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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References
Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–20.
Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87(7):1012–8.
Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R. Anterior femoroacetabular impingement: part II. Midterm results of surgical treatment. Clin Orthop Relat Res. 2004;418:67–73.
Philippon MJ, Schenker ML. Arthroscopy for the treatment of femoroacetabular impingement in the athlete. Clin Sports Med. 2006;25:299–308.
Cadet ER, Chan AK, Vorys GC, Gardner T, Yin B. Investigation of the preservation of the fluid seal effect in the repaired, partially resected, and reconstructed acetabular labrum in a cadaveric hip model. Am J Sports Med. 2012;40(10):2218–23.
Crawford MJ, Dy CJ, Alexander JW, et al. The biomechanics of the hip labrum and the stability of the hip. Clin Orthop Relat Res. 2007;465:16–22.
Ferguson SJ, Bryant JT, Ganz R, Ito K. Acetabular labrum seal: a poroelastic finite element model. Clin Biomech. 2000;15:463–8.
Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech. 2003;36:171–8.
Smith MV, Panchal HB, Ruberte Thiele RA, Sekiya JK. Effect of acetabular labrum tears on hip stability and labral strain in a joint compression model. Am J Sports Med. 2011;39:103S–10.
Hetsroni I, Larson CM, Dela Torre K, Zbeda RM, Magennis E, Kelly BT. Anterior inferior iliac spine deformity as an extra-articular source for hip impingement: a series of 10 patients treated with arthroscopic decompression. Arthroscopy. 2012;28(11):1644–53.
Hetsroni I, Poultsides L, Bedi A, Larson CM, Kelly BT. Anterior inferior iliac spine morphology correlates with hip range of motion: a classification system and dynamic model. Clin Orthop Relat Res. 2013;471(8):2497–503.
Larson CM, Kelly BT, Stone RM. Making a case for anterior inferior iliac spine/subspine hip impingement: three representative case reports and proposed concept. Arthroscopy. 2011;27(12):1732–7.
Zaltz I, Kelly BT, Hetsroni I, Bedi A. The crossover sign overestimates acetabular retroversion. Clin Orthop Relat Res. 2013;471(8):2463–70.
Larson CM. Arthroscopic management of pincer-type impingement. Sports Med Arthrosc Rev. 2010;18(2):100–7.
Philippon MJ, Stubbs AJ, Schenker ML, Maxwell RB, Ganz R, Leunig M. Arthroscopic management of femoroacetabular impingement: osteoplasty technique and literature review. Am J Sports Med. 2007;35(9):1571–80.
Telleria JJ, Safran MR, Harris AH, Gardi JN, Glick JM. Risk of sciatic nerve traction injury during hip arthroscopy-is it the amount or duration? an intraoperative nerve monitoring study. J Bone Joint Surg Am. 2012;94(22):2025–32.
Chow RM, Krych AJ, Levy BA. Arthroscopic acetabular rim resection in the treatment of femoroacetabular impingement. Arthrosc Tech. 2013;2(4):e327–31.
Zumstein M, Hahn F, Sukthankar A, Sussmann PS, Dora C. How accurately can the acetabular rim be trimmed in hip arthroscopy for pincer-type femoral acetabular impingement: a cadaveric investigation. Arthroscopy. 2009;25(2):164–8.
Philippon MJ, Wolff AB, Briggs KK, Zehms CT, Kuppersmith DA. Acetabular rim reduction for the treatment of femoroacetabular impingement correlates with preoperative and postoperative center-edge angle. Arthroscopy. 2010;26(6):757–61.
Bedi A, Dolan M, Hetsroni I, et al. Surgical treatment of femoroacetabular impingement improves hip kinematics: a computer-assisted model. Am J Sports Med. 2011;29(1):43S–9.
Bedi A, Dolan M, Magennis E, Lipman J, Buly R, Kelly BT. Computer-assisted modeling of osseous impingement and resection in femoroacetabular impingement. Arthroscopy. 2012;28(2):204–10.
Bedi A, Galano G, Walsh C, Kelly BT. Capsular management during hip arthroscopy: from femoracetabular impingement to instability. Arthroscopy. 2011;27(12):1720–31.
Guanche CA, Bare AA. Arthroscopic treatment of femoroacetabular impingement. Arthroscopy. 2006;22(1):95–106.
Epstein NP, Safran MR. Stress fracture of the acetabular rim: arthroscopic reduction and internal fixation. J Bone Joint Surg Am. 2009;91(6):1480–6.
Larson CM, Stone RM. The rarely encountered rim fracture that contributes to both femoroacetabular impingement and hip stability: a report of 2 cases of arthroscopic partial excision and internal fixation. Arthroscopy. 2011;27(7):1018–22.
Hapa OH, Bedi A, Gursan O, et al. Anatomic footprint of the direct head of the rectus femoris origin: cadaveric study and clinical series of hips after arthroscopic anterior inferior iliac spine/subspine decompression. Arthroscopy. 2013;29(12):1932–40.
