M. Hevesi (Rochester, US)Mayo Clinic Department of Orthopedic Surgery
Presenter Of 2 Presentations
12.1.1 - Is Microfracture Necessary? Acetabular Chondrolabral Debridement Exhibits Similar Outcomes to Microfracture: A Multi-Center Analysis
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.
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.
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.
18.1.10 - The Sound of Cartilage: Audiometric Characterization of Cartilage Preparation in Joint Preservation Surgery
Precise preparation of cartilage defects is technically critical in joint preservation surgery. Whether employing microfracture or advanced methodologies such as matrix induced autologous chondrocyte implantation (MACI), controlled-depth debridement is key to clinical success, with penetration beyond the calcified layer leading to risk of subchondral fracture whereas inadequate debridement leaves behind a sub-optimal base with residual pathologic tissue. To date, techniques to assist level of debridement remain informal, with surgeons employing experience and often attempting to describe audio feedback with distinct sound and pitch changes assisting with debridement when training others. The purpose of this study was to characterize the audiometric properties of chondral defect debridement by cartilage surgery specialists to inform technique and depth of curettage.
Methods and Materials
Audiometric recordings of cartilage defect preparation with a ringed curette at the time of surgical arthrotomy were obtained for formal analysis, to be correlated to the time at which the calcified layer had been satisfactorily debrided according to the operating surgeon. Digital audio analysis was employed to determine peak sound intensity (decibels, dB) of individual curette strokes as well as stroke spectrography to analyze frequency profile from 0 to 22,000 hertz (Hz). Analysis was performed comparing the curette strokes prior to and immediately following satisfactory cartilage debridement by the surgeon in order to characterize tone and volume intensity profile changes.
Peak curette stroke volume intensity was on average 6.0±1.4 dB or 4-fold higher immediately prior to debridement completion as compared to after satisfactory preparation (p<0.01). In addition, stroke pitch changed substantially, with a sharp drop off in frequencies above 2400 Hz observed following satisfactory defect debridement (p<0.01).
Cartilage surgeons can be assisted by both a substantial decrease in heard curette volume intensity and lower curette pitch when achieving satisfactory calcified layer debridement. This may serve as an additional technical aid during cartilage restoration procedures.