Gupta et al Mar • Apr 2014
“cam” deformity. Each type of bony abnormality can be seen
in isolation or in combination and can lead to FAI.11,15,17,23 In
the past 2 decades, many advances have been made in the
recognition and management of this condition that have led
to improved patient outcomes. Despite improved outcomes,
there remains the opportunity for future advancements. The
purpose of this review is to describe the current evidence and
future directions of the anatomy and pathophysiology, imaging,
biomechanics, clinical decision making, and clinical outcomes
of FAI treatment options.
emoroacetabular impingement (FAI) is a common cause
of hip pain in young adults. FAI can be the result of an
acetabular-sided “pincer” deformity or a femoral-sided
AnAtomy And PAthoPhysiology
Femoroacetabular impingement can result from a cam
deformity,11,13 where there is loss of sphericity of the femoral
head, or from a pincer deformity,11,52 where there is focal or
global acetabular overcoverage of the femoral head. There is a
sex-related difference, with cam lesions more prevalent in
men and acetabular overcoverage more prevalent in
women.13,42,53 Recent studies, however, have demonstrated that
such findings are less likely to be seen in isolation.11,13 Rather,
a combination of these pathologies is more commonly present,
and failure to identify and treat this can lead to undesirable
What’s New in Femoroacetabular
Impingement Surgery: Will We Be
Better in 2023?
Anil K. Gupta, MD, MBA,† Geoffrey D. Abrams, MD,‡ and Shane J. Nho, MD, MS*§
Context: Femoroacetabular impingement (FAI) has been described as a common cause of hip pain in young adults. This
leads to abnormal hip joint mechanics and contact pressures. The associated pathomechanics can lead to the development
of early osteoarthritis. Better understanding of the anatomy and pathophysiology, biomechanics, and diagnostic and thera-
peutic advances has led to improved clinical outcomes. A growing body of evidence has set the foundation for future prog-
ress in the treatment of this commonly encountered condition.
Evidence Acquisition: The PubMed database was searched for English-language articles pertaining to FAI over the past
15 years (1998-2013).
Study Design: Retrospective literature review.
Level of Evidence: Level 4.
Results: The authors evaluated and discussed the current evidence regarding the anatomy, physiology, biomechanics,
imaging, and clinical outcomes of surgical intervention for FAI. Based on this information, future directions for improving
the diagnosis and management of FAI are proposed.
Conclusion: There remains a diverse approach to the diagnosis and management of cam- and/or pincer-type FAI. Recent
advances in clinical diagnosis, imaging, indications, and arthroscopic techniques have led to improved outcomes and have
set the foundation for future progress in the management of this condition.
Strength of Recommendation Taxonomy (SORT): B
Keywords: femoroacetabular impingement; surgical; biomechanics; imaging
[ Orthopaedic Surgery ]
From †Sports Medicine and Shoulder Surgery, Florida Orthopaedic Institute, Tampa, Florida, ‡Department of Orthopedic Surgery, Stanford University, and Veterans
Administration, Palo Alto, California, and §Department of Orthopedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois
*Address correspondence to Shane J. Nho, MD, MS, Department of Orthopedic Surgery, Division of Sports Medicine, Rush University Medical Center, 1611 West Harrison
Street, Suite 300, Chicago, IL 60612 (e-mail: email@example.com).
The following author declared potential conflicts of interest: Shane J. Nho, MD, MS, is a consultant for Stryker, Pivot Medical, and Ossur. He has grants pending for the
Arthroscopic Association of North America, Stryker, and Allosource. He holds stock or stock options in Pivot Medical.
