Future Directions of FAI Surgery: Diagnosis and Treatment

Fig. 19.1

(a) Sagittal T1 fat-saturated MRI image of acetabular cartilage lesion. (b–d) Cartilage lesion after debridement and subsequent particulated juvenile cartilage repair technique. Acetabular labrum indicated with black arrows

Table 19.1

Current and developing diagnostic and treatment techniques for the treatment of femoroacetabular impingement pathology

Diagnostic imaging	Injections	Labrum tears	Cartilage injuries
3D CT	Corticosteroid	Debridement	Debridement
Dynamic computer models	Viscosupplementation	Labral repair	Microfracture
Dynamic ultrasound	Platelet-rich plasma	Labral reconstruction	ACI/MACI
Dynamic MRI	Autologous conditioned plasma		Osteochondral autograft
MRI with cartilage sequences			Osteochondral allograft
Computer navigation			Particulated juvenile cartilage
Robotic-assisted surgery			Micronized allograft cartilage matrix

19.9 Biomarkers of FAI

Circulating biomarkers have been investigated as a noninvasive tool to examine the health of articular cartilage. Several studies have been performed and shown that there are several different compounds that may be used as markers of cartilage and bone health, as well as show evidence of breakdown [80, 81]. As the basic science literature becomes more refined, we will be able to identify the most useful of these markers as it pertains to the hip joint. With this knowledge, these chemical tests could be used to screen and evaluate patients and stratify their risk for developing arthritic hip disease, allowing the targeting of patients who would benefit most from surgical interventions. One of the more innovative uses of new technology is the development of bioprinters. This technology aims to utilize thermoplastic fibers and cell-laden hydrogels to create tissue constructs. These techniques have been developing rapidly, and it is possible to create tissue with specific mechanical properties in order to mimic native structures containing different cell types and bioactive factors [82]. Newer developments have allowed the creation of multiple-layer skin-like soft tissue models including human fibroblasts and keratinocytes in a standardized and reproducible fashion [83]. In the future, this type of technology may allow for the creation of grafts for the repair of articular cartilage lesions and soft tissue injuries such as labral tears that are custom-made for individual patients, enhancing the ability to treat FAI injuries of the hip:

Take-Home Points

1.

Diagnostic imaging techniques, particularly MRI, are becoming more effective for FAI diagnosis and the evaluation of cartilage lesions.
2.

Three-dimensional imaging techniques will continue to grow and enhance the ability to accurately diagnose and treat FAI pathology, including the development of navigation systems.
3.

The treatment of the hip capsule is rapidly evolving, and evidence is beginning to emerge for the biomechanical and clinical benefits of capsular repair and plication.
4.

Labral tears are treated commonly during FAI surgery, and as the treatment methods have evolved from simple debridement to include base refixation and reconstruction, clear indications will emerge and new techniques will develop.
5.

Cartilage repair and reconstruction techniques are growing in use in the hip, to include autograft, allograft, and newer cartilage matrix products to augment traditional microfracture procedures.

Key Evidence Related Sources

1.

Reiman MP, Goode AP, Cook CE, Hölmich P, Thorborg K. Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis. Br J Sports Med. 2015;49(12):811.
2.

Harris-Hayes M, Commean PK, Patterson JD, Clohisy JC, Hillen TJ. Bony abnormalities of the hip joint: a new comprehensive, reliable and radiation-free measurement method using magnetic resonance imaging. J Hip Preserv Surg. 2014;1(2):62–70.
3.

Milone MT, Bedi A, Poultsides L, Magennis E, Byrd JW, Larson CM, Kelly BT. Novel CT-based three-dimensional software improves the characterization of cam morphology. Clin Orthop Relat Res. 2013;471(8):2484–91.
4.

Lazik A, Körsmeier K, Claßen T, Jäger M, Kamminga M, Kraff O, Lauenstein TC, Theysohn JM, Landgraeber S. 3 Tesla high-resolution and delayed gadolinium enhanced MR imaging of cartilage (dGEMRIC) after autologous chondrocyte transplantation in the hip. J Magn Reson Imaging. 2015;42(3):624–33.
5.

Tannenbaum EP, Ross JR, Bedi A. Pros, cons, and future possibilities for use of computer navigation in hip arthroscopy. Sports Med Arthrosc. 2014;22(4):e33–41.
6.

Domb BG, Stake CE, Lindner D, El-Bitar Y, Jackson TJ. Arthroscopic capsular plication and labral preservation in borderline hip dysplasia: two-year clinical outcomes of a surgical approach to a challenging problem. Am J Sports Med. 2013;41(11):2591–8.
7.

Bedi A, Lynch EB, Sibilsky Enselman ER, Davis ME, Dewolf PD, Makki TA, Kelly BT, Larson CM, Henning PT, Mendias CL. Elevation in circulating biomarkers of cartilage damage and inflammation in athletes with femoroacetabular impingement. Am J Sports Med. 2013;41(11):2585–90.

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