Comparing Outcomes in Patients with High-Grade vs. Low-Grade Acetabular Cartilage Lesions
What is the impact of acetabular cartilage damage on outcomes of primary arthroscopic repair for acetabular labral tears?
To answer that question, Dominic Carreira, MD, and colleagues from Peachtree Orthopedics in Atlanta, Georgia, queried a multi-center hip arthroscopy registry for patients who underwent primary labrum repair between 2014 and 2017 and who had documented 2-year outcomes. They assigned the 472 patients to 1 of 3 groups based on severity of articular cartilage damage according to in the Beck classification system:
- Low-grade: Grade 1 or 2 damage
- High-grade: Grade 3 or 4 damage
Patients in all 3 groups experienced statistically significant improvement in scores for the short version of the International Hip Outcome Tool (iHOT-12) from baseline to final follow-up (P<0.001). However, patients with high-grade cartilage damage did not fare as well as patients with lower-grade cartilage damage. The researchers found that the iHOT-12 scores at 2 years were significantly higher in patients with no acetabular articular cartilage damage (mean± SD, 80 ± 21) than in patients with high-grade damage (71 ± 25) (Dunn test, P<0.001).
Presence of high-grade lesions was a negative predictor for achieving the minimum clinically important difference (odds ratio [95% CI], 0.49 [0.25, 0.91]) and the patient acceptable symptom state (0.61 [0.38, 0.98]) when accounting for age, BMI, gender, and preoperative iHOT12 scores in logistic regression models for clinically significant outcome thresholds. Among patients with high grade lesions, there was no significant difference in 2-year iHOT-12scores between those undergoing chondroplasty (n=57) and those undergoing microfracture (n=19) (P = 0.13).
“High grade acetabular articular damage portends inferior patient-reported outcomes 2 years after primary labral repair,” Dr. Carreira reported. “And our results suggest no difference between the efficacy of chondroplasty and microfracture with respect to self-reported outcomes.”
The study findings were presented at the American Orthopedic Society of Sports Medicine-Arthroscopy Association of North America Combined 2021 Annual Meeting.