© 2013 The Author(s)
vol. 6 • no. 2 SPORTS HEALTH
Up to 90% of patients with labral pathology have a
morphologic abnormality of the femoral head-neck junction
or acetabulum.13,16,19,23 Asphericity of the femoral head can lead
to early contact and shear stresses of the anterior-superior
acetabular rim as the hip is brought into flexion and internal
rotation.2,6,7 This can lead to prearthritic pain, early chondral
delamination, and associated labral pathology.8 Similarly,
acetabular overcoverage, both focal and global, can cause
abnormal impaction at the labrum during hip joint motion, as
well as a contrecoup injury to the posteroinferior acetabulum.23
Bedi et al8,9 described static and dynamic factors associated
with prearthritic hip pain. Static factors include anterior
or lateral acetabular undercoverage, femoral anteversion,
and femoral valgus. These factors lead to asymmetric
joint loading and chondral wear during static activities (ie,
stance).8,9 Dynamic factors include cam-type deformity and
acetabular overcoverage. As the hip is dynamically flexed,
there is abnormal engagement between the femoral head
and acetabulum. This alters the mechanics of the joint
and surrounding musculature, leading to pain and early
chondrolabral degeneration.8,9 Dynamic extra-articular
impingement factors, including femoral retroversion, femoral
varus, trochanteric impingement, and anterior-inferior iliac
spine (AIIS) impingement, also occur as the hip is brought into
flexion and/or abduction.8,9
Radiographic assessment of FAI, including true anteroposterior
pelvis, false-profile, cross-table lateral, frog-leg lateral, and 45°
lateral Dunn views, provides useful static evaluation for femoral
or acetabular-sided bony lesions.5,12,58 The ability to extrapolate
spherical pathology from 2-dimensional imaging, however, can
be difficult. For this reason, multiple radiographic views have
been suggested to diagnose cam and pincer deformities. In a
comparative study, Nepple et al48 evaluated the sensitivity and
specificity of specific radiographic views in predicting cam-
type FAI diagnosed by radial-oblique CT reformats (considered
gold standard). They found that a complete radiographic series,
including an anteroposterior pelvis, 45° lateral Dunn, cross-
table lateral, and frog-leg lateral, was 86% to 90% sensitive in
detecting abnormal alpha angles on CT. In an evaluation of the
alpha angle measured on a cross-table lateral view with the leg
in 15° of internal rotation or on the Dunn view, Beaule et al5
found that patients with an alpha angle greater than 65° had
significantly increased risk of cartilage damage.
Radiographic imaging to detect pincer-type deformity can be
challenging. For example, alterations in pelvic tilt and rotation
can influence interpretations of acetabular pathomorphology;
as a result, pincer deformities can be either unrecognized or
falsely identified. In a cadaveric assessment of the normal
pelvis, Siebenrock et al55 demonstrated a correlation between
pelvic tilt and acetabular version. At 9° of pelvic inclination,
all specimens demonstrated positive crossover and posterior
wall signs despite a lack of acetabular retroversion. This study
exposed the need for standardized techniques in radiographic
imaging to account for this variability. Furthermore, in a recent
retrospective study, Nepple et al47 found that coxa profunda,
a commonly accepted radiographic finding demonstrating
global acetabular overcoverage, should be considered a normal
radiographic finding in women.
Computed Tomography and 3-dimensional
Inaccurate or inconclusive preoperative assessment of plain
radiographs can lead to inadequate or excessive resection of
presumed lesions contributing to FAI. Failure to adequately
address the offending 3-dimensional (3D) deformity causing
FAI is the most common reason for failed arthroscopy and
need for revision.29,52 High-resolution CT allows for precise
evaluation of osseous morphology about the hip joint (Figure
1). Three-dimensional modeling is a recent advancement that
has demonstrated promise with regard to dynamic hip analysis
for preoperative planning (Figure 2). Using a noninvasive 3D
CT-based kinematic technique to create a virtual hip model,
Kubiak-Langer et al35 were able to identify the location of
impingement and assess the changes in range of motion before
and after virtual resection of isolated cam, pincer, or combined
lesions. Similarly, Bedi et al9 performed patient-specific 3D CT
modeling of hips with cam and/or pincer deformities. Models were
dynamically assessed for location and extent of impingement.
The location of impingement was unique in each case and did
not correlate with radiographic imaging. Virtual acetabular rim
trimming and/or femoral head-neck osteochondroplasty was
performed to remove areas of impingement, which improved hip
kinematics and range of motion.9
Dynamic 3D CT modeling may also help decipher deformities
that are symptomatic from those that are asymptomatic. Two
recent studies demonstrated the prevalence of cam-type
deformities in asymptomatic individuals. In an evaluation of
200 asymptomatic volunteers who underwent MRI, Hack
Figure 1. Three-dimensional computed tomography scan
demonstrating combined cam and pincer deformities.
