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Arthroscopic Management of Pincer-Type Impingement

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Book cover Diagnosis and Management of Femoroacetabular Impingement

Abstract

Pincer-type femoroacetabular impingement (FAI) is due to repetitive and abnormal contact between the femoral head-neck junction and an area of either focal, relative, or global acetabular overcoverage. When a patient with symptomatic pincer-type FAI continues to have intermittent, activity-related pain that is refractory to at least 6 weeks of nonoperative management, arthroscopic surgical treatment may be considered in the absence of significant degenerative changes on plain radiographs. The goal of FAI surgery is to eliminate areas of symptomatic focal impingement between the proximal femur and pelvis. Intraoperative fluoroscopy, including anteroposterior, cross-table lateral, false profile, and 45° and 90° Dunn lateral views, is arranged to match preoperative imaging to avoid over- or under-resection. Labral preservation, or detachment and repair, is preferred to labral debridement or excision to help maintain femoral stability and physiologic joint seal. Thorough intraoperative fluoroscopic and dynamic evaluation of the hip is crucial to confirm that an adequate bony resection has been performed. Level III and IV studies of arthroscopic treatment of FAI report good to excellent results. Additional clinical studies are needed to determine how to best address complex morphologic problems such as global acetabular overcoverage and relative acetabular retroversion. Prospective studies with long-term follow-up and validated outcome measures will improve the quality of the literature regarding the treatment and outcomes of FAI.

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Author information

Authors and Affiliations

  1. Sports Medicine and Shoulder Service, Department of Orthopaedic Surgery, University of Michigan, MedSport, 24 Frank Lloyd Wright Dr. Lobby A, Ann Arbor, MI, 48106, USA

    James B. Cowan MD & Asheesh Bedi MD

  2. Minnesota Orthopedic Sports Medicine Institute, Twin Cities Orthopedics, Edina, MN, 55435, USA

    Christopher M. Larson MD

  3. Department of Orthopaedic Surgery, University of Michigan, MedSport, 24 Frank Lloyd Wright Dr., Lobby A, Edina, MN, 48106, USA

    Asheesh Bedi MD

Authors
  1. James B. Cowan MD
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  2. Christopher M. Larson MD
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  3. Asheesh Bedi MD
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Corresponding author

Correspondence to Asheesh Bedi MD .

Editor information

Editors and Affiliations

  1. McMaster University, Hamilton, Ontario, Canada

    Olufemi R. Ayeni

  2. Hosp, Academy University of Gothenburg, Dept. of Orthopaedics, Sahlgrenska Univ Hosp, Academy University of Gothenburg, Gothenburg, Sweden

    Jón Karlsson

  3. Steadman Clinic, Ste 1000, Steadman Philippon Research Inst Steadman Clinic, Ste 1000, Vail, Colorado, USA

    Marc J Philippon

  4. Stanford University Dept of Orthopaedic Surg, M/C 6342, Redwood City, California, USA

    Marc R. Safran

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Cowan, J.B., Larson, C.M., Bedi, A. (2017). Arthroscopic Management of Pincer-Type Impingement. In: Ayeni, O., Karlsson, J., Philippon, M., Safran, M. (eds) Diagnosis and Management of Femoroacetabular Impingement. Springer, Cham. https://doi.org/10.1007/978-3-319-32000-7_9

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  • DOI: https://doi.org/10.1007/978-3-319-32000-7_9

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-31998-8

  • Online ISBN: 978-3-319-32000-7

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