This study evaluates the outcome of arthroscopic femoral osteochondroplasty for cam lesions of the hip in the absence of additional pathology other than acetabular chondral lesions. We retrospectively reviewed 166 patients (170 hips) who were categorised according to three different grades of chondral damage. The outcome was assessed in each grade using the modified Harris Hip Score (MHHS) and the Non-Arthritic Hip Score (NAHS). Overall, at the last follow-up (mean 22 months, 12 to 72), the mean MHHS had improved by 15.3 points (95% confidence interval (CI), 8.9 to 21.7) and the mean NAHS by 15 points (95% CI, 9.4 to 20.5). Significantly better results were observed in hips with less severe chondral damage. Microfracture in limited chondral lesions showed superior results. Arthroscopic femoral osteochondroplasty for cam impingement with microfracture in selected cases is beneficial. The outcome correlates with the severity of acetabular chondral damage

Magnetic resonance imaging (MRI) scans are widely used in the assessment of knees, often prior to arthroscopic procedures. The reporting of chondral damage on MRI scans can be variable. The correlation between MRI reports of chondral damage and that found at arthroscopy is often inconsistent. The aim of this study was to identify how well MRI reports correlated with the extent of chondral damage found at arthroscopy. A retrospective case-note review of a single-surgeon series of 175 arthroscopic procedures was performed. 83 patients were included in the study. The remainder were excluded if an MRI scan had not been performed, or had been performed more than 3 months prior to surgery. The condition of the articular cartilage demonstrated by MRI was compared to that found at arthroscopy. Data was analysed for presence and extent of chondral damage. Comparison between MRI and arthroscopy findings showed high Specificity (90%) and Negative Predictive Values (89%) for chondral damage, but low Sensitivity (46%). Cohen's kappa values < 0.2 revealed very poor correlation for the extent of damage. This study demonstrates that MRI is good at describing whether articular damage is present but does not reliably describe the extent of the damage

Purpose: The purpose of this study was to evaluate the outcome of arthroscopic femoral osteochondroplasty for cam lesions of the hip with respect to the severity of acetabular chondral damage. Methods: The study is a retrospective review of 170 patients (35 females, 135 males) who underwent surgery for symptomatic cam femoroacetabular impingement (FAI) between the years 2003 to 2008. The patients were categorized according to three different grades of chondral damage. No patients had evidence of labral pathology. Microfracture of the acetabular chondral damage was also performed when indicated. The clinical results in each grade were measured preoperatively and postoperatively with the modified Harris Hip Score (MHHS) and Non Arthritic Hip Score (NAHS). Results: The mean follow-up time was 22 months (range 12 to 72 months). At the last follow-up, significantly better results were observed in hips with less chondral damage. The mean MHHS improved from 74.1±17.1 to 89.8±11.6 in grade 1 whereas it improved from 62.3±14.3 to 77.4±18.3 in grade 3 (p=0.02). The mean NAHS improved from 70.7±13.5 to 87±16.2 in grade 1 whereas it improved from 60.5±16.2 to 78±17.8 in grade 3 (p=0.04). Microfracture in limited zones of ace-tabular chondral damage had shown superior results. Conclusions: Arthroscopic femoral osteoplasty for hip cam impingement with acetabular chondral damage provides a significant improvement in symptoms. Microfracture of the chondral lesion in selected cases has been demonstrated to be safe and benifical