Gupta et al Mar • Apr 2014
et al26 found a 14% incidence of cam morphology and 10.5%
with an elevated alpha angle. Similarly, Jung et al31 found
a 14.3% incidence of cam-type deformity in asymptomatic
male patients and a 5.6% incidence in asymptomatic female
patients based on abnormal alpha angle measurements on
anterior-posterior CT scout images. Although these patients
had evidence of bony abnormality on static imaging,
dynamic imaging comparison was not performed.31 In a study
comparing patients with symptomatic FAI, asymptomatic
patients with 3D CT evidence of FAI, and asymptomatic
controls, Audenaert et al2 demonstrated increasing hip internal
rotation among groups, respectively. They found that cam size,
acetabular overcoverage, and decreased femoral anteversion all
contributed to the loss of internal rotation.
Dynamic 3D CT analysis has also recently shed light on
potential extra-articular causes of impingement. In a dynamic
CT model of 53 hips of patients with impingement, Hetsroni
et al28 described varying AIIS morphology based on the
relationship between the AIIS and the acetabular rim. They
demonstrated that a prominent AIIS can lead to “subspine
impingement” with loss of hip flexion and internal rotation.
Evaluation of contact points also showed varied sites of contact
on the femoral neck depending on the relative extent of the
prominence.28 Thus, along with intra-articular evaluation, 3D
dynamic CT has tremendous future potential for identifying
additional causes and locations of extra-articular impingement,
including dysplasia, malunion, and heterotopic ossification.
This will allow for a more comprehensive surgical approach in
treating patients with FAI.
Magnetic Resonance Imaging
Magnetic resonance imaging is considered the most sensitive
and specific modality to diagnose labral pathology and
associated bony and soft tissue abnormalities associated with
FAI (ie, subchondral cysts, bony edema, capsular thickening,
synovitis, paralabral cysts, gluteus medius tendinopathy,
adductor longus strain) as well as those independent of FAI
(ie, osteonecrosis of the femoral head, bone tumors, synovial
chondromatosis). Abnormal head-neck morphology and
anterior-superior chondrolabral lesions can been seen in up
to 90% of cases of FAI.32 For the best results, a 1.5- or 3.0-T
magnet with a 2-part shoulder coil, small field-of-view wrap
coil, or multiple-channel cardiac coil should be used.25 Axial-
oblique images oriented along the femoral neck are typically
utilized in the evaluation of a cam deformity, labral tears, and
partial- and full-thickness cartilage defects.25
Cartilage delamination is the early result from focal cam-
type FAI.25 This is commonly seen at the chondrolabral
junction of the anterior-superior acetabulum. It is diagnosed by
fluid extravasation deep to the cartilage (Figure 3). Magnetic
resonance arthrography, which is typically performed to
improve visualization of labral tears, has a 22% sensitivity
and 100% specificity in detecting chondral delamination.1,25
Delamination was most commonly identified on sagittal
T1-weighted and proton-density sequences with fat saturation.1
Recently, delayed gadolinium-enhanced MRI of cartilage
Figure 2. Point cloud model of the acetabulum devised from
3-dimensional computed tomography scan. (A) Joint space
width represented on complete hip joint. (B) View of the modeled
acetabulum surface. (C) View of the modeled acetabulum rim.
Figure 3. Coronal magnetic resonance arthrogram
demonstrating anterior-superior labral tear with chondral
vol. 6 • no. 2SPORTS HEALTH
(dGEMRIC) has been used to evaluate proteoglycan depletion
to predict early cartilage degeneration. Contrast uptake
correlates inversely to the amount of glycosaminoglycan
content present.25 dGEMRIC in symptomatic FAI shows promise
for detecting early cartilage degeneration.1,25
Abnormal contact resulting from FAI leads to labral damage
and a cascade of events resulting in the development of
osteoarthritis. Finite element modeling has demonstrated that
the absence of a functioning labrum results in an increase
(up to 92%) in contact stress of the acetabular cartilage.21 In
addition, the contact area of the femoroacetabular cartilage
shifts laterally toward the acetabular rim. Labral tearing and/
or deficiency can lead to instability.17,18,57 Three-dimensional
motion analysis of cadaveric hips with simulated labral tears
has shown increased distraction.18
The altered contact pressures, eccentric loading, and loss of
stability that results from labral dysfunction may contribute
to the development of osteoarthritis. In a cadaveric study,
Smith et al57 demonstrated that removal of 2 cm or more of the
labrum reduced hip stability. In addition, strain in the anterior-
superior labrum was increased with a circumferential-type
tear.57 In an in vitro biplanar fluoroscopy study, Myers et al44
demonstrated that the labrum served as a secondary stabilizer
to the iliofemoral ligament in limiting external rotation and
The labrum may also contribute to the suction-seal effect
of the joint.17,57 Loss of the suction-seal can lead to subclinical
instability and abnormal articular cartilage contact loading.17,44,57
In a cadaveric study, Cadet et al17 demonstrated that labral
repair results in lower capsular fluid efflux than do partial
labral resection and/or iliotibial band autograft reconstruction.
