Revista de Medicina Desportiva (English) September 2018 - Page 31

Sociedade Portuguesa de Artroscopia e Traumatologia Desportiva Rev. Medicina Desportiva informa, 2018; 9(5):29–31. Slipped Capital Femoral Epiphysiolysis and Concomitant Symptomatic Femoroacetabular Impingement in a Young Footballer demand, as is the case of competi- tive sport. 7 The authors had found out that even on the slight SCFE the residual deformity leads to signifi- cant injuries of the cartilage and of acetabular labrum in 75-100% of cases, they can be found after one year 3 , and they recommend early femoral neck osteoplasty in order to reduce the risk of secondary osteo- arthritis. 5 Dr. André Miguel Costa 1 , Dr. Eurico Bandeira Rodrigues 2 1 Resident; 2 Specialist. Orthopedics and traumatology. Braga Hospital. Portugal Methods ABSTRACT Slipped capital femoral epiphysis is a known cause of cam-type femoro-acetabular impingement, which may lead to early hip osteoarthrosis. We present a case of a slipped capital femoral epiphysis in a young football player with a chronic clinical presentation who later developed femoro-acetabular impingement symptoms. In the same surgical approach was submitted to in situ percutaneous fixa- tion and arthroscopic osteoplasty of the femoral neck. Six weeks later he gradually returned to high level competition and, after two years of follow-up, continues free of symptoms in football practice. KEYWORDS Slipped capital femoral epiphysis, femoroacetabular impingement, sports Introduction Slipped capital femoral epiphysis (SCFE) is one of the most frequents pathologies of the young hip, where there is a posteromedial slip of the femoral head through the physis. 1 In situ fixation is the standard treat- ment of SCFE, promoting the physis closure, preventing a greater slip 2 and the worsening of anterolateral prominence of the femoral meta- physis. 3 The natural history of the dis- ease is controversial. 1 Babu and al described some remodeling potential of the deformity as an explanation for the good results ten to twenty years after isolated in situ fixation in most less active patients. 4 However, It is described the case of a 14-year- old male elite football player with chronic SCFE and secondary FAI. He was referred because of an insidious pain in the left hip lasting for three months and also referring similar complaints one year before. At clinical examination he had a limping gait, preferential external rotation of the hip with passive flexion, decreased internal rotation and a positive impingement test. An x-ray was performed, and it revealed an open proximal femoral physis and a left SCFE, with a slight angle of Southwick of 26° (Figures 1 and 2). The MRI showed a cam type FAI the SCFE creates a secondary cam type femoroacetabular impinge- ment (FAI), where there is a contact between the deformity of femoral neck joint and the acetabular rim. 5,6 The untreated FAI leads to early articular dam- age and osteoar- thritis. Usually, the symptoms start in adult- hood, but they have been more recognized in the paediatric population and may be precipi- tated by exces- sive physical Figure 1 – Anteroposterior X-ray of the pelvis: SCFE on the left Revista de Medicina Desportiva informa september 2018 · 29