini-direct anterior approaches. It has been suggested that surgical dislocation may prevent athletes from returning to a high level. As a result, arthroscopic treatment of FAI is commonly performed and has had promising results in athletes. The mini-direct anterior approach aims to provide the advantages of a minimally invasive procedure with adequate exposure of the hip joint. The purpose of this study is to determine if a mini-open approach for the treatment of FAI in athletic patients can allow return to preoperative activity.

Arthroscopic Management of Femoroacetabular Impingement in Athletes

Background Hip pathology is a significant source of pain and dysfunction among athletic individuals and femoroacetabular impingement is often a causative factor. Arthroscopic intervention has been proposed to address the joint damage and underlying impingement. Hypothesis Arthroscopy may be effective in the management of symptomatic femoroacetabular impingement in athletes. Study Design Case series, Level of evidence, 4. Methods All patients undergoing hip arthroscopy at 1 institution were prospectively assessed with a modified Harris hip score obtained preoperatively and postoperatively at 3, 12, 24, 60, and 120 months. This report consists of a cohort of 200 patients identified who underwent arthroscopic management of femoroacetabular impingement, participated in athletic activities, and had achieved minimum 1-year follow up. Results There was 100% follow-up at an average of 19 months (range, 12-60 months). A total of 116 athletes had achieved 2-year follow-up. For the entire cohort, the average age was 28.6 years (range, 11-60 years) with 148 males and 52 females. There were 159 cam, 31 combined, and 10 pincer lesions. There were 23 professional, 56 intercollegiate, 24 high school, and 97 recreational athletes. The male:female ratio was 2.8:1 among cam lesions and 1:1 among pincer lesions. The median preoperative score was 72 with a postoperative score of 96 and the median improvement was 20.5 points, which was statistically significant (P < .001). Ninety-five percent of professional athletes and 85% of intercollegiate athletes were able to return to their previous level of competition. There were 5 transient neurapraxias (all resolved) and 1 minor heterotopic ossification. One athlete (0.5%) underwent conversion to total hip arthroplasty and 4 (2%) underwent repeat arthroscopy. For the group with minimum 2-year follow up, the median improvement was 21 points with a postoperative score of 96. Conclusion The data substantiate successful outcomes in the arthroscopic management of femoroacetabular impingement with few complications and most athletes were able to resume activities.