Hip Arthroscopic Osteochondral Autologous Transplantation for Treating Osteochondritis Dissecans of the Femoral Head

Abstract

Osteochondritis dissecans (OCD) of the femoral head is not a common source of hip pain. Hip arthroscopy is becoming a more frequent indication for intra-articular pathologies of the hip. Osteochondral autologous transplantation is a promising technique that theoretically can reconstruct osteochondral lesions of the femoral head. We describe our technique for arthroscopic antegrade osteochondral autologous transplantation for the treatment of OCD of the femoral head. The advantages of this technique include that it is a less invasive method with the ability to assess and treat intra-articular pathologies associated with OCD of the femoral head at same time. Case series and outcomes after this technique are not currently reported in the literature; however, it could be a less invasive method and provide favorable clinical outcomes for patients with OCD lesions of the femoral head.

Fig 1

Preoperative radiographs of a 37-year-old female patient who presented to our clinic with a 2-year history of insidious-onset, increasingly intense left hip pain. (A) Pelvic anteroposterior view showing a pistol-grip deformity and the center-edge angle (right, 32°; left, 25°). A round radiolucent lesion (arrow) suggests an osteochondritis dissecans (OCD) lesion at the anterosuperior portion of the left femoral head. (B) Preoperative 3-dimensional computed tomography also showing an OCD lesion (arrow) at the anterosuperior site of the femoral head. (C) Coronal magnetic resonance imaging view (short inversion time inversion-recovery sequence) showing a high-intensity round lesion (arrow) at the anterosuperior portion of the femoral head 1 month before surgery.

Fig 2

Surgical findings and technique. (A) An osteochondritis dissecans (OCD) lesion (arrows), classified as International Cartilage Repair Society grade III, was observed at the anterosuperior femoral head, with the arthroscope viewing from the anterolateral portal (ALP). An awl and probe through the proximal midanterior portal (PMAP) were used to evaluate the OCD lesion. (B) The degenerative OCD lesion was resected with a shaver (Dyonics Bonecutter Platinum, 4.5 mm), viewing from the ALP. (C) A cylindrical autologous osteochondral graft (8.5 mm in diameter) was harvested arthroscopically from the ipsilateral knee joint. (D) A drill guide was introduced through the PMAP, viewing from the ALP. The subchondral bone was drilled to a depth of 14 mm. The dilator was inserted into the drill guide and tapped to the desired depth. The autologous osteochondral graft was tamped into the lesion until the articular surface was flush with the host joint surface. (CP, capsule; FH, femoral head.)

Fig 3

Postoperative results. (A) Anteroposterior view showing graft incorporation. (B) Modified Dunn view showing slight flattening of femoral head. (C, D) Magnetic resonance T2* radial views showing good integration of graft and homogeneous intensity.