Table 2.

Potential Pitfalls of Performing Arthroscopic Microfracture of Hip Augmented With BioCartilage

Obtaining adequate access remains an inherent challenge of performing arthroscopic microfracture of the hip. The procedure can become even more precarious with graft placement, particularly when applying the fibrin glue.

Size- and location-specific indications for microfracture of the hip have yet to be defined. In the experience of the senior author (A.J.S.), anterior and superior acetabular lesions may be more amenable to BioCartilage repair than inferior or posterior lesions because of more direct access.

As with microfracture alone, the cartilage rim surrounding the defect must be robust and intact enough to create a pocket for the graft to sit in. Advanced degenerative lesions are generally contraindicated for traditional microfracture because of thinning around the rim of the defect. Consequently, microfracture augmented with BioCartilage may also not be appropriate for these patients.

It is unclear whether other contraindications for traditional microfracture (e.g., malalignment, prior surgery, and noncompliance) are necessarily contraindications for BioCartilage or whether these may be attenuated by BioCartilage.

The graft must be handled gently during placement because it may break apart in the defect if unstable or if mobilized too aggressively (e.g., if traction is released too quickly). Once traction is removed, reapplying traction should be avoided.

Delivering too much graft to the defect (“overstuffing”) can impede sealing of the repair by the fibrin glue, resulting in possible graft mobilization, poor graft integration, and/or mechanical interference within the hip joint.

Meticulous sterile technique must be used to avoid contamination of foreign graft materials.