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. 1. Chen, A., Youderian, A., Watkins, S., Gouri- neni, P. Arthroscopic femoral neck osteo- plasty in slipped capi- tal femoral epiphysis. J Arthrosc Rel Surg 2014; 30(10):1229- 1234. 2. Tscholl, P. H., Zingg, P. O., Dora, C., Frey, E., Dierauer, S., Ramseier, L. E.. Arthroscopic osteochondroplasty