Results of arthroscopic treatment of chondral delamination in femoroacetabular impingement with bone marrow stimulation and BST-CarGel®

Mahmoud Tahoun; Tamer Aly Shehata; Inmaculada Ormazabal; Jesús Mas; Javier Sanz; Marc Tey Pons

doi:10.1051/sicotj/2017031

Results of arthroscopic treatment of chondral delamination in femoroacetabular impingement with bone marrow stimulation and BST-CarGel^®

SICOT J. 2017:3:51. doi: 10.1051/sicotj/2017031. Epub 2017 Aug 7.

Authors

Mahmoud Tahoun¹, Tamer Aly Shehata², Inmaculada Ormazabal³, Jesús Mas⁴, Javier Sanz⁴, Marc Tey Pons⁵

Affiliations

¹ iMove traumatologia, Hospital Mi Tres Torres, Barcelona, Spain - Hip Unit, Department of Orthopaedics, Hospital del Mar, UAB, Barcelona, Spain - Department of Orthopaedics, Menoufia University, Al Minufya, Egypt.
² Department of Orthopaedics, IHR, Kingdom of Bahrain.
³ Department of Radiology, Hospital Universitari Dexeus, Barcelona, Spain.
⁴ Department of Orthopaedics, Clínica Vistahermosa, Alicante, Spain.
⁵ iMove traumatologia, Hospital Mi Tres Torres, Barcelona, Spain - Hip Unit, Department of Orthopaedics, Hospital del Mar, UAB, Barcelona, Spain.

Abstract

Objectives: The purpose of this study is to show the preliminary results of using chitosan-based scaffold (BST-CarGel^®) with microfracture for treatment of acetabular chondral delamination associated with femoroacetabular impingement.

Methods: A prospective study was performed on 13 hips. Patients were selected in the age group between 18 and 50 years. Patients with delamination of acetabular cartilage associated with femoroacetabular impingement received arthroscopic debridement and microfracture technique. Then cases with defect > 2 cm² were considered for the application of BST-CarGel^® and included in the study. Also, reattachment of the torn labrum and resection of the cam deformity were performed according to the case. For evaluation of the functional outcome, the patients had completed the hip outcome score (HOS) pre- and post-operatively. For evaluation of the regeneration of the cartilage, delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) was used and the percentage of defect filling and type of cartilage studied.

Results: Patients had a mean age of 41 years, with moderate to high level of activity (mean Tegner scale 7). The mean size of the chondral defect after debridement was 3.7 cm². The mean HOS for daily live activities has been improved from 64.4 to 87.4 and for sports subscale from 35.2 to 75.2, which is statistically highly significant. All patients had > 90% of filling of chondral defect.

Conclusion: The use of BST-CarGel^® with microfracture for treatment of acetabular chondral delamination associated with femoroacetabular impingement can improve the functional outcome at two years, with a complete restoration of the cartilage defect in magnetic resonance images (MRI) with specific cartilage sequences.