Is Microfracture Necessary? Acetabular Chondrolabral Debridement/Abrasion Demonstrates Similar Outcomes and Survival to Microfracture in Hip Arthroscopy

A Multicenter Analysis

Mario Hevesi, Christopher Bernard, David E. Hartigan, Bruce A Levy, Benjamin G. Domb, Aaron Krych

Research output: Contribution to journalArticle

Abstract

Background: 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. In addition, patients treated with microfracture are subject to extended protected weightbearing rehabilitation to mitigate risk of subchondral plate fracture and to protect fibrocartilage tissue formation. Purpose: To determine the midterm patient-reported outcomes and failure rate of patients with grade 3 and 4 acetabular labrum articular disruption (ALAD) lesions managed with debridement/abrasion or microfracture. Study Design: Cohort study; Level of evidence, 3. Methods: Primary arthroscopic labral repair cases at 2 centers from November 2008 to April 2016 were reviewed for patients aged <55 years with unipolar ALAD grade 3 and 4 chondrolabral acetabular delamination. Patients undergoing microfracture and debridement/abrasion were compared using the 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: A total of 113 hips in 110 patients (66 males, 44 females; mean age, 34.5 ± 1.1 years) undergoing debridement/abrasion (n = 82) or microfracture (n = 31) were followed for a mean of 4.9 years (range, 2.0-8.5 years). Lesion size was not statistically different between the debridement/abrasion (1.3 ± 1.0 cm2) and microfracture cohorts (1.4 ± 1.0 cm2) (P =.47). Patients undergoing debridement/abrasion achieved 3.6-point mean improvements in VAS (P <.01), 21.2-point improvements in mHHS (P <.01), and 25.4-point improvements in HOS-SSS (P <.01), which were not significantly different from those observed in microfracture patients (P≥.20). The 5-year rate of survival free of revision surgery was 84.0% in the debridement/abrasion group and 85.6% in the microfracture group (P =.78). The cartilage treatment technique was found not to be predictive of revision risk during both univariate (hazard ratio [HR], 1.01; P =.98) and multivariate (HR, 0.93; P =.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 with those of patients undergoing microfracture. These outcomes support the consideration of preferential debridement/abrasion at the discretion of the treating surgeon to optimize recovery while maintaining established positive outcomes after hip arthroscopy.

Original languageEnglish (US)
Pages (from-to)1670-1678
Number of pages9
JournalAmerican Journal of Sports Medicine
Volume47
Issue number7
DOIs
StatePublished - Jun 1 2019

Fingerprint

Stress Fractures
Arthroscopy
Debridement
Hip
Survival
Cartilage
Pain Measurement
Joints
Fibrocartilage
Weight-Bearing
Reoperation
Cohort Studies
Rehabilitation
Survival Rate

Keywords

  • abrasion
  • chondroplasty
  • debridement
  • hip arthroscopy
  • HOS-SSS
  • labral repair
  • MCID
  • mHHS
  • microfracture
  • midterm
  • VAS

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Is Microfracture Necessary? Acetabular Chondrolabral Debridement/Abrasion Demonstrates Similar Outcomes and Survival to Microfracture in Hip Arthroscopy : A Multicenter Analysis. / Hevesi, Mario; Bernard, Christopher; Hartigan, David E.; Levy, Bruce A; Domb, Benjamin G.; Krych, Aaron.

In: American Journal of Sports Medicine, Vol. 47, No. 7, 01.06.2019, p. 1670-1678.

Research output: Contribution to journalArticle

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title = "Is Microfracture Necessary? Acetabular Chondrolabral Debridement/Abrasion Demonstrates Similar Outcomes and Survival to Microfracture in Hip Arthroscopy: A Multicenter Analysis",
abstract = "Background: 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. In addition, patients treated with microfracture are subject to extended protected weightbearing rehabilitation to mitigate risk of subchondral plate fracture and to protect fibrocartilage tissue formation. Purpose: To determine the midterm patient-reported outcomes and failure rate of patients with grade 3 and 4 acetabular labrum articular disruption (ALAD) lesions managed with debridement/abrasion or microfracture. Study Design: Cohort study; Level of evidence, 3. Methods: Primary arthroscopic labral repair cases at 2 centers from November 2008 to April 2016 were reviewed for patients aged <55 years with unipolar ALAD grade 3 and 4 chondrolabral acetabular delamination. Patients undergoing microfracture and debridement/abrasion were compared using the 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: A total of 113 hips in 110 patients (66 males, 44 females; mean age, 34.5 ± 1.1 years) undergoing debridement/abrasion (n = 82) or microfracture (n = 31) were followed for a mean of 4.9 years (range, 2.0-8.5 years). Lesion size was not statistically different between the debridement/abrasion (1.3 ± 1.0 cm2) and microfracture cohorts (1.4 ± 1.0 cm2) (P =.47). Patients undergoing debridement/abrasion achieved 3.6-point mean improvements in VAS (P <.01), 21.2-point improvements in mHHS (P <.01), and 25.4-point improvements in HOS-SSS (P <.01), which were not significantly different from those observed in microfracture patients (P≥.20). The 5-year rate of survival free of revision surgery was 84.0{\%} in the debridement/abrasion group and 85.6{\%} in the microfracture group (P =.78). The cartilage treatment technique was found not to be predictive of revision risk during both univariate (hazard ratio [HR], 1.01; P =.98) and multivariate (HR, 0.93; P =.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 with those of patients undergoing microfracture. These outcomes support the consideration of preferential debridement/abrasion at the discretion of the treating surgeon to optimize recovery while maintaining established positive outcomes after hip arthroscopy.",
keywords = "abrasion, chondroplasty, debridement, hip arthroscopy, HOS-SSS, labral repair, MCID, mHHS, microfracture, midterm, VAS",
author = "Mario Hevesi and Christopher Bernard and Hartigan, {David E.} and Levy, {Bruce A} and Domb, {Benjamin G.} and Aaron Krych",
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day = "1",
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TY - JOUR

