Editorial Commentary: Over-resection, or Under-Resection, of the Femoral Cam Lesion in Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement Syndrome Indicates Different Possible Solutions.

Abstract

As surgeons, we strive to recognize and correct any mistakes that may occur before completing an operation and, importantly, do our best to avoid irreversible mistakes. Over-resection of the femoral cam lesion in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome has been considered irreversible. Although cam under-resection is a technical complication of femoroacetabular impingement surgery to be avoided, avoiding it at the expense of over-resection of the proximal femur is of great concern. Despite the quest to avoid leaving the operating room before the ideal surgical plan has been executed and errors corrected, we must anticipate a certain rate of both over- and under-resection of the cam deformity in the postsurgical patient population. The solution for under-resection is straightforward: additional resection. The same cannot be said for over-resection. Over-resection can result in femoral neck fracture or loss of the hip suction seal. A potential solution is placing a soft-tissue allograft in the over-resection defect (remplissage of the femoral resection lesion). This may address the suction seal for too proximal a resection. In contrast, for too deep a resection in the femoral neck, when fracture is a risk, internal fixation and/or bone grafting may be considered.