Chondral Lesions of the Acetabulum or Femoral Head

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Chondral lesions are among the most elusive sources of hip joint pain. Because of the more constrained anatomy of the hip compared to the shoulder, until recently these lesions were not believed to exist. Furthering the consternation of both patient and clinician, no currently available radiographic test reliably diagnoses the presence or extent of these lesions.1

Even gadolinium-enhanced arthro MRI scanning has limitations in elucidating chondral injuries. This lack of sensitivity may be explained in part by its static nature, as well as the lack of distraction during the study. And yet chondral lesions do occur with frequency. In the senior author's experience of 457 hip arthroscopies during a 6-year period, chondral injuries occurred in the anterior acetabulum in 269 cases (59%), the superior acetabulum in 110 cases (24%), and the posterior acetabulum in 114 cases (25%). Although these lesions were seen most frequently in association with a labral tear, most disturbing was the unstable flap nature and extent of the full-thickness cartilage injury. Seventy percent of the anterior, 27% of the superior, and 36% of the posterior chondral injuries were grade III or IV by Outerbridge criteria.2 In addition, the senior author's classification of labral tears demonstrates a clear decrement in outcome once an associated chondral acetabular lesion of greater than 1 cm occurs.3 (See Chapter 12.)

Chondral injuries may occur in association with a multitude of hip conditions, including labral tears, loose bodies, posterior dislocation, osteonecrosis, SCFE dysplasia, and degenerative arthritis. The difficulty in diagnosing these lesions as well as their effect on outcome provides a cogent rationale for arthroscopic hip surgery.

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