Arthroscopic management of cam, pincer and mixed FAI with labral preservation · advanced
- Cam morphology produces loss of femoral head-neck offset with an alpha angle greater than 50-55 degrees on a true lateral or Dunn view; the typical lesion is anterosuperior at the head-neck junction (1-3 o'clock position).
- Pincer morphology is acetabular overcoverage: the crossover sign on an AP pelvis indicates anterior overcoverage, while a lateral centre-edge angle greater than 40 degrees or an acetabular index less than 0 degrees confirms global pincer.
- A supine traction setup with 8-10 mm of joint distraction is required; the perineal post is padded (minimum 10 cm) and positioned laterally against the ischium to protect the pudendal nerve, with total traction time kept under 90-120 minutes.
- The anterolateral portal is established first under fluoroscopy with the hip in 10-15 degrees of flexion; the mid-anterior portal is then placed under direct vision 3-4 cm distal and lateral to the ASIS to protect the lateral femoral cutaneous nerve.
- Labral refixation after rim trimming restores the suction seal: anchors sit on the acetabular rim with the suture passed through the labrum as a horizontal mattress to evert the labral edge onto the femoral head.
When & Why
Indication. Symptomatic femoroacetabular impingement — groin pain on flexion and internal rotation, a positive impingement (FADIR) test, with documented cam, pincer or mixed morphology on radiographs and an MRI arthrogram — that has failed non-operative treatment for greater than 3-6 months (activity modification, physiotherapy, and at least one intra-articular corticosteroid injection). The ideal candidate is a young, active patient (typically less than 40-45 years) with preserved joint space (greater than 2 mm) and minimal arthritis (Tönnis grade 0-1). Relative indications include mixed cam-pincer morphology with correctable deformity, a labral tear amenable to repair rather than debridement, and the high-demand athlete with performance-limiting symptoms despite optimised conservative care (an earlier surgical threshold of 3-4 months applies to elite athletes). Assess the morphology and the joint before committing. Confirm there is no dysplasia (lateral centre-edge angle greater than 20 degrees) and no established arthritis, because rim trimming in a dysplastic hip worsens instability and arthroscopy in an arthritic hip fails. The decision is a pathway choice:
Activity modification, hip abductor and external rotator strengthening, and an intra-articular injection help roughly 30-50 percent of mild cases. First-line for 3-6 months. A randomised trial (Mansell 2018) found physiotherapy and arthroscopy equivalent at 2 years, but 70 percent of the physiotherapy group crossed over to surgery.
For symptomatic FAI failing conservative care in a young patient with preserved joint space and Tönnis 0-1. Systematic reviews report 70-90 percent good-to-excellent outcomes at 2-5 years and 80-90 percent return to sport in elite athletes when cam resection and labral repair are adequate.
Tönnis grade 2-3 arthritis, joint space less than 2 mm, dysplasia (lateral centre-edge angle less than 20 degrees), active infection or inflammatory arthropathy, or a severe version abnormality needing corrective osteotomy. Consider periacetabular osteotomy, realignment osteotomy or arthroplasty instead.
Consent specifically for traction neurapraxia (1-5 percent), lateral femoral cutaneous nerve injury (2-5 percent), iatrogenic chondral or labral injury (1-3 percent), heterotopic ossification (1-3 percent), residual deformity requiring revision (5-10 percent), infection (less than 1 percent) and deep vein thrombosis. Setup. Supine on a traction table. General anaesthesia with muscle relaxation; a lumbar plexus or fascia iliaca block may be added for analgesia, and hypotensive anaesthesia (mean arterial pressure 60-70 mmHg) reduces bleeding. The perineal post is positioned laterally against the ischium, and traction time is monitored throughout.
The Operation
The goal is to access the hip through two portals under traction, correct the pincer by acetabular rim trimming with labral refixation, correct the cam by femoral osteochondroplasty, and close the capsule — all while protecting the lateral femoral cutaneous nerve, the pudendal nerve and the lateral retinacular vessels. The exposure (positioning, traction and the two portals) is laid out as the first steps below.
Operative sequence
- Supine on a traction table; perineal post (minimum 10 cm padding) positioned laterally against the ischium, never in the midline perineum.
- Operative hip in 10-15 degrees of flexion and neutral-to-slight external rotation; the contralateral leg is abducted 30-45 degrees in slight traction to stabilise the pelvis.
- Apply longitudinal traction in slight flexion and neutral rotation; confirm 8-10 mm of joint distraction on fluoroscopy before any portal placement.
