Chondral defects of the hip are focal areas of damage to the articular cartilage lining the femoral head or acetabulum. These defects can range from softening of the cartilage surface to full-thickness loss exposing the underlying bone. Unlike diffuse osteoarthritis, chondral defects involve a localized area of damage surrounded by healthy cartilage — a distinction with important treatment implications.
Chondral defects rarely occur in isolation — they are almost always the downstream consequence of an underlying structural or mechanical problem. Femoroacetabular impingement (FAI) is the most common cause in young active adults, where the cam or pincer deformity repeatedly abrades the anterosuperior acetabular cartilage with each hip flexion cycle. Hip dysplasia concentrates load on the lateral rim, producing a different but equally destructive cartilage injury pattern. Labral tears and chondral defects are so frequently found together that identifying one on MRI should prompt careful evaluation for the other. Left untreated, focal chondral defects progress to diffuse hip osteoarthritis — making early identification and treatment the key to joint preservation.
Causes
Traumatic injury.
A direct blow to the hip, a fall onto the greater trochanter, or a hip dislocation can shear or impact the cartilage surface, creating a focal defect — sometimes with an osteochondral fragment (cartilage with attached bone) that becomes a loose body within the joint. Traumatic chondral injuries are most common in young, active patients and athletes, and the hip dislocation mechanism is particularly destructive because the entire weight of the body impacts the cartilage surface during the dislocation event.
Underlying hip pathology.
Femoroacetabular impingement, hip dysplasia, and labral tears all create abnormal joint mechanics that progressively damage cartilage through repeated abnormal contact, edge loading, or loss of the normal hydraulic seal that the intact labrum provides. Chondral defects frequently co-occur with these conditions and are among the most important findings identified during hip arthroscopy for FAI or labral pathology. Osteochondritis dissecans (OCD) — a condition in which a segment of cartilage and its underlying subchondral bone becomes ischemic and potentially detaches — is a less common cause that primarily affects adolescents and young adults and can produce a displaced osteochondral loose body if untreated.
Symptoms
Patients typically describe a deep groin or anterior hip pain that worsens with weight-bearing activities, prolonged sitting, pivoting, and athletic activity. Mechanical symptoms — catching, locking, or a sharp clicking with specific movements — are particularly common when a loose osteochondral fragment is present within the joint and becomes interposed between the articular surfaces. Pain typically worsens with activity and improves with rest in the early stages, but becomes progressively more constant and less responsive to rest as the defect enlarges and the surrounding cartilage deteriorates. Many patients have symptoms that closely resemble those of a labral tear — and frequently have both conditions simultaneously — making MRI arthrogram essential for accurately characterizing what is present before surgery.
Diagnosis
A physical exam by a doctor reproduces symptoms with the FADIR test (Flexion, ADduction, Internal Rotation) and assesses range of motion, gait, and associated findings. X-rays may reveal underlying conditions such as FAI bone morphology or dysplasia, but isolated chondral defects typically produce no visible abnormality on plain films — a critical limitation that underscores the need for MRI. An MRI arthrogram is the gold standard for evaluating hip cartilage, identifying the exact location (acetabulum vs. femoral head), size, shape, and depth of chondral defects, associated labral tears, loose bodies, and the integrity of the remaining joint cartilage — all essential for surgical planning and for determining whether a joint-preserving or joint-replacing approach is appropriate. Dedicated dGEMRIC (delayed gadolinium-enhanced MRI of cartilage) or T2 mapping sequences can detect early biochemical changes in cartilage before structural loss is visible on standard sequences, allowing even earlier identification of at-risk areas.
Defect classification (Outerbridge)
Doctors use the Outerbridge classification to grade the severity of chondral damage, which guides surgical decision-making.
- Grade 0: Normal cartilage. No abnormality identified.
- Grade 1: Softening and swelling (blistering) of the cartilage surface without fissuring. The cartilage surface is intact but biomechanically compromised.
- Grade 2: Partial-thickness fissures that do not reach the subchondral bone and measure less than 1.5 cm in diameter. Conservative measures and arthroscopic debridement are appropriate.
- Grade 3: Deep fissuring to the level of subchondral bone in a zone greater than 1.5 cm across. Biologic repair procedures such as microfracture or cartilage transplantation are considered.
- Grade 4: Full-thickness cartilage loss with exposed subchondral bone. The most severe grade — treatment is challenging and outcomes are less predictable in the hip than in the knee.
Treatments
Treatment depends on the size and depth of the defect, its location within the joint (acetabular defects are less accessible and respond less predictably than femoral head defects), patient age, activity level, and the presence of underlying conditions contributing to cartilage damage. Critically, treating a chondral defect without also addressing its mechanical cause — FAI, dysplasia, labral tear — predictably leads to recurrence.
Initial management includes activity modification, weight reduction when appropriate, and anti-inflammatory medications for pain control.
Small or low-grade defects (Grades 1 and 2): Physical therapy focusing on hip abductor and core strengthening, movement pattern correction, and reduced-impact activity can meaningfully improve symptoms and slow progression. Intra-articular injections of corticosteroids or hyaluronic acid provide symptomatic relief and, in the case of platelet-rich plasma (PRP), may offer a modest chondroprotective effect. These measures slow deterioration but do not repair existing cartilage loss.
Symptomatic focal defects in young and active patients
Surgery is advised for young or active patients with persistent symptoms and a focal chondral defect identified on MRI arthrogram. Hip arthroscopy provides direct visualization and treatment of the defect along with any associated labral tears or FAI bone deformity — addressing the mechanical cause at the same time as the cartilage damage is essential for durable results. Arthroscopic treatment options include debridement and chondroplasty (smoothing unstable cartilage edges to prevent further delamination), microfracture (penetrating the subchondral bone to stimulate fibrocartilage fill — most effective for defects under 2 cm²), and in select cases biologic augmentation with scaffold-based cartilage restoration or matrix-induced autologous chondrocyte implantation (MACI). After surgery, a structured rehabilitation program with an extended period of protected weight-bearing — typically 6–8 weeks — is critical to allowing the repair tissue to mature and bond to the surrounding cartilage.
Large full-thickness defects or diffuse cartilage loss
When chondral damage is extensive, involves both the femoral head and acetabulum, or has transitioned to diffuse osteoarthritis, arthroscopic treatment is unlikely to provide durable relief. In these cases — particularly in older patients or those with significant joint space loss — total hip arthroplasty is the most reliable treatment, providing comprehensive pain relief and functional restoration by replacing the damaged joint surfaces entirely.
Get an MRI to Confirm Your Diagnosis
Before surgical planning or starting treatment, a clear MRI diagnosis ensures the right path forward. First Look MRI offers self-pay Hip MRI scans — no doctor's order or insurance required — at our locations in Georgia, Texas, and Colorado.