Arthroscopic Repair of Delaminated Acetabular Articular Cartilage in Femoroacetabular Impingement

Abstract

Lesions to articular cartilage can be difficult to treat and directly impact surgical outcome in hip arthroscopy. This article describes a direct cartilage suture repair technique for a young, active individual with full-thickness acetabular cartilage delamination. Lesions of this type are commonly seen with femoroacetabular impingement. A 17-year-old boy presented with bilateral hip pain greater in the right than left. Arthroscopic intervention for the right hip included direct cartilage repair for the cartilage lesion, osteoplasty for femoroacetabular impingement, repair for an anterior labral tear, capsular plication for iliofemoral ligament laxity, and psoas lengthening. Twelve weeks postoperatively, a standard capsular plication, osteoplasty, and chondroplasty were performed on the left hip. At follow-up, the patient reported feeling 95% normal. He noted that the right and left hips were essentially the same. Symptoms consisted of stiffness after prolonged sitting and mild pain following sports. The patient reported being pain free 90% of the time, with pain 2/10 at worst. He scored a 96 on the modified Harris Hip Score, 93 on the Hip Outcome Score Activities of Daily Living subscale, and 81 on the Hip Outcome Score Sports subscale. Overall, the patient was satisfied with the outcome. The direct cartilage repair, in addition to osteoplasty, anterior superior labral repair, iliofemoral capsular plication, and psoas lengthening, produced an excellent outcome in this young, active patient.

Surgical Technique: Second-generation Bone Marrow Stimulation via Surgical Dislocation to Treat Hip Cartilage Lesions

“…The cause of chondral and osteochondral defects occurring in FAI is subject to some debate. While most agree acetabular chondral delamination occurs as a result of shear forces created by the cam deformity [11,23,29,40,46,50,56,62], the cause of defects occurring remotely to the cam or pincer deformity is subject to more speculation. Charbonnier et al [12] demonstrated impingement and secondary femoral head subluxation in dancers with morphologically normal hips, and two studies have demonstrated decreased hip flexion and abduction in patients with FAI [33,36].…”

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

“…Our review found a case report that presented direct cartilage repair as a possible technique to treat large delaminated full-thickness acetabular cartilage repairs. Sekiya et al [42] described a case of a 17-year-old boy presented with bilateral hip pain because of bilateral CAMtype FAI and a 1-cm delaminated unstable cartilage flap in the anterior-superior acetabulum. Arthroscopic microfracture underneath the flap of anterior-superior acetabular cartilage and an absorbable monofilament suture repair of the cartilage was conducted.…”

Operative treatment of chondral defects in the hip joint: a systematic review

“…Thus, Sekiya et al [19] described a case of a 17-year-old male high school wrestler with bilateral CAM lesions as well as a 1 cm delaminated unstable cartilage flap in the anterior-superior acetabulum. The authors arthroscopically performed a microfracture underneath the flap of anterior superior acetabular cartilage and, due to flap instability, completed a suture repair of the cartilage with an absorbable polydiaxanone monofilament.…”