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Hip Arthroscopy: Management of Chondral Lesions Due to FAI

January 01, 2013

Contributors: Abiola Atanda, MD; Mathew Hamula, BA, BS; Srino Bharam, MD; Srino Bharam, MD

Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.
Peer review has expired on this program. It is the viewer’s responsibility to determine the educational value of this historical content.

Chondral lesions of the hip are typically associated with femoroacetabular impingement (FAI) and chondrolabral dysfunction. These lesions may impair the cartilage functions of lubrication and friction reduction, leading to disabling hip pain. Despite recent advances in imaging techniques, chondral lesions are still challenging to identify in the presence of FAI. Hip arthroscopy is gaining popularity for diagnostic use as well as becoming the therapeutic procedure of choice for chondral lesions. Arthroscopic intervention to the hip allows less invasive methods of treatment without the morbidity associated with open surgical dislocation procedures. Currently, the main surgical treatments of chondral lesions are chondroplasty and microfracture; both show promising results. This video presents arthroscopic techniques for managing chondral lesions of the hip. It also shows a case series focusing on microfracture technique for grade IV chondral lesions associated with FAI. Fifteen patients were treated with microfracture for grade IV lesion with FAI. The group consisted of 10 males and 5 females with an average age of 32 years (range, 17-61). Eight patients had a grade IV lesion on the acetabular rim, and 7 had chondral lesions involving the anterior superior femoral head. A higher incidence of chondral lesions associated with FAI that was diagnosed during arthroscopic evaluation suggests that our techniques for imaging chondral lesions needs improvement. However, 14 of 15 patients improved on Harris Hip Scores, leading us to conclude that microfracture is an effective technique for the management of chondral lesions of the hip due to FAI. The best management, however, remains earlier intervention to prevent cartilage degradation.

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