Treatment of Acetabular Chondral Lesions with Microfracture Technique Using a Curve Guide, Flexible Drill and Hyaluronic Acid Scaffold Membrane Augmentation.

Authors:

Introduction:

The diagnosis and treatment of chondral lesions of the hip remain a challenge for orthopedic surgeons. Acetabular cartilage lesions are frequently found during hip arthroscopy^1,2. The acetabulum is the most common location of chondral lesions in the hip, with one study reporting that 88% of chondral defects are found in the anterior superior acetabulum³.
McCarthy and Lee found that 59% of chondral injuries occurred in the anterior acetabulum, and 24% occurred in the superior acetabulum. Chondral lesions usually do not have self-healing properties⁴. The goal of microfracture is to promote the migration of stem cells and growth factors from beneath the subchondral bone plate into the cartilage defect, which eventually heals to form fibrocartilage⁵.

Technique Description:

Results: 

Domb et al. published results with a minimum 5-year follow-up after hip arthroscopy with microfracture as a part of hip arthroscopy, demonstrating favorable outcomes in 72% of patients (5). A systematic review showed that microfracture and autologous chondrocyte transplantation are associated with equivalent improvement in clinical outcomes in patients with high-grade chondral defects in the hip in the short- and midterm follow-up (5 to 72 months)⁶.

BIBLIOGRAPHY.

1. Mella C, Nuñez A, Villalón I. Treatment of acetabular chondral lesions with microfracture technique. SICOT J 2017; 3:45.
2. Dalich A, Rath E, Atzmon R, Radparvar J, Fontana A, Sharfman Z, Amar E. Chondral lesions in the hip: a review of relevant 
   anatomy, imaging and treatment modalities. Journal of hip preservation surgery 2019; 6(1): 3-15. 
3. Schmid MR, Notzli HP, Zanetti M et al. Cartilage lesions in the hip: diagnostic effectiveness of MR arthrography. Radiology 2003; 226: 382–6.
4. McCarthy JC, Lee J-A. Arthroscopic intervention in early hip disease. Clin Orthop Relat Res 2004; 429: 157–62.
5. Domb B, Rybalko D, Mu B, Litrenta J, Chen A, Perets I. Acetabular microfracture in hip arthroscopy: clinical outcomes with minimum 5-year follow-up. Hip International 2018; 28: 649-656.
6. Marquez-Lara A, Mannava S, Howse E, Stone A, Stubbs A. Arthroscopic management of hip chondral defects: A systematic review of the literature. Arthroscopy 2016; 32:14351443. 

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Treatment of acetabular chondral lesions with microfracture technique