Repair, however, was not as effective as the intact labral state.
clinicAl decision mAking
Nonoperative management of symptomatic FAI can help
alleviate pain and restore function.3,15,23 In a prospective
observational study of patients with symptomatic prearthritic
intra-articular hip disorders, 44% of patients treated
conservatively had a satisfactory outcome at 1 year.30 In
comparing the nonoperative versus operative groups, both
groups demonstrated improved outcomes without a significant
difference.30 The impact of these nonoperative modalities
on the natural history of the development of degenerative
osteoarthritis from FAI is not known, largely because
there is no consensus at this time on the natural history of
asymptomatic and symptomatic FAI.
Intra-articular cortisone injection is often performed to
decipher intra-articular from extra-articular pathology. In a
retrospective review comparing physical examination, MRI,
magnetic resonance arthrography, and intra-articular injection
of anesthetic, Byrd and Jones demonstrated that injection
was 90% accurate at diagnosing intra-articular pathology.15 In
a retrospective review of patients who underwent injection
before arthroscopy, Kivlan et al34 found that patients with
acetabular chondral damage had significant pain relief
compared with those without chondral damage. The presence
and severity of FAI and labral pathology did not influence the
percentage relief from injection.34 Therefore, in patients with
isolated FAI, there is a possibility that they may not obtain
significant benefit from injection if there is no associated
The decision to pursue open versus arthroscopic
intervention depends on the pathomorphology as well
as surgeon experience. Open surgical dislocation may be
the best treatment option for posterior cam deformities
or global pincer deformities in the event that appropriate
access to the joint cannot be attained through traction only.
Studies have demonstrated improved outcomes at midterm
follow-up with this technique, including return to play in
high-level athletes.45,46 This technique, however, is technically
demanding, with complications including trochanteric
nonunion, heterotopic ossification, and avascular necrosis
of the femoral head with acetabular retroversion and/or
posterior wall insufficiency; open reverse periacetabular
osteotomy is effective at reorienting the acetabulum. This is
a technically difficult procedure with risk of neurovascular
injury, symptomatic hardware, and nonunion.8 Studies have
demonstrated improved pain relief, function, and range of
motion when performed effectively.56
Recent technical advances in hip arthroscopy have enabled
surgeons to address osseous and soft tissue pathologies that were
once managed by open surgery. In a comparative series, Bedi
et al10 demonstrated that arthroscopic osteochondroplasty has
similar efficacy to open surgical dislocation for restoring head-
neck offset, depth, and arc of resection for anterior and anterior-
superior cam and focal pincer pathology. Similarly, Buchler
et al12 demonstrated similar efficacy of osseous correction of
cam-type deformity between the 2 techniques. Success of
arthroscopy, however, depended on surgeon experience.12
Current limitations of arthroscopy for FAI, including
posterior-superior cam and acetabular lesions, may become
routinely manageable via arthroscopy and mitigate the
morbidity associated with open procedures.
Long-term Follow-up Studies
Unfortunately, there is a paucity of level 1 or 2 data available.
In a cohort of 50 consecutive patients with 100% follow-up
at 10 years, Byrd and Jones16 reported improved functional
outcome scores in patients who were younger and had a
shorter duration of symptoms and a normal center-edge angle.