T1 - Is Microfracture Necessary? Acetabular Chondrolabral Debridement/Abrasion Demonstrates Similar Outcomes and Survival to Microfracture in Hip Arthroscopy

T2 - A Multicenter Analysis

AU - Hevesi, Mario

AU - Bernard, Christopher

AU - Hartigan, David E.

AU - Levy, Bruce A

AU - Domb, Benjamin G.

AU - Krych, Aaron

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Background: 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. In addition, patients treated with microfracture are subject to extended protected weightbearing rehabilitation to mitigate risk of subchondral plate fracture and to protect fibrocartilage tissue formation. Purpose: To determine the midterm patient-reported outcomes and failure rate of patients with grade 3 and 4 acetabular labrum articular disruption (ALAD) lesions managed with debridement/abrasion or microfracture. Study Design: Cohort study; Level of evidence, 3. Methods: Primary arthroscopic labral repair cases at 2 centers from November 2008 to April 2016 were reviewed for patients aged <55 years with unipolar ALAD grade 3 and 4 chondrolabral acetabular delamination. Patients undergoing microfracture and debridement/abrasion were compared using the 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: A total of 113 hips in 110 patients (66 males, 44 females; mean age, 34.5 ± 1.1 years) undergoing debridement/abrasion (n = 82) or microfracture (n = 31) were followed for a mean of 4.9 years (range, 2.0-8.5 years). Lesion size was not statistically different between the debridement/abrasion (1.3 ± 1.0 cm2) and microfracture cohorts (1.4 ± 1.0 cm2) (P =.47). Patients undergoing debridement/abrasion achieved 3.6-point mean improvements in VAS (P <.01), 21.2-point improvements in mHHS (P <.01), and 25.4-point improvements in HOS-SSS (P <.01), which were not significantly different from those observed in microfracture patients (P≥.20). The 5-year rate of survival free of revision surgery was 84.0% in the debridement/abrasion group and 85.6% in the microfracture group (P =.78). The cartilage treatment technique was found not to be predictive of revision risk during both univariate (hazard ratio [HR], 1.01; P =.98) and multivariate (HR, 0.93; P =.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 with those of patients undergoing microfracture. These outcomes support the consideration of preferential debridement/abrasion at the discretion of the treating surgeon to optimize recovery while maintaining established positive outcomes after hip arthroscopy.

AB - Background: 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. In addition, patients treated with microfracture are subject to extended protected weightbearing rehabilitation to mitigate risk of subchondral plate fracture and to protect fibrocartilage tissue formation. Purpose: To determine the midterm patient-reported outcomes and failure rate of patients with grade 3 and 4 acetabular labrum articular disruption (ALAD) lesions managed with debridement/abrasion or microfracture. Study Design: Cohort study; Level of evidence, 3. Methods: Primary arthroscopic labral repair cases at 2 centers from November 2008 to April 2016 were reviewed for patients aged <55 years with unipolar ALAD grade 3 and 4 chondrolabral acetabular delamination. Patients undergoing microfracture and debridement/abrasion were compared using the 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: A total of 113 hips in 110 patients (66 males, 44 females; mean age, 34.5 ± 1.1 years) undergoing debridement/abrasion (n = 82) or microfracture (n = 31) were followed for a mean of 4.9 years (range, 2.0-8.5 years). Lesion size was not statistically different between the debridement/abrasion (1.3 ± 1.0 cm2) and microfracture cohorts (1.4 ± 1.0 cm2) (P =.47). Patients undergoing debridement/abrasion achieved 3.6-point mean improvements in VAS (P <.01), 21.2-point improvements in mHHS (P <.01), and 25.4-point improvements in HOS-SSS (P <.01), which were not significantly different from those observed in microfracture patients (P≥.20). The 5-year rate of survival free of revision surgery was 84.0% in the debridement/abrasion group and 85.6% in the microfracture group (P =.78). The cartilage treatment technique was found not to be predictive of revision risk during both univariate (hazard ratio [HR], 1.01; P =.98) and multivariate (HR, 0.93; P =.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 with those of patients undergoing microfracture. These outcomes support the consideration of preferential debridement/abrasion at the discretion of the treating surgeon to optimize recovery while maintaining established positive outcomes after hip arthroscopy.

KW - abrasion

KW - chondroplasty

KW - debridement

KW - hip arthroscopy

KW - HOS-SSS

KW - labral repair

KW - MCID

KW - mHHS

KW - microfracture

KW - midterm

KW - VAS

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