Microfracture of Acetabular Chondral Lesions is Not Superior to Other Cartilage Repair Techniques in Patients with Femoroacetabular Impingement Syndrome: A Systematic Review.

PURPOSE: To perform a systematic review to compare clinical outcomes of hip arthroscopy patients undergoing microfracture (MFx) versus other cartilage repair procedures for chondral lesions of the acetabulum. METHODS: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching PubMed, the Cochrane Library, and Embase to identify comparative studies that directly compared outcomes between MFx and other cartilage repair procedures for full-thickness chondral lesions of the acetabulum identified during hip arthroscopy. The search phrase used was: hip AND arthroscopy AND microfracture. Patients were evaluated based on reoperation rates and patient-reported outcomes. RESULTS: Six studies (all level III evidence) met inclusion criteria, including a total of 202 patients undergoing microfracture (Group A) and 327 patients undergoing another cartilage repair procedure (Group B). Mean patient age ranged from 35.0 to 45.0 years. Mean follow-up time ranged from 12.0 to 72.0 months. Significantly better patient-reported outcomes (PROs) were found in patients undergoing treatment with bone marrow aspirate concentrate (BMAC), micro-fragmented adipose tissue concentrate, autologous matrix-induced chondrogenesis (AMIC), and a combination of AMIC and BMAC compared to MFx. No studies found significantly better postoperative PROs in Group A. The reoperation rate ranged from 0% to 34.6% in Group A and 0% to 15.9% in Group B. Three of five studies reporting on reoperation rate found a significantly higher reoperation rate in Group A, with no difference in the other two studies. CONCLUSION: The literature on MFx of acetabular chondral lesions is limited and heterogeneous. Based on the available data, MFx alone results in a higher or equivalent reoperation rate and inferior or equivalent PROs compared to other cartilage repair procedures for acetabular chondral lesions in patients with femoroacetabular impingement syndrome.