EP3.2 One Hip, Two Pathologies (case report): Arthroscopic Management of Early Osteonecrosis and CAM-Type Femoroacetabular Impingement with Bone Marrow Aspirate Concentrate

Abstract Introduction Femoral Head Osteonecrosis is a progressive condition resulting from compromised subchondral blood supply, potentially leading to femoral head collapse and early osteoarthritis. In young patients, joint-preserving strategies are essential, particularly when osteonecrosis coexists with mechanical abnormalities such as CAM-type femoroacetabular impingement (FAI) and labral tears. Addressing both biological and mechanical factors is critical to optimize outcomes. Case Presentation A 16-year-old male presented with a 6-month history of severe right hip pain (VAS 9/10) following a motorcycle-related trauma. Symptoms included pain at rest and during activity, functional limitation (Harris Hip Score: 58), and sleep disturbance. Physical examination revealed abnormal gait, tenderness, positive anterior apprehension, and a positive FADIR test, with limitation of hip range of motion, particularly in flexion and internal rotation. Plain radiographs demonstrated CAM-type morphology with an alpha angle of 82° and a lateral center-edge angle (LCEA) of 26°. MRI subsequently revealed a labral tear, synovitis, and early-stage osteonecrosis (ARCO I), without femoral head collapse. The patient underwent hip arthroscopy in the supine position using an outside-in approach. The procedure included labral repair with suture anchors, dynamic fluoroscopy-guided femoroplasty, and retrograde core decompression. Biological augmentation was performed using bone marrow aspirate concentrate (BMAC) combined with bone graft (chips and matrix). Results At 3-month follow-up, the patient reported complete pain resolution and significant functional improvement. Range of motion improved to flexion 100°, internal rotation 20°, and external rotation 35°. The Harris Hip Score improved from 58 preoperatively to 91, achieving an excellent functional outcome. Follow-up radiographs demonstrated no evidence of femoral head collapse, with findings consistent with adequate structural preservation. No complications were observed. The patient continues with a structured rehabilitation program. Conclusion This case highlights the importance of a comprehensive treatment strategy in young patients with early Femoral Head Osteonecrosis associated with CAM-type FAI. Addressing both structural impingement and biological compromise through combined arthroscopic techniques and BMAC augmentation may help preserve the native joint and delay disease progression. Furthermore, BMAC has demonstrated high success rates in early-stage osteonecrosis, supporting its role as a valuable adjunct in joint-preserving procedures.