Editorial Commentary: Hip Chondral Defect Treatment Requires Cells, Signal, and Scaffold: The Chef Is In the Kitchen.

Abstract

Hip cartilage defects are most common in the anterosuperior acetabulum and central femoral head, and, while chondrolabral delamination can be treated satisfactorily with repair, articular defects are variably treated, with overall heterogenous outcomes. Hip chondral lesions have consistently predicted arthroplasty following arthroscopy. Microfracture in isolation has waned in attractiveness and use in both the hip and knee, given similar results to debridement alone and the addition of intraoperative time and potential postoperative complications such as subchondral fracture and intralesional osteophyte formation. We recommend debridement for small-to-moderate (<6 cm²) full-thickness chondral defects. However, the poor prognosis for grade III to IV defects highlights the need for novel treatment options. One such approach is "biologically enhanced" microfracture in conjunction with (autologous) platelet-rich plasma, micronized allograft extracellular cartilage matrix, and fibrin glue. This certainly satisfies our biologic mantra of "cells, signal, and scaffold," providing the influx of marrow-based stromal cells, platelet-rich plasma, and matrix-associated growth factors, and fibrin-sealed defect fill.