Acetabular Chondral Defects Research Articles

Sport Activity and Clinical Outcomes after Hip Arthroscopy with Acetabular Microfractures at a Minimum 2-Year Follow-Up: A Matched-Pair Controlled Study.

Background: Acetabular microfractures for cartilage lesions have been shown to be a safe procedure able to improve patient reported outcomes (PROs). Nevertheless, the return to sport activity rate represents a crucial outcome to be investigated in these young athletic patients. Methods: Patients undergoing acetabular microfracture for full chondral acetabular lesions were compared to a 1:1 matched-pair by age and gender control group undergoing hip arthroscopy without microfractures. Clinical assessment was performed with PROs and participation in sports in terms of type and level of activities was evaluated preoperatively and at 2-years follow-up. Results: A total of 62 patients with an average age of 35.1 ± 8.1 (microfracture group) and 36.4 ± 6.3 (control group) were included. In both groups, the average values of PROs significantly increased from preoperatively to the last follow-up. There was no significant difference between the two groups in the number of patients playing at the amateur and elite level preoperatively and at the last follow-up. Conclusions: Microfractures for the management of full-thickness acetabular chondral defect provides good clinical results at a minimum follow-up of two years, which are not inferior to a matched-pair control group. Patients undergoing this procedure are likely able to return at the same level of sport before surgery.

Biological Augments for Acetabular Chondral Defects in Hip Arthroscopy-A Scoping Review of the Current Clinical Evidence.

A wide array of joint-preserving surgical techniques exists in the management of acetabular chondral defects (ACDs). The purpose of this review is to summarize the clinical outcomes of the recent biologics used to treat ACDs during hip arthroscopy. Increasing evidence is available for different biological solutions used in the hip. Studies have shown promising outcomes with minimal complications when using biologics as augmentation to microfracture (MF), including different scaffolds or stem cells, or to enhance autologous chondrocyte implantation (ACI). However, data so far is scarce, and more trials and longer follow-ups are needed to better delineate the appropriate indications and benefits for each technique. Presently, the level of evidence is low, but in general, biologics appear safe and trend toward beneficial compared to standard surgical techniques. Augmented MF is recommended for small to medium ACDs, and matrix-assisted ACI or three-dimensional ACI is recommended for medium to large defects.

Better Clinicoradiological Results of BST-CarGel Treatment in Cartilage Repair Compared With Microfracture in Acetabular Chondral Defects at 2 Years

Background: BST-CarGel (CarGel) is an injectable chitosan scaffold that is mixed with fresh, autologous blood and injected into the site of microfracture (MF) to physically stabilize clots and enhance cartilage repair. Purpose: To evaluate short-term clinicoradiological outcomes of patients treated arthroscopically for acetabular chondral defects with CarGel in conjunction with MF compared with those treated with MF alone. Study Design: Cohort study; Level of evidence, 3. Methods: All patients who underwent hip arthroscopy and received MF with or without CarGel for acetabular chondral defects between 2014 and 2018 with a minimum 2-year clinicoradiological follow-up were included. Intraoperative details, postoperative complications, and clinical outcome scores, including the international Hip Outcome Tool–33 (iHOT-33), Hip Outcome Score (HOS)–Activities of Daily Living (HOS-ADL), and Hip Outcome Score–Sports Profile, were analyzed. Serial plain radiographs were assessed independently by 2 blinded observers. A survival analysis was performed to identify the number of cases converted to total hip arthroplasty (THA) in both groups, which was correlated with the cartilage defect size at the time of surgery. Results: Eighty patients (54 CarGel and 26 MF) were evaluated, including 56 men (70%) and 48 right hips (60%). Three patients were lost to follow-up. There were no major adverse events in either group. The average defect size was 3.63 and 4.97 cm2 in MF and CarGel, respectively (P = .002). There was a statistically significant improvement in iHOT-33 (from 43.24 to 60.17 in MF and from 41.13 to 58.39 in CarGel) and HOS-ADL (from 62.25 to 76.75 in MF and from 44.69 to 79.16 in CarGel) scores. There was no difference between the 2 groups in the outcome scores after adjusting for covariates. Survival analysis showed 34.6% of MF cases and 5.9% of CarGel cases were converted to THA (P = .001). The mean defect size of the failure group was higher in CarGel than in MF (8.83 and 3.72 cm2, respectively). Mean joint space reduction was 1.41 mm in MF and 0.19 mm in CarGel (P < .001). Conclusion: Two-year clinicoradiological results were promising in these lesions that are difficult to treat. Arthroscopic treatment of chondral acetabular defects with CarGel demonstrated a significant decrease in progressive loss of joint space and conversion to THA compared with MF as an isolated procedure.