We present 10–15 year follow-up of 33 patients who underwent Elmslie-Trillat osteotomy for severe patellar subluxation or dislocation. In the literature it has been reported that tibial tubercle osteotomy predisposes to subsequent patella-femoral arthritis, however it has never been documented if pre existent knee chondral damage has any role in this development. In our group all patients had pre-op knee arthroscopy performed and extant of chondral damage was documented. We pre-formed an evaluation by long-term follow-up to determined weather pre-op chondral damage was the cause of subsequent osteoarthritis of patella-femoral joint. All patients were invited to attend outpatient clinic for clinical examination and knee radiographs and assessed by an independent research surgeon. Mean age at follow-up was 43 years and average follow-up was 10.5 years (range 10–15 years). 90% follow-up was achieved. Knee function was assessed by clinical scores (Lysholm knee score, American Knee Score, Oxford Knee score, Tegner and Insall knee scores) and three radiographs (AP, Lateral and Merchant views) were performed. Four patients had developed significant arthritis and underwent joint arthroplasty. Majority of patients reported good results with no further dislocation. However we noticed that extant of pre-op chondral damage was a significant factor in subsequent development of patella-femoral arthritis. We will present our data which is unique as no previous such long-term results have been reported for tibial tubercle transfers followed-up for more than 10 years and have pre-op arthroscopic documented chondral damage

We present 10–15 year follow-up of 33 patients who underwent Elmslie-Trillat osteotomy for severe patellar subluxation or dislocation. In the literature it has been reported that tibial tubercle osteotomy predisposes to subsequent patella-femoral arthritis, however it has never been documented if pre-existent knee chondral damage has any role in this development. In our group all patients had pre-op knee arthroscopy performed and extant of chondral damage was documented. We preformed an evaluation by long-term follow-up to determine weather pre-op chondral damage was the cause of subsequent osteoarthritis of patella-femoral joint. All patients were invited to attend outpatient clinic for clinical examination and knee radiographs and assessed by an independent research surgeon. Mean age at follow-up was 43 years and average follow-up was 10.5 years (range 10–15 years). 90% follow-up was achieved. Knee function was assessed by clinical scores (Lysholm knee score, American Knee Score, Oxford Knee score, Tegner and Insall knee scores) and three radiographs (AP, Lateral and Merchant views). Four patients had developed significant arthritis and underwent joint arthroplasty. Majority of patients reported good results with no further dislocation. However we noticed that extant of pre-op chondral damage was a significant factor in subsequent development of patella-femoral arthritis. We will present our data which is unique as no previous such long-term results have been reported for tibial tubercle transfers followed-up for more than 10 years and have pre-op arthroscopic documented chondral damage

Aims. The prevalence of osteoarthritis (OA) associated with instability of the shoulder ranges between 4% and 60%. Articular cartilage is, however, routinely assessed in these patients using radiographs or scans (2D or 3D), with little opportunity to record early signs of cartilage damage. The aim of this study was to assess the prevalence and localization of chondral lesions and synovial damage in patients undergoing arthroscopic surgery for instablility of the shoulder, in order to classify them and to identify risk factors for the development of glenohumeral OA. Methods. A total of 140 shoulders in 140 patients with a mean age of 28.5 years (15 to 55), who underwent arthroscopic treatment for recurrent glenohumeral instability, were included. The prevalence and distribution of chondral lesions and synovial damage were analyzed and graded into stages according to the division of the humeral head and glenoid into quadrants. The following factors that might affect the prevalence and severity of chondral damage were recorded: sex, dominance, age, age at the time of the first dislocation, number of dislocations, time between the first dislocation and surgery, preoperative sporting activity, Beighton score, type of instability, and joint laxity. Results. A total of 133 patients (95%) had synovial or chondral lesions. At the time of surgery, shoulders were graded as having mild, moderate, and severe OA in 55 (39.2%), 72 (51.4%), and six (4.2%) patients, respectively. A Hill-Sachs lesion and fibrillation affecting the anteroinferior glenoid cartilage were the most common findings. There was a significant positive correlation between the the severity of the development of glenohumeral OA and the patient’s age, their age at the time of the first dislocation, and the number of dislocations (p = 0.004, p = 0.011, and p = 0.031, respectively). Conclusion. Synovial inflammation and chondral damage associated with instability of the shoulder are more prevalent than previously reported. The classification using quadrants gives surgeons more information about the chondral damage, and could explain the pattern of development of glenohumeral OA after stabilization of the shoulder. As the number of dislocations showed a positive correlation with the development of OA, this might be an argument for early stabilization. Cite this article: Bone Joint J 2024;106-B(10):1125–1132

