دانلود رایگان مقاله آرتروسکوپی فمولار استئوکندروپلاستی برای گیرافتادگی فموراستابولار

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.

Discussion

Multiple authors have published techniques for femoral osteoplasty to correct cam-type FAI. Jackson et al.10 described a technique in which they start distally on the neck and progress proximally to resect the bony deformity with care to not over-resect proximally because this could negate the suction-seal effect of the labrum. Philippon et al.11 described the resection of 5 to 7 mm in depth and 8 to 12 mm in width from the 6- to 12-o’clock position on the femoral head with intermittent dynamic examination to evaluate for impingement, although they start inferiorly and progress superiorly. Similarly, Bedi et al.7 have described their technique for FAI surgery and detailed their use of a T-capsulotomy and osteoplasty with radiographic evaluation and dynamic arthroscopic examination. Byrd and Jones12 presented a proximal-to-distal technique with good functional outcomes at 2 years’ followup.