SAN FRANCISCO — Discrete, full-thickness chondral
defects of the hip can successfully be treated with
microfracture, allowing for a return to elite competition,
according to a recently presented study.
The findings were shared by John E. McDonald, Jr., MD,
2011 Annual Meeting of the Arthroscopy Association of North
“Discrete chondral defects of the acetabulum and femoral head
are potentially morbid injuries to an elite-level athlete, and very little data
exists documenting return-to-play at this level following arthroscopic
treatment of these lesions,” McDonald said, adding that while hip
arthroscopy has been shown to help return players to an elite level of play, no
specific study has investigated the microfracture subset of the cohort.
McDonald reported on Dr. Marc J. Philippon’s
experience with 41 elite athletes who underwent arthroscopic microfracture by a
single surgeon between 1999 and 2008. He reported 34 of the elite-level
athletes met the study’s inclusion criteria — reported in the study
as having a discrete Outerbridge grade IV chondral lesion either on the femoral
head (three), acetabulum (27) or both (four). Further inclusion criteria
included a lesion amenable to microfracture and a patient with an expressed
desire to return to their professional career.
McDonald reported that the elite athletes in the study
represented professionals from hockey, soccer, football, baseball, tennis and
golf. Each patient in the study underwent concomitant
labral debridement (eight), repair (23) or reconstruction
(three). Data for the study were obtained following these operations, and
included the number of games and seasons played at an elite level after the
original arthroscopic microfracture procedure.
Quick return to play
McDonald reported that 79% (27 of 34) of the elite
athletes who underwent microfracture returned to play at an elite level for an
average of four seasons, with a range of one season to 11 seasons.
“Ninety-six percent of those who returned began
play during the same season or the season following the microfracture,” he
Of the seven athletes who did not return to play, two
played soccer, three played hockey, one played baseball and one played
football. Six of the seven athletes underwent a concomitant labral repair, and
one underwent a labral reconstruction.
“We looked at age, location of microfracture, and
whether the athlete played a contact or non-contact sport and found no
statistical significance in our cohort regarding whether they returned or did
not return to play,” McDonald said. “There was no correlation between
age and number of season played postoperatively.”
Possibilities of microfracture
The findings shed light on the possibilities of
microfracture when treating discrete, full-thickness chondral defects of the
hip in elite-level athletes, McDonald said.
“This is a large series of professional athletes
undergoing arthroscopic hip microfracture,” he concluded. “Very
little data exists regarding these patients in the literature. We have shown
they can return to play, they can play the same or the next season, and they
are able to play for an extended period of time. Hopefully we have provided
reliable data to these patients and their families, coaches and teams regarding
their ability to return to sport.” – by Robert Press
- McDonald JE, Philippon MJ, Herzog M. Return to play following
arthroscopic microfracture of the hip in elite athletes. Paper SS-40. Presented
at the 2011 Annual Meeting of the Arthroscopy Association of North America.
April 14-16. San Francisco.
- John E. McDonald, Jr., MD, can be reached at The Steadman Philippon
Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657; email:
- Disclosure: McDonald has no relevant financial disclosures.
McDonald showed a very good retrospective review of
microfractures in elite athletes during hip arthroscopy. We all know cartilage
lesions tend to be a very difficult problem to treat, especially with an
increasing and active population with an increased awareness of degenerative
tears. This paper shows there is a supportive treatment of full-thickness
Each one of these patients underwent multiple associated
procedures — femoral neck osteoplasty, acetabular osteoplasty, labral work
and some ligamentum teres work. I would like to know how these procedures would
potentially affect, and if the microfracture actually is what we are measuring
here or whether these associated procedures are something that we can discuss.
— Bojan B. Zoric, MD
Disclosure: He is a paid consultant and is on the speakers
bureau/paid presentations for Smith & Nephew.
Having had arthroscopic femoracetabular impingement
surgeries, including microfracture in both of my own (non-elite athletic) hips,
let me chime in on this timely study.
Arthroscopic hip microfracture chondroplasty is
inherently attractive as a relatively simple procedure that appears to be
effective. But we are still dealing with fibrocartilage, which may have
durability issues. With the acceptance of acetabular rim trimming of pincer
impingement, microfracture is less often needed as typical acetabular rim
cartilage damage is removed during rim trimming. But there are cases when a
residual full-thickness defect exists, and I will then perform arthroscopic
Some surgeons are repairing delaminated acetabular
cartilage to the underlying bony base, often with microfracture preparation,
although a recent study questions the viability of the cartilage flap.
Moreover, as most of these lesions may be at the acetabular rim, containment of
bone marrow-derived growth factors and stem cells by concomitant labral repair
or even reconstruction may be critical to any procedural success.
— Dean K. Matsuda, MD
Today Editorial Board member
Kaiser West Los Angeles Medical Center
Los Angeles, Calif.
Disclosure: He has no relevant financial