This 2007 technique paper by Philippon describes the arthroscopic approach to treating femoroacetabular impingement (FAI) in high-demand patients and athletes. It reviews the pathoanatomy of cam and pincer FAI, relevant imaging findings, and step-by-step osteoplasty and rim trimming techniques with postoperative rehabilitation protocols.
Hip OA was long considered idiopathic in a large proportion of patients. This paper, building on Ganz's foundational work, establishes that unrecognized cam or pincer morphology drives early cartilage and labral failure and likely explains much of that "idiopathic" OA.
When you see a young athlete with groin pain, limited flexion and internal rotation, and a positive anterior impingement test, order a cross-table lateral and measure the alpha angle. An angle above 42° warrants further workup; 74° is the FAI average.
Before ordering rim trimming, confirm the center-edge angle is above 20°. Operating on a borderline dysplastic hip with pincer morphology and removing the overcoverage will convert a stable joint into an unstable one.
Labral preservation matters: refixation with bioabsorbable anchors after rim trimming produces better outcomes than debridement. If any viable labral tissue remains, repair it rather than resect it.
This 2007 technique paper by Philippon describes the arthroscopic approach to treating femoroacetabular impingement (FAI) in high-demand patients and athletes. It reviews the pathoanatomy of cam and pincer FAI, relevant imaging findings, and step-by-step osteoplasty and rim trimming techniques with postoperative rehabilitation protocols.
Hip OA was long considered idiopathic in a large proportion of patients. This paper, building on Ganz's foundational work, establishes that unrecognized cam or pincer morphology drives early cartilage and labral failure and likely explains much of that "idiopathic" OA.
When you see a young athlete with groin pain, limited flexion and internal rotation, and a positive anterior impingement test, order a cross-table lateral and measure the alpha angle. An angle above 42° warrants further workup; 74° is the FAI average.
Before ordering rim trimming, confirm the center-edge angle is above 20°. Operating on a borderline dysplastic hip with pincer morphology and removing the overcoverage will convert a stable joint into an unstable one.
Labral preservation matters: refixation with bioabsorbable anchors after rim trimming produces better outcomes than debridement. If any viable labral tissue remains, repair it rather than resect it.