Viscosupplementation with hyaluronic acid (HA) is an established intervention for pain control in patients with mild to moderate osteoarthritis (OA) of the hip and knee. It is highly concentrated at the surface of the articular cartilage and the superficial layers of the synovial membrane. In the synovial fluid, HA acts as both a lubricant and a shock absorber. Due to the meshwork it forms with aqueous solutions, it acts as a semi-permeable barrier regulating metabolic exchanges between cartilage and the synovial fluid, and a viscoelastic shield around synoviocytes and adjacent nerve endings. Through its molecular size HA hinders the free movement of lytic enzymes and inflammatory mediators, and enhances chondrocyte metabolism. Osteoarthritis is associated with a decrease in concentration and average molecular weight of native HA in synovial fluid.

The mechanism of action of administered intra-articular HA is not completely understood, but as its clinical benefit exceeds its intra-articular presence, it is thought to perhaps induce native biosynthesis of HA and other extracellular matrix components and in particular suppress the inflammatory response and inhibit substance P, in addition to contributing to shock absorption by means of its viscoelastic properties.

Problems include inconvenience, expense and the logistical problems associated with multiple injections, injection technique and level of skill required by the administering physician, variable clinical response and adverse reactions.

In this independent, prospective, randomized trial, we compare efficacy and complications associated with treatment 100 athletes (112 knees) using durolaneTM and synvisc oneTM using the Visual Analogue Score, SF-36 V2 questionaire, and Oxford knee scores. Range of movement and absence from sporting activity is recorded at each visit. These assessments are repeated at 3, 6, 9 and 12 months. Significant improvement is seen in the VAS, SF 36 V2 and Oxford Knee Scores (p=0.01) and reduction in the use of analgesics and anti-inflammatories is seen with both products at 3 months post injection, with a significant advantage to the duro-lane group (p=0.001). At 6 months, this difference is extended even further. A small but statistical difference is noted in the time taken for the athlete to return to sporting activity following a rest period due to pain. Adverse reactions occur significantly less with the more effective product. We conclude that intra-articular HA a useful intervention in patients with mild to moderate OA of the knee, can produce sustained pain relief at 6 months, and can reduce the requirement for analgesia and anti-inflammatory medication during this time.

Abstract. Introduction. High posterior tibial slope (PTS) has been recognised as a risk factor for anterior cruciate ligament rupture and graft failure. This prospective randomised study looked at intra-operative findings of concomitant intra-articular meniscal and chondral injuries during a planned ACL reconstruction. Material and Methods. Prospective data was collected as part of a randomised trial for ACL reconstruction techniques. Intra-operative data was collected and these findings were compared with the PTS measured on plain radiograph by a single person twice through a standardised technique and intra-observer analysis was performed. Results. 49 confirmed ACL rupture patients were in the trial. The average age was 34 (23–66) years and 12 patients were female. 17 patients (34%) had PTS of 12 degrees or more. The intra-observer analysis for PTS measurements in a 2-sided paired T test, showed a mean difference of 0.03 degrees with a P value = 0.83. 23 patients had medial meniscal pathology identified, 15 (65%) had a PTS <12 degrees. 16 patients had lateral meniscus pathology and 9 (56%) had a PTS <12 degrees. Chondral damage did not appear significantly different in the two groups (<12 degrees 15% vs >12 degrees 23%). Conclusion. In this sample, a PTS >12 degrees was not associated with a higher incidence of meniscal or chondral damage after a confirmed ACL rupture

