Revista de Medicina Desportiva (English) September 2018 | Page 32

with an α angle of 85°, without any
apparent associated injuries of the
cartilage or labrum (Figures 3 and 4).
During the same procedure, were
performed a percutaneous in situ
fixation a with cannulated screw
and a hip arthroscopy that showed
the anterolateral deformity of the
femoral neck, slight synovitis and
the absence of cartilage and labrum
injuries. The osteoplasty of the
femoral neck was performed.
He started an early physical
rehabilitation, with partial load of
the operated limb for two weeks and
then he progressed to total load.
Results
After six weeks he denied any pain,
he had a normal gait and a full
range of motion, with the internal
rotation similar to the one on the
contralateral side, the impingement
test was negative, and he could
return to sports without any limita-
tions. Currently, two years after the
surgical treatment, he is still asymp-
tomatic, and he doesn’t have any
clinical signs of femoroacetabular
impigement. Recent x-rays do not
show any injury (Figures 5 and 6). He
still plays at high level.
Discussion
SCFE is a devastating pathology for
the pediatric population, affecting 11
in every 100,000 children. It can lead
to a deformity of the femoral neck,
condrolysis and avascular necrosis
of the femoral head. 8
In situ fixation, by definition,
fixes the femoral neck on a posi-
tion of deformity. Although the
anteromedial prominence of the
neck caused by the slip of the
proximal femoral physis may have
some remodeling capacity, this is
not expected to occur after physeal
closure with fixation. 1 In situ isolated
fixation seems to have reasonable
results for the treatment of SCFE,
although the majority of patients do
not have high physical demand.
The observations during surgery
for treatment of deformity after
SCFE confirm the high incidence of
injuries of labrum and acetabular
cartilage. 8,9 On 176 hips subjected
to in situ fixation, 33% had pain and
12% needed surgical revision after
an average follow-up of 16-years. 9
After 30-40 years, the incidence of
osteoarthritis on the slight SCFE is
15-25%. 10 The severity of the injuries
seems to increase with the duration
of the symptoms and on the larger
sliding angles. 9 The absence of pain
does not exclude the presence of
joint damage. 8 It is demonstrated
that all degrees of SCFE lead to some
functional loss, with early signifi-
cant joint damage even after a slight
SCFE 8,9,11 , that can be justified with
the limited capacity of reshaping the
deformity. 3
There is evidence that FAI result-
ing from SCFE decreases the athletic
performance 6 and the level of activ-
ity seems to influence the severity
of the joint damage. 9 It is expected
on young athlete, practicing a very
competitive and demanding sport,
where there is full of range move-
ments of flexion and abduction, the
progressive and irreversible evolu-
tion to labral and cartilaginous
injury.
Since the deformity after slippage
is associated with bad results on the
long term, the surgical treatment
is recommended on the sympto-
matic patients with α angle >60°. 6
So, on this athlete with FAI, with
complaints associated with an acute
exacerbation of a chronic SCFE, it
was decided to perform the osteo-
plasty of the femoral neck and a
simultaneous in situ fixation, a tech-
nique already described and with
good clinical and imaging results
on the short term follow-up. 11-13
The arthroscopic osteoplasty is a
technique with little morbidity and
useful for the treatment of deform-
ity after SCFE. 8
The labrum and the cartilage
injuries decrease the likelihood of
success of the treatment of FAI. 6
Since there wasn’t articular injuries,
we believe the correction of the early
deformity was the best method for
treatment of this condition, improv-
ing pain and mobility, and avoiding
sequels and secondary injuries in
the future. It also contributed for the
maintenance of the sports activity at
a high competitive level.
Conclusion
The mild or moderate SCFE, symp-
tomatic or not, causes osteoarthritis
of the hip and can lead to the early
need for arthroplasty on this popu-
lation. The treatment is surgical, and
it reduces pain, improves the func-
tion and decrease the progression to
osteoarthritis. It should include the
prevention of a larger deformity by
in situ fixation and the correction of
the existing deformity, in order to
prevent irreversible joint damage.
The early arthroscopic osteoplasty
seems to be a safe option, although
is still missing studies to confirm the
long-term results.
Bibliography
Figure 2 – X-ray (profile) of the left hip:
prominent anterior metaphysis.
30 september 2018 www.revdesportiva.pt
Figure 3 – MRI (coronal view) of the hip: posteromedial devia-
tion of the left femoral head.
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