Discussion

There are very few published series following arthroscopic microfracture for full-thickness chondral defects of the hip. In 2002, Byrd et al [27] reported on nine patients with an inverted acetabular labrum. Three of these patients were treated using a microfracture technique. At a minimum 2-year follow-up, those patients that underwent microfracture were the only patients to return to a level of activity higher than simple activities of daily living. These three patients' activities included martial arts, horseback riding, and fitness activities.

In a group of 28 professional athletes, 19 cartilage lesions were treated in addition to other pathologies. All athletes had pain relief and returned to competition by 12 weeks postoperatively (Bharam S, et al. Unpublished data, Meeting of the American Orthopaedic Society for Sports Medicine, Orlando, FL, 2002) Recently, Byrd et al reported on 21 patients who underwent microfracture of the hip. The average size of the lesion was 12.2 mm2, and the average age of the patient was 35 years. At the 2-year follow-up, 86% of the patient had improved and no complications were reported (Byrd T, et al. Unpublished data. Meeting of 2005 ISAKOS Meeting, Miami, FL).

McCarthy et al [28] described a cohort of 10 elite athletes that underwent hip arthroscopy for a variety of diagnoses. Of these, four patients had chondral injury on the acetabular side of the joint that underwent an unspecified treatment. All 10 athletes returned to compete in their sport. Fargo et al [29] evaluated 28 hips that underwent arthroscopy for acetabular labral tears with a minimum follow-up of 13 months. They found that patients with degenerative changes noted either radiographically or arthroscopically, whether on the femoral or acetabular chondral surface, had a significantly worse outcome (P =0.008, P= 0.0004, and P =0.003, respectively).

In 2003, the first long-term outcomes paper was published on the microfracture technique in the knee [10]. This study reported on 72 patients an average of

11 years following microfracture of the knee, with the longest follow-up at 17 years. With a 95% follow-up rate, the results showed overall improvement in symptoms and function. Patient reported decreased pain and swelling at postoperative year 1, continued decrease at year 2, and those clinical improvements were maintained over the study period. The study identified age as the only independent predictor of Lysholm improvement. Patients over 35 years of age improved less than patient under 35; however, both groups showed improvement [10].

Recently microfracture has been compared with autologous chondrocyte transplantation in the knee [10]. In a randomized study, 40 patients were treated with microfracture and 40 patients were treated with autologous chondrocyte transplantation. Both groups showed improvement in functional outcome and reduced pain. No differences in the repair tissue were noted histologically. Microfracture had a lower rate of failure and repeat debridement.

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