CORR Insights®: Acetabular Version Increases During Adolescence Secondary to Reduced Anterior Femoral Head Coverage.

Abstract

Orthopaedic surgeons have a working knowledge of the association between cam deformity and increased activity during adolescence [6, 16]. But we are less familiar with development of the acetabulum during the adolescent period and the potential relationship between changes in acetabular orientation and a pincer femoroacetabular impingement (FAI) morphology. And while more research has been done in the last 5 years [7, 10], there is limited evidence on the arthroscopic treatment of FAI in patients who are skeletally immature. For example, we know that the incidence of cam-type deformity may be related to early sports activities [6]; however, less is known about the acetabular side. To my knowledge, there have been no important new studies on pincer morphology and its association with symptomatic FAI. In the current study, Grammatopoulos and colleagues [3] use MRI to investigate changes to acetabular version during adolescence and identify demographic factors associated with acetabular development in a cohort of 17 asymptomatic adolescent patients (34 hips). They found that: (1) Acetabular version increased during adolescence, and (2) the acetabular femoral coverage decreased anteriorly, which correlated with acetabular version change. The authors could not conclude, however, whether demographic variables were associated with their findings. Still, the results of this study indicate that acetabular version increases, particularly rostrally, with skeletal maturity. Acetabular version has major implications regarding the decisionmaking process for potential hip preservation surgery [14]. When treating acetabular retroversion, there are several options: reverse (anteverting) periacetabular osteotomy (PAO), open surgical dislocation, and hip arthroscopy. The degree of retroversion, the amount of posterior wall insufficiency, and the presence of any degree of dysplasia all are important when selecting surgical treatment. Global acetabular retroversion is characterized by an anterolateral acetabular over-coverage that can coexist with dysplasia and lead to impingement [17]. Acetabular retroversion can lead to symptomatic and painful FAI [15]. Historically, reverse (also known as anteverting) PAO has been the gold standard for surgical treatment for the retroverted acetabulum, and has shown good results during shortand mid-term follow-up [12]. And although this procedure has shown good results in patients with and without dysplasia, an arthroscopic approach involving anterior rim trimming, cam deformity correction, labral anatomy, and function restoration and capsular plication has been proposed as an alternative to achieve favorable results in patients with acetabular retroversion and without severe dysplasia [4]. Arthroscopic management could potentially decrease morbidity as well as improve treatments of intra-articular pathology [11, 13]. However, posterior wall deficiency This CORR Insights is a commentary on the article “Acetabular Version Increases During Adolescence Secondary to Reduced Anterior Femoral Head Coverage” by Grammatopoulos and colleagues available at: DOI: 10. 1097/CORR.0000000000000900. The author certifies that neither he, nor any members of his immediate family, have any commercial associations (such as consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. The opinions expressed are those of the writer, and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons. David R. Maldonado MD (✉), American Hip Institute , 999 E Touhy Ave Ste 450, Des Plaines, IL 60018, USA, Email: david. maldonado@americanhipinstitute.org