Acetabular Chondral Lesions in Hip Arthroscopy: Relationships Between Grade, Topography, and Demographics

Suárez-Ahedo, Carlos; Gui, Chengcheng; Rabe, Stephanie M.; Chandrasekaran, Sivashankar; Lodhia, Parth; Domb, Benjamin G.

doi:10.1177/0363546517708192

Cited by 65 publications

(58 citation statements)

References 15 publications

(16 reference statements)

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“…Our findings are supported by previous studies that similarly demonstrated that male sex, older age, and elevated alpha angles were independently associated with the presence of acetabular damage during hip arthroscopic surgery. 23 , 34 , 38 Despite these findings, labral tearing and chondral damage seen intraoperatively did not correlate with PRO scores. While these results may seem counterintuitive, they are consistent with the findings of Westermann et al, 36 who showed that HOOS scores did not correlate well with macroscopic findings of damage during hip arthroscopic surgery for patients with FAI and that these scores correlated better with mental health, activity levels, and smoking status.…”

Section: Discussionmentioning

confidence: 79%

Correlation of Patient Symptoms With Labral and Articular Cartilage Damage in Femoroacetabular Impingement

Grace

Samaan

Souza

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:Femoroacetabular impingement (FAI) can lead to labral and articular cartilage injuries as well as early osteoarthritis of the hip. Currently, the association of patient symptoms with the progression of labral and articular cartilage injuries due to FAI is poorly understood.Purpose:To evaluate the correlation between patient-reported outcome (PRO) scores and cartilage compositional changes seen on quantitative magnetic resonance imaging (MRI) as well as cartilage and labral damage seen during arthroscopic surgery in patients with FAI.Study Design:Cohort study; Level of evidence, 3.Methods:Patients were prospectively enrolled before hip arthroscopic surgery for symptomatic FAI. Patients were included if they had cam-type FAI without radiographic arthritis. All patients completed PRO scores, including the Hip disability and Osteoarthritis Outcome Score (HOOS) and a visual analog scale for pain. MRI with mapping sequences (T1ρ and T2) on both the acetabular and femoral regions was performed before surgery to quantitatively assess the cartilage composition. During arthroscopic surgery, cartilage and labral injury grades were recorded using the Beck classification. Pearson and Spearman correlation coefficients were then obtained to evaluate the association between chondrolabral changes and PRO scores.Results:A total of 46 patients (46 hips) were included for analysis (mean age, 35.5 years; mean body mass index [BMI], 23.9 kg/m2; 59% male). Increasing BMI was correlated with a more severe acetabular cartilage grade (ρ = 0.37; 95% CI, 0.08-0.65). A greater alpha angle was correlated with an increased labral tear grade (ρ = 0.59; 95% CI, 0.37-0.82) and acetabular cartilage injuries (ρ = 0.61; 95% CI, 0.42-0.80). With respect to PRO scores, increasing femoral cartilage damage in the anterosuperior femoral head region, as measured on quantitative MRI using T1ρ and T2 mapping, correlated with lower (worse) scores on the HOOS Activities of Daily Living (r = 0.35; 95% CI, 0.06-0.64), Symptoms (r = 0.32; 95% CI, 0.06-0.57), and Pain (r = 0.31; 95% CI, 0.06-0.55) subscales. There was no correlation between PRO scores and acetabular cartilage damage or labral tearing found on quantitative MRI or during arthroscopic surgery.Conclusion:Femoral cartilage damage, as measured on T1ρ and T2 mapping, appears to have a greater correlation with clinical symptoms than acetabular cartilage damage or labral tears in patients with symptomatic FAI.

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Section: Discussionmentioning

confidence: 79%

Correlation of Patient Symptoms With Labral and Articular Cartilage Damage in Femoroacetabular Impingement

Grace

Samaan

Souza

et al. 2018

Orthopaedic Journal of Sports Medicine

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“…20 Reduced hip extension during walking is also commonly seen in patients with early hip OA 46 and is thought to be a compensation strategy to unload the anterior hip joint, 24 the common location of chondrolabral abnormalities associated with FAIS. 36 It is important to note that HA for FAIS changes hip morphology, but much of the intra-articular abnormality remains. More than 80% of all patients in this study had acetabular cartilage defects during the time of arthroscopic surgery, which is a common finding in comparable cohorts.…”

