Hip arthroscopy in the adolescent and pediatric athlete

The current literature offers only sparse reports of the use of hip arthroscopy in the pediatric patient injured during athletics. In contrast, the role of this technique in the diagnosis and treatment of multiple childhood hip conditions including pyarthrosis, Legg-Calvé-Perthes disease, slipped capital femoral epiphysis, coxa vara, juvenile chronic arthritis, chondrolysis, and avascular necrosis is well described. The application of this relatively uncommon technique to the young athlete has only recently become more attractive. The ability to examine and treat traumatic intra-articular pathology with minimal morbidity and prompt recovery is mandated by the young age of these patients and their demanding activity levels. Hip arthroscopists are now beginning to correlate preoperative physical exam findings and history with diagnosis and expectations for outcome. As our combined experience with this technique grows, the specific indications for its use in the young athlete become increasingly better defined. In pediatric and adolescent patients, the new onset of hip pain should warrant a high level of suspicion for the more common causes of pain such as infection, Legg-Calvé-Perthes disease, slipped capital femoral epiphysis, or developmental dysplasia. When these have been evaluated, further differential diagnosis should include labral tears, loose bodies, synovitis, and chondral lesions. As this review begins to elucidate, these conditions are amenable to arthroscopic evaluation and treatment. At this time, the presence of reproducible mechanical symptoms after a twisting or axial loading injury during athletics should prompt the orthopaedic surgeon to consider arthroscopic examination of the hip if conservative therapy fails. Satisfying and reproducible results have been achieved when using hip arthroscopy within these parameters.