Arthroscopic Femoral Osteochondroplasty for Cam-type Femoroacetabular Impingement: Cortical–Cancellous Sclerotic Boundary Guides Resection Depth

Hip arthroscopy and femoral osteochondroplasty are commonly used in the treatment of femoroacetabular impingement (FAI). Determining the correct resection depth of the femoral head–neck cam lesion intraoperatively can be challenging. Both inadequate resection and over-resection may result in complications, underlying the importance of using a consistent and accurate technique when resecting and reshaping the proximal femur. Osseous resection to a depth of the subchondral cortical–cancellous bone margin in individuals with FAI has been shown to restore proximal femoral anatomy to within submillimeter differences when compared with control subjects without FAI. This bony boundary may be used as an intraoperative guide to consistently achieve appropriate resection depth. The sclerotic margin indicating the extent of the cam-type deformity can be evaluated with preoperative radiographs and recreated fluoroscopically, giving the surgeon a reliable intraoperative template. In addition, changes in clinical appearance during arthroscopy, particularly identification of the underlying trabecular structure at the cortical–cancellous border during resection, provides a visible, reliable intraoperative guide to resection depth.