The diagnosis and treatment of labral and chondral injuries

Hip arthroscopy is an excellent way to evaluate, diagnose, and treat acetabular labral and chondral lesions. It is minimally invasive and can be done on an outpatient basis. Candidates for hip arthroscopy will have functionally limiting symptoms and reproducible physical findings. Patients will often have mechanical symptoms such as clicking, catching, locking, or giving way. Symptoms may be preceded by a traumatic event such as a fall or twisting injury or may have an insidious onset. Radiographic studies are not sensitive enough to diagnose intra-articular hip pathology; however, contrast agents used in conjunction with CT and MRI may aid in the diagnosis. Therefore, a high level of clinical suspicion and prudent clinical judgment are warranted. A thorough knowledge of positioning and anatomic relationships to portal placement is necessary to prevent potential neurovascular complications from occurring during hip arthroscopy. Labral tears are the most common cause of mechanical hip symptoms. Tears occur anteriorly, and associated chondral lesions are common. The severity of the chondral lesion is highly correlated with the surgical outcome. The most frequently observed chondral lesion is the watershed lesion, which consists of a labral tear with separation of the labrum from the articular surface at the labral-cartilage junction. The difficulty in identifying these lesions as well as their effect on outcome provides a convincing rationale for arthroscopic hip surgery. Arthroscopic treatment of these tears involves judicious debridement back to a stable base while carefully preserving the capsular labral tissue. Eliminating the source of mechanical symptoms secondary to labral pathology should alleviate the patient's discomfort. Chondral defects are drilled or treated with a microfracture technique to enhance fibrocartilage formation. Patient outcomes are directly dependent on the stage or extent of the labral and chondral lesion.