Is Microfracture Necessary? Acetabular Chondrolabral Debridement/Abrasion Demonstrates Similar Outcomes and Survival to Microfracture in Hip Arthroscopy: A Multicenter Analysis

Hevesi, Mario; Bernard, Christopher D.; Hartigan, David E.; Levy, Bruce A.; Domb, Benjamin G.; Krych, Aaron J.

doi:10.1177/0363546519845346

Cited by 37 publications

(17 citation statements)

References 62 publications

(76 reference statements)

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“…Large effect sizes for patient-reported physical activity (where able to be calculated) were seen in all studies at latest follow-up for the HOS, HOOS, HAGOS and iHOT33 subscales, with the exception of ten study groups for the HOS [44, 80,85,97,98,138,142,144,146,147]; and one for HAGOS [17] in which effect sizes were moderate pre-to post-arthroscopy. In assessing progress between two post-arthroscopy time points, Kemp et al [89] determined a small effect size for the HOOS-SR.…”

Section: Main Findingsmentioning

confidence: 99%

Physical Activity Following Hip Arthroscopy in Young and Middle-Aged Adults: A Systematic Review

et al. 2020

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Background: Hip arthroscopy is a common surgical intervention for young and middle-aged adults with hiprelated pain and dysfunction, who have high expectations for returning to physical activity following surgery. The purpose of this review was to evaluate the impact of hip arthroscopy on physical activity post-arthroscopy. Methods: A systematic search of electronic databases was undertaken in identifying studies from January 1st 1990 to December 5th 2019. The search included English language articles reporting physical activity as an outcome following hip arthroscopy in adults aged 18-50 years. Quality assessment, data extraction and synthesis of included studies were undertaken. Results: Full text articles (n = 234) were assessed for eligibility following screening of titles and abstracts (n = 2086), yielding 120 studies for inclusion. The majority (86%) of the studies were level 4 evidence. One study reported objective activity data. The most frequently occurring patient-reported outcome measure was the Hip Outcome Score-sport-specific subscale (HOS-SS, 84% of studies). Post--arthroscopy improvement was indicated by large effect sizes for patient-reported outcome measures (standard paired difference [95% confidence interval] −1.35[−1.61 to −1.09] at more than 2 years post-arthroscopy); however, the majority of outcome scores for the HOS-SS did not meet the defined level for a patient-acceptable symptom state. Conclusion: The current level of available information regarding physical activity for post arthroscopy patients is limited in scope. Outcomes have focused on patients' perceived difficulties with sport-related activities with a paucity of information on the type, quality and quantity of activity undertaken. Level of Evidence: Level IV, systematic review of Level 2 through to Level 4 studies

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Section: Main Findingsmentioning

confidence: 99%

Physical Activity Following Hip Arthroscopy in Young and Middle-Aged Adults: A Systematic Review

et al. 2020

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“… 2 Underpreparation leads to inadequate debridement of pathologic cartilage, which impairs collagen bonding and increases risk of delamination. 3 , 4 In contrast, overpreparation leads to violation of the subchondral plate and associated risk of subchondral fracture and intralesional osteophyte formation.…”

Section: Introductionmentioning

confidence: 99%

The Sound of Cartilage Repair: The Importance of Using Pitch and Volume Cues in Cartilage Restoration Surgery

Hevesi

Genechten

Krych

et al. 2021

Arthroscopy Techniques

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Articular cartilage defects are common and can result in substantial pain and disability, prompting operative intervention, which commonly includes chondral debridement. Controlled defect preparation up to but not beyond the calcified cartilage layer is key to clinical success, but this remains technically challenging. We present a technique highlighting the substantial decrease in curette stroke volume and associated shift to a lower pitch when achieving satisfactory open cartilage defect debridement. These audiologic cues correlate well with histologic accuracy of debridement. Therefore, quantifiable pitch and volume changes serve as valuable technical cues for precise defect preparation at the time of joint preservation surgery. Classifications I: knee, II: cartilage.