Section: Discussionmentioning

confidence: 99%

Hip Function 6 to 10 Months After Arthroscopic Surgery: A Cross-sectional Comparison of Subjective and Objective Hip Function, Including Performance-Based Measures, in Patients Versus Controls

Wörner

Nilsson

Thorborg

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: Little is known about hip-related function, mobility, and performance in patients after hip arthroscopic surgery (HA) during the time that return to sports can be expected. Purpose: To evaluate measures of subjective and objective hip function 6 to 10 months after HA in patients compared with healthy controls and to compare objective function in the HA group between the operated and nonoperated hips. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 33 patients who had undergone HA (mean, 8.1 ± 2.6 months postoperatively) and 33 healthy participants matched on sex, age, and activity level were compared regarding subjective hip function (Copenhagen Hip and Groin Outcome Score [HAGOS]) and objective function including hip range of motion (ROM; flexion, internal rotation, and external rotation), isometric hip muscle strength (adduction, abduction, flexion, internal rotation, and external rotation), and performance-based measures: the Y Balance Test (YBT), medial and lateral triple-hop test, and Illinois agility test. Group differences were analyzed using independent-samples t tests. Paired-samples t tests were used for a comparison of the operated and nonoperated hips. Standard effect sizes (Cohen d ) were provided for all outcomes. Results: The HA group reported worse subjective hip function than the control group (HAGOS subscores: d = –0.7 to –2.1; P ≤ .004). Objective measures of hip ROM ( d = –0.5 to –1.1; P ≤ .048), hip flexion strength ( d = –0.5; P = .043), and posteromedial reach of the YBT ( d = –0.5; P = .043) were also reduced in the HA group, although there were no significant differences between groups regarding the remaining objective measures ( d = –0.1 to –0.4; P ≥ .102 to .534). The only significant difference between the operated and nonoperated hips in the HA group was reduced passive hip flexion ( d = –0.4; P = .045). Conclusion: Patients who had undergone HA demonstrated reduced subjective hip function compared with controls 6 to 10 months after surgery, when return to sports can be expected. While most objective strength and performance test results were comparable between the HA and control groups at 6 to 10 months after surgery, the HA group presented with impairments related to hip mobility and hip flexion strength. No consistent pattern of impairments was found in operated hips compared with nonoperated hips.

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“…[18][19][20][21] Concomitant acetabular chondral lesions are a common finding in patients with femoroacetabular impingement undergoing hip arthroscopy, with rates ranging from 80% to 100% of patients. [22][23][24][25] This discrepancy between imaging and arthroscopy reduces our ability to have appropriate preoperative discussions with patients about their pathology and treatment options. It also limits our ability to have the appropriate chondral transplantation equipment available.…”

Section: Discussionmentioning

confidence: 99%

Single-Stage Arthroscopic Autologous Matrix–Enhanced Chondral Transplantation (AMECT) in the Hip

Craig

Maak

2020

Arthroscopy Techniques

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Chondral defects of the acetabulum in patients with femoroacetabular impingement syndrome are an increasingly recognized cause of worse outcomes after treatment. Multiple procedures have been described for the treatment of hip cartilage lesions including microfracture, autologous chondrocyte implantation, matrix-induced autologous chondrocyte implantation, and autograft and allograft transplantation. However, many of these techniques have poor long-term outcomes, require multiple surgical procedures, or rely on planned preoperative identification of the chondral lesion. This Technical Note describes our technique of autologous matrixeenhanced chondral transplantation, a single-stage treatment for acetabular cartilage lesions that harvests chondral tissue from the femoral cam deformity and combines it with chondral extracellular matrix, growth factors, and autologous peripheral blood.

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Acetabular Chondral Lesions in Hip Arthroscopy: Relationships Between Grade, Topography, and Demographics

Cited by 65 publications

References 15 publications

Correlation of Patient Symptoms With Labral and Articular Cartilage Damage in Femoroacetabular Impingement

Correlation of Patient Symptoms With Labral and Articular Cartilage Damage in Femoroacetabular Impingement

Hip Function 6 to 10 Months After Arthroscopic Surgery: A Cross-sectional Comparison of Subjective and Objective Hip Function, Including Performance-Based Measures, in Patients Versus Controls

Single-Stage Arthroscopic Autologous Matrix–Enhanced Chondral Transplantation (AMECT) in the Hip

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