Page 23 - ISAKOS 2020 Newsletter Volume 2
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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.
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.
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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