Abstract
The purpose of this study is to investigate the outcomes from anchor-induced chondral damage of the hip, both with and without frank chondral penetration. A multicenter retrospective case series was performed of patients with chondral deformation or penetration during initial hip arthroscopic surgery. Intra-operative findings, post-surgical clinical courses, hip outcome scores and descriptions of arthroscopic treatment in cases requiring revision surgery and anchor removal are reported. Five patients (three females) of mean age 32 years (range, 16–41 years) had documented anchor-induced chondral damage with mean 3.5 years (range, 1.5–6.0 years) follow-up. The 1 o'clock position (four cases) and anterior and mid-anterior portals (two cases each) were most commonly implicated. Two cases of anchor-induced acetabular chondral deformation without frank penetration had successful clinical and radiographic outcomes, while one case progressed from deformation to chondral penetration with clinical worsening. Of the cases that underwent revision hip arthroscopy, all three had confirmed exposed hard anchors which were removed. Two patients have had clinical improvement and one patient underwent early total hip arthroplasty. Anchor-induced chondral deformation without frank chondral penetration may be treated with close clinical and radiographic monitoring with a low threshold for revision surgery and anchor removal. Chondral penetration should be treated with immediate removal of offending hard anchor implants. Preventative measures include distal-based portals, small diameter and short anchors, removable hard anchors, soft suture-based anchors, curved drill and anchor insertion instrumentation and attention to safe trajectories while visualizing the acetabular articular surface.
Highlights
The acetabular labrum provides a significant functional role and may be important in overall hip preservation [1,2,3,4]
The purpose of this study is to investigate the outcomes from anchor-induced chondral damage of the hip, both with and without frank chondral penetration
Two cases of anchor-induced acetabular chondral deformation without frank penetration had successful clinical and radiographic outcomes, while one case progressed from deformation to chondral penetration with clinical worsening
Summary
The acetabular labrum provides a significant functional role and may be important in overall hip preservation [1,2,3,4]. Labral tears often occur in the setting of bony dysmorphisms such as dysplasia and femoroacetabular impingement (FAI). Arthroscopic surgery for FAI is a less invasive option that typically addresses bony deformities and chondrolabral pathology [5, 6]. Patients undergoing labral refixation have better outcomes than those undergoing labral debridement [7,8,9,10]. When the labrum is deficient and/or irreparable, labral reconstruction has been performed with early successful outcomes [11,12,13,14,15]. Current labral repair and reconstruction techniques utilize suture anchor fixation
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