FAI has recently been recognized as a major source of hip pain, labral tears, reduced range of motion, and decreased performance in the athlete. In the past, labral tears were regarded as isolated pathologies, and proposed treatment involved simple resection of the tears . Although labral debridement may yield immediate postoperative pain relief, long-term outcomes of this procedure can be improved . As a result, Ganz et al [5,6] have sought a cause for labral tears; they have proposed FAI as an underlying mechanism in a significant proportion of labral tears. Further, FAI has been shown to be a significant cause of early osteoarthritis in the hip [2-4,8,9]. As a result, treatment of the impingement as well as the associated pathology is thought to improve patient outcome following hip arthroscopy.
Historically, an open surgical dislocation procedure for FAI decompression has been advocated to provide an unobstructed 360° view of both the femoral head and acetabulum [6,16]. Although a study has shown good midterm results with this technique , the surgical trauma sustained during the open dislocation may make it difficult for high-level athletes to return to play. Proponents of the open technique have argued that the "constrained hip renders [arthro-scopic] access to the underlying cause of impingement technically challenging, if not impossible" . However, with the combined use of long and flexible arthroscopic instrumentation, and controlled intra-operative manipulation of the lower extremity, we believe that 360° access to the femoral head-neck junction is definitely possible with arthroscopy. The senior author has performed over 516 hip arthroscopies for decompression of FAI between September 2000 and April 2005. In a review, 45 of these patients were professional athletes who each experienced symptomatic improvement and all returned to play (Philippon MJ, unpublished data, 73rd Annual Meeting of the American Academy of Orthopaedic Surgeons, 2006).
In conclusion, athletes presenting with hip pain should be evaluated for the signs and symptoms of FAI in addition to those of labral and chondral injuries. The increasing popularity of hip arthroscopy has led to the development of this new technique. Advantages to the arthroscopic approach seem to be a reduction in postoperative morbidity and a more prompt postoperative return to play for athletes. By treating FAI in athletes at an early stage, it is hopeful that osteo-arthritis progression in the years following competition will be delayed or completely prevented.
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