Paper #42 - ISHA Annual Scientific Meeting 2016

Severe Chondral Injuries Associated to FAI Treated with Hyalofast® Scaffold, Microfractures and Peripheral Blood Stem Cells. Clinical and Imaging Results with a Minimum Follow-Up of 12 Months.

Claudio Rafols, MD, Santiago CHILE
Tomas Amenabar, MD, Santiago CHILE
Juan Eduardo Monckeberg Diaz, PhD, Santiago CHILE
Christian Huamani, MD, Santiago CHILE

Clinica MEDS, Santiago, RM, CHILE

FDA Status Not Applicable

Summary: We present our series of 16 hips with FAI and severe chondral injuries treated with microfractures, Hyalofast ® scaffold and stem cells. HOS improved significantly from an average of 66.9 to 94.9. One-year follow-up MRI showed an excellent ICRS cartilage repair assessment score.

It is well known that the morphologic conflict present in FAI leads to articular cartilage damage and the end stage involves exposed bone in the acetabulum. The presence of chondral damage has been shown to be a bad prognostic that could lead to early osteoarthritis, thus several techniques are being used to promote a reparative response.

To present the clinical and imaging results of a case series of patients with severe chondral damage (ICRS 3 and 4) due to FAI treated with microfracture, Hyalofast ® scaffold and peripheral blood obtained stem cells.

Patients had hip arthroscopy surgery due to FAI with our standard technique through anterior lateral, mid anterior and distal accessory portals using an outside-inside approach to the hip. For stem cells harvest we followed previously reported protocols and obtained them from peripheral blood after bone marrow stimulation.
During surgery acetabular overcoverage, labral tear and femoral bump were addressed sequentially as needed.
After that the chondral lesion was treated. First, cartilage injury was delimited and the calcified layer removed prior to microfracture. Second, microfracture were done. Then, with the joint dry the Hyalofast ® scaffold was put in place. Finally, stem cells were injected into the scaffold. Intraoperatively the lesions were measured with an arthroscopic probe and classified according to ICRS. After the surgery patients were encouraged to partial weight bear for 4 weeks and started our standard physiotherapy protocol. Postoperatively patients were evaluated routinely using the Hip Outcome Score (HOS) and one year after surgery they had a MRI and ICRS cartilage repair assessment was done.

16 hips in 14 patients were included. The mean follow up was 16 months (SD 4, range 12-25). 13 patients were male, there was one woman who had bilateral hip surgery. Mean age was 33.7 (SD 8.4, range 21-48). 50% of the hips had CAM FAI and 50% had Mixed FAI. 13 hips (81%) had ICRS type 4 lesions and 19% type 3A. The most common location was zones 2 and 3 (43%), followed by 2,3 and 4 (25%), only 3 (25%) and only 2 (7%). The mean size of the lesions was 16 mm (SD 2.3, range 12-20) by 5 mm (SD 1.7, range 2-8). HOS improved significantly from 66.9 (SD 5, range 60-73) to 94.9 (SD 5.4 , range 85-100) (p<0.05). Two patients were professional soccer players and returned to professional sports at 10 and 11 months after surgery.
ICRS cartilage repair assessment showed that all the lesions were categorized as nearly normal cartilage. 56% of them had 11 points and 44% had 10 points.

In our series the treatment of chondral injuries in FAI surgery showed excellent short-term results with a significant improvement in HOS. Moreover, the cartilage repair obtained with this technique was substantial as showed by the ICRS cartilage repair assessment score.