Arthroscopic Hip Surgery for the Management of Acetabular Labral Tears and Femoroacetabular Impingement in Athletes: Recent Advances in Surgical Techniques and a Brief Review of Outcomes

The term femoroacetabular impingement (FAI) includes altered osseous morphology of the femoral head-neck junction (cam lesion), acetabular rim (pincer lesion), or both (mixed lesions). Restoration of the acetabular labral seal is critical to re-establish function and stability of the hip joint. A non-operative management consisting of rest, activity modification, nonsteroidal anti-inflammatory drugs, physical therapy, and consideration of a one-time, image-guided, intra-articular steroid injection can successfully provide pain relief and improve hip function in many patients. Arthroscopic hip surgery is indicated for patients in whom a trial of non-operative management has failed to relieve symptoms. It is vital to correct the underlying abnormal osseous morphology in addition to treatment of the labral pathology. In patients with symptomatic FAI, surgical procedures such as femoral osteochondroplasty, acetabuloplasty, or both (as clinically indicated) should be undertaken. Numerous surgical techniques have been developed to address the pathologic labrum where the labrum is either torn, unstable, deficient, or otherwise incompetent. A labral repair should be performed for patients in whom enough competent tissue is available to restore the labral seal. Labral reconstruction using autograft or allograft is performed for patients when there is deficient or incompetent labral tissue that is not amenable to repair. Labral reconstruction should also be undertaken for the revision setting or in the presence of an ossified labrum. Arthroscopic correction of underlying osseous impingement and labral preservation techniques provides pain relief, improves joint function, enables the patients to return to their activities of daily living, and also allows a high rate of return-to-play in recreational and elite athletes.