Microfracture allows for quick return to play for elite athletes with chondral defects of the hip

SAN FRANCISCO — Discrete, full-thickness chondral defects of the hip can successfully be treated with microfracture, allowing for a return to elite competition, according to a recently presented study.

The findings were shared by John E. McDonald, Jr., MD, at the 2011 Annual Meeting of the Arthroscopy Association of North America.

“Discrete chondral defects of the acetabulum and femoral head are potentially morbid injuries to an elite-level athlete, and very little data exists documenting return-to-play at this level following arthroscopic treatment of these lesions,” McDonald said, adding that while hip arthroscopy has been shown to help return players to an elite level of play, no specific study has investigated the microfracture subset of the cohort.

Elite-level athletes

McDonald reported on Dr. Marc J. Philippon’s experience with 41 elite athletes who underwent arthroscopic microfracture by a single surgeon between 1999 and 2008. He reported 34 of the elite-level athletes met the study’s inclusion criteria — reported in the study as having a discrete Outerbridge grade IV chondral lesion either on the femoral head (three), acetabulum (27) or both (four). Further inclusion criteria included a lesion amenable to microfracture and a patient with an expressed desire to return to their professional career.

McDonald reported that the elite athletes in the study represented professionals from hockey, soccer, football, baseball, tennis and golf. Each patient in the study underwent concomitant labral debridement (eight), repair (23) or reconstruction (three). Data for the study were obtained following these operations, and included the number of games and seasons played at an elite level after the original arthroscopic microfracture procedure.

Quick return to play

McDonald reported that 79% (27 of 34) of the elite athletes who underwent microfracture returned to play at an elite level for an average of four seasons, with a range of one season to 11 seasons.

“Ninety-six percent of those who returned began play during the same season or the season following the microfracture,” he added.

Of the seven athletes who did not return to play, two played soccer, three played hockey, one played baseball and one played football. Six of the seven athletes underwent a concomitant labral repair, and one underwent a labral reconstruction.

“We looked at age, location of microfracture, and whether the athlete played a contact or non-contact sport and found no statistical significance in our cohort regarding whether they returned or did not return to play,” McDonald said. “There was no correlation between age and number of season played postoperatively.”

Possibilities of microfracture

The findings shed light on the possibilities of microfracture when treating discrete, full-thickness chondral defects of the hip in elite-level athletes, McDonald said.

“This is a large series of professional athletes undergoing arthroscopic hip microfracture,” he concluded. “Very little data exists regarding these patients in the literature. We have shown they can return to play, they can play the same or the next season, and they are able to play for an extended period of time. Hopefully we have provided reliable data to these patients and their families, coaches and teams regarding their ability to return to sport.” – by Robert Press

Reference:

• McDonald JE, Philippon MJ, Herzog M. Return to play following arthroscopic microfracture of the hip in elite athletes. Paper SS-40. Presented at the 2011 Annual Meeting of the Arthroscopy Association of North America. April 14-16. San Francisco.

• John E. McDonald, Jr., MD, can be reached at The Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657; email: johnmcdonald2@gmail.com.
• Disclosure: McDonald has no relevant financial disclosures.

McDonald showed a very good retrospective review of microfractures in elite athletes during hip arthroscopy. We all know cartilage lesions tend to be a very difficult problem to treat, especially with an increasing and active population with an increased awareness of degenerative tears. This paper shows there is a supportive treatment of full-thickness cartilage lesions.

Each one of these patients underwent multiple associated procedures — femoral neck osteoplasty, acetabular osteoplasty, labral work and some ligamentum teres work. I would like to know how these procedures would potentially affect, and if the microfracture actually is what we are measuring here or whether these associated procedures are something that we can discuss.

— Bojan B. Zoric, MD
Moderator
Disclosure: He is a paid consultant and is on the speakers bureau/paid presentations for Smith & Nephew.

Having had arthroscopic femoracetabular impingement surgeries, including microfracture in both of my own (non-elite athletic) hips, let me chime in on this timely study.

Arthroscopic hip microfracture chondroplasty is inherently attractive as a relatively simple procedure that appears to be effective. But we are still dealing with fibrocartilage, which may have durability issues. With the acceptance of acetabular rim trimming of pincer impingement, microfracture is less often needed as typical acetabular rim cartilage damage is removed during rim trimming. But there are cases when a residual full-thickness defect exists, and I will then perform arthroscopic microfracture chondroplasty.

Some surgeons are repairing delaminated acetabular cartilage to the underlying bony base, often with microfracture preparation, although a recent study questions the viability of the cartilage flap. Moreover, as most of these lesions may be at the acetabular rim, containment of bone marrow-derived growth factors and stem cells by concomitant labral repair or even reconstruction may be critical to any procedural success.

— Dean K. Matsuda, MD
Orthopedics Today Editorial Board member
Kaiser West Los Angeles Medical Center Los Angeles, Calif.
Disclosure: He has no relevant financial disclosures.