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To Trim or Not to Trim: Revisiting Acetabuloplasty During Hip Arthroscopy for Femoroacetabular Impingement and
Jacob D Mikula1, Rakan R Alshaibi1, John J Kelly1
1Department of Orthopaedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
Purpose Of Review:
Acetabuloplasty is a common component of hip arthroscopy for pincer-type and mixed femoroacetabular impingement (FAI), yet the optimal degree of correction remains controversial. Historically, rim trimming has often been guided by radiographic normalization, particularly of the lateral center-edge angle (LCEA). The purpose of this review is to synthesize current evidence regarding acetabular morphology, radiographic assessment, clinical outcomes related to the degree of acetabular correction, and intraoperative strategies that support optimal correction during acetabuloplasty.
Recent Findings:
Recent literature suggests that acetabular overcoverage should not be viewed as a uniform indication for [aggressive] rim resection. Although the LCEA remains a useful measure of acetabular coverage, it incompletely captures focal versus global overcoverage, acetabular version, and dynamic impingement. Mid-term studies have demonstrated favorable outcomes after hip arthroscopy for pincer morphology, with no consistent relationship between postoperative LCEA normalization and patient-reported outcomes. In addition, patients with residual postoperative overcoverage may achieve outcomes comparable to those with normalized coverage and may actually demonstrate lower rates of conversion to arthroplasty. At the same time, excessive rim resection risks iatrogenic undercoverage, instability, edge loading, and accelerated degeneration. Current evidence supports a patient specific rather than radiographically uniform approach to acetabuloplasty. Successful treatment appears to depend on restoring functional femoroacetabular clearance while preserving sufficient acetabular coverage for joint stability and load distribution. Incremental resection, dynamic intraoperative reassessment, labral preservation, and balanced correction of acetabular- and femoral-sided pathology are central to this strategy. Future studies should emphasize three-dimensional assessment, standardized reporting, and longer-term evaluation of joint preservation.