Christopher M. Larson

Femoroacetabular impingement is a disorder associated with labrochondral injury and the development of osteoarthritis. Although femoroacetabular impingement is a 3-dimensional disorder with variable size and extent of impingement between individuals, there are 2 primary types of hip impingement: Cam-type and Pincer-type. Cam-type impingement is the result of asphericity of the femoral head-neck junction whereas Pincer-type impingement results from acetabular overcoverage. This paper will focus on Pincer-type pathology. The pathomechanics and most common subtypes of pincer impingement, typical patient presentation, radiographic and imaging findings, surgical indications, intraoperative findings, and specific arthroscopic surgical techniques will be described.

Purpose: The purpose of this study was to compare the outcomes of arthroscopic labral debridement with those of labral refixation. Methods: We reviewed patients who underwent labral debridement during a period before the development of labral repair techniques. Patients with labral tears deemed repairable with our current arthroscopic technique were compared with patients who underwent labral refixation with a minimum 1 of year of follow‐up. To better match the 2 groups, only patients with labral pathology caused by pincer‐type or combined pincer‐ and cam‐type femoroacetabular impingement were included. In the first 36 hips the labrum was debrided (group 1); in the next 39 hips the labrum underwent refixation (group 2). Outcomes were measured preoperatively and postoperatively with the modified Harris Hip Score (HHS), Short Form 12, and visual analog scale for pain. Preoperative and postoperative radiographs were obtained to evaluate bony resection (α angle) and osteoarthritis (Tönnis grade). Results: The mean age was 31 years in group 1, with a mean follow‐up of 21.4 months, and 27 years in group 2, with a mean follow‐up of 16.5 months. Preoperative subjective outcomes scores were not significantly different between groups. At the 1‐year follow‐up visit, subjective outcomes were significantly improved ( P < .01) in both groups. HHSs were significantly better for the refixation group (94.3) compared with the debridement group (88.9) at 1 year ( P = .029). At most recent follow‐up, good to excellent results were noted in 66.7% of hips in the debridement group compared with 89.7% of hips in the refixation group ( P < .01). Conclusions: Although other variables could have influenced these outcomes, these preliminary results indicate that labral refixation resulted in better HHS outcomes and a greater percentage of good to excellent results compared with the results of labral debridement in an earlier cohort. Level of Evidence: Level III, retrospective comparative study.

Purpose: The purpose of this study was to evaluate the early outcomes of arthroscopic management of femoroacetabular impingement (FAI). Methods: Ninety‐six consecutive patients (100 hips) with radiographically documented FAI were treated with hip arthroscopy, labral debridement or repair/refixation, proximal femoral osteoplasty, or acetabular rim trimming (or some combination thereof). Outcomes were measured with the impingement test, modified Harris Hip Score, Short Form 12, and pain score on a visual analog scale preoperatively and postoperatively at 6 weeks, 3 months, and 6 months, as well as yearly thereafter. Preoperative and postoperative radiographic α angles were measured to evaluate the adequacy of proximal femoral osteoplasty. Results: There were 54 male and 42 female patients with up to 3 years' follow‐up (mean, 9.9 months). The mean age was 34.7 years. Isolated cam impingement was identified in 17 hips, pincer impingement was found in 28, and both types were noted in 55. Thirty hips underwent labral repair/refixation. A comparison of preoperative scores with those obtained at most recent follow‐up revealed a significant improvement ( P < .001) for all outcomes measured: Harris Hip Score (60.8 v 82.7), Short Form 12 (60.2 v 77.7), visual analog score for pain (6.74 v 1.88 cm), and positive impingement test (100% v 14%). The α angle was also significantly improved after resection osteoplasty. Complications included heterotopic bone formation (6 hips) and a 24‐hour partial sciatic nerve neurapraxia (1 hip). No hip went on to undergo repeat arthroscopy, and three hips have subsequently undergone total hip arthroplasty. Conclusions: Arthroscopic management of patients with FAI results in significant improvement in outcomes measures, with good to excellent results being observed in 75% of hips at a minimum 1‐year follow‐up. Alteration in the natural progression to osteoarthritis and sustained pain relief as a result of arthroscopic management of FAI remain to be seen. Level of Evidence: Level IV, therapeutic case series.