Podium Presentation Microfracture/Bone Marrow Stimulation

12.1.1 - Is Microfracture Necessary? Acetabular Chondrolabral Debridement Exhibits Similar Outcomes to Microfracture: A Multi-Center Analysis

Presentation Number
12.1.1
Presentation Topic
Microfracture/Bone Marrow Stimulation
Lecture Time
17:00 - 17:09
Session Type
Free Paper Session
Corresponding Author
  • M. Hevesi (Rochester, US)
Authors
  • M. Hevesi (Rochester, US)
  • C. Bernard (Rochester, US)
  • D. Hartigan (Rochester, US)
  • B. Levy (Rochester, US)
  • B. Domb (Des Plaines, US)
  • A. Krych (Rochester, US)
Disclosure
No Significant Commercial Relationship

Abstract

Purpose

Hip arthroscopy is becoming more advanced and commonly performed. However, significant controversy exists regarding whether high-grade acetabular cartilage lesions should be treated with debridement/abrasion or microfracture. The purpose of this study was to determine the mid-term patient-reported outcomes and failure rates of Grade 3 and 4 acetabulum labrum articular disruption (ALAD) lesions managed with debridement/abrasion or microfracture.

Methods and Materials

Primary arthroscopic labral repair cases at two centers from November 2008 to April 2016 were reviewed in patients aged <55 years with unipolar ALAD Grade 3/4 chondrolabral acetabular delamination. Patients undergoing microfracture and debridement/abrasion were compared using visual analog pain scale (VAS), modified Harris Hip Score (mHHS), and Hip Outcome Score–Sports Specific Subscale (HOS-SSS) to determine predictors of outcomes and failure.

Results

113 hips in 110 patients (66 M, 44 F, mean age 34.5±1.1) undergoing debridement/abrasion (n=82) or microfracture (n=31) were followed for a mean of 4.9 years (range 2.0–8.5). Lesion size was not statistically different between the debridement/abrasion (1.3±1.0 cm2) and microfracture cohorts (1.4±1.0 cm2, p=0.47). Patients undergoing debridement/abrasion achieved 3.6 point mean improvements in VAS (p<0.01), 21.2 point improvements in mHHS (p<0.01), and 25.4 point improvements in HOS-SSS (p<0.01), which were statistically similar to that observed in microfracture patients (p≥0.20). Five-year survival free of revision surgery was 84.0% in the debridement/abrasion group and 85.0% in the microfracture group (p=0.78). Cartilage treatment technique was found not to be predictive of revision risk during both univariate (Hazards Ratio [HR]:1.01, p=0.98) and multivariate (HR:0.93, p=0.90) analysis accounting for patient age, lesion grade, and acetabular coverage.

Conclusion

Patients undergoing debridement/abrasion of high-grade unipolar acetabular cartilage lesions demonstrate similar outcome scores and revision rates compared to patients undergoing microfracture. These outcomes support the consideration of preferential debridement/abrasion at the discretion of the treating surgeon in order to optimize recovery while maintaining established positive outcomes following hip arthroscopy.

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