- Keep continuous traction time under 90-120 minutes total; release traction when you move to the peripheral compartment.
- Mark the greater trochanter and the anterior superior iliac spine. The anterolateral portal sits 2 cm proximal and 2 cm anterior to the greater trochanter tip, in line with the femoral neck axis.
- With the hip distracted, insert a spinal needle under fluoroscopic guidance aiming for the superior joint space; confirm intra-articular position with an air arthrogram or saline injection.
- Dilate the tract and insert a 70-degree arthroscope.
- From the anterolateral portal viewing the anterior capsule, insert a spinal needle for the mid-anterior portal under direct vision, placed 3-4 cm distal and 3-4 cm lateral to the ASIS, staying lateral to the sartorius.
- Dilate the tract and introduce a radiofrequency ablator or shaver.
- Create an interportal capsulotomy connecting the two portals, dividing the iliofemoral ligament in a controlled manner.
- Systematically assess the labral tear location, size and tissue quality (typically anterosuperior in cam FAI), the chondral damage on the acetabular rim and femoral head (Outerbridge grade), the acetabular rim morphology and crossover sign under direct vision, and the cam prominence on the head-neck junction.
- Document the findings and plan the sequence of rim trimming, labral repair and femoral osteochondroplasty.
- Elevate the labrum from the rim with a radiofrequency ablator or elevator, preserving the chondrolabral junction, and resect the pincer prominence with a 5.5 mm burr.
- Focal anterior pincer (with cam): resect 3-5 mm of anterior rim from the 12 to 3 o'clock position. Global pincer: limit resection to 2-3 mm laterally and 3-4 mm anteriorly to avoid creating iatrogenic dysplasia.
- Confirm adequate resection by eliminating the crossover sign on fluoroscopy and on direct vision.
- Repair the labrum with 2.3 mm or 2.9 mm knotless or knotted suture anchors placed along the acetabular rim.
- Pass the suture through the labrum as a horizontal mattress, everting the labral edge slightly onto the femoral head to restore the suction seal.
- Tie with the hip distracted, then reduce the hip and confirm the seal with dynamic testing (flexion and rotation under direct vision).
- Release traction and flex the hip to 45-60 degrees to access the peripheral compartment, and identify the cam prominence at the head-neck junction.
- With a 5.5 mm burr resect the cam from the medial synovial fold (12 o'clock) to the lateral retinacular vessels (around the 3 o'clock position); never extend the resection posterior to the 10-11 o'clock position.
- Restore a smooth head-neck offset to an alpha angle less than 50 degrees, confirmed on intraoperative fluoroscopy.
- Perform arthroscopic and fluoroscopic assessment in flexion, abduction and rotation to confirm impingement-free motion; address any residual prominence with additional burring.
- Confirm the resection is adequate medially and laterally without violating the retinacular vessels or creating a cortical notch.
- Close the interportal capsulotomy side-to-side with 2-3 absorbable sutures (number 2 Vicryl or equivalent) to restore capsular integrity and reduce instability risk; closure is mandatory in borderline dysplasia or ligamentous laxity.
- Close the portal sites with absorbable sutures and apply sterile dressings. No drain is required.
A needle trajectory placed too anterior or too medial risks the femoral neurovascular bundle; a portal placed too distal threatens the lateral retinacular vessels on the femoral neck; and inadequate distraction (less than 8 mm) risks chondral scuffing as the needle or cannula enters. Confirm 8-10 mm of distraction before any instrumentation, stay lateral to the sartorius, and use blunt dissection through the subcutaneous tissue to protect the lateral femoral cutaneous nerve branches.
Over-resection (greater than 5-6 mm) converts overcoverage into iatrogenic dysplasia and instability. Watch also for chondral injury from burr slippage or thermal damage, disruption of the chondrolabral junction that destabilises the labrum, and inadequate resection that leaves residual pincer impingement. Confirm crossover-sign elimination on fluoroscopy before moving on.
The lateral retinacular vessels on the posterolateral neck give rise to the lateral epiphyseal artery, the dominant blood supply to the femoral head; injury here causes avascular necrosis. Do not extend resection posterior to the 10-11 o'clock position, and avoid thermal injury from prolonged burring. Over-resection of greater than 30 percent of the neck diameter or a cortical notch risks femoral neck fracture; under-resection leaves residual cam, the most common reason for revision.
