Five-year results of arthroscopic techniques for the treatment of acetabular chondral lesions in femoroacetabular impingement.

Donato Mancini,Andrea Fontana

doi:10.1007/s00264-014-2403-1

Abstract

This study assesses and compares the clinical outcomes of the arthroscopic matrix-induced autologous chondrocyte implant (MACI) and autologous matrix-induced chondrogenesis (AMIC) techniques for the treatment of acetabular chondral defects between 2 and 4cm(2) consequent to femoral acetabular impingement. Fifty-seven consecutive patients were treated with the MACI (n = 26) or AMIC (n = 31) technique. Patients were assessed pre-operatively and up to five years using the modified Harris Hip Score (mHHS) to compare outcomes. In both the MACI and AMIC groups, significant hip score improvements were measured over baseline levels at six months post-op (81.2 ± 8.4 for MACI, 80.3 ± 8.3 for AMIC, both p < 0.001). The mHHS continued to improve up to three years post-op and remained stable over time until the final five year follow-up. Statistically significant differences between the groups were not observed. The mean mHHS improvement at the five year follow-up with respect to preoperative level was 37.8 ± 5.9 and 39.1 ± 5.9 in patients who underwent MACI and AMIC, respectively (NS). Subgroup analysis of both MACI and AMIC treatment outcomes for patients with an initial chondral defect larger than 3cm(2) yielded comparable results at each time point. This study suggests that both arthroscopic MACI and AMIC are valid procedures to repair medium-sized chondral defects on the acetabular side of the hip found during treatment of femoroacetabular impingement. Due to its high sustainability and minimal invasiveness, the single-stage AMIC procedure can reduce total treatment time and minimise morbidity while providing the same beneficial effects as the two-stage MACI intervention.

Highlights

Femoroacetabular impingement (FAI) is a common cause of hip pain most frequently affecting athletes and active young individuals [1,2,3,4]
Pre-operative modified Harris Hip Score (mHHS) was similar between the groups, with mean scores of 46.5 ±7 for the matrix-induced autologous chondrocyte implant (MACI) group and 44.9±5.9 for the autologous matrix-induced chondrogenesis (AMIC) group (NS)
In the overlapping period during which MACI and AMIC were both performed (6 MACI and 15 AMIC), allocation into each treatment group did not affect the homogeneity of each group as the mean lesion size for these subgroups was comparable and similar to the respective whole population (2.8±1 and 2.8±0.8 for MACI and AMIC, respectively, NS; a lesion smaller than 3 cm2 accounted for 50 % in the MACI group and 53 % in the AMIC group)

Summary

Introduction

Femoroacetabular impingement (FAI) is a common cause of hip pain most frequently affecting athletes and active young individuals [1,2,3,4]. FAI is often compounded by acetabular cartilage damage and labral lesions, rapid return to health is of personal and economic importance, in such patient groups [5,6,7]. Choice of treatment option to repair cartilage defects in the hip depends on the size and severity of the injury. Most patients treated with MFx realise complication-free functional improvement, are able to resume an active lifestyle and return to sport [11, 12]. MFx is known to be less effective in patients with larger chondral lesions (2–4 cm2) or early osteoarthritis [13]

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