AANA25 Hip Access Pass-CONCURRENT SESSION 2A: Hip FAI, Innovations in 2025

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Video Summary

The session, moderated by Chris Larson, centered on femoroacetabular impingement (FAI), its challenging deformities, arthroscopic correction techniques, and capsular management. Larson recounted the early 2000s' formative days of hip arthroscopy and emphasized the evolution from limited exposure—dubbed by Professor Reinhold Ganz as a "peep show"—to now achieving approximately 300 degrees of femoral head-neck junction access with advanced fluoroscopy and dynamic intraoperative assessments. Key maneuvers such as flexion-abduction and anterior impingement tests guide precise corrections of femoral CAM deformities in multiple planes, though posterior deformities remain difficult to access arthroscopically.<br /><br />Adi Kahana presented data on staged bilateral hip arthroscopy in high-level athletes, demonstrating similarly favorable midterm outcomes and return-to-sport rates compared to unilateral procedures, with over 84% returning to sport and sustained five-year participation. Ligamentous laxity patients, discussed by Dr. Quesada, showed comparable long-term outcomes and return-to-sport rates as non-laxity controls, with the aid of capsular plication techniques enhancing joint stability.<br /><br />Ashish Bedi underscored preoperative imaging's importance, fluoroscopic guidance, and customized capsulotomies for managing large and complex CAM deformities to preserve native joint contour and suction seal. Dr. Westerman detailed acetabular rim deformity management—simpler anterior overcoverage corrections and more complex global or rim fractures—highlighting fixation strategies when resection risks dysplasia.<br /><br />Ben Dome emphasized the critical importance of preserving and repairing the capsule to prevent instability and optimize outcomes, advocating routine capsular closure or placation, especially in hypermobile or borderline dysplastic patients. Interactive case discussions revealed nuanced decision-making for rim fractures, highlighting partial resection, fixation techniques, and the primacy of femoral deformity correction to extend athletes' careers. The panel stressed meticulous capsular handling with retraction sutures or scope-assisted maneuvers, judicious use of traction, and understanding individualized anatomy for successful arthroscopic FAI management.

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Keywords

femoroacetabular impingement

hip arthroscopy

capsular management

CAM deformities

fluoroscopic guidance

capsular plication

ligamentous laxity

acetabular rim deformity

capsular closure

arthroscopic correction