Investigations Examining Outcomes
Following FAI Treatment
With some exceptions, studies examining outcomes for
patients undergoing treatment for FAI are mostly limited to
Gupta et al Mar • Apr 2014
smaller patient populations with short- to mid-term follow-up
(Table 1). In one of the larger studies on FAI treatment, Larson
et al39 investigated the effect of radiographic arthritis on
clinical outcomes in cohorts with FAI only and those with FAI
and radiographic osteoarthritis. A total of 210 patients were
included and followed for a minimum of 1 year (mean, 27
months). Improvements in Harris Hip Score (HHS), SF-12 (Short
Form–12), and visual analog scale (VAS) for pain were greater
in the group without osteoarthritis so that those with less than
50% joint space narrowing or more than 2 mm of joint space
remaining fared better. Chondral damage noted on MRI and
longer duration of preoperative symptoms were associated
with worse clinical outcomes.39
Byrd and Jones14 studied the results of FAI surgery in athletes,
including 23 professional and 56 intercollegiate athletes. A
total of 200 patients was followed for a minimum of 1 year,
with a majority of patients having cam pathology. There was
significant improvement in the modified HHS (to a mean of 96
postoperatively) as compared with preoperative values, and
95% of professional athletes and 85% of intercollegiate athletes
were able to return to sports.14
Philippon et al51 examined clinical outcomes in 112 patients
following arthroscopic treatment for FAI. Mean patient age
was 40.6 years, and mean follow-up was 2.3 years. Most
patients underwent treatment for mixed (cam and pincer)
impingement, 23 underwent osteoplasty only, and 3 had
acetabuloplasty alone. The mean modified HSS improved
from 58 preoperatively to 84 postoperatively, with 10 patients
undergoing total hip arthroplasty at an average of 16 months.
The preoperative HHS, joint space greater than 2 mm, and
repair of labral pathology rather than debridement were
predictors for a more favorable outcome.51
Malviya et al41 prospectively followed a cohort of 80 patients
(40 professional athletes and 40 recreational athletes) to
examine differences in return to sport and activity following
arthroscopic treatment for FAI. Compared with preoperative
values, there was a 2.6-fold improvement in training time and
a 3.2-fold increase in time spent competing in the patients’
desired sport 1 year following surgery. Overall, mean time
to return to sport was 5.2 months, with professional athletes
returning at an average of 4.2 months and recreational athletes
at 6.8 months. Professional athletes also returned to their
preinjury level of sport at a higher rate than that of recreational
athletes at the 1-year mark.41
Studies Examining Arthroscopic
Treatment of Labral Pathology in FAI
When intrasubstance tears of the labrum are present, some
favor debridement while others prefer maintaining labral tissue
and refixation (Table 2).22,33,36
Larson et al,38 in a cohort study of 94 patients undergoing
either labral debridement or refixation, showed that
postoperative HHS, SF-12, and VAS were all significantly
better in the refixation group at a mean follow-up of 42
months. Good to excellent results were noted in 68% of the
debridement group versus 92% of the refixation group.37
Limitations of this investigation include the use of a historical
Schilders et al54 investigated labral resection versus refixation in
96 patients at a mean 2.4 years postoperatively. HHS in the labral
repair group improved from 60 to 94 and from 63 to 89 in the
labral resection group. Based on a regression model, the mean
benefit of performing labral fixation over resection was 7.3 points
on the HHS grading system.54 Preserving labral tissue when
possible seems reasonable because of the sealing function of the
labrum; the decision to perform labral debridement/resection
versus refixation typically depends on a variety of factors: the
type and location of the tear, healing capacity, the size of the
labrum, the status of the articular cartilage, and the skill of the
surgeon.33,53 Outcomes following refixation versus debridement/
resection may be more dependent on the status of the labrum at
the time of arthroscopy rather than the treatment provided.
When the labrum is not salvageable, some surgeons turn
to labral reconstruction.50 Philippon et al50 reported clinical
results of labral reconstruction using autograft iliotibial band
in patients with advanced labral degeneration or labral
deficiency. The mean HHS significantly improved preoperatively
to postoperatively in the 47 patients, with a mean patient
satisfaction score of 8 (scale, 1-10) over the 18-month follow-up.
