Arthroscopic Femoral Osteochondroplasty for Cam-Type Femoroacetabular Impingement: The Trough Technique

Abstract

Arthroscopic osteochondroplasty has become the most common treatment for cam-type femoroacetabular impingement. However, gauging the appropriate depth and location of the femoral osteochondroplasty remains challenging, given the parallax observed from using a 70 arthroscope across multiple viewing perspectives. Consequently, reliable techniques must use a combination of arthroscopic and fluoroscopic checks and balances to assess the femoral head-neck junction to help guide bony resection. We have developed a technique for osteochondroplasty that has made the process more efficient and reliable in our hands. It involves creating a trough at the apex of the osteochondroplasty and then contouring the proximal and distal regions to re-create normal proximal femoral geometry. This article details our technique for femoral osteochondroplasty, which can be performed alone for isolated cam impingement or in concert with other intra-and extra-articular procedures to address associated hip pathology.

Hip Arthroscopy Capsular Closure: The Figure of Eight Technique

“…At this point, all intra-articular, acetabular, and labral pathology is addressed with the hip in traction. 17 …”

“…If present, the cam lesion is identified and an osteochondroplasty is performed as previously described. 17 …”

Advanced Hip Arthroscopy: What’s New?

“…At the completion of the procedure, the joint is irrigated to remove bony debris, and radiofrequency is used to provide hemostasis at the site of bone resection in order to minimize the risk of hetero-topic ossification and adhesions, respectively. Capsular closure is performed in selected cases [8,24,32,33] (Fig. 26.5).…”

Hip arthroscopy for femoroacetabular impingement

“…A ‘trough technique’ described by Aoki et al makes a trough where the resection should be deepest and contours around it proximally and distally to avoid resecting too much. 48 As FAI is a dynamic condition, an important part of assessing the adequacy of the bony work is putting the leg through a ROM to ensure that the impingement has been dealt with. During this dynamic evaluation, the labral repair, if one has been performed, can also be assessed.…”