Draw a circle around the femoral head, then a line from the centre of the head to the point where the head-neck contour exits the circle on the true lateral or Dunn view. An angle greater than 50-55 degrees defines a cam lesion. Intraoperatively, resect until this angle is less than 50 degrees on multiplanar fluoroscopy.
A horizontal mattress suture passed through the substance of the labrum everts the labral edge onto the femoral head and restores the suction seal; test it by reducing the hip and confirming the labrum holds negative pressure. Reserve debridement for irreparable tissue (ossified or severely damaged) — multiple cohort studies and meta-analyses show repair is superior to debridement.
Aftercare & Complications
Rehabilitation | Phase | Timing | Weight-bearing and bracing | Therapy focus | |-------|--------|----------------------------|---------------| | Immediate | 0-2 weeks | Partial weight-bearing (~20 kg) with crutches; abduction brace limiting flexion over 90 degrees and external rotation after labral repair | Wound care, multimodal analgesia, DVT prophylaxis in high-risk patients; isometric activation | | Early | 2-6 weeks | Wean crutches when pain-free (typically 3-4 weeks); brace for 2-3 weeks | Passive and active-assisted range of motion to full by 6 weeks; abductor and external rotator strengthening; stationary bike with a high seat | | Return to function | 6-12 weeks | Brace off; progressive loading | Closed-chain exercises, single-leg stance and dynamic stabilisation; low-impact sport (swimming, cycling) from 8-12 weeks | | Return to sport | 3-9 months | Full | Running at 3-4 months if asymptomatic; cutting and pivoting sport at 4-6 months; contact or overhead sport at 6-9 months after pain-free full range of motion, strength symmetry and return-to-sport testing | Follow-up is at 2 weeks, 6 weeks, 3 months, 6 months and 1 year, with radiographs at 6 weeks and 1 year to assess resection adequacy and heterotopic ossification, and patient-reported outcomes (iHOT-33, HOS, mHHS) collected at each visit. The revision rate is 5-15 percent at 5 years, with most revisions occurring within 2 years for residual deformity. Complications
- Incidence
- 1-5 percent
- Recognition
- Perineal numbness, erectile dysfunction or urinary retention (pudendal); foot drop or posterior thigh numbness (sciatic); usually resolves within 4-12 weeks
- Prevention and management
- Limit traction to under 90-120 minutes, use a padded lateral perineal post, release traction intermittently and monitor sensation every 15 minutes; most resolve spontaneously; nerve conduction studies if beyond 3 months
- Incidence
- 2-5 percent
- Recognition
- Numbness or painful dysaesthesia over the anterolateral thigh; transient or permanent
- Prevention and management
- Blunt subcutaneous dissection, stay 3 cm lateral to the ASIS, establish the mid-anterior portal under direct vision; reassurance and neuropathic agents; exploration rarely needed
- Incidence
- 1-3 percent
- Recognition
- Scuffing or gouging of the femoral head or acetabular cartilage during portal placement or instrumentation; labral penetration by a suture or anchor
- Prevention and management
- Adequate distraction (8-10 mm) before portal placement, blunt cannulas and visualising all instrument entry; small defects left alone or microfractured; labral penetration needs suture removal and re-repair
- Incidence
- 5-15 percent (leading cause of revision)
- Recognition
- Persistent mechanical symptoms, positive impingement test, alpha angle over 50 degrees or persistent crossover sign on radiographs
- Prevention and management
- Systematic intraoperative dynamic assessment in multiple positions with fluoroscopic confirmation; revision arthroscopy to complete resection and address missed subspine or ischiofemoral impingement
- Incidence
- 1-3 percent (higher without prophylaxis)
- Recognition
- Painful limitation of motion 6-12 weeks postoperatively; radiographic bone formation in the soft tissues
- Prevention and management
- Routine NSAID prophylaxis (indomethacin 25 mg three times daily for 4-6 weeks, or celecoxib 200 mg daily) in high-risk patients; observation if asymptomatic; excise mature symptomatic bone after 6 months
- Incidence
- less than 0.5 percent
- Recognition
- Acute pain and inability to bear weight after osteochondroplasty; radiograph or CT confirms the fracture
- Prevention and management
- Limit resection depth to under 30 percent of the neck diameter, avoid cortical notches and use multiplanar fluoroscopy; protected weight-bearing if non-displaced, fixation or arthroplasty if displaced
- Incidence
- 1-2 percent
- Recognition
- Groin pain on loading, apprehension in extension and external rotation, increased femoral head translation on imaging
- Prevention and management
- Avoid excessive rim trimming (over 5-6 mm) and perform capsular closure in borderline dysplasia or laxity; activity modification and dynamic-stabilisation therapy; capsular plication or periacetabular osteotomy if refractory
- Incidence
- less than 1 percent
- Recognition
- Erythema, warmth, swelling, purulent discharge; raised CRP and white cell count; positive cultures
- Prevention and management
- Sterile technique with antibiotic prophylaxis at induction (cefazolin); oral antibiotics if superficial; arthroscopic or open washout with IV antibiotics and culture-directed therapy if deep
Under-resection of the cam is the single most common reason patients return for revision hip arthroscopy. Prevent it with a systematic intraoperative dynamic assessment in flexion, abduction and rotation and fluoroscopic confirmation of an alpha angle under 50 degrees — never accept a residual prominence to save time.