Four patients went on to total hip arthroplasty, with age being
a significant independent predictor of patient outcome.50 In
a cohort of 19 patients undergoing labral reconstruction, 3
underwent total hip arthroplasty within the 3 years, and 14 of 16
patients had improved subjective functional scores.59
Open Versus Arthroscopic Treatment of FAI
Treatment of FAI was initially performed through an open
surgical dislocation.23 Treatment for FAI now includes open
surgical dislocation,23 all-arthroscopic,10-12 and combined mini-
open and arthroscopic techniques.40 Comparison between
techniques is difficult because of the varying outcome measures.
In a group of patients with FAI, 23 underwent arthroscopy and
15 open dislocation.60 Ten patients were randomly allocated to
a treatment group while the others made their own decision.
The arthroscopy group had a significantly better follow-up, up
to 1 year postoperatively. Shorter hospital stay and time off work
were noted in the arthroscopy group; additionally, there was
overcorrection of morphologic abnormalities at the head-neck
junction in the arthroscopy group.60
A systematic review of outcomes and complications of
arthroscopic, mini-open, and surgical dislocation techniques
showed that all 3 methods were effective in the treatment of
FAI.43 The arthroscopic group had a lower rate of complications
(0%-5% major complication rate).43 The open dislocation group
had a relatively high rate of postoperative complications (0%-
20% major complication rate), mostly related to trochanteric
osteotomy-related issues.43 The mini-open group had a
lower complication rate than the open group (0%-17% major
complication rate) but a higher incidence of lateral femoral
cutaneous nerve injury versus the arthroscopic group.43
vol. 6 • no. 2SPORTS HEALTH
Table 1. Selected studies investigating arthroscopic treatment of FAI
No. Follow-upMain Outcomes
Failures Other Findings
612 3.2 y QoL score improved 1
77% of patients
showed QoL improved
by at least 1 grade
NRMean change in QoL not
significantly different for men
vs women, age > 50 vs < 50
y; associated pathologies not
associated with QoL score
210 27 mo HHS, SF-12, VAS better
for patients without
12% FAI and
52% FAI/OA, no
MRI chondral damage and
longer duration of symptoms
led to lower scores
20016 mo HHS improvement of
20 points with cam
improvement for pincer
0.5% THA, 1.5%
Patient with microfracture
had average 20-point HHS
122 2.3 y HHS improved from
58 preoperatively to
was 9 (1-10 scale)
NRPreoperative HHS, lack of
joint space narrowing, and
labral repair associated with
improved outcome following
116 2 yHHS improved from 72
preoperatively to 96
10% not able to RTS
0.5% THA, 2%
Microfracture and bipolar
cartilage lesion RTS 92%
11010 mo WOMAC improved from
60 preoperatively to
77% satisfied or very
satisfied with result
4% THA or
Patients with early OA had
significantly lower WOMAC
scores than those without
80 1.4 y HHS improved from 61
preoperatively to 84
improved from 68
NR Lower mean time to RTS
for professional versus
4727 mo HHS improved from 69
preoperatively to 85
improved from 79
preoperatively to 91
7% unable to return
to same level of
Alpha angle correction from 76
degrees preoperatively to 51
1.5 y HHS improved by 21
points and HOS
improved by 16
points; all self-
No intra- or
No difference in final scores
for labral debridement
FAI, femoroacetabular impingement; HHS, Harris Hip Score; HOS, Hip Outcome Score; NAHS, Non-Arthritic Hip Score; NR, not reported; OA, osteoarthritis;
QoL, quality of life; RTS, return to sport; SF-12, Short Form–12; THA, total hip arthroplasty; VAS, visual analog scale.
aAge < 20 y.
Gupta et al Mar • Apr 2014
One of the main controversies among different treatment
centers is whether young, asymptomatic patients with
the anatomy of FAI should undergo prophylactic surgical
treatment.11 Identification of patients who may benefit from
prophylactic surgery may be aided by new methods of
advanced imaging. Standard magnetic resonance sequences
cannot detect the biochemical changes that precede
morphologic changes. Furthermore, dGEMRIC imaging can
quantify the spatial variations in glycosaminoglycans, the main
constituent of articular cartilage besides water, which heralds
the onset of cartilage degradation.3,4
The treatment of FAI is a moving target currently under debate
and unresolved. Only rigorous scientific investigation in well-
designed biomechanical and clinical investigations can enhance
our knowledge and ultimately improve the treatment of FAI.
