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Hip Videos: Cartilage
Is It Safe to Perform an Early Arthroscopy After a Traumatic Hip Dislocation With an Associated Pelvic Ring Injury? Report of Our Technique
Hip arthroscopy is useful in the treatment of several intra-articular pathologies, however, its use in high-energy hip and pelvis injuries raises concerns about fluid extravasion and stability of the pelvic ring. We present our arthroscopic surgical technique (initial access to the peripheral compartment) to remove intra-articular loose bodies and treat associated lesions, as well as our concerns with the technique, in case of a traumatic hip dislocation associated with a contralateral pelvic ring injury.Reverse Microfracture of the Hip Acetabulum: A Technique for the Wave Lesion
The long-term efficacy of the treatment of chondral lesions is very important to prevent hip osteoarthritis. Microfracture, autologous chondrocyte transplantation, and direct chondral repair, among others, are techniques that have shown good results in some cases. We propose a technique to treat wave lesions through reverse microfracture, with bubble decompression and adherence of the natural scar from the detached cartilage.Arthroscopic Management for Acetabular Rim Stress Fracture and Osteochondritis Dissecans in the Athlete With Hip Dysplasia
Intra-articular lesions are common in patients with acetabular hip dysplasia. Rim stress fractures (RSFs) have also been described in patients with acetabular hip dysplasia. This lesion is believed to be a result of an unfused secondary ossification center or a stress fracture that could be caused by repetitive impingement of an abnormal-shaped femoral head-neck junction. In addition, osteochondritis dissecans of the acetabulum is a rare condition that can also result from impingement and has been described in patients with hip dysplasia.Arthroscopic Treatment of Hip Chondral Defect With Microfracture and Platelet-Rich Plasma–Infused Micronized Cartilage Allograft Augmentation
Over the past decade, arthroscopic microfracture has become increasingly popular to treat full-thickness (Outerbridge grade IV) chondral defects of the hip. This procedure borrows marrow stimulation treatment principles and techniques from knee arthroscopy, with similar mixed clinical outcomes that may be more favorable in the short term (<2 years) and poorer in the long term. Despite these varied outcomes, microfracture remains the most frequently used technique to treat small focal chondral defects because of the relative ease and cost-effectiveness of the procedure.Arthroscopic Microfracture of Hip Chondral Lesions
Microfracture of hip chondral lesions has been performed for more than a decade with modified treatment principles and techniques from knee arthroscopy. This note and accompanying video review the pertinent techniques, pearls, and pitfalls of the microfracture procedure in the treatment of hip chondral lesions. After debridement of damaged chondral tissue, the size of the lesion is approximated to determine the number of microfracture holes to create. The working portal may be adjusted based on the site of the lesion.Ultrasound Arthroscopy of Hip in Treatment of Osteochondritis Dissecans
An ultrasound arthroscopy (UA) technique is a promising tool for the evaluation of the articular cartilage during arthroscopic examination. However, the applicability of UA for the evaluation of the hip joint is unknown. We describe a UA assessment of a patient with osteochondritis dissecans at the femoral head. An ultrasound catheter designed for intravascular imaging was inserted into the hip joint by use of conventional arthroscopic portals, and the cartilage surfaces of the femoral head and acetabulum were investigated with ultrasound.Intraosseous Infiltration of Platelet-Rich Plasma for Severe Hip Osteoarthritis
This work describes a technique of platelet-rich plasma (PRP) infiltration for the treatment of severe hip osteoarthritis (OA). Although the results achieved with intra-articular infiltrations of PRP are promising, they may be insufficient in the long-term for severe hip OA. The technique consists of a combined intra-articular and intraosseous infiltration of PRP to reach all joint tissues, especially the subchondral bone, and hence facilitate a greater distribution of PRP. Diagnosis is based on clinical and radiographic findings, and patients with grade III OA according to the Tönnis scale, as well as patients who have not responded to conventional treatment, are considered candidates for this technique.Labral Gracilis Tendon Allograft Reconstruction and Cartilage Regeneration Scaffold for an Uncontained Acetabular Cartilage Defect of the Hip
Hip cartilage injuries are very common, with rates as high as 50% having been reported in some series; abnormal femoral acetabular contact can result in a full-thickness cartilage defect or labral lesion. The prevalence of labral lesions can be as high as 55%. This Technical Note describes an arthroscopic technique to reconstruct an uncontained, full-thickness, focal cartilage defect of the acetabulum, with reconstruction of the missing labrum using a gracilis allograft and use of a biological liquid scaffold for cartilage reconstruction.Hip Arthroscopy for Removal of an Acetabular Rim–Based Osteoid Osteoma and Concomitant Femoroacetabular Impingement Correction
