Riedl Moritz, Banke Ingo J, Goronzy Jens, Sobau Christian, Steimer Oliver, Thier Steffen, Zinser Wolfgang, Henssler Leopold, Alt Volker, Fickert Stefan
Department of Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany.
Sporthopaedicum Straubing, 94315 Straubing, Germany.
J Clin Med. 2022 Oct 25;11(21):6283. doi: 10.3390/jcm11216283.
According to current recommendations, large cartilage defects of the hip over 2 cm are suggested to undergo autologous chondrocyte transplantation (ACT), while small defects should be treated with microfracture. We investigated if patients with small chondral defects of the hip joint (≤100 mm) actually benefit from microfracture.
In this retrospective multicenter cohort study 40 patients with focal acetabular cartilage defects smaller than 100 mm and of ICRS grade ≥2 caused by femoroacetabular impingement were included. Twenty-six unrandomized patients underwent microfracture besides treatment of the underlying pathology; in 14 patients cartilage lesions were left untreated during arthroscopy. Over a mean follow-up of 28.8 months patient-reported outcome was determined using the iHOT33 (international hip outcome tool) and the VAS (visual analog scale) for pain.
The untreated group showed a statistically significant improvement of the iHOT33 after 12 ( = 0.005), 24 ( = 0.019), and 36 months ( = 0.002) compared to the preoperative score, whereas iHOT33 in the microfracture group did not reveal statistically significant changes over time. There was no significant difference between both groups on any time point. Regarding pain both groups did not show a significant improvement over time in the VAS.
The subjective outcome of patients with small cartilage defects of the hip (≤100 mm) improves 12 months after arthroscopic FAIS surgery without any cartilage treatment. However, no improvement could be seen after microfracture. Therefore, a reserved surgical treatment for small cartilage defects of the hip under preservation of the subchondral bone is recommended especially if a simultaneous impingement correction is performed.
根据当前建议,髋关节超过2厘米的大软骨缺损建议进行自体软骨细胞移植(ACT),而小缺损则应采用微骨折治疗。我们研究了髋关节小软骨缺损(≤100平方毫米)的患者是否真的能从微骨折治疗中获益。
在这项回顾性多中心队列研究中,纳入了40例因股骨髋臼撞击导致的局灶性髋臼软骨缺损小于100平方毫米且国际软骨修复协会(ICRS)分级≥2级的患者。26例未随机分组的患者除了治疗潜在病理状况外还接受了微骨折治疗;14例患者在关节镜检查期间未对软骨损伤进行治疗。在平均28.8个月的随访期内,使用国际髋关节结局工具(iHOT33)和视觉模拟评分法(VAS)评估疼痛程度,以此确定患者报告的结局。
与术前评分相比,未治疗组在术后12个月(P = 0.005)、24个月(P = 0.019)和36个月(P = 0.002)时iHOT33有统计学意义的改善,而微骨折组的iHOT33随时间未显示出统计学意义的变化。两组在任何时间点均无显著差异。关于疼痛,两组在VAS评分上随时间均未显示出显著改善。
髋关节小软骨缺损(≤100平方毫米)患者在关节镜下股骨髋臼撞击综合征(FAIS)手术后12个月,未进行任何软骨治疗,主观结局有所改善。然而,微骨折治疗后未见改善。因此,建议对髋关节小软骨缺损采取保留软骨下骨的保守手术治疗,尤其是在同时进行撞击矫正的情况下。