Viva & Exam Focus
CAMCAM — Femoral morphology assessment
PINCERPINCER — Acetabular morphology assessment
Location: The LFCN emerges 2-3 cm medial and inferior to the ASIS and divides into branches that cross the sartorius origin. Risk: A mid-anterior portal placed too medial or too proximal transects or stretches the LFCN, causing numbness or dysaesthesia over the anterolateral thigh. Protection: Blunt subcutaneous dissection, stay lateral to the sartorius, establish the mid-anterior portal under direct vision.
Location: Exits the pelvis through the greater sciatic notch and re-enters through the lesser sciatic notch, passing medial to the ischial tuberosity. Risk: Excessive or prolonged traction against a poorly padded post compresses the nerve against the ischium, producing perineal numbness, erectile dysfunction or urinary retention. Protection: Position the post laterally against the ischium, use at least 10 cm of padding, limit traction to under 90-120 minutes and release traction during the peripheral-compartment work.
Location: Run along the posterolateral femoral neck just distal to the head-neck junction; they give the lateral epiphyseal artery, the dominant femoral head supply. Risk: Aggressive posterior or lateral cam resection injures them, causing femoral head avascular necrosis. Protection: Limit osteochondroplasty to the anterosuperior head-neck junction (12 to 3 o'clock); never extend posterior to the 10-11 o'clock position or distal to the retinacular fold.
Location: The labrum attaches to the rim via the chondrolabral junction; the free edge creates the suction seal with the femoral head. Risk: Overzealous rim trimming or labral debridement disrupts the seal, causing persistent pain, microinstability and accelerated chondral wear. Protection: Preserve at least 3-4 mm of labral width and use a horizontal mattress that everts the labral edge onto the femoral head.
Location: Lies posterior to the greater trochanter; at risk with posterior portal placement or excessive hip extension under traction. Risk: Posterior portal misplacement or prolonged extension under traction stretches the nerve, producing foot drop or posterior thigh numbness. Protection: Use only anterolateral and mid-anterior portals for standard FAI surgery; keep the hip in slight flexion (10-15 degrees) during traction.
Location: The femoral neck calcar and anterolateral cortex carry the structural loads; excessive cam resection weakens the neck. Risk: Removing greater than 30 percent of the neck diameter or notching the cortex deeper than 4-5 mm increases fracture risk, especially in young active patients. Protection: Resect only the cam prominence to restore offset (alpha angle less than 50 degrees), confirm with multiplanar fluoroscopy and avoid a cortical notch.
Clinical Decision Scenarios
Practise clinical reasoning and management decisions out loud
“A 28-year-old professional footballer presents with 8 months of groin pain and mechanical catching in the right hip. AP pelvis and Dunn lateral radiographs demonstrate a cam lesion with an alpha angle of 68 degrees and a positive crossover sign. MRI arthrogram shows an anterosuperior labral tear with no significant chondral loss. How do you manage this patient?”
“You are performing hip arthroscopy for cam FAI. After completing the cam resection you notice that the lateral retinacular vessels appear stretched and the femoral head perfusion seems compromised on intraoperative assessment. What do you do?”
“A 35-year-old woman 18 months after hip arthroscopy for mixed FAI presents with recurrent groin pain and a positive impingement test. Postoperative radiographs show an alpha angle of 62 degrees (pre-operative 72 degrees) and a persistent crossover sign. What is your diagnosis and management?”
