Combined Pinning and Arthroscopic Osteoplasty for Stable Slipped Capital Femoral Epiphysis

Abstract

In the past, the natural history of mild slipped capital femoral epiphysis (SCFE) was thought to be benign, and in situ pinning was considered the standard of care. Recently, open and arthroscopic studies have found high rates of intra-articular damage to the acetabular cartilage and labrum even in mild SCFE. Additionally, more recent clinical studies have found hip pain in one-third of patients with a mild SCFE and reduced Tegner and Lysholm scores at intermediate follow-up relative to age-matched controls. Femoroacetabular impingement (FAI), caused by the anterior metaphyseal prominence of the femoral neck entering the acetabulum, appears to be a source of this intra-articular injury. It is believed that by removing the prominent metaphyseal bone and reestablishing an appropriate head-neck offset, femoral osteoplasty will eliminate impingement and reduce subsequent intra-articular damage. Based on the increasing evidence of early articular damage after mild SCFE, the senior author (ML) began treating all mild slips with in situ pinning and immediate arthroscopic head-neck osteoplasty in 2008.