We reviewed 5086 patients with a mean age of 30 years (9 to 69) undergoing primary reconstruction of the anterior cruciate ligament (ACL) in order to determine the incidence of secondary pathology with respect to the time between injury and reconstruction. There was an increasing incidence of medial meniscal tears and chondral damage, but not lateral meniscal tears, with increasing intervals before surgery. The chances of requiring medial meniscal surgery was increased by a factor of two if ACL reconstruction was delayed more than five months, and increased by a factor of six if surgery was delayed by > 12 months. The effect of delaying surgery on medial meniscal injury was also pronounced in the patients aged < 17 years, where a delay of five to 12 months doubled the odds of medial meniscal surgery (odds ratio (OR) 2.0, p = 0.001) and a delay of > 12 months quadrupled the odds (OR 4.3, p = 0.001). Increasing age was associated with a greater odds of chondral damage (OR 4.6, p = 0.001) and medial meniscal injury (OR 2.9, p = 0.001), but not lateral meniscal injury. The gender split (3251 men, 1835 women) revealed that males had a greater incidence of both lateral (34% (n = 1114) vs 20% (n = 364), p = 0.001) and medial meniscal tears (28% (n = 924) vs 25% (n = 457), p = 0.006), but not chondral damage (35% (n = 1152) vs 36% (n = 665), p = 0.565). We conclude that ideally, and particularly in younger patients, ACL reconstruction should not be delayed more than five months from injury. Cite this article: Bone Joint J 2013;95-B:59–64

To determine the relationship between advancing months from ACL rupture and the incidence of intra-articular meniscal and chondral damage. From a prospectively collected database 5086 patients undergoing primary ACL reconstruction, using hamstring graft, carried out between January 2000 and August 2010 were identified. Data collected included the interval between injury and surgery, type and location of meniscal tears (requiring meniscectomy) and location and severity of chondral damage (ICRS grading system). Patients were grouped according to time interval and age. The median time from ACL injury to ACL reconstruction was 3 months (range 0.25 to 480). Overall, an increasing incidence of medial meniscal injury and chondral damage occurred with advancing chronicity of ACL deficiency. The incidence of medial meniscal injury requiring meniscectomy increased from 18% of patients undergoing ACL reconstruction within 4 months of injury to 59% of patients if ACL reconstruction was delayed more than 12 months (p<0.001). The incidence of lateral meniscal tears did not increase significantly over time. The increasing incidence of secondary pathology with advancing chronicity was more pronounced in the younger age groups. The risk of a medial meniscal tear requiring resection was significantly less if surgery was performed before 5 months in the <17 years group (Odds Ratio 2) and 17–30 years group (OR 1.9), but less so in the 31–50 years group (OR 1.5) and >50 years group (OR 1.5). Advancing age was associated with a greater incidence of chondral damage and medial meniscal injury, but not lateral meniscal injury. Males had a greater incidence of lateral meniscal tears (34% vs. 20%), but not medial (28% vs. 25%) or chondral damage (35% vs. 36%), compared to females. The incidence of chondral damage and medial meniscal tears increases with advancing time after ACL injury. Particularly in younger patients, ACL reconstruction should be performed within 4 months of ACL injury in order to minimise the risk of irreversible damage to meniscal and chondral structures

We present the ten- to 15-year follow-up of 31 patients (34 knees), who underwent an Elmslie-Trillat tibial tubercle osteotomy for chronic, severe patellar instability, unresponsive to non-operative treatment. The mean age of the patients at the time of surgery was 31 years (18 to 46) and they were reviewed post-operatively, at four years (2 to 8) and then at 12 years (10 to 15). All patients had pre-operative knee radiographs and Cox and Insall knee scores. Superolateral portal arthroscopy was performed per-operatively to document chondral damage and after the osteotomy to assess the stability of the patellofemoral joint. A total of 28 knees (82%) had a varying degree of damage to the articular surface. At final follow-up 25 patients (28 knees) were available for review and underwent clinical examination, radiographs of the knee, and Cox and Insall scoring. Six patients who had no arthroscopic chondral abnormality showed no or only early signs of osteoarthritis on final radiographs; while 12 patients with lower grade chondral damage (grade 1 to 2) showed early to moderate signs of osteoarthritis and six out of ten knees with higher grade chondral damage (grade 3 to 4) showed marked evidence of osteoarthritis; four of these had undergone a knee replacement. In the 22 patients (24 knees) with complete follow-up, 19 knees (79.2%) were reported to have a good or excellent outcome at four years, while 15 knees (62.5%) were reported to have the same at long-term follow-up. The functional and radiological results show that the extent of pre-operatively sustained chondral damage is directly related to the subsequent development of patellofemoral osteoarthritis. Cite this article: Bone Joint J 2013;95-B:478–85

