Arthroscopic Repair of Delaminated Acetabular Articular Cartilage Using Fibrin Adhesive. Results at One to Three Years

Abstract

We describe one- to three-year results of a novel use of fibrin glue in the treatment of cartilage damage by arthroscopy in the hip. This technique uses the microfracture technique and fibrin adhesive to bond delaminated articular cartilage to the underlying subchondral bone. This is generally performed in conjunction with treatment of underlying pathology such as femoroacetabular impingement. Patients were assessed using the modified Harris Hip Score (MHHS) pre- and post-operatively, and statistical significance determined by Student's t-test. We report the mid-term results of 43 patients with femoroacetabular impingement who have undergone this technique for re-attachment of delaminated chondral flaps. There was a statistically significant improvement in MHHS at a mean of 28 months (16 to 42 months) after surgery (p<0.0001). The MHHS for pain improved significantly from 21.8 (95% CI 19.0 to 24.7) pre-operatively to 35.8 (95% CI 32.6 to 38.9) post-operatively (p<0.0001). The MHHS for function also showed significant, although more modest, improvements from 40.0 (95% CI 37.7 to 42.3) pre-operatively to 43.6 (95% CI 41.4 to 45.8) post-operatively (p=0.0006). There were three patients who had early (within 12 months of the index procedure) revision arthroscopy for iliopsoas pathology. Arthroscopic repair of delaminated acetabular articular cartilage using fibrin adhesive is a useful technique in the treatment of early cartilage damage. We have seen encouraging mid-term results, although further studies are warranted.

Viability assessment of the chondral flap in patients with cam-type femoroacetabular impingement: a preliminary report

“…The work by Stafford and colleagues 16 has demonstrated promising results with flap refixation at midterm follow-up. Conducting longer term repair outcome studies and developing tools to better identify these patients may allow the clinician to further prevent progression of hip osteoarthritis in this select population.…”

“…Recent literature suggests that refixation of the cartilage flap with a fibrin adhesive could provide the most favourable result in regards to joint preservation. 16 Harris hip scores for pain and function were found to be significantly better at midterm follow up. Our results provide more evidence that refixation could indeed be reasonable to consider when flaps are encountered in surgery, although further viability assays are needed.…”

“…More recently, some have proposed cartilage refixation using a fibrin adhesive. 16 While the cartilage flaps seem to be macroscopically normal, the viability of the cartilage flaps has yet to be investigated. The purpose of this study was to determine if the acetabular cartilage still has viable cartilage cells and, if so, what type of cartilage is present.…”

Outcomes of cartilage repair techniques for chondral injury in the hip—a systematic review

“…Mean mHHS was improved significantly after surgery, and in all five patients who underwent revision arthroscopy at a later date, the chondral repair appeared intact. Stafford et al [50] reported the results of 43 patients with FAI who have undergone fibrin adhesive technique for reattachment of delaminated chondral flaps. Both mHHS for pain and function improved significantly after the operation.…”

The Rigid Curette Technique for the Application of Fibrin Bioadhesive During Hip Arthroscopy for Articular Cartilage Lesions

“…6 The use of bioadhesives has been reported for the treatment of delaminating articular cartilage lesions in the hip. 7 Tzaveas and Villar 8 reported injecting fibrin adhesive into the cartilage pocket through a needle; the delaminated chondral surface was firmly pressed against bone with an angled arthroscopic punch. The fibrin adhesive set and re-bonded the delaminated chondral surface to the underlying subchondral bone.…”