Acetabular Debridement Demonstrates Similar Outcomes and Survival to Microfracture in Hip Arthroscopy: A Multi-Center Analysis

Abstract

Objectives:Hip arthroscopy is becoming more advanced and commonly performed. However, significant controversy exists regarding whether high grade acetabular cartilage lesions should be treated with debridement or microfracture. In addition, patients treated with microfracture are subject to extended partial weight-bearing rehabilitation in order to mitigate risk of subchondral plate fracture and protect fibrocartilage tissue formation. The purpose of this study was to determine the mid-term patient-reported outcomes and failure rate and patient-reported outcomes of Grade 3 and 4 acetabulum labrum articular disruption (ALAD) lesions managed with microfracture or debridement.Methods:Primary arthroscopic labral repair cases at two centers from November 2008 to April 2016 were reviewed in patients aged < 55 years with unipolar ALAD Grade 3 and 4 pathology. Patients undergoing microfracture and debridement were compared using visual analog pain scale (VAS), modified Harris Hip Score (mHHS), and Hip Outcome Score - Sports Specific Subscale (HOS-SSS) to determine predictors of outcomes and failure.Results:127 hips in 123 patients (47 M, 76 F, mean age 34.7 ± 11.1) undergoing debridement (n = 95) or microfracture (n = 32) were followed for a mean of 4.9 years (range 2.0 - 8.5). Patients undergoing debridement achieved 3.5 point mean improvements in VAS (p < 0.01), 20.9 point improvements in mHHS (p < 0.01), and 25.5 point improvements in HOS-SSS (p < 0.01), which was statistically similar to that observed in microfracture patients (p ≥ 0.19). Five-year survival free of revision surgery was 83.0% in the debridement group and 85.6% in the microfracture group (p = 0.85). Cartilage treatment technique was found not to be predictive of revision risk during both univariate (p = 0.84) and multivariate (p = 0.84) analysis.Conclusion:Patients undergoing debridement of high grade unipolar acetabular cartilage lesions demonstrate similar patient reported outcome scores and revision rates compared to patients undergoing microfracture. These outcomes support debridement of acetabular lesions in order to optimize recovery while maintaining established positive outcomes following hip arthroscopy.Table 1.Univariate analysis of risk factors for revision surgeryVariableHR (95% CI) P-value Treatment DebridementReference Microfracture0.91 (0.34-2.41)0.84Age ≤35 yearsReference >35 years1.14 (0.49-2.67)0.76BMI ≤30Reference >301.3 (0.48-3.48)0.61Gender FemaleReference Male0.88 (0.37-2.10)0.77ALAD Grade Grade 3Reference Grade 40.92 (0.28-3.03)0.89LCEA <25°Reference ≥25°0.95 (0.29-3.12)0.94Capsular Repair No RepairReference Repair1.07 (0.43-2.70)0.88