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Minced Cartilage Implantation in Acetabular Cartilage Defects: Case Series with 2-Year Results
(2023)
Objective
The objective was to evaluate clinical outcome and safety of arthroscopic, autologous minced cartilage implantation for acetabular cartilage lesions observed during hip arthroscopy to treat femoroacetabular impingement syndrome (FAIS).
Design
Eleven male patients, average age: 29.4 ± 5.4 years, average body mass index (BMI): 24.2 ± 2.2 kg/m2, scheduled for hip arthroscopy due to FAIS accompanied by an acetabular cartilage lesion were included in the case series. Cartilage tissue was harvested and minced from the loose cartilage flap at the chondrolabral lesion by arthroscopic shaver, augmented with autologous conditioned plasma, implanted into the defect, and fixated by autologous thrombin. Concomitant interventions were performed as indicated. The patients were evaluated preoperatively and at 24-month follow-up, using the International Hip Outcome Tool-12 (iHOT-12) and Visual Analog Scale (VAS) pain score and by magnetic resonance imaging (MRI) using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) grading scale at the 2-year follow-up.
Results
The defect size was on average 3.5 cm2 (1.5-4.5 cm2). From preoperatively to 2 years postoperatively, the iHOT-12 significantly improved from 50.2 ± 18 to 86.5 ± 19 (P < 0.0001), and pain score decreased from 5.6 ± 1.8 to 1.0 ± 1.5 (P < 0.0001) on the Visual Analog Scale pain score. Regarding functional outcome and pain, 10 of the 11 patients and all patients reached the minimal clinically important difference (MCID), respectively. The postoperative average MOCART score was 87.2 (± 9.2). No adverse events or reoperations were observed.
Conclusions
Arthroscopic, autologous minced cartilage implantation for treating full-thickness acetabular cartilage lesions in FAIS shows statistically and clinically significant improvement at short-term follow-up.
Operationsziel
Durchführung einer periazetabulären Osteotomie (PAO) über einen minimal-invasiven Zugang zur dreidimensionalen Korrektur der Orientierung der Hüftgelenkpfanne.
Indikationen
Symptomatische Hüftdysplasie in der Adoleszenz nach dem Schluss der Y‑Wachstumsfuge und beim Erwachsenen.
Kontraindikationen
Fortgeschrittene Arthrose (Arthrosegrad ≥ 2 nach Tönnis), präformierte Sekundärpfanne, offene Y‑Wachstumsfuge.
Operationstechnik
Über einen minimal-invasiven Zugang wird eine periazetabuläre Osteotomie durchgeführt.
Ergebnisse
Insgesamt wurden 39 Patienten über 3,5 (3 bis 4,5) Jahre nachbeobachtet. Der laterale Centrum-Erker-Winkel nach Wiberg konnte signifikant von 16,1° (7–24°) auf 30,5° (25–37°) (p < 0,0001), der Tragflächenwinkel von 13,2° (2–25,3°) auf 2,8° (−3–13°) (p < 0,0001) korrigiert werden. Die mittlere Operationszeit betrug 88 (57 bis 142) Minuten. Es traten keine schweren Komplikationen auf.