Focal articular cartilage injuries

Causes include traumatic injury, e.g. from a direct blow to the greater trochanter or from femoroacetabular impingement. Xrays are very useful in determining the extent of articular damage and are routinely obrtained. In determining the presence of focal areas of chondral injury, MRIs have improved considerably in recent years and depend in part on the quality of the images and the experience of the reader. The presence of chondral lesions of the femoral head or the acetabulum has been shown to result in a poorer prognosis following arthroscopic treatment of a labral tear.

Signs and Symptoms
A deep ache in the joint may be reported by the patient, and the pain may be noted anteriorly, laterally, or posteriorly. A click or mechanical sensation in the joint will probably not be noted in the early stage of injury.

Differential Diagnosis
Differential diagnosis includes fractures, stress fractures, intra-articular derangement such as a labral tear, and degenerative joint disease.

If nonoperative treatment consisting of activity modification, physical therapy, NSAIDS, and glucosamine chondroitin fail, treatment may consist of arthroscopic microfracture versus total joint replacement, depending on patient specific factors and the extent of articular cartilage injury.

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