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2021 AOSSM-AANA Combined Annual Meeting Recordings
High-grade Acetabular Cartilage Lesions in Primary ...
High-grade Acetabular Cartilage Lesions in Primary Hip Arthroscopy: A 472-patient Multicenter Cohort
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Video Transcription
All right, thanks a lot for this opportunity here. So we're talking about cartilage lesions in arthroscopy, and specifically related to injuries noted during labral repair. The disclosures are listed here. This is part of our MASH effort. The core group is the main authors, and I think all the guys that have contributed to this study, as well as to the larger group. By way of introduction, there's conflicting evidence linking acetabular articular cartilage defects with poor outcomes in hip arthroscopy, and particularly in lower grade levels of articular cartilage injury, tonus one or lower. And part of our goals here were to look to see whether the cartilage injuries were generalizable to a multicenter cohort. In the past, we've demonstrated inter-rater reliability that's been moderate, and published that as part of our study. There is a lack of consensus, as well, related to decision-making for high-grade cartilage lesions, should we microfracture or chondroplasty, and that's addressed here, as well. And clinically significant thresholds in hip arthroscopy are being published much more frequently now, and I think this is the first study that's really looking at these different thresholds related to articular cartilage defects in labral repairs. So our inclusion criteria is all tonus grade less than two, primary surgeries with repairs. We had data pre-, intra-, and post-op with two-year outcomes. Five centers were represented. The cartilage injuries were stratified basically into three levels, so no damage, low-grade damage, which was BEC one or two, and then high-grade three and four. Some IHOT scores were compared at a minimum of two-year follow-up. So the main insights were that the presence of any acetabular chondrosis is associated with older age. It's also associated with worse two-year IHOT-12 scores, and there's a lower frequency of patient acceptable symptom state, as well. In addition, we showed that comparing to no damage or low-grade damage, high-grade chondrosis was associated with a higher BMI, as well as with male patients. Additional trend that was noted is that high-grade chondrosis tended to have a lower frequency of achieving minimal clinical important difference and substantial clinical benefit relative to no damage or low damage, but that did not achieve significance. So then further study controlling for age, BMI, gender, and preoperative IHOT-12, we showed that presence of high-grade lesions was a negative predictor for achieving substantial clinical benefit. High-grade lesions were a negative predictor for patient acceptable symptom state. So results, there's no significant differences observed in two-year outcomes in patients with high-grade lesions also undergoing chondroplasty versus microfracture. So you can see on the top here, the numbers were relatively low, so 50 and 14. The conclusions may be limited by sample size, and this really does warrant further study. So in conclusion, articular cartilage defects portend inferior two-year clinical outcomes in primary hip arthroscopy, and some differences do exist in patient populations presenting with these different levels of chondrosis. High-grade damage is associated with male patients and high BMIs, and there's no definitive conclusion based on this study related to the efficacy of chondroplasty versus microfracture. Thanks very much. Thank you.
Video Summary
In this video, the speaker discusses cartilage lesions in arthroscopy, specifically relating to injuries observed during labral repair. The aim of the study was to determine whether cartilage injuries in a multicenter cohort were generalizable. The findings showed that the presence of any acetabular chondrosis is associated with older age and worse two-year clinical outcomes. High-grade chondrosis was also associated with a higher BMI and male patients. Results did not demonstrate significant differences in outcomes between chondroplasty and microfracture for high-grade lesions. The speaker suggests that further research is needed to confirm these conclusions due to the limited sample size. Overall, articular cartilage defects have negative implications for clinical outcomes in primary hip arthroscopy.
Asset Caption
Dominic Carreira, MD
Keywords
cartilage lesions
arthroscopy
labral repair
acetabular chondrosis
clinical outcomes
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