Femoroacetabular impingement is a prearthritic deformity frequently associated with early chondral damage. Several techniques exist for restoring larger cartilage defects. While AMIC proved to be an effective treatment in knee and ankle, there are only short-term data available in hip. This study aimed to investigate the mid-term clinical outcome of patients with chondral lesions treated by AMIC and evaluate the quality of repair tissue via MRI. This retrospective, single center study includes 18 patients undergoing surgical hip dislocation for FAI between 2013 and 2016. Inclusion criteria were: cam or pincer-type FAI, femoral or acetabular chondral lesions > 1 cm. 2. , (IRCS III-IV). Due to exclusion criteria and loss-to-follow-up 9 patients (10 hips) could be included. Patient reported outcome measures included Oxford Hip Score (OHS) & Core Outcome Measure Index (COMI)). MRIs were evaluated using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. None of the patients underwent revision surgery except screw removals from the greater trochanter. Followup data indicate a satisfactory to good hip function at 5 years: PROMS improved from pre- to postop at 5 years: OHS from 38.1 to 43.4, COMI from to 1.8 and UCLA from 4 to 8.1 respectively. MOCART score was 67.5 postoperatively. Subgrouping showed slightly better results for acetabular defects (Ø 69.4) compared femoral defects (Ø 60). Based on the reported mid-term results, we consider AMIC as a valuable treatment option for larger chondral defects of the hip

Introduction. Patellofemoral instability is one of the most common presentations to a children's orthopaedic clinic. Recurrent patellar dislocations and instability episodes are painful, disabling and increase the risk of irreversible chondral damage. The medial patellofemoral ligament is the primary static stabiliser to prevent lateral dislocation of the patella and is almost always torn or attenuated in these cases. Reconstruction of this ligament is commonly performed using autologous hamstring tendon however there has been some interest recently in use of quadriceps tendon as a graft. Children with patellar instability also present unique challenges due to the small size of the patella and the presence of open growth plates which may require adaptations to the common techniques. Methods. Patients undergoing medial patellofemoral ligament reconstruction using quadriceps tendon autograft were identified using electronic theatre records. Prospectively collected clinical records and imaging findings were reviewed and underlying pathology, additional procedures at time of MPFL reconstruction, current function and need for further revision surgery determined. Results. Between January 2019 and August 2023, 50 MPFL reconstructions were performed in 37 children using partial thickness quadriceps autograft. Patient age at time of surgery ranged from 5 to 17 years (median age 13 years). The technique was utilised for a variety of indications including recurrent traumatic and habitual patellofemoral instability, fixed dislocations, and revision MPFL reconstruction. Conclusion. Partial thickness quadriceps tendon autograft can be used safely to primarily reconstruct the medial patellofemoral ligament in paediatric population, including those children with open growth plates. It also has utility in revision cases following previous failed hamstring MPFL reconstruction. We have noted that the younger the child, the more distal to the physis lies the femoral point of isometricity, rendering this a safe and reproducible treatment in this age group. Use of this technique has increased in our unit as we have observed that patients seem to be satisfied with their clinical and functional outcomes with a low incidence of short- and medium-term complications

