LAUSR

To the Editor: Arthroscopic treatment of femoroacetabular impingement (FAI) is becoming more popular as reports of improvements in hip-specific outcome scores (eg, modified Harris Hip Score, Non-Arthritic Hip Score) at 2 to 10 years are favorable, with low complication rates in several large adult series.1 However, similar reports on the use of arthroscopic treatment of FAI in adolescent and young adult patients are much less.2 For this reason, we read with great interest the article entitled “Hip arthroscopy successfully treats femoroacetabular impingement in adolescent athletes” by Litrenta et al.3 In their study, the authors addressed the favorable results for adolescent athletes with FAI who have undergone hip arthroscopic surgery. Although we agree with the conclusion similar to our previous studies observed in the clinic, there is one of the concerns worth exploring. The authors stated that patients aged 15.9 ± 1.2 years old (range: 13.1 to 18.0 y old) and underwent hip arthroscopy for FAI were included. Our concern is that whether skeletally immature FAI patients were included in their study. In fact, skeletally mature adolescent FAI patients could be treated the same way as an adult. However, it may not extrapolate to performing hip arthroscopy in younger pediatric patients with open physes.4 For fear of destroying the femoral head epiphyseal and physeal cartilage, we haven’t any clinical experience on femoral osteochondroplasty in skeletally immature FAI patients. Only 1 study showed that, although significant improvement in clinical outcomes can be anticipated after arthroscopic treatment of FAI in skeletally immature FAI patients, the initial hip arthroscopy and cam osteochondroplasty may increase mechanical stress on the unfused proximal femoral physis and stimulate bone formation, resulting in postoperative cam regrowth.5 Therefore, it is important to evaluate skeletal maturity carefully before operation and monitor cam or pincer lesion development after arthroscopic treatment of FAI in adolescents. We do think it is more clinically meaningful for the author to provide relevant data in this field. Again, much appreciation is extended to the authors for sharing with us their successful experience with hip arthroscopy for FAI among adolescent athletes. If possible, we hope the authors could provide more data to ease our concern.