Microfracture of the Hip in Athletes

Crawford, Kevin; Philippon, Marc J.; Sekiya, Jon K.; Rodkey, William G.; Steadman, J. Richard

doi:10.1016/j.csm.2005.12.004

Cited by 146 publications

(95 citation statements)

References 22 publications

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“…Hip arthroscopy is useful in the treatment of labral tears, but labral excision alone does not completely resolve hip pain in patients with concomitant cartilage injury, with success rates of only 21% reported [5,17,35,42]. Microfracture of the acetabulum or acetabular rim resection can be performed in conjunction with the arthroscopy, but in either case the chondral delamination will alter the prognosis and postoperative rehabilitation protocol [6,8,11,28,32,39,40,42]. An open femoroacetabular osteoplasty with resection of as much as 1 cm of the rim of the acetabulum to remove the site of chondral delamination can be planned if preoperatively it is recognized the labral tear is associated with acetabular cartilage delamination [35].…”

Section: Discussionmentioning

confidence: 99%

“…Femoroacetabular impingement is recognized as one of the major causes of labral tears of the hip [24,36,45,46]. Depending on the status of the acetabular articular cartilage, labral tears secondary to femoroacetabular impingement can be treated by various surgical procedures, including arthroscopic débridement, labral reattachment, labral surgery with concomitant chondral microfracture, or labral surgery with open or arthroscopic femoral head-neck osteochondroplasty [8,10,11,30,31,34,39,40]. The outcomes, complications, and postoperative recovery after these procedures are very different [6,10,16,17,30,31,37,42].…”

Section: Introductionmentioning

confidence: 99%

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Delamination Cysts: A Predictor of Acetabular Cartilage Delamination in Hips with a Labral Tear

Gdalevitch

Smith

Tänzer

2008

Clin Orthop Relat Res

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The treatment and prognosis of labral tears of the hip depend primarily on whether there is concomitant injury of the adjacent acetabular articular cartilage. We asked whether a delamination cyst on the preoperative plain radiographs correlated with delamination of the acetabular articular cartilage at the time of hip arthroscopy. We reviewed the preoperative radiographs of 125 consecutive hips that had a labral tear at hip arthroscopy for the presence of a delamination cyst. A delamination cyst was defined as an acetabular subchondral cyst either directly adjacent to a lateral acetabular cyst or in relation to a subchondral crack in the anterosuperior portion of the acetabulum. All patients with acetabular cartilage delamination at arthroscopy were identified. There were 16 patients with delamination cysts on radiographs and 15 patients with cartilage delamination at arthroscopy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Delamination Cysts: A Predictor of Acetabular Cartilage Delamination in Hips with a Labral Tear

Gdalevitch

Smith

Tänzer

2008

Clin Orthop Relat Res

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“…This clot provides the environment for the pluripotent and mesenchymal cells to differentiate and form fibrocartilaginous tissue filling the defect. 2,7 Although the new fibrocartilage lacks the biomechanical properties of native hyaline articular cartilage, specifically in its ability to tolerate sheer stresses, 8 it has been shown to relieve symptoms in 70% to 90% of patients undergoing knee microfracture. 7 The standard technique, adapted from the knee, uses longer microfracture awls to accommodate the hip joint.…”

Section: Microfracturementioning

confidence: 99%

“…2 A literature search identified only 6 studies focusing specifically on microfracture of the hip, four of which focused on clinical outcomes of the procedure (Table 1). The procedure uses arthroscopic instruments to create perforations in the bone to provide a conduit for undifferentiated stem cells to migrate from the marrow into the area of the defect to form a clot.…”

Section: Microfracturementioning

confidence: 99%

Arthroscopic Acetabular Microfracture With the Use of Flexible Drills: A Technique Guide

Haughom

Erickson

Rybalko

et al. 2014

Arthroscopy Techniques

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Chondral injuries of the hip joint are often symptomatic and affect patient activity level. Several procedures are available for addressing chondral injuries, including microfracture. Microfracture is a marrow-stimulating procedure, which creates subchondral perforation in the bone, allowing pluripotent mesenchymal stem cells to migrate from the marrow into the chondral defect and form fibrocartilaginous tissue. In the knee, microfracture has been shown to relieve pain symptoms. In the hip, microfracture has been studied to a lesser extent, but published studies have shown promising clinical outcomes. The depth, joint congruity, and geometry of the hip joint make microfracture technically challenging. The most common technique uses hip-specific microfracture awls, but the trajectory of impaction is not perpendicular to the subchondral plate. Consequently, the parallel direction of impaction creates poorly defined channels. We describe an arthroscopic microfracture technique for the hip using a flexible microfracture drill. The drill and angled guides simplify access to the chondral defect. The microfracture drill creates clear osseous channels, avoiding compaction of the surrounding bone and obstruction of the channels. Furthermore, this technique allows for better control of the angle and depth of the drill holes, which enhances reproducibility and may yield improved clinical outcomes.

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“…Fullthickness cartilage damage is treated with debridement to create stable borders. Microfracture is performed when necessary according to the technique of Steadman and colleagues 10 in cases in which bone is present after the bony decompression at the surgeon's discretion.…”

Section: Acetabular Notchplastymentioning

confidence: 99%

Arthroscopic Decompression of Central Acetabular Impingement With Notchplasty

Gupta

Redmond

Hammarstedt

et al. 2014

Arthroscopy Techniques

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Acetabular notch osteophytes are often encountered during routine diagnostic arthroscopy of the hip. It has been our observation that when notch osteophytes are present, there is often corresponding chondral damage to the anterosuperior femoral head and ligamentum teres degeneration. We propose that removal of the notch osteophyte and decompression of the articulating surface offer an effective method of delaying the progression of arthritis. This article describes in detail the technique used to perform arthroscopic acetabular notchplasty, and a companion video, demonstrating the procedure, is included. Our experience suggests that decompression of the acetabular notch can remove offending structural abnormalities that can potentially cause further chondral damage and may hasten the progression of arthritis.

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Microfracture of the Hip in Athletes

Cited by 146 publications

References 22 publications

Delamination Cysts: A Predictor of Acetabular Cartilage Delamination in Hips with a Labral Tear

Delamination Cysts: A Predictor of Acetabular Cartilage Delamination in Hips with a Labral Tear

Arthroscopic Acetabular Microfracture With the Use of Flexible Drills: A Technique Guide

Arthroscopic Decompression of Central Acetabular Impingement With Notchplasty

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