1. Anderson LA, Peters CL, Park BB, Stoddard GJ, Erickson JA, Crim JR.
Acetabular cartilage delamination in femoroacetabular impingement: risk
factors and magnetic resonance imaging diagnosis. J Bone Joint Surg Am.
Audenaert E, Van Houcke J, Maes B, Vanden Bossche L, Victor J, Pattyn
C. Range of motion in femoroacetabular impingement. Acta Orthop Belg.
Bashir A, Gray ML, Boutin RD, Burstein D. Glycosaminoglycan in articular
cartilage: in vivo assessment with delayed Gd(DTPA)(2-)-enhanced MR
imaging. Radiology. 1997;205:551-558.
Bashir A, Gray ML, Hartke J, Burstein D. Nondestructive imaging of human
cartilage glycosaminoglycan concentration by MRI. Magn Reson Med.
Beaule PE, Hynes K, Parker G, Kemp KA. Can the alpha angle assessment
of cam impingement predict acetabular cartilage delamination? Clin Orthop
Relat Res. 2012;470:3361-3367.
Table 2. Selected studies investigating arthroscopic treatment of labral pathology in FAI
No. Follow-upMain Outcomes
962.4 yHHS in the labral repair group
improved more than in the
labral resection group
No patient went on
effect of cartilage
lesions on HHS
Larson et al39
94 42 mo HHS, SF-12, and VAS all
improved in labral refixation
group versus labral
2 patients revision
HO, 2 revision
No difference in
reduction of alpha
81 3 y HHS and NAHS improved by 18
and 17 points postoperatively,
respectively; synovitis and
cartilage lesions had negative
effect on postoperative
3 patients THA No effect of labral
tear type on
75 19 moLabral refixation group with
improved HHS versus labral
HHS < 70,
(P > 0.05)
No difference in
SF-12 or VAS
2 y Merle d’Aubigne score better
at 1 and 2 years for labral
reattachment group versus
labral resection group
prevalent in labral
resection group at
1 and 2 years
FAI, femoroacetabular impingement; HHS, Harris Hip Score; HO, heterotopic ossification; NAHS, Non-arthritic Hip Score; NR, not reported; SF-12, Short
Form–12; THA, total hip arthroplasty; VAS, visual analog scale.
vol. 6 • no. 2SPORTS HEALTH
6. Bedi A, Dolan M, Hestroni I, et al. Surgical treatment of femoroacetabular
impingement improves hip kinematics: a computer-assisted model. Am J
Sports Med. 2011;39:43S-49S.
Bedi A, Galano G, Walsh C, Kelly BT. Capsular management during hip
arthroscopy: from femoroacetabular impingement to instability. Arthroscopy.
Bedi A, Kelly BT. Femoroacetabular impingement. J Bone Joint Surg Am.
Bedi A, Kelly NH, Baad M, et al. Dynamic contact mechanics of the medial
meniscus as a function of radial tear, repair, and partial meniscectomy.
J Bone Joint Surg Am. 2010;92:1398-1408.
Bedi A, Zaltz I, De La Torre K, Kelly BT. Radiographic comparison of
surgical hip dislocation and hip arthroscopy for treatment of cam deformity
in femoroacetabular impingement. Am J Sports Med. 2011;39:20S-28S.
Brockenbrough G. Many patients with FAI may benefit from hip arthroscopy.
Orthopedics Today. http://www.healio.com/orthopedics/arthritis/news/
Buchler L, Neumann M, Schwab JM, Iselin L, Tannast M, Beck M. Arthroscopic
versus open cam resection in the treatment of femoroacetabular impingement.
Byrd JW, Jones KS. Arthroscopic femoroplasty in the management of cam-
type femoroacetabular impingement. Clin Orthop Relat Res. 2009;467:
Byrd JW, Jones KS. Arthroscopic management of femoroacetabular
impingement in athletes. Am J Sports Med. 2011;39:7S-13S.
Byrd JW, Jones KS. Diagnostic accuracy of clinical assessment, magnetic
resonance imaging, magnetic resonance arthrography, and intra-articular
injection in hip arthroscopy patients. Am J Sports Med. 2004;32:1668-1674.
Byrd JW, Jones KS. Prospective analysis of hip arthroscopy with 10-year
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