Abstract：
OBJECTIVE: Bone marrow stimulation is a common treatment for full-thickness cartilage defects in the hip joint. However, common procedures may result in poor fibrous repair tissue and changes to the subchondral anatomy. This study investigated the clinical outcome of a cohort of International Cartilage Repair Society (ICRS) grades 3 and 4 cartilage defects treated with bone marrow stimulation compared to those who received simple debridement/chondroplasty.
METHODS: In this retrospective registry study, 236 patients with uni-focal acetabular chondral lesions of the hip up to 400 mm² (mean 177.4 ± 113.4 mm²) and of ICRS grade ≥3 with follow-up of at least 12 months (mean 33.2 ± 15.3 months) were included. Eighty-one patients underwent bone marrow stimulation (microfracture: n = 44, abrasion: n = 37) besides treatment of the underlying pathology, 155 patients underwent defect debridement/chondroplasty. The patient-reported outcome was measured using the International Hip Outcome Tool 33 (iHOT33) score and the Visual Analogue Scale (VAS) for pain.
RESULTS: iHOT33 and VAS both improved highly statistically significantly (p < 0.001) in the debridement group after 6, 12, 24, 36 and 60 months compared to the preoperative scores, whereas iHOT33 and VAS after microfracture or abrasion did not show statistically significant changes over time. Twenty-four and sixty months postsurgery the debridement group revealed significant higher scores in the iHOT33 compared to the bone marrow stimulation groups.
CONCLUSIONS: Patients with chondral lesions of the hip ≤400 mm2 sustainably benefit from arthroscopic debridement under preservation of the subchondral bone plate in terms of functional outcome and pain in contrast to patients treated with bone marrow stimulation. These findings discourage the currently recommended use of microfracture in the hip joint.
METHODS: Level III.
METHODS: In this retrospective registry study, 236 patients with uni-focal acetabular chondral lesions of the hip up to 400 mm² (mean 177.4 ± 113.4 mm²) and of ICRS grade ≥3 with follow-up of at least 12 months (mean 33.2 ± 15.3 months) were included. Eighty-one patients underwent bone marrow stimulation (microfracture: n = 44, abrasion: n = 37) besides treatment of the underlying pathology, 155 patients underwent defect debridement/chondroplasty. The patient-reported outcome was measured using the International Hip Outcome Tool 33 (iHOT33) score and the Visual Analogue Scale (VAS) for pain.
RESULTS: iHOT33 and VAS both improved highly statistically significantly (p < 0.001) in the debridement group after 6, 12, 24, 36 and 60 months compared to the preoperative scores, whereas iHOT33 and VAS after microfracture or abrasion did not show statistically significant changes over time. Twenty-four and sixty months postsurgery the debridement group revealed significant higher scores in the iHOT33 compared to the bone marrow stimulation groups.
CONCLUSIONS: Patients with chondral lesions of the hip ≤400 mm2 sustainably benefit from arthroscopic debridement under preservation of the subchondral bone plate in terms of functional outcome and pain in contrast to patients treated with bone marrow stimulation. These findings discourage the currently recommended use of microfracture in the hip joint.
METHODS: Level III.
摘要：
目的：骨髓刺激是髋关节全层软骨缺损的常用治疗方法。然而,常见的手术可能会导致不良的纤维修复组织和软骨下解剖结构的变化。这项研究调查了与接受简单清创/软骨成形术的人相比，接受骨髓刺激治疗的国际软骨修复协会（ICRS）3级和4级软骨缺损队列的临床结果。
方法：在这项回顾性注册研究中，包括236例髋臼软骨单灶性病变至400mm²（平均177.4±113.4mm²），ICRS等级≥3，随访至少12个月（平均33.2±15.3个月）的患者。81例患者除了接受基础病理治疗外，还接受了骨髓刺激（微骨折：n=44，磨损：n=37）。155例患者接受了缺损清创/软骨成形术。使用国际髋关节结果工具33（iHOT33）评分和疼痛视觉模拟量表（VAS）测量患者报告的结果。
结果：清创组术后6、12、24、36和60个月与术前评分相比，iHOT33和VAS均有显著的统计学改善（p<0.001）。而微骨折或磨损后的iHOT33和VAS没有显示出统计学上显著的变化。术后24个月和60个月，清创组发现iHOT33评分明显高于骨髓刺激组。
结论：与骨髓刺激治疗的患者相比，在保留软骨下骨板的情况下，髋部软骨病变≤400mm2的患者在功能结局和疼痛方面可持续受益于关节镜清理。这些发现阻碍了目前推荐的髋关节微骨折的使用。
方法：三级。
方法：在这项回顾性注册研究中，包括236例髋臼软骨单灶性病变至400mm²（平均177.4±113.4mm²），ICRS等级≥3，随访至少12个月（平均33.2±15.3个月）的患者。81例患者除了接受基础病理治疗外，还接受了骨髓刺激（微骨折：n=44，磨损：n=37）。155例患者接受了缺损清创/软骨成形术。使用国际髋关节结果工具33（iHOT33）评分和疼痛视觉模拟量表（VAS）测量患者报告的结果。
结果：清创组术后6、12、24、36和60个月与术前评分相比，iHOT33和VAS均有显著的统计学改善（p<0.001）。而微骨折或磨损后的iHOT33和VAS没有显示出统计学上显著的变化。术后24个月和60个月，清创组发现iHOT33评分明显高于骨髓刺激组。
结论：与骨髓刺激治疗的患者相比，在保留软骨下骨板的情况下，髋部软骨病变≤400mm2的患者在功能结局和疼痛方面可持续受益于关节镜清理。这些发现阻碍了目前推荐的髋关节微骨折的使用。
方法：三级。