Promising radiological outcome after repair of acetabular chondral defects by microfracture augmented with chitosan-based scaffold: mid-term T2 mapping evaluation.

Radiological evaluation of the repair tissue produced after arthroscopic treatment of acetabular chondral lesions associated with femoroacetabular impingement (FAI) by the chitosan-based scaffold. Patients of age 18-55years with clinical and radiological features of FAI and non-arthritic non-dysplastic hips were selected for arthroscopic treatment. Full-thickness acetabular chondral defects were filled with chitosan-based scaffold material after microfracture. T2 mapping was carried out for all patients after 24months using a 1.5-T machine. Nine regions of interest (ROIs) were localized from three consecutive sagittal slices including the area of repair. T2 relaxation times of ROIs in the repair area were compared with the corresponding posterior cartilage. Twenty-one patients, 17 men and 4 women, underwent arthroscopic treatment of full-thickness acetabular chondral defects with mean size of 3.6 ± 1cm2 (range 2-6cm2). Zone 2 was affected in all cases while zone 3 was involved in 13 cases. T2 relaxation values were collected from 189 ROIs for quantitative analysis. Within the peripheral repair area, the mean T2 value was 49.1 ± 7.2ms (ms), while ROIs of the central repair area had mean T2 values of 50.2 ± 7.1ms. Posterior cartilage showed mean T2 value of 46.2 ± 7.6ms CONCLUSION: Arthroscopic microfracture of large full-thickness acetabular chondral defects with chitosan-based scaffold produced a homogenous repair tissue similar to the corresponding native cartilage of the same joint on quantitative T2 mapping at mid-term follow-up. augmentation of the microfracture by chitosan-based scaffold is a promising modality for treatment of large full-thickness acetabular defects. IV.

A critical review of the literature on arthroscopic autologous matrix-induced chondrogenesis and matrix-assisted autologous chondrocyte transplantation for acetabular chondral defects

Background/Aims Significant acetabular chondral defects are a common clinical finding during hip arthroscopy, for which the current surgical management approach may be falling short. Autologous matrix-induced chondrogenesis and matrix-assisted autologous chondrocyte transplantation are two novel cell-regenerative therapies that offer a way to repair acetabular chondral defects. Methods A literature search of Cochrane, CINAHL, AMED and Medline (2007–2017) databases revealed seven relevant articles, but only four involved a hip arthroscopic approach. Results All included studies demonstrated some significant improvements in patient-reported outcomes for autologous matrix-induced chondrogenesis and matrix-assisted autologous chondrocyte transplantation. There appears to be a practical advantage in terms of cost and convenience for using one-step autologous matrix-induced chondrogenesis. However, over-reliance on one particular research team and use of small-scale retrospective studies constitutes low-level, non-generalisable evidence. Conclusions The literature does not convincingly support either of these new applications over and above any other currently available treatments. Further research is needed and should involve different centres, longer follow-ups and place a higher emphasis on methodological rigour in order to maximise the trustworthiness of results.

Primary labral reconstruction in patients with femoroacetabular impingement, irreparable labral tears and severe acetabular chondral defects decreases the risk of conversion to total hip arthroplasty: a pair-matched study.

In the presence of severe acetabular cartilage defects, the benefits of labral reconstruction (RECON) versus labral resection (RESEC) have not been determined. Prospectively collected data between October 2008 and December 2016 were retrospectively reviewed. Inclusion criteria were hip arthroscopy, acetabular Outerbridge grade III/IV, irreparable labral tears that underwent RECON or RESEC, and minimum 2-year postoperative measures for the modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score–Sports Specific Subscale, International Hip Outcome Tool, Patient Satisfaction and Visual Analogue Scale for pain. Exclusion criteria included Tönnis grade >1, previous hip conditions or previous ipsilateral hip surgeries. A 1:1 matched-pair analysis was performed based on age ±5 years, sex, body mass index ±5 kg/m2, Tönnis grade, acetabular microfracture, femoral Outerbridge grade (0 or I compared with II, III or IV). Relative risk (RR) and conversion rate to total hip arthroplasty (THA) were calculated. A total of 38 RECON hips were successfully matched. Both groups demonstrated significant improvements in patient-reported outcomes (PROs). THA conversion was 5.3% and 21.1% for the RECON and RESEC groups, respectively (P = 0.04). RECON was four times less likely to require THA conversion than the RESEC group (RR=4.0; 95% CI 0.91–17.63). In the setting of primary arthroscopic management of femoroacetabular impingement, irreparable labral tears and acetabular chondral lesions of Outerbridge III/IV, patients that underwent RECON and RESEC experienced significant improvement in PROs at minimum 2-year follow-up, and these functional scores were comparable when groups were matched. However, RR and rate to THA conversion were significantly higher in the RESEC group.

