Evaluating the Morphology of Unique Superficial Fissured Cartilage Lesions at the Femoral Head-Neck Junction in Patients with Femoroacetabular Impingement Syndrome

Kohei Yamaura; Haruki Nishimura; Joseph J Ruzbarsky; Benjamin D Kuhns; Michael T Mullen; Victoria R Duke; Kelsey M O'Hara; Jarrod M Brown; Spencer M Comfort; William S Hambright; Chelsea S Bahney; Johnny Huard; Marc J Philippon

doi:10.1177/23259671231219217

Evaluating the Morphology of Unique Superficial Fissured Cartilage Lesions at the Femoral Head-Neck Junction in Patients with Femoroacetabular Impingement Syndrome

Orthop J Sports Med. 2024 Feb 8;12(2):23259671231219217. doi: 10.1177/23259671231219217. eCollection 2024 Feb.

Authors

Kohei Yamaura^{1

2}, Haruki Nishimura¹, Joseph J Ruzbarsky^{1

3}, Benjamin D Kuhns^{1

3}, Michael T Mullen¹, Victoria R Duke¹, Kelsey M O'Hara¹, Jarrod M Brown¹, Spencer M Comfort¹, William S Hambright¹, Chelsea S Bahney^{1

4}, Johnny Huard¹, Marc J Philippon^{1

3}

Affiliations

¹ Center for Regenerative and Personalized Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA.
² Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
³ The Steadman Clinic, Vail, Colorado, USA.
⁴ The Orthopaedic Trauma Institute, University of California, San Francisco (UCSF), San Francisco, California, USA.

Abstract

Background: While an association between femoroacetabular impingement (FAI) and osteoarthritis (OA) has been reported, the mechanistic differences and transition between the 2 conditions is not fully understood. In FAI, cartilage lesions at the femoral head-neck junction can sometimes be visualized during hip arthroscopy.

Purpose/hypothesis: The purpose of this study was to describe a unique dimpled pattern of superficial fissured cartilage lesions on the femoral head-neck junction at impingement site in patients with FAI syndrome (FAIS) and to evaluate the clinical, histological, and genetic phenotype of this cartilage. We hypothesized that the cartilage lesions may indicate risk for, or predict occurrence of, OA.

Study design: Controlled laboratory study.

Methods: Six hips (6 patients; mean age, 34.2 ± 12.9 years; range, 19-54 years) with dimpled or fissured cartilage were included among patients who underwent hip arthroscopy for treatment of FAIS from October 2020 through December 2021. This affected cartilage (dimple-pattern group) and normal cartilage (control group) on the femoral head-neck junction were collected from the same patients and evaluated for histological quantification by Mankin scores and expression of proteins related to cartilage degeneration (eg, matrix metalloproteinase [MMP]-1, MMP-2, MMP-3, MMP-10, and MMP-12, tissue inhibitor of metalloproteinase [TIMP]-1 and TMP-2, aggrecan neopepitope CS846, and hyaluronic acid [HA]) with the use of Milliplex Multiplex Assays.

Results: All 6 hips were of the mixed FAI subtype. Preoperatively, 4 of 6 hips had Tönnis grade 1 radiographic changes, which was associated with greater femoral head chondral damage visualized intraoperatively. Mankin scores for the normal cartilage group and the dimple-pattern group were 0.67 ± 0.82 and 3.3 ± 0.82, respectively. Dimple pattern fissured cartilage showed a significant increase in Mankin score (P = .031) and a significant increase in protein expression of CS846 (P = .031) compared with normal cartilage. There were no significant differences in MMPs, TIMPs, or HA levels between the 2 groups.

Conclusion: The dimple pattern fissured cartilage, compared to normal cartilage, showed histologically significant cartilage degeneration and a significant increase in protein expression of CS846, a biomarker for early OA.

Clinical relevance: This lesion serves as helpful visual indicator of early degeneration of the cartilage of femoral head-neck junction caused by FAIS.

Keywords: cartilage defect; femoral head; femoroacetabular impingement; hip arthroscopy.