Diagnosis
- Cam: alpha angle greater than 50-55 degrees on true lateral or Dunn view; anterosuperior head-neck junction (1-3 o'clock)
- Pincer: crossover sign on AP pelvis, lateral centre-edge angle greater than 40 degrees, acetabular index less than 0 degrees
- Mixed morphology is most common (60-70 percent); address both in one procedure
- Labral tear is typically anterosuperior in cam FAI; assess repairability on MRI arthrogram
- Contraindications: Tönnis 2-3, joint space less than 2 mm, lateral centre-edge angle less than 20 degrees
Surgical anatomy
- Labrum: fibrocartilaginous ring, peripheral blood supply; preserve 3-4 mm of width after trimming
- Lateral retinacular vessels: posterolateral neck; do NOT resect posterior to the 10-11 o'clock position
- Lateral femoral cutaneous nerve: emerges 2-3 cm medial to the ASIS; protect with blunt dissection and direct vision
- Pudendal nerve: compressed by the perineal post; position post laterally with 10 cm padding, limit traction to under 90-120 minutes
- Iliofemoral ligament divided in the interportal capsulotomy; close the capsule in revision or borderline dysplasia
Indications
- Symptomatic FAI with documented morphology failing conservative care for greater than 3-6 months
- Young active patient (less than 40-45 years) with joint space greater than 2 mm and Tönnis 0-1
- Mechanical symptoms with a labral tear amenable to repair
- Elite athlete: earlier threshold of 3-4 months
- Absolute contraindications: advanced arthritis, active infection, severe version abnormality needing osteotomy
Operative technique
- Supine traction with a lateral padded post; 8-10 mm distraction on fluoroscopy; traction under 90-120 minutes
- Anterolateral portal first under fluoroscopy; mid-anterior portal under direct vision 3-4 cm distal and lateral to the ASIS
- Interportal capsulotomy; systematic central-compartment diagnostic arthroscopy
- Rim trimming 3-5 mm anteriorly for focal pincer, 2-3 mm laterally; confirm crossover-sign elimination
- Labral refixation: 2.3-2.9 mm anchors, horizontal mattress to restore the seal
- Cam resection from 12 to 3 o'clock to an alpha angle less than 50 degrees; protect the retinacular vessels; capsular closure
Danger zones
- Lateral femoral cutaneous nerve: stay 3 cm lateral to the ASIS with blunt dissection
- Pudendal nerve: lateral post, 10 cm padding, limit traction, monitor sensation every 15 minutes
- Lateral retinacular vessels: do not extend cam resection posterior to 10-11 o'clock or create a notch
- Chondrolabral junction: preserve 3-4 mm of labral width
- Femoral neck: resect under 30 percent of the neck diameter, avoid notching
Complications
- Traction neurapraxia 1-5 percent; usually resolves within 4-12 weeks
- Lateral femoral cutaneous nerve injury 2-5 percent
- Residual deformity 5-15 percent; leading cause of revision
- Heterotopic ossification 1-3 percent; NSAID prophylaxis in high-risk patients
- Iatrogenic chondral or labral injury 1-3 percent
Rehabilitation
- Partial weight-bearing 2-4 weeks; abduction brace 2-3 weeks limiting flexion over 90 degrees
- Range of motion and isometric strengthening from week 2; resistance by week 4-6
- Sport-specific training from 8-12 weeks; cutting and pivoting sport at 4-6 months
- Follow-up at 2 and 6 weeks, 3, 6 and 12 months; radiographs at 6 weeks and 1 year
- Revision rate 5-15 percent at 5 years, most for residual cam within 2 years
Special situations
- Borderline dysplasia (lateral centre-edge angle 20-25 degrees): minimal or no rim trimming, mandatory capsular closure, consider periacetabular osteotomy
- Elite athletes: earlier threshold (3-4 months), 80-90 percent return-to-sport rate
- Older patients (greater than 45-50 years): conservative indications, ensure minimal chondral damage, realistic expectations
- High BMI (greater than 35-40): increased technical difficulty and complication risk
- Revision: CT with 3D reconstruction mandatory; outcomes 10-15 percent lower than primary
Background & Evidence
Pathoanatomy. In cam morphology, an aspherical femoral head-neck junction abuts the acetabular rim during flexion and internal rotation, shearing the labrum and cartilage at the chondrolabral junction. In pincer morphology, acetabular overcoverage levering the femoral head causes focal or global impingement that crushes the labrum. The two commonly coexist — mixed morphology is the most common pattern (60-70 percent of FAI) — and the repetitive contact produces the labral tear and chondral damage that drive symptoms. The labrum deepens the socket and creates a suction seal with the femoral head; its blood supply is peripheral (capsular side), which is why the free edge heals poorly after debridement and why refixation preserving labral width is preferred.