Do Larger Acetabular Chondral Defects Portend Inferior Outcomes in Patients Undergoing Arthroscopic Acetabular Microfracture? A Matched-Controlled Study

To elucidate the effect, if any, of acetabular chondral defect size on surgical outcomes after arthroscopic microfracture was performed with concomitant treatment for labral tears and femoroacetabular impingement (FAI) syndrome. The study period was between February 2008 and November 2014. Data were collected on patients who underwent hip arthroscopy. The inclusion criteria were acetabular microfracture; concomitant treatment for labral tears and FAI syndrome; and preoperative modified Harris Hip Score, Nonarthritic Hip Score, Hip Outcome Score-Sports Specific Subscale, and visual analog scale. Exclusion criteria were Workers' Compensation, preoperative Tönnis grade >1, or previous ipsilateral hip surgeries or conditions. Patients were grouped based on smaller chondral defects (SCDs) or larger chondral defects (LCDs), then matched 1:1 by age at surgery ±10years, sex, body mass index ±5, labral treatment, capsular treatment, acetabuloplasty, and femoroplasty. Outcomes, secondary arthroscopies, and conversions to total hip arthroplasty (THA) were documented. Of 131 eligible cases, 107 (81.7%) had minimum 2-year follow-up. Before matching, the conversion rate to THA was higher for LCDs (24.6%) than for SCDs (12.0%). Thirty-five patients were matched for each group. Mean follow-up time was 47.9months (range, 24.0, 84.1) for the matched LCD group and 46.1months (range, 24.0, 88.1) for the matched SCD group. Ligamentum teres debridement (P= .03) was performed more frequently in the LCD group. No other differences were found regarding demographics, intraoperative findings, procedures, traction time, preoperative scores, or follow-up scores. Both groups demonstrated significant improvements in all scores. Rates of revision or conversion to THA were similar between groups. The relative risk for conversion to THA was 2.33 for patients with defects ≥300mm2 compared with patients with defects ≤250mm2 (P= .13). Deep vein thrombosis occurred in 3 (5.3%) patients with LCDs. Matched patients with either SCDs or LCDs undergoing arthroscopic acetabular microfracture with concomitant treatment for labral tears and FAI syndrome demonstrated similar improvements at minimum 2-year follow-up. Patients with chondral defects approaching 300mm2 or greater may have a higher propensity toward conversion to THA. Level III, retrospective comparative therapeutic trial.

Autologous Membrane Induced Chondrogenesis (AMIC) for the treatment of acetabular chondral defect

Autologous Membrane Induced Chondrogenesis (AMIC) for the treatment of acetabular chondral defect

Arthroscopic Repair of Acetabular Cartilage Lesions by Chitosan-Based Scaffold: Clinical Evaluation at Minimum 2 Years Follow-up

