2017 ISAKOS Biennial Congress ePoster #716

 

Comparison Of Microfracture Versus Rim Trim And Labral Repair In The Treatment Of Acetabular Chondral Damage Associated With Cam Dominant Femoroacetabular Impingement

Matthew J. Brick, MBChB, FRACS, Auckland NEW ZEALAND
Catherine J. Bacon, PhD, MSc, BSc, BPhed(Hons), Auckland NEW ZEALAND
Joshua S. Knudsen, MBChB, Auckland NEW ZEALAND
Claudia R. Brick, BMedSci, Auckland NEW ZEALAND

Orthosports North Harbour, Auckland, NEW ZEALAND

FDA Status Cleared

Summary

This study provides current surgical outcome data evaluating two surgical treatments for cam dominant femoroacetabular impingement.

Abstract

Background

Full thickness articular cartilage loss from the anterolateral acetabulum is a well-recognised problem in the setting of cam-dominant femoroacetabular impingement (CAM FAI). A variety of arthroscopic treatments have been advocated including removal of the cartilaginous flap and microfracture to exposed bone, repair of the flap, and trimming of the acetabular rim thus removing the chondral defect. There are no current data on the superiority of these methods.

Purpose

To evaluate the outcomes of acetabular microfracture versus acetabular rim trim and labral repair and the arthroscopic treatment of patients with diagnosed CAM dominant femoroacetabular impingement.

STUDY DESIGN:
Pre- and post-operative data were prospectively collected and retrospectively reviewed for patients who underwent hip arthroscopy at our institution between 2010 and 2014. Between 2010 and 2012 full thickness chondral defects were treated with microfracture of any Grade 4 cartilage loss. Between 2012 and 2014 patients were treated with rim trim and labral repair providing socket morphology would allow bone removal. Non-arthritic hip (NAH) score, visual analogue scale for pain and normality, patient satisfaction, and lateral centre edge angle were all recorded.

Results

A total of 200 procedures were included in Group 1 (microfracture) and 184 in Group 2 (rim trim and labral repair). Revision surgery was required for 11 Group 1 procedures (5% rate), but only 3 within 2 years of surgery, and 5 Group 2 procedures (3% rate), all within 2 years of surgery. Preliminary hip score data showed no difference between groups in total NAH scores, increasing from 60.4 [95% confidence interval 57.2 to 63.7] before surgery to 80.0 [77.3 to 82.6] after surgery in Group 1 and from 65.3 [61.4 to 69.1] to 85.9 [82.8 to 89.0] after surgery in Group 2 (p = 0.7 for analysis of variance time x group interaction).

Conclusion

This study demonstrates that hip arthroscopy with either microfracture or rim trim and labral repair can successfully treat CAM dominant femoroacetabular impingement with a minimum of 2-year follow-up. Both procedures have low revision rates.

KEYWORDS: Arthroscopic Surgery; Surgical Procedures; Hip Joint; Hip Injuries; Impingement; Cartilage