Techniques for treatment of chondral defects in the hip
Krueger, Christine Erin
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Hip arthroscopy is a relatively new procedure and is used to treat loose bodies, labral tears, femoroacetabular impingement, and chondral injuries, among other pathologies. Acetabular tear are one of the most common indications and are commonly accompanied by a chondral lesion. The labra1 tear and chondral defect are often caused by an underlying morphological conflict such as femoroacetabular impingement: a cam or pincer. Untreated chondral lesions will eventually lead to osteoarthritis and total joint replacement. Thus, their treatment is critical to preservation of the hip joint. Depending on the grade of the chondral lesion, different techniques for treatment are recommended in the literature. Common treatments are debridement, excision, and microfracture. It is also important to treat the underlying bony impingement and to repair the labrum to recreate the seal of the synovial fluid inside of the joint. Two novel methods of treating chondral damage are fibrin adhesive and autologous chondrocyte implantations. These techniques may enhance the quality of the chondral repair and further delay the progression of osteoarthritis. Osteochondraldissecans is a condition in which a segment of osteochondral tissue is loose or separated from the underlying subchondral bone. Techniques for treatment of OCD lesions in the knee have a long history of clinical outcomes and may be applicable for treatment of chondral lesions in the hip. Treatments of chondral defects in the hip are well documented and depend on the classification of the lesion. There is no gold standard of care to return the joint back to its pre-lesion state. The literature shows that as much viable cartilage tissue as possible should be saved, sealants should be used to reattach that viable tissue back to the subchondral bone, and microfracture should be performed to encourage healing. If there is not any viable tissue, microfracture for a small lesion is effective to promote the growth of fibrocartilage, which results in satisfactory short-term clinical outcomes. For a large defect, an implant such as ACT should be considered. An animal study that compares the various methods of chondral defect treatment should be performed so that biopsies can be done post-operatively to identify and evaluate the tissue in the defect after the healing period. In clinical studies, MRI should be used postoperatively to supplement the pain and function scores with visual evaluation of the articular tissue.
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