Meeting News CoveragePerspective

Speaker: Hip arthroscopy has a role in the management of FAI in adolescents

SEATTLE ─ Hip arthroscopy can be used in the management of adolescents with symptomatic femoroacetabular impingement, according to data presented at the American Orthopaedic Society for Sports Medicine Annual Meeting, here.

“This study reports favorable outcomes of arthroscopic management of [femoroacetabular impingement] FAI in adolescents with results at least comparable to an adult population. Concomitant procedures and revision surgery are both more common among adolescents and there is certainly a propensity for athletes in both groups,” J.W. Thomas Byrd, MD, said.

Byrd and colleagues at the Nashville Sports Medicine Center prospectively assessed 122 consecutive hips among 108 adolescent patients who had arthroscopic surgery for symptomatic FAI. The adolescent group was 55% female with an average age of 16 years. The matched control group was 122 patients with an average of 36 years and was 58% male. Minimum follow-up was 1 year with an average follow-up of 30 months. Overall, 96% of the adolescents participated in athletics compared with 61% of the adults in the control group.

The average improvement in the modified Harris Hip Score was 23 points for the adolescent group and 21 points for the adult group. For the adolescent group, FAI correction was performed for 36 cam and 17 pincer lesions and for 69 combined lesions. There were 111 labral tears that required 85 refixations and 26 debridements. There were 101 acetabular chondral lesions with four microfractures. There were three femoral chondral lesions. The researchers removed seven loose bodies and debrided 19 lesions of the ligamentum teres. Concomitant extraarticular procedures included 13 iliopsoas tendon releases and two iliotibial band tendinoplasties.

Among the adult cohort, the researchers performed FAI correction for 53 cam and 5 pincer lesions and for 64 combined lesions. There were 103 labral tears that required 52 refixations and 50 debridements. There were 112 acetabular chondral lesions with 20 microfractures and 17 femoral chondral lesions. The researchers removed 17 loose bodies and debrided 21 lesions of the ligamentum teres in the adult group. Concomitant extraarticular procedures included four iliopsoas tendon releases and one abductor repair.

Four adolescents needed repeat arthroscopic surgery and one patient underwent a periacetabular osteotomy. One adult patient had repeat arthroscopic surgery. – by Kristine Houck, MA, ELS

Reference:

Byrd JWT. Paper #32. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 10-13, 2014; Seattle.

Disclosure: Byrd is a consultant to and receives research support from Smith & Nephew Endoscopy and is a consultant to and has stock in A3 Surgical.

SEATTLE ─ Hip arthroscopy can be used in the management of adolescents with symptomatic femoroacetabular impingement, according to data presented at the American Orthopaedic Society for Sports Medicine Annual Meeting, here.

“This study reports favorable outcomes of arthroscopic management of [femoroacetabular impingement] FAI in adolescents with results at least comparable to an adult population. Concomitant procedures and revision surgery are both more common among adolescents and there is certainly a propensity for athletes in both groups,” J.W. Thomas Byrd, MD, said.

Byrd and colleagues at the Nashville Sports Medicine Center prospectively assessed 122 consecutive hips among 108 adolescent patients who had arthroscopic surgery for symptomatic FAI. The adolescent group was 55% female with an average age of 16 years. The matched control group was 122 patients with an average of 36 years and was 58% male. Minimum follow-up was 1 year with an average follow-up of 30 months. Overall, 96% of the adolescents participated in athletics compared with 61% of the adults in the control group.

The average improvement in the modified Harris Hip Score was 23 points for the adolescent group and 21 points for the adult group. For the adolescent group, FAI correction was performed for 36 cam and 17 pincer lesions and for 69 combined lesions. There were 111 labral tears that required 85 refixations and 26 debridements. There were 101 acetabular chondral lesions with four microfractures. There were three femoral chondral lesions. The researchers removed seven loose bodies and debrided 19 lesions of the ligamentum teres. Concomitant extraarticular procedures included 13 iliopsoas tendon releases and two iliotibial band tendinoplasties.

Among the adult cohort, the researchers performed FAI correction for 53 cam and 5 pincer lesions and for 64 combined lesions. There were 103 labral tears that required 52 refixations and 50 debridements. There were 112 acetabular chondral lesions with 20 microfractures and 17 femoral chondral lesions. The researchers removed 17 loose bodies and debrided 21 lesions of the ligamentum teres in the adult group. Concomitant extraarticular procedures included four iliopsoas tendon releases and one abductor repair.

Four adolescents needed repeat arthroscopic surgery and one patient underwent a periacetabular osteotomy. One adult patient had repeat arthroscopic surgery. – by Kristine Houck, MA, ELS

Reference:

Byrd JWT. Paper #32. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 10-13, 2014; Seattle.

Disclosure: Byrd is a consultant to and receives research support from Smith & Nephew Endoscopy and is a consultant to and has stock in A3 Surgical.

    Perspective

    Given the demands of adolescents in sports and the performing arts, health care providers are seeing these patients with hip injuries more frequently and at younger ages. Dr. Thomas Byrd and Kay Jones reviewed their experience with adolescent patients (less than 18 years) with femoroacetabular impingement (FAI) who underwent hip arthroscopy compared to a matched control group between 18 and 50 years with an average follow-up of 29 months. Both groups improved in terms of clinical outcome from baseline to most recent follow-up by more than 20 points. The adolescent group had five additional surgeries, whereas the control group had only one repeat arthroscopy.

    Adolescents with hip pain attributed to FAI that is unresponsive to nonsurgical treatment benefit from hip arthroscopy to address chondrolabral injury and underlying FAI deformities. Patient selection is critical for these patients as some may have dysplasia or dysplasia variants that need to be recognized to avoid additional surgery for these patients. Additionally, there are a subset of these patients who also have evidence of hypermobility in which their joint capsule needs to be handled meticulously and repaired if undergoing arthroscopy. Proper selection of adolescent patients can provide excellent pain relief and improvement in hip function. Additional studies will be necessary to determine whether surgical intervention may be able to protect the hip from further joint injury and possibly alter the course of joint degeneration over time.
    • Shane J. Nho, MD, MS
    • Assistant Professor, Department of Orthopedic Surgery, Division of Sports Medicine Rush University Medical Center Chicago

    Disclosures: Nho is a consultant for Stryker and Ossur and receives research support from Stryker and Allosource.

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