Arthroscopic treatment of chondral defects in the hip: a systematic review of the literature

The aim of this study was to assess the evidence for arthroscopic treatment of chondral defects of the hip through a systematic review of the literature.
A systematic review of the literature was carried out in order to identify all publications relating to arthroscopic treatment of chondral defects in the hip joint. Case reports, open surgical techniques and those relating to osteonecrosis were excluded. The publications were assessed for the size of the chondral lesion, its location, its severity, the size of the chondral defect and the surgical technique. Associated injuries, the length of follow-up and the outcome scores were recorded. The study cohorts were defined by surgical technique (debridement versus microfracture versus autologous chondrocyte implantation). A statistical analysis of these data was also carried out.
The literature search identified 269 articles, of which only 12 met the study criteria. In all, these articles covered 579 cases treated with debridement, 279 with the microfracture technique and 37 with autologous chondrocyte implantation. Patients were followed up for a mean of 27.1 months. All the lesions treated either with microfracture or with autologous chondrocyte implantation were high grade (Outerbridge 3 to 4). The size of the lesion, however, was significantly larger in the cases treated with autologous chondrocyte implantation than in those that underwent the microfracture technique. All cohorts showed a significant improvement in hip outcome scores after hip arthroscopy.
This systematic review showed that all three techniques (debridement, microfracture, autologous chondrocyte implantation) were associated with a similar improvement in hip outcome scores in patients with high-grade chondral lesions of the hip, both in the immediate and in the medium-term postoperative period. Furthermore, although there were no differences in patient demographics by surgical technique, we confirmed the hypothesis that lesion size varies significantly between the arthroscopic techniques and that the decision to use one technique rather than another may be determined by the size of the lesion. Lesion size is therefore very likely to influence the choice of technique and may also represent a useful measure of the success of surgery.
Source: “Arthroscopy”, July 2016