Abstract. Introduction. The aim of this study was to determine the factors affecting return to sport (RTS) and career longevity of elite athletes after microfracture of the knee. Methods. A retrospective review of a consecutive series of elite athletes with chondral injuries in the knee treated with microfracture was undertaken. RTS was defined as competing in at least one event at professional level or national/ international level in amateur sport. Demographic, pre, intra and post operative factors affecting RTS were analysed. Results. Fifty six athletes, including 35 (62.5%) footballers and 14 (25.0 %) rugby players, with a mean age 24.8 (+/− 3.9) years, were included. 18 (32.1 %) of chondral injuries were secondary to trauma, 20 (35.7 %) post meniscectomy, 9 (16.1%) post anterior cruciate ligament (ACL) reconstruction and 9 (16.1%) idiopathic. Fifty (89.3%) of athletes RTS at a mean time of 10.0 (+/−5.8) months. 43 (86.0%) athletes were still playing at 2 years. At 5 years 25 (59.5%) of the players who had RTS and had surgery more than 5 years ago were still playing professional sport. Factors associated with not playing at 5 years were cartilage lesions >1.5cm2(52.4% vs 66.7%), more than 1 lesion (35.7% vs74.1%), lateral meniscal surgery (42.1% vs 73.7%) and effusion on RTS (47.7% vs 72.2%). Conclusion. Over 89 % of elite athletes returned to professional sport after microfracture in the knee. However, the ability to continue playing is affected by several factors such as the extent of the chondral damage and recurrent effusions

Arthroscopic hip surgery is increasingly common in Australia. Hip arthroscopy is indicated for a range of diagnostic and therapeutic purposes, including labral tears, capsular laxity and femoral-acetabular impingement (FAI). Despite this, previous cohort studies aiming to characterise hip pathology seen on arthroscopic examination are mostly limited to patients with known diagnoses of FAI. Therefore, little is known of the native articular wear patterns encountered in other disease states. Therefore, we aimed to define common osteochondral wear patterns for a cohort of patients managed via hip arthroscopy. We retrospectively analysed intraoperative data for 1127 patients managed via hip arthroscopy between 2008 and 2013, for either therapeutic or diagnostic purposes. Intraoperative data was categorized by location (A-E as defined by Fontana et al. 2016) and chondral damage (0-4 scale as defined by Beck et al. 2005) with respect to both acetabulum and femoral head. Data for 1127 patients were included. Location of acetabular chondral pathology was variable with locations C. 1. and D. 1. representing the most common regions of damage. Labral tears predominated in locations C and D. Femoral chondral pathology was evenly distributed. The degree of femoral chondral injury was predominantly grade 1, whilst acetabular wear was evenly distributed. Large proportions of wear were observed at the peripheral superior and anterior regions of the lunate surface of the acetabulum in keeping with prior works. However, we observed higher rates of central wear and lower rates of grade 4 acetabular damage extending into superior/posterior zones, in our cohort. Our work characterises common articular wear patterns encountered at the time of hip arthroscopy. Further inquiry into the natural history of osteochondral lesions is needed to better understand and manage these conditions

For chondral damage in younger patients, surgical best practice is microfracture, which involves drilling into the bone to liberate the bone marrow. This leads to a mechanically inferior fibrocartilage formed over the defect as opposed to the desired hyaline cartilage that properly withstands joint loading. While some devices have been developed to aid microfracture and enable its use in larger defects, fibrocartilage is still produced and there is no clear clinical improvement over microfracture alone in the long term. Our goal is to develop 3D printed devices, which surgeons can implant with a minimally invasive technique. The scaffolds should match the functional properties of cartilage and expose endogenous marrow cells to suitable mechanobiological stimuli in-situ, in order to promote healing of articular cartilage lesions before they progress to osteoarthritis, and rapidly restore joint health and mobility. Importantly, scaffolds should direct a physiological host reaction, instead of a foreign body reaction, associated with chronic inflammation and fibrous capsule formation, negatively influencing the regenerative outcome. Our novel silica/polytetrahydrofuran/polycaprolactone hybrids were prepared by sol-gel synthesis and scaffolds were 3D printed by direct ink writing. 3D printed hybrid scaffolds with pore channels of ~250 µm mimic the compressive behaviour of cartilage. Our results show that these scaffolds support human bone marrow stem/stromal cell (hMSC) differentiation towards chondrogenesis in vitro under hypoxic conditions to produce markers integral to articular cartilage-like matrix evaluated by immunostaining and gene expression analysis. Macroscopic and microscopic evaluation of subcutaneously implanted scaffolds in mice showed that scaffolds caused a minimal resolving inflammatory response. Our findings show that 3D printed hybrid scaffolds have the potential to support cartilage regeneration. Acknowledgements: Authors acknowledge funding provided by EPSRC grant EP/N025059/1