To evaluate the functional outcome of using chitosan-based material in our patients after 2years of follow-up. Nonarthritic nondysplastic femoroacetabular impingement patients with an acetabular chondral lesion, 18 to 55years of age, were included for arthroscopic repair between May 2013 and July 2015. Full-thickness chondral defects ≥2cm2 were filled with chitosan-based implant after microfractures. Follow-up consisted of alpha angle assessment and clinical outcome in the form of the Non Arthritic Hip Score (NAHS), International Hip Outcome Tool 33 (iHOT33), Hip Outcome Score of Activities of Daily Living (HOS-ADL), and Hip Outcome Score of Sports Specific Scale (HOS-SSS). Twenty-three patients were included. The mean follow-up was 38.4 ± 7.0months (range, 24-50months). The mean defect size was 3.5 ± 1.0cm2, principally involving zone 2 and to a lesser extent in zones 1 and 3. Using femoroplasty, the alpha angle was corrected from a mean 70.5 ± 6.3° to 44.3 ± 4.9° (P= .00001). Significant improvement occurred comparing the preoperative to the first-year postoperative patient-reported outcomes: P= .00001 for the NAHS, P= .00004 for the iHOT33, P= .00005 for the HOS-ADL, and P= .0002 for the HOS-SSS. No statistically significant change has been observed in the patient-reported outcomes obtained at the endpoint when compared with the first-year values (P= .13 for the NAHS, P= .21 for the HOS-ADL, and P= .29 for the HOS-SSS), except for the iHOT33, which showed further significant improvement (P= .02). Up to 91% of the patients met or exceeded the minimal clinically important difference. One patient needed total hip arthroplasty. Perineal hypoesthesia occurred in 3 patients, who recovered within 2 to 6weeks, and 1 patient needed a prolonged physiotherapy program for postoperative muscular stiffness. The arthroscopic combined treatment of microfractures and chitosan-based scaffold has maintained satisfactory clinical outcomes in 91% of the patients with s large (≥2cm2) full-thickness acetabular chondral defect associated with femoroacetabular impingement at a mean follow-up of 38.4months. The study could not definitely draw any conclusion regarding the safety of chitosan-based material for use in the hip joint. Level IV, case series.

Safety Profile and Short-term Outcomes of BST-CarGel as an Adjunct to Microfracture for the Treatment of Chondral Lesions of the Hip.

Background:Acetabular cartilage lesions are a common abnormality found in patients undergoing hip arthroscopic surgery and may cause pain and functional limitations. Several strategies have been developed to treat chondral defects, with no overwhelming success. Recently, BST-CarGel has gained interest as a scaffolding material that can be injected into the microfracture site to stabilize the clot and facilitate cartilage repair.Purpose:To perform a retrospective analysis of prospectively collected data to evaluate the safety profile and short-term clinical and radiographic outcomes of patients treated arthroscopically with BST-CarGel for acetabular chondral defects in conjunction with microfracture.Study Design:Case series; Level of evidence, 4.Methods:A retrospective chart review was performed on all patients who underwent hip arthroscopic surgery by the senior surgeon to identify those who had BST-CarGel applied to their hip from November 2014 to July 2016, and basic demographic information for those patients was obtained. Operative reports and patient charts were reviewed to assess intraoperative and postoperative complications as well as to obtain the details of surgery, including lesion size and treatment method of the labrum (repair vs reconstruction). All patients filled out self-reported questionnaires, including the international Hip Outcome Tool (iHOT), Hip Outcome Score–Activities of Daily Living (HOS-ADL), and Hip Outcome Score–Sports Profile (HOS-SP) at the time of consultation and at 1 year postoperatively, and results were used to assess the clinical outcomes of surgery.Results:Thirty-seven patients (37 hips) with a mean age of 36.19 years at the time of the index procedure were evaluated. There were 30 male patients, and 20 procedures were performed on the right hip. The minimum follow-up was 1 year, with a mean follow-up of 12.72 months. There were no major adverse events of deep vein thrombosis, blood vessel or nerve damage, hemarthrosis, arthralgia, or device-related adverse events. Two patients (5.4%) were readmitted because of pain, probably resulting from an inflammatory reaction to BST-CarGel. At 1 year postoperatively, there were statistically significant improvements in the iHOT (40.4 to 59.1; P < .001), HOS-ADL (60.6 to 71.4; P = .02), and HOS-SP (36.9 to 51.6; P = .01) scores. When the patients were subdivided based on the chondral defect size, the iHOT score improved for all chondral defect sizes, and the HOS-SP score improved in patients with medium (2-4 cm2) and very large (>6 cm2) chondral defects. In addition, the iHOT score improved whether the patients had their labrum repaired or reconstructed (P < .001 and P = .02, respectively).Conclusion:The arthroscopic treatment of chondral acetabular defects with BST-CarGel demonstrates a satisfactory safety profile, with statistically significant improvement in patient-reported clinical outcome scores, even for those with very large chondral defect sizes.

