Anchor-induced chondral damage in the hip

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.

Complications in Hip Arthroscopy

“…Suture anchors placed too far from the articular cartilage can evert or medialises the labrum and compromise its function, while anchors placed too close to the articular cartilage can cause iatrogenic cartilage injury. From a multicentre retrospective case series 42 , the 1 o'clock position and anterior/mid-anterior portals were most commonly implicated. To prevent this serious complication, surgeons should be aware that the distal anterolateral accessory (DALA) portal allows anchors to be placed at a greater distance from the articular surface than the anterolateral (AL) and mid-anterior (MA) portals when using a straight drill guide 43 .…”

“…This may decrease the incidence of intra-articular penetration during arthroscopic hip labral repair. Other preventative measures may include use of small diameter and short anchors, removable hard anchors, soft suture-based anchors, curved drills and anchor insertion instrumentation and attention to safe trajectories while visualising the acetabular articular surface 42 .…”

Complications in Hip Arthroscopy

“…Suture anchors placed too far from the articular cartilage can evert or medialises the labrum and compromise its function, while anchors placed too close to the articular cartilage can cause iatrogenic cartilage injury. From a multicentre retrospective case series 42 …”

Persistent or recurrent symptoms after arthroscopic surgery for femoroacetabular impingement: A review of imaging findings

“…b,c). Involvement of the subchondral bone even without a chondral defect can progress to chondral penetration, intra‐articular displacement and severe chondral damage …”