Minimally invasive percutaneous radiofrequency ablation (RFA) techniques are the standard of care for treating simple osteoid osteomas (OOs). Historically, OOs were treated with open en bloc resection or curettage of the nidus. RFA procedures have been linked to soft-tissue complications of varying severity. In addition, RFA may be a poor choice for periarticular OOs because of the potential for procedure-related articular cartilage damage. Hip arthroscopy is a widely accepted approach for the treatment of femoroacetabular impingement.Arthroscopic Juvenile Allograft Cartilage Implantation for Cartilage Lesions of the Hip
Cartilage lesions in the hip are of high prevalence. Most of these lesions are treated with microfracture. Microfracture has relatively good subjective outcomes for smaller lesions; however, it is limited by the ability to reproduce hyaline cartilage, especially in older patients. For larger chondral defects, we present a technique using juvenile allograft cartilage implantation implanted arthroscopically to treat cartilage lesions in the hip. The purpose of this technical note is to describe the arthroscopic technique for treating chondral lesions in the hip with allograft juvenile cartilage.Reconstruction of Focal Femoral Head Cartilage Defects With a Chitin-Based Scaffold
It is well known that articular cartilage defects have little capability to heal. For grade III or IV cartilage defects, surgical intervention may be required for symptomatic patients. Microfracture is a commonly used surgical technique to address these injuries. However, microfracture has drawbacks, which include the risk of ossification of the newly formed tissue, as well as the imperfect and fragile nature of the fibrous cartilage. Given the challenges associated with microfracture, BST-CarGel (Piramal Healthcare, Laval, Quebec, Canada) has been developed to stabilize and support the nascent clot.Arthroscopic Bone Grafting of Deep Acetabular Cysts Using a Curved Delivery Device
Acetabular intraosseous cysts are frequently encountered in patients with dysplasia or femoroacetabular impingement. Small cysts are typically addressed by removing the cyst lining and stimulating healing via microfracture or abrasion chondroplasty. In contrast, larger cysts involving 1-3 cm3 frequently require additional fortification with bone graft material to facilitate osseous ingrowth and cyst healing. Previous arthroscopic reports have described the use of rim trimming to access the extra-articular side of the cyst, with subsequent use of straight metal cannulas for delivery of bone graft material.Hip Arthroscopic Osteochondral Autologous Transplantation for Treating Osteochondritis Dissecans of the Femoral Head
Osteochondritis dissecans (OCD) of the femoral head is not a common source of hip pain. Hip arthroscopy is becoming a more frequent indication for intra-articular pathologies of the hip. Osteochondral autologous transplantation is a promising technique that theoretically can reconstruct osteochondral lesions of the femoral head. We describe our technique for arthroscopic antegrade osteochondral autologous transplantation for the treatment of OCD of the femoral head. The advantages of this technique include that it is a less invasive method with the ability to assess and treat intra-articular pathologies associated with OCD of the femoral head at same time.Bridging Suture Repair for Acetabular Chondral Carpet Delamination
Acetabular chondral carpet delamination is a frequent finding at hip arthroscopy. The cartilage is macroscopically normal but deboned from the subchondral bone, without a disruption at the chondrolabral junction. Arthroscopic anatomic repair of delaminated cartilage is challenging. We propose that a combination of microfracture and use of stitches to press the delaminated cartilage against the subchondral bone using a suture limb offers an effective method to provide an environment for cartilage repair.Technique of Arthroscopically Assisted Transtrochanteric Drilling for Femoral Head Chondral Defects
Microfracture is a marrow-stimulation technique in which damaged cartilage is drilled or punched, perforating the subchondral bone and generating a blood clot within the defect that matures into fibrocartilage. Microfracture for the treatment of small cartilage defects of the hip has shown good results. Arthroscopic procedures are less invasive than open procedures and have a reduced incidence of complications such as infection or avascular necrosis of the femoral head. Furthermore, arthroscopic procedures allow for a shorter recovery time, resulting in not only lower overall treatment costs but also higher patient satisfaction.Endoscopic Pubic Symphysectomy for Recalcitrant Osteitis Pubis
Recalcitrant osteitis pubis presents a challenging problem for orthopaedic surgeons. Various surgical interventions have been described for treatment, including opening-wedge resection, symphysiodesis, and curettage. We propose that endoscopic pubic symphysectomy offers an effective method of treating such a challenging problem. This article describes in detail the technique used to perform endoscopic pubic symphysectomy, and a companion video demonstrating the procedure is included. Our experience suggests that removal of the interpubic fibrocartilaginous lamina and resection of approximately 1 cm of bone can successfully eliminate all sources of pain and dysfunction caused by the recalcitrant osteitis pubis.Arthroscopic Treatment of Hip Chondral Defects With Bone Marrow Stimulation and BST-CarGel