Acetabular Focal Chondral Lesions Are Not Associated With Worse Outcomes After Periacetabular Osteotomy: A Matched Group Analyses

BackgroundThe purpose of this study was to assess the outcomes of patients who underwent combined hip arthroscopy and periacetabular osteotomy with acetabular focal chondral defects and compare these outcomes with a group of patients without focal chondral defects. MethodsA retrospective review looking at patients who underwent hip arthroscopy and/or periacetabular osteotomy was performed. Minimum 2-year follow-up, Tönnis grade 0-1, and a Beck chondromalacia stages 4-5 were included. Twenty-eight hips met inclusion criteria. These patients were then matched 1:1 and compared. ResultsThe average acetabular chondral defect size was 144.3 mm2 ± standard deviation 116.2. Postoperative, modified Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score, and University of California Los Angeles scores were similar between groups (P = .382, P = .755, P = .763, respectively). At the last follow-up, Tönnis grade was similar between groups (P = .552). No association between having a defect and increased risk of failure was noted (hazard ratio 1.35 [95% CI 0.43-4.24], P = .607). ConclusionWe found that patients with focal chondral defects did similar to a comparison group of patients without chondral defects.

Arthroscopic Treatment of Acetabular Condral Defects Using BST-CarGel

Objectives:The purpose of this study is to retrospectively analyze prospectively collected data to evaluate the shortterm outcome of patients treated arthroscopically with BSTCarGel for acetabular chondral defect.Methods:Between November 2014 and December 2015, 22 patients (23 hips) underwent hip arthroscopy for correction of femoroacetabular impingement, labral repair and treatment of acetabular chondral defect. Patient evaluations included general assessment with iHOT33 questionnaire at the time of preoperative consultation, and the postoperative followup at 2 weeks, 6 weeks, 3 months, 6 months, 1 year and 2 year marks. Additionally, preoperative and postoperative plain radiographs and MRarthrogram scans were analyzed for evaluation.Results:22 patients (23 hips) have been evaluated with a mean age of 33.34 years at the time of the index operation. There were 16 males (17 hips, mean age of 32.00) and 6 female (6 hips, mean age of 37.15). The average followup was 1 year, with a minimum followup of 6 months. The preoperative iHOT33 score was 47.1, the 6 months postoperative score was 54.8, and the 12 month postoperative score was 63.7 (p < 0.05) MRIArthrograms demonstrated a decrease in the size of the chondral defects. No significant adverse outcomes have been reported.Conclusion:Arthroscopic treatment of chondral acetabular defect with BSTCarGel demonstrates encouraging signs of cartilage healing as shown on MRarthrograms, without significant adverse outcomes. Longer followup is required to determine if this improvement is maintained.

Arthroscopic Treatment of Acetabular Chondral Defect Using Bst-Cargel

Arthroscopic Treatment of Acetabular Chondral Defect Using Bst-Cargel

Autologous Membrane Induced Chondrogenesis (AMIC) for the treatment of acetabular chondral defect.

Acetabular chondral defect are very frequently associated to FAI. Treatment options are still questionable. Between 2008 and 2014, 201 patients over 583 have been arthroscopically treated with the AMIC procedure for grade III and/or IV acetabular chondral lesions. Patients age was between 18 and 50 years; acetabular chondral lesion size was between 2 and 4 cm2; radiological Tönnis degree of osteoarthritis was ≤ 2. The mean follow up of the entire group of 201 patients was 5 years (from 8 to 2). Significant improvement, as measured by the mHHS, was observed at 6 months in comparison to preoperative levels (80.3 ± 8.3) (p<0.001). Continuous improvement with respect to each previous evaluation time point was seen, reaching the highest improvement level at the three year follow-up (85.5 ± 7.2). The mean mHHS improvement recorded at the five year follow-up compared with preoperative scores was 39.1 ± 5.9. AMIC is a valid procedure to repair medium-sized chondral defects on the acetabular side of the hip found during treatment of FAI and lead to long-term favourable outcomes. IV.

Treatment of acetabular chondral defects in femoral acetabolar impingement. AMIC vs microfractures. A 5-year follow-up study

