PMID- 31091140
OWN - NLM
STAT- MEDLINE
DCOM- 20200420
LR  - 20200420
IS  - 1552-3365 (Electronic)
IS  - 0363-5465 (Linking)
VI  - 47
IP  - 7
DP  - 2019 Jun
TI  - Is Microfracture Necessary? Acetabular Chondrolabral Debridement/Abrasion 
      Demonstrates Similar Outcomes and Survival to Microfracture in Hip Arthroscopy: A 
      Multicenter Analysis.
PG  - 1670-1678
LID - 10.1177/0363546519845346 [doi]
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 
      cm(2)) and microfracture cohorts (1.4 +/- 1.0 cm(2)) ( 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.
FAU - Hevesi, Mario
AU  - Hevesi M
AD  - Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Bernard, Christopher
AU  - Bernard C
AD  - Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Hartigan, David E
AU  - Hartigan DE
AD  - Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Phoenix, 
      Arizona, USA.
FAU - Levy, Bruce A
AU  - Levy BA
AD  - Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Domb, Benjamin G
AU  - Domb BG
AD  - American Hip Institute, Westmont, Illinois, USA.
FAU - Krych, Aaron J
AU  - Krych AJ
AD  - Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20190515
PL  - United States
TA  - Am J Sports Med
JT  - The American journal of sports medicine
JID - 7609541
SB  - IM
MH  - Acetabulum/surgery
MH  - Adult
MH  - Arthroscopy/*methods
MH  - Cohort Studies
MH  - Debridement/*methods
MH  - Female
MH  - Fractures, Stress/*surgery
MH  - Hip Joint/*surgery
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Patient Reported Outcome Measures
MH  - Treatment Outcome
MH  - Visual Analog Scale
MH  - Young Adult
OTO - NOTNLM
OT  - HOS-SSS
OT  - MCID
OT  - VAS
OT  - abrasion
OT  - chondroplasty
OT  - debridement
OT  - hip arthroscopy
OT  - labral repair
OT  - mHHS
OT  - microfracture
OT  - midterm
EDAT- 2019/05/16 06:00
MHDA- 2020/04/21 06:00
CRDT- 2019/05/16 06:00
PHST- 2019/05/16 06:00 [pubmed]
PHST- 2020/04/21 06:00 [medline]
PHST- 2019/05/16 06:00 [entrez]
AID - 10.1177/0363546519845346 [doi]
PST - ppublish
SO  - Am J Sports Med. 2019 Jun;47(7):1670-1678. doi: 10.1177/0363546519845346. Epub 
      2019 May 15.