Microfracture, the current standard of care for the treatment of non-degenerative chondral lesions in the hip joint, is limited by the poor quality of the filling fibrocartilaginous tissue. BST-CarGel (Piramal Life Sciences, Laval, Quebec, Canada) is a chitosan-based biopolymer that, when mixed with fresh, autologous whole blood and placed over the previously microfractured area, stabilizes the blood clot and enhances marrow-triggered wound-healing repair processes. BST-CarGel has been previously applied in the knee, with statistically significant greater lesion filling and superior repair tissue quality compared with microfracture treatment alone.Management of a Large Acetabular Chondrolabral Injury in a Young Patient With Femoroacetabular Impingement
Patients with mixed-type femoroacetabular impingement syndrome often have concomitant chondrolabral pathology in addition to the characteristic cam and pincer lesions. Unfortunately, these patients are typically young, and the pathology is localized to the weight-bearing dome of the acetabulum. Complete preoperative characterization of labral and cartilage lesions is often not possible even with advanced imaging techniques, and the full extent of the injury may not be appreciated without direct arthroscopic visualization.Arthroscopic Acetabular Microfracture With the Use of Flexible Drills: A Technique Guide
Chondral injuries of the hip joint are often symptomatic and affect patient activity level. Several procedures are available for addressing chondral injuries, including microfracture. Microfracture is a marrow-stimulating procedure, which creates subchondral perforation in the bone, allowing pluripotent mesenchymal stem cells to migrate from the marrow into the chondral defect and form fibrocartilaginous tissue. In the knee, microfracture has been shown to relieve pain symptoms. In the hip, microfracture has been studied to a lesser extent, but published studies have shown promising clinical outcomes.Arthroscopic Resection of Intra-Articular Osteochondromas of the Hip
Proximal femur osteochondromas are relatively rare, particularly in the femoral neck. The choice of treatment poses difficulties to the surgeon. We report an unusual case of a patient with 2 osteochondromas in the femoral neck causing femoroacetabular impingement. Appropriate identification and precise resection of the lesions are important steps of the surgical procedure. We present our arthroscopic surgical technique to access the lesions and perform their resection. To our knowledge, this is the first report of hip arthroscopic resection of 2 osteochondromas with considerable dimensions causing femoroacetabular impingement.The Rigid Curette Technique for the Application of Fibrin Bioadhesive During Hip Arthroscopy for Articular Cartilage Lesions
Encouraging midterm results have recently been reported for the arthroscopic treatment of delaminating articular cartilage lesions at the capsulolabral junction of the hip joint using fibrin bioadhesive. The needle used to introduce the bioadhesive is long, flexible, and often difficult to position. We describe a novel technique for introducing the needle that allows accurate placement behind the delaminated articular cartilage pocket during hip arthroscopy.Arthroscopic-Assisted Core Decompression for Osteonecrosis of the Femoral Head
The management of pre-collapse osteonecrosis of the femoral head is controversial. Core decompression is a technique that theoretically decreases the intraosseous pressure of the femoral head, resulting in a local vascularized healing response. Its efficacy has been shown in delaying early subchondral collapse. We describe the technique of arthroscopic-assisted core decompression of the femoral head for osteonecrosis. The advantages of this technique include evaluation of the presence or absence of articular cartilage injury, subchondral collapse, and guidance during reaming and curettage.Arthroscopic Treatment of Labral Tears and Concurrent Avascular Necrosis of the Femoral Head in Young Adults
Avascular necrosis (AVN) of the femoral head is a progressive disease affecting young adults that results in collapse of the femoral head and subsequent degenerative joint disease. Although precollapse stages of AVN can be successfully treated with core decompression, making the diagnosis is often difficult given alternative sources of hip pain in this age group. We propose that arthroscopic-assisted core decompression of the femoral head offers an effective method of addressing AVN of the femoral head as well as coexistent hip disorders in the same operation.The Use of a Ureteric Stone Basket for Removing Loose Bodies at Hip Arthroscopy
We present the use of a ureteric stone basket for arthroscopic removal of loose bodies from the hip joint. The technique is easy to perform and reduces the time required for loose body retrieval while minimizing the risk of iatrogenic damage to the cartilage surfaces of the joint.Hip Arthroscopy and the Anterolateral Portal: Avoiding Labral Penetration and Femoral Articular Injuries
Establishing the introductory viewing portal is a key step in hip arthroscopy. Most hip arthroscopists initially gain access to the central compartment of the hip through the anterolateral portal. Iatrogenic injury to the labrum or the femoral head chondral surface is a common yet under-reported complication of the procedure. Instead of directing the needle toward the clear space of the distracted joint, labral penetration can be minimized by directing the needle slightly anteroinferior to the clear space, overlapping the superior femoral head.
