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Analysis of the Current Indications for Microfracture of Chondral Lesions in the Hip Joint: Letter to the Editor

Dear Editor: We have read the interesting article titled ‘‘Analysis of the Current Indications for Microfracture of Chondral Lesions in the Hip Joint’’ in the recent issue of The American Journal of Sports Medicine. We thank the authors for reporting on this uncommon subject. Microfracture has been used by the hip arthroscopic surgeon very often to treat chondral lesions, and most of the concepts were borrowed from the knee. It is more interesting to note that the authors have recommended microfracture even for larger lesions and older patients, against the generally recommended guidelines for the knee. In their study, approximately 94% of the labral tears were treated with excision, but in recent times, labral repair or reconstruction has been strongly recommended to ensure the sealing effect, which could possibly help in normal hip kinematics by stabilizing the joint’s fluid. However, some studies have reported no difference in the outcomes between repair and excision groups. Larson and Giveans have shown superior results with labral repair, and in their study, both the groups had similar underlying chondral lesions. Krych et al have achieved better results with labral refixation in their prospective study of female patients. The authors have reported overall outcomes irrespective of whether the patients underwent labral excision or repair in the setting of microfracture. The labral repair group was small (4 patients), which might not affect the overall outcomes of the study but can affect the smaller (7 patients in the larger size chondral lesions subgroup) subgroup’s results with the possible positive effect of labral repair by itself or possible stabilization of the clot after microfracture. We are interested in learning the outcomes of the subgroups without the possible positive effect of labral repair. Was there any patient who underwent both labral repair and microfracture for a larger lesion over 4 cm? If so, what was the outcome after excluding the repaired ones from the larger lesion group when compared to the patients with smaller sized lesions who underwent labral excision alone? Similarly, was there any patient who underwent both labral repair and microfracture from the over 50-year-old group? If so, what was the outcome after excluding the older patients who underwent repair from the subgroup compared to the younger patients who underwent labral excision alone? We think that more studies like this are needed in the future to define the exact indications and contraindications of the microfracture procedure for chondral lesions of the hip.