AANA Lab Course 914 - Advanced Hip Arthroscopy-Osteochondral, Subchondral, and Chondral Defects; Advanced Techniques, Srino Bharam, MD

Osteochondral, Subchondral, and Chondral Defects; Advanced Techniques, Srino Bharam, MD

Pdf Summary

This presentation by Dr. Srino Bharam, Clinical Professor at Mount Sinai School of Medicine and Director of Hip Preservation at Lenox Hill Hospital, explores advanced techniques in diagnosing and managing osteochondral, subchondral, and chondral defects of the hip, particularly associated with femoroacetabular impingement (FAI).<br /><br />The hip joint is a constrained ball-and-socket joint with thin, curved cartilage that is vulnerable to sagittal damage. Chondral lesions linked to FAI commonly involve labral pathology, cam and pincer deformities, dysplasia, trauma, avascular necrosis, and synovial chondromatosis. Cam-type lesions cause abnormal shear forces resulting in chondromalacia (softening and ballooning of cartilage), chondrolabral separation, cartilage delamination, and flap tears. Pincer-type lesions cause overhang of the acetabular rim leading to labrum crushing and contre-coup lesions.<br /><br />Radiographic evaluation includes standard AP pelvis, false profile views, and specialized MRI sequences (T1, PD, dGEMRIC, T2, T1 rho) to assess cartilage and labral damage, though MRI sensitivity especially for delamination remains limited. Arthroscopic grading of chondral damage follows the Outerbridge classification (Grades I-IV). A validated six-zone acetabular classification for chondral lesions in FAI grades damage from softening to exposed bone.<br /><br />Treatment focuses on arthroscopic procedures: abrasion chondroplasty for cartilage fibrillation, microfracture for Grade IV lesions with healthy borders, debridement of flap tears, and osteochondral plugs for large lesions. Labral preservation (repair or reconstruction) is important to restore the labral seal and cartilage protection. Postoperative weightbearing progresses typically over 6 weeks.<br /><br />Molecular studies show that cartilage in cam deformities exhibits altered biomechanical properties, increased permeability, and elevated expression of inflammatory and catabolic genes compared to osteoarthritis, highlighting the pathological nature of these lesions.<br /><br />Outcomes data support microfracture as effective in improving function (e.g., Harris Hip Score) in FAI patients with focal chondral defects, while advanced imaging and molecular insights promise improved diagnosis and management strategies for hip cartilage lesions related to FAI.

Keywords

Femoroacetabular Impingement

Hip Cartilage Defects

Chondral Lesions

Cam and Pincer Deformities

Arthroscopic Treatment

Microfracture Technique

Labral Preservation

MRI Imaging Sequences

Outerbridge Classification

Molecular Pathology of Cartilage