Technique of Arthroscopically Assisted Transtrochanteric Drilling for Femoral Head Chondral Defects

Abstract

Microfracture is a marrow-stimulation technique in which damaged cartilage is drilled or punched, perforating the subchondral bone and generating a blood clot within the defect that matures into fibrocartilage. Microfracture for the treatment of small cartilage defects of the hip has shown good results. Arthroscopic procedures are less invasive than open procedures and have a reduced incidence of complications such as infection or avascular necrosis of the femoral head. Furthermore, arthroscopic procedures allow for a shorter recovery time, resulting in not only lower overall treatment costs but also higher patient satisfaction. Medial and parafoveal cartilage defects of the femoral head can be challenging to effectively microfracture using standard arthroscopy portals because of the acute angles required for instrument manipulation. This report describes a technique for microfracturing these challenging areas of the femoral head using a 2.7-mm K-wire and drilling in a transtrochanteric direction using arthroscopic and imaging guidance to target the area of chondral damage.

Arthroscopic-assisted Retrograde Drilling for the Treatment of Osteochondral Lesions of the Femoral Head: Surgical Technique and Outcome of a Case Series

“…28 Likewise, we believe that size of the OCD is of utmost importance to indicate an arthroscopic-assisted procedure, as it does not seem reasonable to treat a defect greater than 2 cm with this technique. 11 Therefore, we suggest that greater OCDs should be treated with reattachment of the fragment through surgical hip dislocation and internal fixation. Lamplot et al 29 have reported predictable x-ray healing and significant clinical improvement following open reduction and internal fixation at mean follow-up of 4.6 years in a series of 7 patients with osteochondritis dissecans with underlying Perthes disease.…”

“…4,[22][23][24][25] Lately, due to patients reluctance to undergo a major surgery, there has been a trend towards developing arthroscopic alternatives, including transtrochanteric drilling and even arthroscopic retrograde osteochondral autologous transplantation. 11,26,27 In this scenario, we intended to report the outcomes of an arthroscopically assisted, percutaneous retrograde drilling of the femoral head.…”

“…Unlike Chandrasekaran et al, 11 we used a 3.2-mm drill instead of 2.7-mm guide wire. We have described acceptable results at short-term to mid-term using this technique, significantly improving the functional outcomes.…”

“…Only 1 report has described an arthroscopy-assisted and C-arm-assisted technique of femoral head microfracture using a 2.7-mm K-wire drilling in a transtrochanteric. 11 As hip arthroscopy has already proven to be noninvasive and cost-effective, we aimed to describe the surgical technique for microfracturing osteochondral lesions of the femoral head with a 3.2-mm drill in an arthroscopically assisted manner and to report our short-term to mid-term results using this technique.…”

“…Retrograde drilling has been widely described within osteochondral lesions of the talus8–10; however, its application has not been popularized upon the hip. Only 1 report has described an arthroscopy-assisted and C-arm-assisted technique of femoral head microfracture using a 2.7-mm K-wire drilling in a transtrochanteric 11…”