Arthroscopic Treatment of Chondral Defects in the Hip: AMIC, MACI, Microfragmented Adipose Tissue Transplantation (MATT) and Other Options

Overview

Journal SICOT J

Publisher EDP Sciences

Specialty Orthopedics

Date 2017 Jun 8

PMID 28589877

Citations 22

Authors

Eugenio Jannelli

Andrea Fontana

Affiliations

Soon will be listed here.

Abstract

Chondral lesions are currently considered in the hip as a consequence of trauma, osteonecrosis, dysplasia, labral tears, loose bodies, dislocation, previous slipped capital femoral epiphysis and Femoro-Acetabular-Impingement (FAI). The management of chondral lesions is debated and several techniques are described. The physical examination must be carefully performed, followed by radiographs and magnetic resonance imaging (MRI). Differential diagnosis with other pathologies must be considered. Debridement is indicated in patients younger than 50 years with a chondropathy of 1st or 2nd degree. Microfractures are indicated in patients younger than 50 years with a chondropathy of 3rd or 4th degree less than 2 cm. Matrix-Induced Autologous Chondrocyte Implantation (MACI) and Autologous Matrix-Induced Chondrogenesis (AMIC) procedures are indicated in patients with full-thickness symptomatic 3rd-4th degree chondral defects, extended 2 cm or more. The AMIC procedure has the advantage of a one-step procedure and much less expense. Microfragmented adipose tissue transplantation (MATT) is indicated for the treatment of delamination and 1st and 2nd degree chondral lesions, regardless of the age of the patient. Chondral defects are effective when the joint space is not compromised. When the Tonnis classification is two or greater, treatment of chondral lesions should be considered ineffective.

Citing Articles

Current understanding of articular cartilage lesions in femoroacetabular impingement syndrome.

Li Z, Yu J, An P, Zhang W, Tian K J Orthop Surg Res. 2024; 19(1):886.

PMID: 39734214 PMC: 11684245. DOI: 10.1186/s13018-024-05322-6.

Arthroscopic Repair of Acetabular Cartilage Delamination Using Chondral Nail Fixation in Patients With Femoroacetabular Impingement.

Dong H, Tian K, Gao G, Liu R, Zhang S, Liu Z Arthrosc Tech. 2024; 13(5):102950.

PMID: 38835465 PMC: 11144942. DOI: 10.1016/j.eats.2024.102950.

Best practice guidelines for clinical and radiological assessment of patients with femoroacetabular impingement. Results from the ISHA International Delphi Consensus Project-Phase 2.

Radha S, Hutt J, Lall A, Domb B, Lynch T, Griffin D J Hip Preserv Surg. 2024; 11(1):44-50.

PMID: 38606327 PMC: 11005775. DOI: 10.1093/jhps/hnad028.

Novel Allograft in the Load-Bearing Portion of the Femoral Head.

Renshaw A, Duru N, Assid E, Williams G, Suri M, Jones D Ochsner J. 2024; 24(1):67-73.

PMID: 38510225 PMC: 10949049. DOI: 10.31486/toj.23.0066.

Management of chondral and osteochondral lesions of the hip : A comprehensive review.

Itha R, Vaishya R, Vaish A, Migliorini F Orthopadie (Heidelb). 2023; 53(1):23-38.

PMID: 37815635 PMC: 10781822. DOI: 10.1007/s00132-023-04444-9.

References

Philippon M, Schenker M, Briggs K, Maxwell R . Can microfracture produce repair tissue in acetabular chondral defects?. Arthroscopy. 2008; 24(1):46-50. DOI: 10.1016/j.arthro.2007.07.027. View

Johnston T, Schenker M, Briggs K, Philippon M . Relationship between offset angle alpha and hip chondral injury in femoroacetabular impingement. Arthroscopy. 2008; 24(6):669-75. DOI: 10.1016/j.arthro.2008.01.010. View

Enseki K, Martin R, Draovitch P, Kelly B, Philippon M, Schenker M . The hip joint: arthroscopic procedures and postoperative rehabilitation. J Orthop Sports Phys Ther. 2006; 36(7):516-25. DOI: 10.2519/jospt.2006.2138. View

