Arthroscopic Chondral Nail Fixation for Treating Acetabular Cartilage Delamination Results in Improved Pain Relief at Minimum 2-Year Follow-Up in Patients With Femoroacetabular Impingement Syndrome: A Propensity-Matched Study.

Abstract

Purpose: To investigate the clinical outcomes after arthroscopic chondral nail fixation for acetabular cartilage delamination (ACD) in patients with femoroacetabular impingement syndrome (FAIS), as well as the presentation of ACD on magnetic resonance imaging (MRI), at follow-up.

Methods: A retrospective review was performed between March 2021 and March 2022 at our institute. Patients undergoing primary hip arthroscopy for FAIS in whom ACD was diagnosed intraoperatively were included. The exclusion criteria were incomplete data or loss to minimum 2-year follow-up and concomitant hip conditions including hip osteoarthritis with a Tönnis grade greater than 1, avascular necrosis, Legg-Calvé-Perthes disease, osteoid osteoma, synovial chondromatosis, pigmented villonodular synovitis, and developmental dysplasia of the hip. Patients who underwent chondral nail fixation were matched 1:1 to a control cohort of patients who only underwent simple debridement. Preoperative and minimum 2-year postoperative patient-reported outcome scores, including the visual analog scale (VAS) pain score and modified Harris Hip Score (mHHS), as well as percentage achieving the minimal clinically important difference and patient acceptable symptom state (PASS), were collected and compared. MRI was performed preoperatively and at final follow-up to assess ACD.

Results: Fifty-eight patients were included in the study (29 patients in each group). Both groups showed improved VAS pain scores and mHHS values after surgery (all P < .05). The chondral nail group showed better postoperative VAS pain scores (P = .022) than the control group, whereas the postoperative mHHS values were comparable between the 2 groups (P = .852). No significant differences in achievement of the minimal clinically important difference were found between the 2 groups (all P > .05). More patients in the chondral nail group achieved the PASS for the VAS pain score compared with the control group (75.9% vs 48.3%, P = .030). No patient underwent revision surgery or conversion to total hip arthroplasty. The chondral nail group showed a significantly higher rate of ACD healing on MRI compared with the control group (P < .001).

Conclusions: Patients undergoing arthroscopic chondral nail fixation for the treatment of ACD showed significant pain relief, greater achievement of the PASS for the VAS pain score, and a higher rate of ACD healing on MRI compared with those undergoing simple debridement.

Level of evidence: Level III, retrospective cohort study.