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“…27 A recent cohort study of patients undergoing debridement/abrasion of high-grade unipolar acetabular cartilage lesions demonstrated similar outcome scores and revision rates to those of patients undergoing microfracture. 11 Numerous studies have explored the possibility of augmentation of cartilage repair using different stem cells, growth factors, and scaffolds. One strategy is to modulate the chondral defect microenvironment to generate more hyaline-like cartilage.…”

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confidence: 99%

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confidence: 99%

Intra-articular Injection of Bevacizumab Enhances Bone Marrow Stimulation–Mediated Cartilage Repair in a Rabbit Osteochondral Defect Model

et al. 2021

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Background: Bone marrow stimulation (BMS) via microfracture historically has been a first-line treatment for articular cartilage lesions. However, BMS has become less favorable because of resulting fibrocartilage formation. Previous studies have shown that angiogenesis blockade promotes cartilage repair. Bevacizumab is a Food and Drug Administration–approved medication used clinically to prevent angiogenesis. Hypothesis: The intra-articular injection of bevacizumab would prevent angiogenesis after BMS and lead to improved cartilage repair with more hyaline-like cartilage. Study Design: Controlled laboratory study. Methods: The dose of bevacizumab was first optimized in a rabbit osteochondral defect model with BMS. Then, 48 rabbits (n = 8/group/time point) were divided into 3 groups: osteochondral defect (defect), osteochondral defect + BMS (BMS group), and osteochondral defect + BMS + bevacizumab intra-articular injection (bevacizumab group). Rabbits were sacrificed at either 6 or 12 weeks after surgery. Three-dimensional (3D) micro–computed tomography (microCT), macroscope score, modified O’Driscoll histology scores, collagen type 2, Herovici staining, and hematoxylin and eosin staining were performed. Angiogenesis markers were also evaluated. Results: The intra-articular dose of 12.5 mg/0.5 mL bevacizumab was found to be effective without deleteriously affecting the subchondral bone. Intra-articular injection of bevacizumab resulted in significantly improved cartilage repair for the bevacizumab group compared with the BMS or the defect group based on 3D microCT, the macroscope score (both P < .05), the modified O’Driscoll histology score ( P = .0034 and P = .019 vs defect and BMS groups, respectively), collagen type 2, Herovici staining, and hematoxylin and eosin staining at 6 weeks. Cartilage in the bevacizumab group had significantly more hyaline cartilage than did that in other groups. At 12 weeks, the cartilage layer regenerated in all groups; however, the bevacizumab group showed more hyaline-like morphology, as demonstrated by microCT, histology scores ( P < .001 and .0225 vs defect and BMS groups, respectively), histology, and immunohistochemistry. The bevacizumab injection did not significantly change mRNA expressions of smooth muscle actin, vascular endothelial growth factor, or hypoxia-inducible factor-1 alpha. Conclusion: Intra-articular injection of bevacizumab significantly enhanced the quality and quantity of hyaline-like cartilage after BMS in a rabbit model. Future large-animal and human studies are necessary to evaluate the clinical effect of this therapy, which may lead to improved BMS outcomes and thus the durability of the regenerated cartilage. Clinical Relevance: The use of bevacizumab may be an important clinical adjunct to improve BMS-mediated cartilage repair.

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Is Microfracture Necessary? Acetabular Chondrolabral Debridement/Abrasion Demonstrates Similar Outcomes and Survival to Microfracture in Hip Arthroscopy: A Multicenter Analysis

Cited by 37 publications

References 62 publications

Physical Activity Following Hip Arthroscopy in Young and Middle-Aged Adults: A Systematic Review

Physical Activity Following Hip Arthroscopy in Young and Middle-Aged Adults: A Systematic Review

The Sound of Cartilage Repair: The Importance of Using Pitch and Volume Cues in Cartilage Restoration Surgery

Intra-articular Injection of Bevacizumab Enhances Bone Marrow Stimulation–Mediated Cartilage Repair in a Rabbit Osteochondral Defect Model

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