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Updated: Jun 29, 2026

Autologous Microfractured and Purified Adipose Tissue for Arthroscopic Management of Osteochondral Lesions of the Talus
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Reverse Microfracture for Acetabular Wave Signs: Clinical and MRI Outcomes at Minimum 2-Year Follow-up.

Leandro Calil De Lazari1, Fabio Stucchi Devito2, Renato Magalhães de Oliveira Filho1

  • 1Hospital São Lucas, Ribeirão Preto, São Paulo, Brazil.

Orthopaedic Journal of Sports Medicine
|June 23, 2026
PubMed
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Reverse microfracture shows promise for treating acetabular wave signs, improving hip function and reducing pain. This cartilage-preserving technique did not show further cartilage damage in patients with femoroacetabular impingement (FAI).

Area of Science:

  • Orthopedic surgery
  • Cartilage repair
  • Hip arthroscopy

Background:

  • Acetabular wave signs are a form of cartilage delamination that can worsen in femoroacetabular impingement (FAI).
  • Optimal surgical strategies for acetabular wave signs lack high-quality evidence.
  • Reverse microfracture is explored as a safe, cost-effective, cartilage-preserving option.

Purpose of the Study:

  • To evaluate clinical and imaging outcomes of arthroscopic reverse microfracture for acetabular wave signs.
  • To assess if the supralabral reverse drilling technique causes additional articular cartilage damage.
  • Hypothesis: The technique improves outcomes without further cartilage damage.

Main Methods:

  • Retrospective case series of 40 patients (mean age 40.2 years) undergoing hip arthroscopy with reverse microfracture for FAI.
Keywords:
arthroscopyarticular cartilagechondral lesionhipmicrofracturereverse drillingwave sign

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  • Minimum 2-year follow-up assessing Harris Hip Score (HHS), visual analog scale (VAS), lateral center-edge angle (LCEA), alpha angle, and MRI.
  • Reverse drilling performed from the supralabral region without articular cartilage damage.

    • Main Results:

    • Significant improvement in HHS (68.88 to 97.90) and VAS (7.40 to 1.35) (P < .001).
    • Significant reduction in alpha angle (61.88° to 50.05°) and LCEA (36.75° to 32.43°) (P < .001).
    • Postoperative MRI showed no cartilage deterioration or new lesions; cartilage appearance was similar to adjacent areas.

    Conclusions:

    • Reverse microfracture may be a viable treatment for acetabular wave signs, improving pain and function.
    • The procedure showed no evidence of additional cartilage damage on MRI at 2-year follow-up.
    • Clinical improvements may stem from comprehensive FAI management rather than reverse drilling alone due to the lack of a control group.