Chondral lesions in the hip: a review of relevant anatomy, imaging and treatment modalities

Abstract

The diagnosis and treatment of chondral lesions in the hip is an ongoing challenge in orthopedics. Chondral lesions are common and several classification systems exist to classify them based on severity, location, radiographic parameters, and potential treatment options. When working up a patient with a potential hip chondral lesion, a complete history, thorough physical exam, and ancillary imaging are necessary. The physical exam is performed with the patient in standing, supine, prone, and lateral positions. Plain film radiographs are indicated as the first line of imaging; however, magnetic resonance arthrogram is currently the gold standard modality for the diagnosis of chondral lesions outside of diagnostic arthroscopy. Multiple treatment modalities to address chondral lesions in the hip exist and new treatment modalities continue to be developed. Currently, chondroplasty, microfracture, cartilage transplants (osteochondral autograft transfer, mosaicplasty, Osteochondral allograft transplantation) and incorporation of orthobiologics (Autologous chondrocyte implantation, Autologous matrix-induced chondrogenesis, Mononuclear concentrate in platelet-rich plasma) are some techniques that have been successfully applied to address chondral pathology in the hip. Further refinement of these modalities and research in novel techniques continues to advance a surgeon’s ability to address chondral lesions in the hip joint.

Surgical Hip Dislocation and Fresh Osteochondral Allograft Transplantation for Femoroacetabular Impingement and Concomitant Chondral Lesion

“…2,3 Hip-preserving strategies have gained in popularity, and treatment options include chondroplasty, marrow stimulation, autologous chondrocyte implantation and osteochondral autograft/allograft transplants. 1,4 Although the existing literature on hip osteochondral allograft transplantation (OCA) is limited, 5,6 especially in the setting of large lesions (>2 cm 2 ), open surgical dislocation and OCA represent a viable option that facilitates simultaneous treatment of underlying morphological abnormalities, such as cam lesions. In this article, we describe our preferred surgical approach for this type of lesion (Video).…”

“…Chondral lesions often produce pain and loss of function and can lead to degenerative joint disease. 1 Rarely isolated, they are prevalent in the setting of other intra-articular conditions such as osteonecrosis, labral tears, loose bodies, femoroacetabular impingement (FAI), arthritis, and dysplasia ( Figures 1 and 2 ). Previously published articles have reported a possible association between cam impingement and parafoveal osteochondral lesions, as a manifestation of the complex pathomechanics associated with FAI.…”

Autologous matrix-induced chondrogenesis and bone marrow aspirate concentrate compared with microfracture for arthroscopic treatment of femoroacetabular impingement and chondral lesions of the hip: bridging the osteoarthritis gap and facilitating enhanced recovery

“…The MF group had a significantly lower iHOT functional outcome with a high failure rate, progressing to total hip replacement, suggestive of ongoing deterioration and failure of the construct stability. The current gold standard treatment for small chondral defects <2 cm 2 in the hip is MF [ 22 ]. There is uncertainty in the treatment of larger defects due to various factors.…”

Capsular Management of the Hip During Arthroscopic Acetabular Chondral Resurfacing: Pearls, Pitfalls, and Optimal Surgical Technique

“…T he arthroscopic management of focal chondral lesions of the hip has evolved in an attempt to alleviate symptoms and mitigate progressive chondrolabral damage while treating femoroacetabular impingement syndrome (FAIS). [1][2][3] This evolution has included abrasion chondroplasty, 4 microfracture, 5 fibrin adhesive for partly detached acetabular cartilage flaps, 6 mononuclear cell concentrate with platelet-rich plasma, 7 various types of autologous cartilage grafts, [8][9][10][11][12][13] and synthetic matrix substances, 14,15 among other hip preservation techniques. In earlier reports, the underlying surgical principles consistently aimed at debriding the loose cartilage fragments from the defect bed and creating stable margins.…”