In situ pinning with arthroscopic osteoplasty for mild SCFE: A preliminary technical report.
BACKGROUND
There is emerging evidence that even mild slipped capital femoral epiphysis leads to early articular damage. Therefore, we have begun treating patients with mild slips and signs of impingement with in situ pinning and immediate arthroscopic osteoplasty. DESCRIPTION OF TECHNIQUES: Surgery was performed using the fracture table. After in situ pinning and diagnostic arthroscopy, peripheral compartment access was obtained and head-neck osteoplasty was completed.


METHODS
Between March 2008 and August 2009, three male patients (age range, 11-15 years; BMI, 22-31 kg/m(2)) presented with slip angles between 15º and 30º. All were ambulatory without assistance but had 2 to 12 weeks of hip and/or knee pain, limited motion and a positive impingement test. Postoperatively, patients were assessed at 6 weeks; 3 and 6 months; then every 6 months for the first two years. Hip motion, epiphyseal-metaphyseal offsets and alpha angles were determined. Patients completed the UCLA activity scale at latest followup that ranged from 6 to 23 months.


RESULTS
Arthroscopic evaluation revealed labral fraying, acetabular chondromalacia, and a prominent metaphyseal ridge. At last followup, each was pain-free and had returned to unrestricted activities. Hip motion improved in all and none demonstrated clinical impingement. Radiographs showed normalized epiphyseal-metaphyseal offsets and alpha angles.


CONCLUSIONS
In situ pinning with arthroscopic osteoplasty can limit impingement after mild slipped capital femoral epiphysis. Due to limited followup, we are unable to say whether this protocol reduces subsequent articular damage. Although we recommend performing these procedures concomitantly, they can be performed in a staged fashion, especially since hip arthroscopy following an epiphyseal slip can be challenging.
Leunig
Michael
M
Department of Orthopedics, Schulthess Clinic, Zürich, Switzerland.
Horowitz
Kevin
K
Manner
Hannes
H
Ganz
Reinhold
R
D000293:Adolescent; D001182:Arthroscopy / Q000295:instrumentation*; D002648:Child; D004839:Epiphyses, Slipped / Q000150:complications / Q000601:surgery*; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D009984:Orthopedic Fixation Devices; D010146:Pain / Q000209:etiology / Q000601:surgery; D010147:Pain Measurement; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D016474:Weight-Bearing