Introduction Repair of chondral lesions stemming from femoroacetabular impingement requires specific therapeutic approaches, in addition to impingement treatment. This retrospective analysis of consecutive patients from a single centre compares microfracture (MFx) with the enhanced microfracture autologous matrix-induced chondrogenesis (AMIC) technique. The treatment modalities differ in that the AMIC procedure incorporates a collagen matrix, used to cover and protect the blood clot generated by microfracture (MFx). Methods Acetabular chondral lesions ranging from 2 to 8 cm 2 in 77 and 70 patients were treated by MFx or AMIC, respectively. Treatment outcomes were assessed by the modified Harrison Hip Score with follow-up at 6 months, 1, 2, 3, 4, and 5 years. Both MFx and AMIC significantly improved the clinical status at 6 months and 1 year. Over the 2–5-year period, a progressive degradation of functionality was measured in the MFx group, while the positive outcomes of the AMIC group remained stable. In addition, the AMIC treatment group performed significantly better than MFx group at each long-term time point. No conversion to total hip arthroplasty (THA) was observed in the AMIC group, whereas THA was necessary in 7.8% of the patients in the MFx group. Results The results of this study provide proof that both MFx and AMIC therapy improve clinical outcomes associated with repair of acetabular chondral damage. The AMIC group showed long-term durable improvement, scoring significantly better than the MFx group, particularly in large (?4 cm 2 ) lesions over the 2–5-year period examined.

Comparison of 3.0-T MR vs 3.0-T MR arthrography of the hip for detection of acetabular labral tears and chondral defects in the same patient population.

We report our experience in diagnostic sensitivity of 3.0-T conventional MR vs 3.0-T MR arthrography of the hip for detection of acetabular labral tears and chondral defects in the same patient population. 43 consecutive patients had both conventional hip MR and MR arthrography examinations performed. These examinations were reviewed retrospectively by independent reading of two musculoskeletal radiologists who read the MR and MR arthrogram examinations in a randomized fashion (i.e. MR and MR arthrogram examinations were read at separate sittings and in a randomized fashion so as not to bias reviewers). Scans were assessed for acetabular labral tears and chondral defects. All patients went on to arthroscopy. Of these 43 patients, 40 had acetabular labral tears read by Reader 1 and 39 had acetabular labral tears read by Reader 2 on MR arthrogram, 39 had acetabular labral tears read by Reader 1 and 38 had acetabular labral tears read by Reader 2 on conventional MR examination. There were 42 labral tears in 43 patients at arthroscopy. There were four false-negative labral tears compared with arthroscopy on MR and three false negatives on MR arthrography for Reader 1 and five false negatives on MR and four false negatives on MR arthrography for Reader 2. Each reader had one false-positive labral tear compared with arthroscopy on both MR and MR arthrography. There were 32 acetabular chondral defects at arthroscopy. Reader 1 saw 21 acetabular chondral defects on conventional MR and 27 chondral defects at MR arthrography. Reader 2 saw 19 acetabular chondral defects at conventional MR and 25 acetabular chondral defects on MR arthrography. There were no false-positive readings of chondral defects compared with arthroscopy on MR and one false positive for Reader 1 and two false positives for Reader 2 on MR arthrography as compared with arthroscopy. On conventional MR examination, sensitivities and specificities as compared with arthroscopy were as follows: Reader 1 acetabular labral tear (90% sensitivity, 0% specificity) and Reader 2 acetabular labral tear (88% sensitivity, 0% sensitivity). On MR arthrogram, sensitivities and specificities as compared with arthroscopy for Reader 1 were 93%, 0% and for Reader 2 were 90%, 0%, respectively. Sensitivities and specificities for detection of acetabular chondral defects as compared with arthroscopy were Reader 1 conventional MR (65% sensitivity, 100% specificity), Reader 1 MR arthrography (81% sensitivity, 91% specificity), Reader 2 conventional MR (59% sensitivity, 100% specificity) and Reader 2 MR arthrography (71% sensitivity, 82% specificity). In this series, 3.0-T MR demonstrated sensitivity for detection of acetabular labral tears that rivals the sensitivity of 3.0-T MR arthrography of the hip. In this series, 3.0-T MR arthrography was more sensitive than conventional 3.0-T MR for detection of acetabular chondral defects. 3.0-T MR and MR arthrography are near equivalent in the diagnosis of acetabular labral tears. This information is useful for pre-operative planning.

Microfracture for Acetabular Chondral Defects in Patients With Femoroacetabular Impingement