- Defining morphology
- Loss of femoral head-neck offset
- Imaging hallmark
- Alpha angle greater than 50-55 degrees on true lateral or Dunn view; lesion at 1-3 o'clock
- Arthroscopic correction
- Femoral osteochondroplasty to restore offset and an alpha angle less than 50 degrees
- Defining morphology
- Acetabular overcoverage
- Imaging hallmark
- Crossover sign (focal anterior) or lateral centre-edge angle greater than 40 degrees / acetabular index less than 0 degrees (global)
- Arthroscopic correction
- Selective acetabular rim trimming with labral refixation
- Defining morphology
- Both cam and pincer
- Imaging hallmark
- Features of both; the most common pattern (60-70 percent)
- Arthroscopic correction
- Address both components in a single procedure
Imaging assessment. Weight-bearing AP pelvis and a true lateral or Dunn view define the morphology, supplemented by an MRI arthrogram for the labral tear and a CT with 3D reconstruction to map the cam lesion and AIIS morphology pre-operatively. Key measurements: - Alpha angle — greater than 50-55 degrees on the true lateral or Dunn view defines cam morphology.
- Crossover sign — the anterior acetabular wall crosses the posterior wall laterally on the AP pelvis, indicating focal anterior overcoverage.
- Lateral centre-edge angle — 25-40 degrees is normal; greater than 40 degrees is global pincer; 20-25 degrees is borderline dysplasia; less than 20 degrees is dysplasia and contraindicates rim trimming.
- Acetabular index — 0 to +10 degrees is normal; less than 0 degrees indicates superior overcoverage.
- Tönnis grade — 0-1 is suitable for arthroscopy; 2-3 contraindicates it.
- Extrusion index — greater than 25 percent suggests dysplasia. Key evidence. Mansell (2018) randomised hip arthroscopy against physiotherapy in military patients with FAI and found no significant difference at 2 years, though 70 percent of the physiotherapy group crossed over to surgery — supporting shared decision-making and an initial conservative trial. The UK FASHIoN trial (Griffin, 2018) found hip arthroscopy superior to best conservative care at 12 months for hip-related quality of life (iHOT-33, HOS). A meta-analysis (Wu, 2020) demonstrated superior outcomes and lower reoperation rates with labral repair over debridement when tissue permits. A systematic review (Wininger, 2022) showed traction-related complications are reported significantly more often in prospective than retrospective series, underlining the importance of careful perineal post padding and limited traction time. Patient selection — special situations. In borderline dysplasia (lateral centre-edge angle 20-25 degrees), rim trimming is minimal or avoided and capsular closure is mandatory, with consideration of a combined periacetabular osteotomy. Elite athletes warrant an earlier surgical threshold (3-4 months) and aggressive rehabilitation, with an 80-90 percent return-to-sport rate. Older patients (greater than 45-50 years) need conservative indications and minimal chondral damage (Outerbridge less than 3) with realistic expectations, and total hip arthroplasty is considered if significant degenerative change is present. A high body mass index (greater than 35-40) increases technical difficulty and complication risk, favouring weight reduction or an open approach.
References
Arthroscopic Surgery or Physical Therapy for Patients With Femoroacetabular Impingement Syndrome: A Randomized Controlled Trial With 2-Year Follow-up
- Randomised trial of military patients with FAI; hip arthroscopy versus physiotherapy
- No significant difference in outcomes at 2 years; 70 percent of the physiotherapy group crossed over to surgery
- Supports shared decision-making for initial treatment options
Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial
- UK multicentre randomised trial: hip arthroscopy superior to conservative care at 12 months (HOS, iHOT-33)
- Clinically important improvement in hip-related quality of life with arthroscopy
- Supports arthroscopic surgery as an effective option for symptomatic FAI
Arthroscopic labral debridement versus labral repair for patients with femoroacetabular impingement: A meta-analysis
- Meta-analysis demonstrating superior outcomes with labral repair over debridement in FAI
- Better patient-reported outcomes and lower reoperation with repair when tissue permits
Post-Related Complications in Hip Arthroscopy Are Reported Significantly Greater in Prospective Versus Retrospective Literature: A Systematic Review
- Systematic review: traction-related complications are higher in prospective studies of hip arthroscopy
- Emphasises the need for careful perineal post padding and limited traction time