Arthroscopic treatment of Cam-type femoroacetabular impingement

Abstract

Femoroacetabular impingement (FAI) is a common cause of hip pain and limited range of motion among young and middle-aged active adults and athletes. The acetabular labral tear and cartilage damage secondary to FAI may increase the risk of hip osteoarthritis. FAI is characterized by pathologic impact between the femoral headneck junction and the acetabular rim secondary to bony deformity. According to the pathological anatomy leading to impingement, the FAI can be divided into the femoral cam-type deformity (Cam), the acetabular over-coverage deformity (Pincer) and a combination of both. In recent years, arthroscopic osteoplasty of the femoral head-neck junction is the main way to treat the Cam deformity; However, there still remain some controversies about how to perform an adequate and effective arthroscopic femoroplasty. Based on this problem, the present article reviewed the preoperative diagnosis, intraoperative evaluation, surgical techniques and postoperative evaluation of Cam-type FAI to explore how to adequately correct Cam deformity under arthroscopy. In the present study, a total of 1928 related articles were obtained by searching PubMed, Web of Science, Cochrane library, China Knowledge Network, Wanfang Full-text Database and Weipu Science and Technology Journal Database. According to the inclusion and exclusion criteria, 43 papers were finally included. After summarizing the above literatures, it was found that anatomical structures such as Cam deformity, femoral neck anteversion, and acetabular coverage can be evaluated preoperatively by X-ray, three-dimensional CT and MRI. X-ray fluoroscopy and arthroscopic dynamic examination are performed during the femoroplasty to locate the Cam deformity and to determine whether the femoral neck offset radio and the spherical structure of femoral head are corrected, at the same time, it is necessary to consider the overall anatomy of the hip joint to achieve an adequate resection of the Cam deformity and restore the normal mobility of the hip joint.