Stuart M, Lubowitz J . What, if any, are the indications for arthroscopic debridement of the osteoarthritic knee?. Arthroscopy. 2006; 22(3):238-9. DOI: 10.1016/j.arthro.2006.01.008. View

Byrd J, Jones K . Prospective analysis of hip arthroscopy with 10-year followup. Clin Orthop Relat Res. 2009; 468(3):741-6. PMC: 2816779. DOI: 10.1007/s11999-009-0841-7. View

Steinwachs M, Guggi T, Kreuz P . Marrow stimulation techniques. Injury. 2008; 39 Suppl 1:S26-31. DOI: 10.1016/j.injury.2008.01.042. View

Fukumoto T, Sperling J, Sanyal A, Fitzsimmons J, Reinholz G, Conover C . Combined effects of insulin-like growth factor-1 and transforming growth factor-beta1 on periosteal mesenchymal cells during chondrogenesis in vitro. Osteoarthritis Cartilage. 2002; 11(1):55-64. DOI: 10.1053/joca.2002.0869. View

Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock K . Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003; (417):112-20. DOI: 10.1097/01.blo.0000096804.78689.c2. View

Beck M, Kalhor M, Leunig M, Ganz R . Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005; 87(7):1012-8. DOI: 10.1302/0301-620X.87B7.15203. View

10.

Bakopoulou A, Leyhausen G, Volk J, Tsiftsoglou A, Garefis P, Koidis P . Comparative analysis of in vitro osteo/odontogenic differentiation potential of human dental pulp stem cells (DPSCs) and stem cells from the apical papilla (SCAP). Arch Oral Biol. 2011; 56(7):709-21. DOI: 10.1016/j.archoralbio.2010.12.008. View

11.

Gigante A, Bevilacqua C, Ricevuto A, Mattioli-Belmonte M, Greco F . Membrane-seeded autologous chondrocytes: cell viability and characterization at surgery. Knee Surg Sports Traumatol Arthrosc. 2006; 15(1):88-92. PMC: 1779626. DOI: 10.1007/s00167-006-0115-9. View

12.

Akimau P, Bhosale A, Harrison P, Roberts S, McCall I, Richardson J . Autologous chondrocyte implantation with bone grafting for osteochondral defect due to posttraumatic osteonecrosis of the hip--a case report. Acta Orthop. 2006; 77(2):333-6. DOI: 10.1080/17453670610046208. View

13.

DeAngelis N, Busconi B . Assessment and differential diagnosis of the painful hip. Clin Orthop Relat Res. 2003; (406):11-8. DOI: 10.1097/01.blo.0000043039.84315.be. View

14.

Zantop T, Petersen W . Arthroscopic implantation of a matrix to cover large chondral defect during microfracture. Arthroscopy. 2009; 25(11):1354-60. DOI: 10.1016/j.arthro.2009.04.077. View

15.

Fraser J, Wulur I, Alfonso Z, Hedrick M . Fat tissue: an underappreciated source of stem cells for biotechnology. Trends Biotechnol. 2006; 24(4):150-4. DOI: 10.1016/j.tibtech.2006.01.010. View

16.

Khanduja V, Villar R . The arthroscopic management of femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc. 2007; 15(8):1035-40. DOI: 10.1007/s00167-007-0319-7. View

17.

Jankowski R, Deasy B, Huard J . Muscle-derived stem cells. Gene Ther. 2002; 9(10):642-7. DOI: 10.1038/sj.gt.3301719. View

18.

Tuli R, Tuli S, Nandi S, Wang M, Alexander P, Haleem-Smith H . Characterization of multipotential mesenchymal progenitor cells derived from human trabecular bone. Stem Cells. 2003; 21(6):681-93. DOI: 10.1634/stemcells.21-6-681. View

19.

Steadman J, Briggs K, Rodrigo J, Kocher M, Gill T, Rodkey W . Outcomes of microfracture for traumatic chondral defects of the knee: average 11-year follow-up. Arthroscopy. 2003; 19(5):477-84. DOI: 10.1053/jars.2003.50112. View

20.

Clohisy J, Beaule P, OMalley A, Safran M, Schoenecker P . AOA symposium. Hip disease in the young adult: current concepts of etiology and surgical treatment. J Bone Joint Surg Am. 2008; 90(10):2267-81. DOI: 10.2106/JBJS.G.01267. View