Background: Microfracture is a proven technique to treat articular cartilage defects in the knee. However, there is little evidence in the literature to confirm the ability of microfracture to produce repair tissue in the hip joint. Purpose: The purpose of this study was to report the macroscopic and microscopic appearances of repair tissue after microfracture performed at hip arthroscopic surgery for isolated full-thickness acetabular cartilage defects in patients with femoroacetabular impingement (FAI). Study Design: Case series; Level of evidence, 4. Methods: Twenty patients who underwent arthroscopic surgery for FAI had a localized full-thickness acetabular chondral defect treated by microfracture and then underwent a later second-look hip arthroscopic procedure. The size of the full-thickness defect was measured at the primary arthroscopic procedure. A visual assessment of the extent and quality of repair tissue was performed at second-look arthroscopic surgery. Two patients also had a biopsy of the repair tissue, which was studied histologically. Results: At an average follow-up of 17 months, 19 of the 20 patients had a mean fill of 96% ± 7% with macroscopically good quality repair tissue. One patient had only a 25% fill with poor quality repair tissue. Histologically, the tissue was found to be primarily fibrocartilage with some staining for type II collagen in the region closest to the bone. Conclusion: Microfracture in the hip appears to be an effective technique that produces excellent coverage of the defect with good quality repair tissue on visual inspection and microscopic examination at an average follow-up of 17 months.

Midterm Outcomes in Patients With Cam Femoroacetabular Impingement Treated Arthroscopically

The purpose of this study was to evaluate the midterm outcomes of patients with cam-type femoroacetabular impingement treated arthroscopically. Outcomes were measured with the Nonarthritic Hip Score (NAHS), visual analog scale pain scores, and satisfaction levels preoperatively; at 6 weeks and 3, 6, 12, and 24 months postoperatively; and at final follow-up. Two hundred one procedures were available for final assessment with a minimum follow-up of 36 months (mean, 46 months). Ninety-nine percent of hips had a preoperative Tönnis grade of 1 or less. The NAHS significantly improved from a mean of 56.1 to 78.2 (P < .001). Visual analog scale pain scores improved from a mean of 6.8 to 2.7 (P < .001). Preoperative to postoperative satisfaction levels improved from 0.5% to 75% of procedures. Twelve patients required hip arthroplasty during the follow-up period and had a higher incidence of grade 4 acetabular chondral defects versus those without arthroplasty (P < .03). Patients with pincer resections had significantly poorer results versus the remainder of the cohort (P < .01). We have shown satisfactory results using a validated hip scoring system, showing improvement in NAHS, pain scores, and satisfaction levels in a large cohort of patients with cam-type femoroacetabular impingement followed up for a mean of 46 months. The results have shown improvement and stability throughout a range of 36 to 70 months' follow-up. There was no difference in preoperative to postoperative NAHS between age groups. There was a larger percentage of grade 4 acetabular chondral defects in those patients who needed conversion to hip arthroplasty. Patients with associated pincer pathology had poorer results after acetabular rim resection. Level IV, therapeutic case series.

Hip Arthroscopy Catastrophic Failure: What Happened to the Joint?

Hip Arthroscopy Catastrophic Failure: What Happened to the Joint?

Paper # 40: Relationship Between the Presence of a Rim Fragment and Intra-Articular Pathology in Patients with Femoroacetabular Impingement

This study evaluated the presence of a rim fragment in pre-operative radiographs of FAI patients, and found that hips with a rim fragment were 3.7 times less likely to have femoral head's chondral defects compared to the hips without a rim fragment. Femoroacetabular impingement (FAI) has been recognized as a common cause of hip pain. Plain radiograph has been used to identify cam and pincer type of FAI. An acetabular rim fragment is frequently found in radiographs of FAI patients. The purpose of this study was to analyze the relationship between the presence of a rim fragment and intra-articular pathology in patients with FAI. Preoperative radiographs, an anteroposterior view of the pelvis and a lateral cross-table view of the affected hip, of 86 hips of FAI patients who underwent primary hip arthroscopy were reviewed by a surgeon blinded to the patients' symptoms and intraoperative findings. An acetabular rim fragment was identified in 15 hips (17 %) with a median size of 2.5 mm (1.0 to 20.7 mm). There were no significant differences in radiographic measurements of minimum joint space, alpha angle, center edge angle, and Sharp angle between the patients with a rim fragment and those without a rim fragment. There was no association between the presence of an acetabular chondral defect and the presence of a rim fragment (p=0.579). Sixty-five percent of hips without a rim fragment had a chondral defect on the femoral head while 33% of hips with a rim fragment had it (p=0.025). Hips with no rim fragment were 3.7 (95CI 1.2 – 11.5) times more likely to have a chondral defect on the femoral head compared to those with a rim fragment. Hips with a rim fragment were less likely to have femoral head's chondral defects compared to the hips without a rim fragment. The presence of a rim fragment is an adaptive response to abnormal shearing forces in FAI, acting as a “natural rim trimming”.