Philippon MJ, Schenker ML. A new method for acetabular rim trimming and labral repair. Clin Sports Med. 2006;25:293–7.
Ross JR, Bedi A, Stone RM, et al. Intraoperative fluoroscopic imaging to treat cam deformities: correlation with 3-dimensional computed tomography. Am J Sports Med. 2014;42(6):1370–6.
Fabricant PD, Heyworth BE, Kelly BT. Hip arthroscopy improves symptoms associated with FAI in selected adolescent athletes. Clin Orthop Relat Res. 2012;470(1):261–9.
Larson CM, Giveans MR. Arthroscopic management of femoroacetabular impingement: early outcomes measures. Arthroscopy. 2008;24(5):540–6.
Malviya A, Stafford GH, Villar RN. Impact of arthroscopy of the hip for femoroacetabular impingement on quality of life at a mean follow-up of 3.2 years. J Bone Joint Surg Br. 2012;94(4):466–70.
Nho SJ, Magennis EM, Singh CK, Kelly BT. Outcomes after the arthroscopic treatment of femoroacetabular impingement in a mixed group of high-level athletes. Am J Sports Med. 2011;39(1):14S–9.
Philippon M, Schenker M, Briggs K, Kuppersmith D. Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression. Knee Surg Sports Traumatol Arthrosc. 2007;15:908–14.
Philippon MJ, Weiss DR, Kuppersmith DA, Briggs KK, Hay CJ. Arthroscopic labral repair and treatment of femoroacetabular impingement in professional hockey players. Am J Sports Med. 2010;38(1):99–104.
Krych AJ, Thompson M, Knutson Z, Scoon J, Coleman SH. Arthroscopic labral repair versus selective labral debridement in female patients with femoroacetabular impingement: a prospective randomized study. Arthroscopy. 2013;29(1):46–53.
Larson CM, Giveans MR. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement. Arthroscopy. 2009;25(4):369–76.
Larson CM, Giveans MR, Stone RM. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement: mean 3.5-year follow-up. Am J Sports Med. 2012;40(5):1015–21.
Ng VY, Arora N, Best TM, Pan X, Ellis TJ. Efficacy of surgery for femoroacetabular impingement: a systematic review. Am J Sports Med. 2010;38(11):2337–45.
Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA. Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Joint Surg Br. 2009;91(1):16–23.
Redmond JM, El Bitar YF, Gupta A, Stake CE, Domb BG. Arthroscopic acetabuloplasty and labral refixation without labral detachment. Am J Sports Med. 2014;43:105–12.
Bedi A, Chen N, Robertson W, Kelly BT. Management of labral tears and femoroacetabular impingement of the hip in the young, active patient. Arthroscopy. 2008;24(10):1135–45.
Botser IB, Smith TW, Nasser R, Domb BG. Open surgical dislocation versus arthroscopy for femoroacetabular impingement: a comparison of clinical outcomes. Arthroscopy. 2011;27(2):270–8.
Matsuda DK, Carlisle JC, Arthurs SC, Wierks CH, Philippon MJ. Comparative systematic review of the open dislocation, mini-open, and arthroscopic surgeries for femoroacetabular impingement. Arthroscopy. 2011;27(2):252–69.
Papalia R, Del Buono A, Franceschi F, Marinozzi A, Maffulli N, Denaro V. Femoroacetabular impingement syndrome management: arthroscopy or open surgery? Int Orthop. 2012;36:903–14.
Larson CM, Giveans MR, Taylor M. Does arthroscopic FAI correction improve function with radiographic arthritis? Clin Orthop Relat Res. 2011;469:1667–76.
Matsuda DK. Protrusio acetabuli: contraindication or indication for hip arthroscopy? and the case for arthroscopic treatment of global pincer impingement. Arthroscopy. 2012;28(6):882–8.
Matsuda DK, Gupta N, Hanami D. Hip arthroscopy for challenging deformities: global pincer femoroacetabular impingement. Arthrosc Tech. 2014;3(2):e197–204.
Safran MR, Epstein NP. Arthroscopic management of protrusio acetabuli. Arthroscopy. 2013;29(11):1777–82.
Leunig M, Nho SJ, Turchetto L, Ganz R. Protrusio acetabuli: new insights and experience with joint preservation. Clin Orthop Relat Res. 2009;467(9):2241–50.
Liechti EF, Ferguson SJ, Tannast M. Protrusio acetabuli: joint loading with severe pincer impingement and its theoretical implications for surgical therapy. J Orthop Res. 2014;33:106–13.
Zaltz I, Kelly BT, Larson CM, Leunig M, Bedi A. Surgical treatment of femoroacetabular impingement: what are the limits of hip arthroscopy? Arthroscopy. 2014;30(1):99–110.
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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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