Summary

Postoperative MRI-Arthrograms demonstrate a significant decrease in the size of chondral defects in patients who were treated arthroscopically with BST-CarGel

Abstract

Purpose: 
Acetabular cartilage lesions are a common pathology found in patients undergoing hip arthroscopy and may cause pain and functional limitation. Irrespective of the cause, chondral lesions have nearly no self-repair capabilities, and most likely will progress to generalized degeneration if left untreated. Several strategies have been developed to treat chondral defect with no overwhelming success. Recently, BST-CarGel (Piramal Life Sciences, Bio-Orthopaedic Division) which is a gel-forming biopolymer (Chitosan based) injectable medical device has gained interests as a scaffolding material that can be injected into the site of micro-fracture to stabilize the clot and facilitate the cartilage repair. This study aims to perform a retrospective analysis of prospectively collected data to evaluate the short-term outcome of patients treated arthroscopically with BST-CarGel for acetabular chondral defect.

Methods: 
Between November 2014 and December 2015, 22 patients (23 hips) underwent hip arthroscopy for correction of femoroacetabular impingement, labral repair and treatment of acetabular chondral defect. Patient evaluations included general assessment with iHOT-33 questionnaire at the time of preoperative consultation, and the postoperative follow-up at 2 weeks, 6 weeks, 3 months, 6 months, 1 year and 2 year marks. In addition, preoperative and postoperative plain radiographs and MR arthrogram scans were analyzed for evaluation. 

Results: 
22 patients (23 hips) have been evaluated with mean age of 33.34 years at time of the index operation. There were 16 males (17 hips, mean age of 32.00) and 6 female (6 hips, mean age of 37.15). Minimum follow up time was 12 months. The preoperative iHOT score was 47.1 and the score at 12 months postoperative visit was 63.7. MR arthrograms demonstrated a significant decrease in the size of the chondral defects. No significant adverse outcomes have been reported. 

Conclusions: 
Arthroscopic treatment of chondral acetabular defect with BST-CarGel demonstrates encouraging signs of cartilage healing as shown on MR arthrograms, without significant adverse outcomes. Longer follow-up may be required to demonstrate any significant change of the iHOT-33 scores. 

Level of evidence: Level IV (case series)