Editorial Commentary: Acetabular Cartilage Delamination in Patients Having Femoroacetabular Impingement Syndrome Surgery Requires a Single-Stage Solution.

Abstract

Acetabular cartilage delamination (ACD) can result in focal chondral defects, increasing contact stresses and contributing to osteoarthritis. This is commonly associated with femoroacetabular impingement, particularly with cam deformities due to shearing of the cam on the acetabulum. Additionally, ACD associated with labral tears or chondrolabral separation, when untreated, can compromise labral repair outcomes. ACD is often missed on preoperative magnetic resonance imaging and magnetic resonance arthrography, which show a sensitivity of <80%. Thus, given the ubiquity of ACD in patients undergoing femoroacetabular impingement surgery, a single-stage treatment option is essential. Acetabular shape, depth, and constraint, coupled with the thinness of acetabular cartilage, make treatment technically difficult, particularly arthroscopically. Treatment generally falls within 3 categories: repair, repair with augmentation, or cell-based cartilage transplantation. Currently, we most commonly employ primary repair and incorporate the cartilage flap into the labral repair.