Due to the increasing acceptance of the concept of femoroacetabular impingement (FAI) in sports medicine during the last decade, hip arthroscopy has evolved to a frequently performed standardized procedure and FAI to probably one of the main indications for hip arthroscopy (HAS). The diagnosis of FAI can be confirmed before arthroscopy; a painful and diminished internal rotation of
the hip and characteristic findings on X-rays and MR Imaging are key. Open surgical dislocation of the hip still must be considered the golden standard for treating this condition; nevertheless, arthroscopic techniques allowing treating Off-Set pathologies in-between the posterosuperior and inferomedial retinaculum, acetabular rim trimming and even repair of the labrum are well described.
Our own investigations using MR imaging after arthroscopy show that compared to open surgical dislocation the same quality of correction can be achieved within this sector. The advantages of the arthroscopic procedure are, in addition to the cosmetic aspect, the trochanteric osteotomy with consecutive eventual screw removal, which becomes unnecessary, shorter hospital stay and shorter rehabilitation time. The main limitations of HAS concern pathologies outside the sector in between the posterosuperior and anteroinferior retinaculum, which often are not well achievable, the consecutive risk of residual impingement, the very high technical skills necessary (for example for labral repair), and the potential of iatrogenic damage to cartilage. Therefore some morphological
constellations still are contraindications for HAS and treated by open surgical dislocation in our hands.