This approach described by Clohisy et al., Laude et al., and others has been used for patients with cam impingement. After hip arthroscopy for intraarticular or central compartment labral débridement or repair, the anterior aspect of the hip is approached through a limited Smith-Petersen approach or Hueter approach (through the sheath of the tensor fascia lata). The osteochondroplasty of the femoral head-neck junction is performed under direct vision. With traction, the anterior rim of the acetabulum can be resected with reflection of the labrum and reattachment with suture anchors, although the extent of rim exposure and resection is limited. The advantage of this approach is primarily avoiding the morbidity of surgical dislocation with a larger exposure including trochanteric osteotomy. This approach allows direct vision of the cam deformity on the femoral head–neck junction, which can be difficult to visualize and resect arthroscopically. The limitation of this approach is that only the anterior aspect of the femoral head and neck and acetabular rim can be accessed. The lateral femoral cutaneous nerve may be injured in this approach as well. Placing the incision several centimeters lateral to the anterosuperior iliac spine and approaching the anterior hip through the fascial sheath of the tensor fascia lata may lessen the risk of injury to the nerve.
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With the patient supine, perform a standard arthroscopic examination of the hip for inspection of the articular cartilage of the femoral head, acetabulum, and acetabular labrum. Débride any unstable flaps of acetabular labrum and associated articular cartilage flaps.
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After arthroscopic débridement is completed, irrigate the joint, remove the arthroscopic instruments, and release the traction.
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Obtain a cross-table lateral or frog-leg lateral fluoroscopy view to ensure excellent visualization of the proximal femur, specifically the femoral head–neck junction ( Figure 7-1 ).
Figure 7-1
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Make a 6- to 10-cm incision, starting just inferior to the anterosuperior iliac spine and incorporating the anterior arthroscopy portal incision ( Figure 7-2 ).
