Rodriguez-Fontan Francisco, Payne Karin A, Chahla Jorge, Mei-Dan Omer, Richards Abigail, Uchida Soshi, Pascual-Garrido Cecilia
Regenerative Orthopedics Laboratory, Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Steadman Philippon Research Institute, Vail, Colorado, USA.
Orthop J Sports Med. 2017 Aug 16;5(8):2325967117723608. doi: 10.1177/2325967117723608. eCollection 2017 Aug.
Chondrolabral damage is commonly observed in patients with cam-type femoroacetabular impingement (FAI). Chondral flap reattachment has recently been proposed as a possible preservation technique.
PURPOSE/HYPOTHESIS: The purpose of this study was to determine the viability and tissue quality of chondral flaps from patients with FAI at the time of arthroscopy. It was hypothesized that chondral flaps from patients with cam lesions of the hip would exhibit less viability and greater tissue degeneration than would those of a matched control group.
Cohort study; Level of evidence, 2.
Patients with cam-type FAI who were treated with hip arthroscopy between 2014 and 2016 were asked to participate in this study. The cartilage lesions were localized and classified intraoperatively according to Beck classification. A chondral flap (study group) and a cartilage sample (control group) were obtained from each patient for histologic evaluation. Cellular viability and tissue quality were examined and compared in both groups. Cellular viability was determined with live/dead staining, and tissue quality was evaluated using safranin O/fast green, hematoxylin and eosin (H&E) staining, and immunohistochemistry for collagen II. Osteoarthritis Research Society International (OARSI) grading was used for quality assessment, and Image J software was used to calculate the percentage of tissue viability and Col II stain.
A total of 10 male patients with a mean age of 38.4 years (range, 30-55 years) were enrolled. All chondral flaps were classified as Beck grade 4. The mean cellular viability of the chondral flaps was reduced (54.6% ± 25.6%), and they were found to be degenerated (OARSI grade, 4 ± 1.27). Control samples also had reduced viability (38.8% ± 30.3%) and were degenerative (OARSI grade, 3.5 ± 1.38). There was no statistically significant intergroup difference for viability ( = .203) or OARSI grade ( = .645), nor was there an intragroup correlation between viability and OARSI grade ( > .05). A significant negative correlation ( = -0.9, = .035) was found between OARSI grade and collagen II percentage scale in 5 selected samples.
Despite appearing normal macroscopically, the chondral flaps from patients with cam-type FAI displayed loss of viability and tissue degeneration. In addition, control samples obtained away from the injury area also displayed cartilage damage and degeneration. Careful consideration should be taken when attempting to reattach the chondral flap.
盂唇损伤在凸轮型股骨髋臼撞击症（FAI）患者中较为常见。最近有人提出软骨瓣重新附着是一种可能的保留技术。
目的/假设：本研究的目的是确定关节镜检查时FAI患者软骨瓣的活力和组织质量。研究假设为，与匹配的对照组相比，髋关节凸轮损伤患者的软骨瓣活力更低，组织退变更严重。
队列研究；证据等级，2级。
邀请2014年至2016年间接受髋关节镜治疗的凸轮型FAI患者参与本研究。术中根据贝克分类法对软骨损伤进行定位和分类。从每位患者获取一个软骨瓣（研究组）和一个软骨样本（对照组）进行组织学评估。检查并比较两组的细胞活力和组织质量。通过活/死染色确定细胞活力，使用番红O/固绿、苏木精和伊红（H&E）染色以及II型胶原免疫组化评估组织质量。采用国际骨关节炎研究学会（OARSI）分级进行质量评估，使用Image J软件计算组织活力百分比和II型胶原染色百分比。
共纳入10例平均年龄为38.4岁（范围30 - 55岁）的男性患者。所有软骨瓣均分类为贝克4级。软骨瓣的平均细胞活力降低（54.6% ± 25.6%），且发现其退变（OARSI分级，4 ± 1.27）。对照样本的活力也降低（38.8% ± 30.3%），且有退变（OARSI分级，3.5 ± 1.38）。两组间在活力（P = 0.203）或OARSI分级（P = 0.645）方面无统计学显著差异，且组内活力与OARSI分级之间无相关性（P > 0.05）。在5个选定样本中，OARSI分级与II型胶原百分比量表之间存在显著负相关（r = -0.9，P = 0.035）。
尽管凸轮型FAI患者的软骨瓣在宏观上看似正常，但显示出活力丧失和组织退变。此外，从损伤区域以外获取的对照样本也显示出软骨损伤和退变。在尝试重新附着软骨瓣时应谨慎考虑。
