Page 23 - ISAKOS 2020 Newsletter Volume 2

Overall, these findings appear to be more consistent with a resolving post-traumatic subchondral fracture in an area of pincer impingement plus a chondrolabral lesion. Perhaps further testing with a local anaesthetic intra-articular injection would prove or disprove bone edema (active osteonecrosis) as the cause of pain.
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Conservative treatment can be used while waiting for the resolution of the acute inflammation and subchondral fracture resolution. As the patient currently has no pain, I would delay any surgical treatment until the pain is worse and / or the patient skeletally mature (in 1 or 2 years). I would approach this case with hip arthroscopy to repair the chondrolabral lesion and treat the pincer impingement, combined with a small anterior wall acetabular resection and a mini bumpectomy. If the subchondral head lesion is big enough, then I would consider bone decompression combined with retrograde cancellous bone-packing or treatment with retrograde osteochondral autograft transfer system (OATS). At our institution, we utilize expanded mesenchymal stem cells (MSCs) as presented at the 2017 ISHA conference.
References:
1. Mont MA, Zywiel MG, Marker DR, McGrath MS, Delanois RE. The natural history of untreated asymptomatic osteonecrosis of the femoral head: a systematic literature review. The Journal of bone and joint surgery American volume. 2010 Sep 15;92(12):2165- 70. Epub 2010/09/17. 2. Assenmacher AT, Pareek A, Reardon PJ, Macalena JA, Stuart MJ, Krych AJ. Long-term Outcomes After Osteochondral Allograft: A Systematic Review at Long-term Follow-up of 12.3 Years. Arthroscopy. 2016 Oct;32(10):2160-2168. doi: 10.1016/j. arthro.2016.04.020. Epub 2016 Jun 15.PMID: 27317013
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