EP9.9 Redefining the Standard of Care for Femoral Neck Stress Fractures in High-Performance Sport patients - The HAM Technique

Abstract Introduction Femoral neck stress fractures (FNSF) in high-performance athletes are high-risk injuries and more often nowadays. Their presentation is insidious, and delayed management can lead to displacement, avascular necrosis, hip labral tears and cartilage tears. The HAM technique (arthroscopic-fluoroscopic assisted fixation + drainage of the hematoma) simultaneously addresses bone instability and frequently overlooked intra-articular injuries, including labral tears and chondral damage. Methods Under general anesthesia and fine hip distraction, hip arthroscopy is performed in the modified supine position. An inverted T-shaped capsulotomy with a 50° radiofrequency wand allows hematoma drainage and decompression and intracapsular pressure reduction. Two percutaneous guidewires are placed from the posterolateral femoral cortex toward the femoral head center, this followed by two 7.3 mm fully threaded titanium screws with washers under fluoroscopic AP and axial view and arthroscopic control. In the central compartment (70° scope), the chondrolabral injury is identified and repaired using knotless 2.8 mm anchors and a 1.8 mm all-suture anchors. Bone marrow aspirate concentrate (BMAC) is harvested from the ASIS and applied over the repaired labrum using an 8 Fr neonatal feeding tube. Outcomes Stable fixation enables bone healing within 12–16 weeks, while labral repair restores the acetabular suction seal, improving hip biomechanics. BMAC application enhances labral and bone interface healing. In the described series, athletes regained full range of motion (flexion, abduction, rotations), absence of pain at rest and during activity, and 5/5 muscle strength (flexors, extensors, abductors) per the Medical Research Council scale. No neurological deficits or infections were reported. Full activity resumption occurs by 16 weeks. Discussion Unlike isolated percutaneous fixation, the HAM technique addresses associated intraarticular pathology present in up to 50% of FNSF cases. Arthroscopy reduces intracapsular pressure, prevents displacement, and optimizes screw placement. The use of BMAC and suture anchors makes it reproducible even in resource-limited settings. Postoperative rehabilitation must correct abductor weakness and gait abnormalities (contralateral pelvic drop, medial knee displacement) to prevent recurrence. Conclusion The HAM technique is a comprehensive, innovative, and reproducible strategy for managing high-risk FNSF in athletes. By combining stable fixation, chondrolabral repair, and regenerative biology, it optimizes hip preservation and facilitates a safe return to sport. Prospective comparative studies are warranted. Clinical relevance This case highlights the multimodal approach of our group, the role of hip arthroscopy, percutaneous screw fixation, chondrolabral repair, BMAC placement at the fracture site, plus a systematic medical and rehabilitation management to achieve good-to-excellent results in a high-performance athlete presenting a high-risk femoral neck stress fracture with associated chondrolabral injury.