ICL 305-1 Arthroscopic Management of Hip Labral Pathology and Impingement: 2014-Ayeni Handout

Ayeni Handout

Pdf Summary

This instructional course lecture by Dr. Olufemi Ayeni at AANA 2015 provides an evidence-based overview of systematic reviews in femoroacetabular impingement (FAI) surgery. Systematic reviews collect and summarize all available evidence on a research question using explicit, reproducible methods to minimize bias, often including meta-analyses for quantitative synthesis.<br /><br />FAI surgery has seen a dramatic rise—from an 18-fold increase in hip arthroscopy between 1999-2009 among board examinees to a projected doubling of procedures in the U.S. between 2008-2013—despite limited controlled studies. Patients often experience prolonged diagnostic delays (average 21 months) and consult multiple providers. Diagnosis accuracy shows variability; radiologists and orthopedic surgeons demonstrate low inter-rater reliability.<br /><br />Globally, FAI management is inconsistent. Clinical indications vary widely (e.g., positive impingement signs and symptom duration), and diagnostic imaging approaches are heterogeneous—ranging from X-rays to MRI and CT scans—with no consensus on standards. The quality of evidence supporting physical examination tests is low, though some common test batteries exist.<br /><br />Surgical outcomes indicate that restoring the alpha angle below 55° in cam-type FAI improves patient outcomes. Regarding labral tear management, six studies showed superior outcomes with repair versus debridement. Pediatric FAI surgery yields high satisfaction rates (84-100%) with low revision rates.<br /><br />Surgeons face a learning curve with operative time and complications decreasing after approximately 30 cases; however, definitive metrics are lacking. Reported complication rates vary. Outcome reporting across clinical, radiographic, gait, and biomarker domains is heterogeneous. Future directions emphasize developing composite scoring systems to standardize outcome measurement.<br /><br />In sum, FAI surgery evidence is expanding, but practice variability, diagnostic inconsistency, and outcome heterogeneity highlight the need for rigorous, standardized research and reporting frameworks to support clinical decision-making and patient care.

Keywords

Femoroacetabular impingement

FAI surgery

Systematic reviews

Hip arthroscopy

Diagnostic imaging

Alpha angle

Labral tear repair

Pediatric FAI outcomes

Surgical learning curve

Outcome measurement standardization