Abstract
BACKGROUND: Acetabular cartilage delamination (ACD) is a common femoroacetabular impingement (FAI) complication that can cause progressive osteoarthritis if untreated. The early diagnosis and appropriate treatment are crucial to prevent irreversible joint damage. However, its radiological diagnosis is challenging, and there is no clear treatment algorithm. PURPOSE: To provide an up-to-date overview of the diagnosis and treatment of ACD in patients with FAI. STUDY DESIGN: Scoping review; Level of evidence, 4. METHODS: A comprehensive search of the PubMed database was conducted using relevant search terms related to FAI and ACD. Articles that met the inclusion criteria and focused on the diagnosis and treatment of ACD were selected and reviewed. RESULTS: A systematic search of the PubMed database was performed using the keywords "femoroacetabular impingement" and "delamination." The initial search yielded 42 articles. After removal of 12 duplicates, 30 articles underwent full screening. Four review articles, 1 case report, and 9 irrelevant studies were subsequently excluded. Ultimately, 16 studies met the inclusion criteria and were analyzed for information regarding the diagnosis and treatment of ACD in patients with FAI.Diagnostic imaging modalities such as magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) demonstrated potential in detecting ACD in patients with FAI; however, their accuracy varied across studies. MRI demonstrated satisfactory sensitivity and specificity alongside moderate interobserver reliability in detecting ACD. However, MRA showed inconsistent results, with some studies reporting poor sensitivity due to limited joint distensibility. Treatment options for ACD included nonoperative management, arthroscopic debridement, microfracture, fibrin adhesive, microfragmented adipose tissue transplantation (MATT), and chitosan-based scaffolds. Studies have reported favorable outcomes with the various surgical techniques; nevertheless, long-term follow-up data are limited. CONCLUSION: Advanced imaging techniques are valuable tools for diagnosing ACD in patients with FAI; however, challenges in terms of achieving optimal sensitivity and specificity persist. Surgical interventions, including arthroscopic techniques and tissue augmentation with fibrin adhesive, MATT, and chitosan-based scaffolds, have potential in restoring cartilage integrity and improving clinical outcomes. Further studies should refine the diagnostic criteria and establish optimal treatment algorithms for ACD in patients with FAI.