This study aimed to analyse the incidence, the operative findings and outcomes of hip arthroscopy after periacetabular osteotomy (PAO). We conducted a retrospective study of prospective collected data to report the operative findings and outcomes of hip arthroscopy for recurrent pain following PAO for acetabular dysplasia. Demographic data, radiographic and arthroscopic findings were analysed. Pre- and post-operative patient reported outcome measures (PROMs) were collected. Of 184 PAO patients, 15 hips in 15 patients (8.2%) underwent post-PAO hip arthroscopy with 2 males and 13 females at a mean time of 3.9 ±2.9(0.3–10) years. Hip arthroscopy findings included labral tears (15 hips, 100%), chondral damage (11 hips, 73%) with one Beck 1, two Beck 2, four Beck 4, and four Beck 5 damage. There were 8 (53%) isolated labral debridement, 7 (47%) labral repair, and 2 (13%) adhesiolysis. A femoral osteochondroplasty was performed in 4 (27%) hips. Four hips (27%) were finally converted to total hip replacement at a mean delay of 2.3 ±1.4 (0.7–3.2) years post hip arthroscopy and these 4 patients were significantly older than those who were not (p=0.02). There were no significant differences in PROMs pre and post hip scope. 8.2% of patients undergoing a PAO required a hip scope for persistent hip pain. Common post-PAO hip arthroscopy findings included labral tears, chondral changes and femoroacetabular impingement. 27% of patients finally underwent conversion to total hip replacement at a mean follow-up of 4.5 years post hip scope

Chondral hip injuries are common secondary to femoroacetabular impingement (FAI). Treatment with arthroscopic procedures including chondroplasty and microfracture is becoming increasingly common but literature is limited to case series at specialist centres. The aim of this study is to compare outcomes of arthroscopic acetabular chondral procedures using the NAHR dataset (UK) which represents the largest series to date. All adult Arthroscopies recorded in the NAHR from Jan 2012 were available for inclusion. Exclusions included significant arthritis and femoral, complex or revision chondral procedures. Patients completed iHOT-12 & EQ-5D Index pre-operatively, 6 and 12 months. Data was analysed using T-test/ANOVA for between group/within group for continuous variables, chi square test for categorical variables and linear regression model for multivariable analysis. 5,752 patients, 60% female. 27% Chondroplasty, 5% Microfracture, 68% no Chondral Procedure. Maximum acetabular Outerbridge classification 14% Grade 1, 15% Grade 2, 17% Grade 3, 8% Grade 4, 9% no damage, not recorded in 37%. Higher proportion of Cam impingement in association with chondral treatments and a larger proportion of patients with no impingement recorded in group with no chondral procedures. There was a significant improvement versus baseline for all groups in iHOT-12 and EQ-5D Index (p<0.0001) including Grade four Outerbridge. There was significantly greater improvement in pre-operative scores in the chondroplasty group compared to the microfracture group at 6 and 12 months (p<0.05). Following hip arthroscopy, patients with chondral procedures experienced improved outcome scores despite Outerbridge 4 chondral damage. Presence of cam lesions are more commonly associated with chondral treatments. Good outcomes were maintained up to 12 months for chondral procedures, regardless of age or impingement pathology however pincers improved less and patients over 40 years took longer to see improvement

