title: Surgical indications for arthroscopic management of femoroacetabular impingement.
abstract: OBJECTIVE
  The clinical literature was systematically reviewed to determine the consistently reported indications for arthroscopic management of femoroacetabular impingement (FAI).
  
  
  METHODS
  Two databases (Medline and EMBASE) were screened for clinical studies involving the arthroscopic surgical management of FAI. A full-text review of eligible studies was conducted, and the references were searched. Articles published from 1980 until June 2011 were included, and the inclusion criteria were as follows: studies of human patients of all ages and genders with FAI, studies with a minimum of 6 months of patient follow-up, and studies reporting clinical outcome data. A quality assessment of the included articles was conducted.
  
  
  RESULTS
  We included 20 articles in this review, involving a total of 1,368 patients. We identified a lack of consensus on clinical and radiographic indications for the arthroscopic management of FAI. The indications varied from a positive impingement sign (45%) and symptoms or pain for more than 6 months (35%) to a series of positive special tests (25%). Commonly reported radiographic indicators for arthroscopic FAI management included the following: results from a computed tomography scan or magnetic resonance imaging (60%), cam or pincer lesions evident on anteroposterior and/or lateral radiographs (50%), loss of sphericity of the femoral neck (30%), acetabular retroversion (30%), magnetic resonance arthrography (25%), reduction in head-neck offset (25%), an alpha angle greater than 50° (25%), and coxa profunda (25%).
  
  
  CONCLUSIONS
  We found that there was great inconsistency among the indications for arthroscopic management of FAI. Clinical and radiographic indices remain largely unvalidated. This review highlights the need for more consistent reporting of surgical indications for the arthroscopic management of FAI. Future research should explore what combination of clinical and radiographic indications should be best used to determine arthroscopic FAI management.
  
  
  METHODS
  Level IV, systematic review of Level II to IV studies.
authors.affiliation: Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1200 Main St W, Hamilton, Ontario, Canada. ayenif@mcmaster.ca
authors.forename: Olufemi R
authors.initials: OR
authors.lastname: Ayeni
authors.forename: Ivan
authors.initials: I
authors.lastname: Wong
authors.forename: Teresa
authors.initials: T
authors.lastname: Chien
authors.forename: Volker
authors.initials: V
authors.lastname: Musahl
authors.forename: Bryan T
authors.initials: BT
authors.lastname: Kelly
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
mesh_terms: D001182:Arthroscopy; D057925:Femoracetabular Impingement / Q000601:surgery*; D006801:Humans