Chondral Injuries Of The

Chondral injuries of the hip may be seen in conjunction with a variety of hip disorders, and may result from an atraumatic or traumatic etiology. These disorders include labral tears, loose bodies, hip instability or dislocation, osteo-necrosis of the femoral head, slipped capital femoral epiphysis, hip dysplasia, and degenerative joint disease [12-17]. Chondral injuries can be acute, chronic, or degenerative, and may be partial thickness or full thickness lesions.

In their report after arthroscopy of 457 hips over a 6-year period, McCarthy et al [17] found that most chondral injuries were associated with a torn acetabular labrum. The anterior acetabulum was affected in the majority of hips. Chondral injury was noted in the superior acetabulum in 24%, and the posterior acetabulum in 25% of the patients in this series. Seventy percent of anterior acetabular chondral lesions were Outerbridge grade III or IV, whereas only 36% of all posterior and 27% of all superior acetabular defects were graded III or IV.

Another common injury pattern is the cartilage defects in the presence of cam or pincer impingement. Cam impingement results from pathologic contact between an abnormally shaped femoral head and neck with a normal acetabu-lum. As the hip flexes, this abnormal region of the femoral head contacts the acetabulum. This contact results in force, which can produce chondral injury. Pincer impingement is the result of contact between an abnormal acetabular rim and, typically, a normal femoral head-neck junction. This results in decreased joint clearance and repetitive contact between the femoral neck and acetabulum. This repetitive contact can cause injury to the chondral surface of the femur or a "contre-coup" injury of the acetabulum.

As the experience with hip arthroscopy expands, so, too, will the ability to recognize the various injury patterns to the chondral surfaces of the hip. As our understanding of the pathologic processes contributing to chondral injury of the hip joint improves, perhaps we will be able to intervene preventing the progression to osteoarthritis.

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