We present to you a match-controlled study assessing co-existing arthroscopic findings during hip arthroscopy in patients with an intraoperative diagnosis of a central acetabular osteophyte (CAO). We feel that this manuscript is both pertinent and timely. Recent literature has described the entity of central acetabular impingement, in which an osteophyte of the cotyloid fossa impinges against the superomedial femoral head and fovea. The technique for central acetabular decompression has also been described to treat this entity. The primary purpose of this study was to report the prevalence of femoral head articular damage in a matched cohort of patients with and without central acetabular osteophyte (CAO) that was identified during hip arthroscopy. A secondary purpose was to identify the rates of co-existing intraarticular pathology in both patient groups. Intraoperative data was collected prospectively on all patients undergoing hip arthroscopy at our institution between February 2008 to March 2015,. The inclusion criteria for this study were the presence of a CAO identified during hip arthroscopy for a labral tear and/or femoroacetabular impingement (FAI). Exclusion criteria were revision surgeries, Tönnis grade 1 and higher, and previous hip conditions such as Legg-Calves-Perthes disease, avascular necrosis, and prior surgical intervention. The matched cohort control group was selected based on gender, age within 5 years, body mass index (BMI), and workers' compensation claim, on a 1:3 ratio to patients who underwent hip arthroscopy for a labral tear and/or FAI and did not have a CAO. The CAO group consisted of 126 patients, which were matched to 378 patients in the control group. The grades of femoral and acetabular chondral damage were significantly different between the two groups (p<0.01). This study showed that patients with CAO had a significantly higher prevalence of femoral and acetabular chondral damage, size of articular defects on both surfaces and the prevalence of LT tears compared to matched controls

Objectives. Sustained intra-articular delivery of pharmacological agents is an attractive modality but requires use of a safe carrier that would not induce cartilage damage or fibrosis. Collagen scaffolds are widely available and could be used intra-articularly, but no investigation has looked at the safety of collagen scaffolds within synovial joints. The aim of this study was to determine the safety of collagen scaffold implantation in a validated in vivo animal model of knee arthrofibrosis. Materials and Methods. A total of 96 rabbits were randomly and equally assigned to four different groups: arthrotomy alone; arthrotomy and collagen scaffold placement; contracture surgery; and contracture surgery and collagen scaffold placement. Animals were killed in equal numbers at 72 hours, two weeks, eight weeks, and 24 weeks. Joint contracture was measured, and cartilage and synovial samples underwent histological analysis. Results. Animals that underwent arthrotomy had equivalent joint contractures regardless of scaffold implantation (-13.9° versus -10.9°, equivalence limit 15°). Animals that underwent surgery to induce contracture did not demonstrate equivalent joint contractures with (41.8°) or without (53.9°) collagen scaffold implantation. Chondral damage occurred in similar rates with (11 of 48) and without (nine of 48) scaffold implantation. No significant difference in synovitis was noted between groups. Absorption of the collagen scaffold occurred within eight weeks in all animals. Conclusion. Our data suggest that intra-articular implantation of a collagen sponge does not induce synovitis or cartilage damage. Implantation in a native joint does not seem to induce contracture. Implantation of the collagen sponge in a rabbit knee model of contracture may decrease the severity of the contracture. Cite this article: J. A. Walker, T. J. Ewald, E. Lewallen, A. Van Wijnen, A. D. Hanssen, B. F. Morrey, M. E. Morrey, M. P. Abdel, J. Sanchez-Sotelo. Intra-articular implantation of collagen scaffold carriers is safe in both native and arthrofibrotic rabbit knee joints. Bone Joint Res 2016;6:162–171. DOI: 10.1302/2046-3758.63.BJR-2016-0193