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• W4226081923 abstract "We read with great interest the publication by Schallmo et al., [1] ‘Clinical presentation, imaging findings and arthroscopic features in skeletally immature and mature adolescent hip patients: a comparative double-cohort retrospective study’. The authors assessed the differences in clinical presentation and extent of surgery required based on skeletal maturity between two cohorts of the adolescent at the time of arthroscopic femoroacetabular impingement correction. The authors concluded that skeletal immaturity in hips would be associated with a lower frequency of pincer impingement and a decreased need for surgical acetabuloplasty. Generally speaking, this study is very important and interesting. However, some aspects still need to be further improved. All patients underwent plain-film radiographic and MRI scans without computed tomography (CT) scans. Actually, three-dimension CT (3D-CT) scans of the pelvis (and distal femur for assessment of femoral version) as part of clinical assessment and preoperative surgical planning could be used to fully define the location and size of femoral and acetabular deformity. The alpha angle could also be measured circumferentially around the femoral head-neck according to the clock-face methods [2]. A comprehensive preoperative evaluation is helpful for the surgeon to thoroughly deal with the bone deformity during the operation. Furthermore, it is also meaningful to evaluate the classification of the anterior inferior iliac spine (AIIS) between two cohorts of adolescent patients. Recently, AIIS deformity as an extra-articular source for femoroacetabular impingement (FAI) is concerned increasingly [3]. We note that the shortcomings of the Risser grading system were discussed by the authors. We agree with the authors that the Risser stage should be used in conjunction with other tools such as skeletal age, chronologic age and time since menarche in females to gauge skeletal maturity, particularly growth potential [4]. Regarding growth and development of the proximal femur, we know that the closure of the physes is initiated at ages 16–18 years, with 88% fusion at age 17–18 years and 100% fusion at age 20 years [5]. In clinic, concerns should be raised that performing femoral osteoplasty for the treatment of a symptomatic cam lesion in the skeletally immature (with open proximal femoral growth plate) patient would result in an additional damage to the physis, growth disturbance after hip arthroscopy. Therefore, the status of the physis (i.e. open vs. closed) should be determined in MRI images and during arthroscopic surgery. Carter et al., [5] found that patients with closed growth plates had a larger distance between the cam lesion and the physeal scar than those with open growth plates. We suggest that the author conduct such research and comparison between two cohorts of adolescent patients. Obtained the date of the distance between the cam lesion and the growth plate will help us further understand an etiological link between the two. Finally, it is interesting to find that there was a preponderance of females included in this study (80.5% in skeletally immature group and 63.3% in skeletally mature group) [1], although the typical individual affected by cam-type FAI is a young male. Again, this suggests that this study population may not have entirely represented the overall patient population of adolescent patients with FAI We respect the great contributions of the authors and would also be very much interested in the authors’ response to these issues. Acknowledgements This study is support by Shenzhen Second People’s Hospital Clinical Research Project (20193357019). Conflicts of interest There are no conflicts of interest." @default.
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• W4226081923 date "2021-11-23" @default.
• W4226081923 modified "2023-09-25" @default.
• W4226081923 title "Letter regarding ‘Clinical presentation, imaging findings and arthroscopic features in skeletally immature and mature adolescent hip patients: a comparative double-cohort retrospective study’" @default.
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• W4226081923 doi "https://doi.org/10.1097/bpb.0000000000000922" @default.
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