Cartilage lesion: Definition, Uses, and Clinical Overview

Posted on February 27, 2026 | by drhip

Cartilage lesion Introduction (What it is)

A Cartilage lesion is an area of damaged joint cartilage.
It most often refers to injury or wear of the smooth “articular cartilage” that covers the ends of bones.
It is commonly discussed in the hip, knee, ankle, and shoulder in orthopedics and sports medicine.
It can be found on imaging or during arthroscopy when evaluating joint pain or mechanical symptoms.

Why Cartilage lesion used (Purpose / benefits)

In clinical care, the term Cartilage lesion is used to name and describe a specific type of joint surface damage. That description matters because cartilage is a specialized tissue with different healing potential than bone, tendon, or muscle. Labeling a problem as a cartilage lesion helps clinicians communicate what structure is involved, how severe it appears, and what management pathways may be considered.

A practical purpose of identifying a cartilage lesion is to explain symptoms that are otherwise hard to localize. Articular cartilage itself has limited nerve supply, but cartilage damage can be associated with irritation of surrounding pain-generating structures such as the synovium (joint lining), subchondral bone (bone just under the cartilage), labrum in the hip, and adjacent ligaments or capsule. A cartilage lesion may also contribute to joint swelling, catching, or reduced tolerance for impact activity.

From a planning standpoint, a cartilage lesion provides a framework for deciding whether care is mainly:

Nonoperative (education, activity modification strategies, physical therapy approaches, symptom-control medications when appropriate), or
Procedural/surgical (arthroscopic assessment, smoothing of unstable cartilage, repair of associated problems, or cartilage restoration techniques in selected cases).

It is also used in documentation, research, and insurance coding to describe the diagnosis and justify imaging, rehabilitation, or operative decision-making. Expected benefits of accurately characterizing a cartilage lesion include clearer prognosis discussions and more consistent follow-up, though outcomes vary by clinician and case.

Indications (When orthopedic clinicians use it)

Orthopedic and sports medicine clinicians commonly use the term Cartilage lesion in scenarios such as:

Persistent joint pain where cartilage injury is suspected after history and exam
Mechanical symptoms (catching, clicking, locking sensations) that may reflect unstable cartilage or associated labral/meniscal pathology
Post-traumatic joint pain after a fall, collision, twisting injury, or hip dislocation/subluxation
Evaluation of hip pain in femoroacetabular impingement (FAI) or borderline dysplasia, where cartilage damage may coexist
Recurrent joint swelling or effusions, especially after activity
Preoperative planning for arthroscopy or other joint-preserving surgery
Assessment of focal cartilage defects on MRI (or MR arthrogram in some hip evaluations)
Intraoperative findings during arthroscopy when imaging is inconclusive
Monitoring degenerative change where focal cartilage loss may be an early feature of osteoarthritis

Contraindications / when it’s NOT ideal

A Cartilage lesion is a diagnostic descriptor rather than a single treatment, so “not ideal” usually refers to when cartilage-focused procedures or certain management pathways may be less suitable. Common situations include:

Diffuse, end-stage osteoarthritis with widespread cartilage loss, where focal cartilage restoration is often less applicable
Uncorrected structural problems (for example, significant malalignment, marked instability, or major hip dysplasia) when cartilage procedures alone may not address the underlying mechanics
Inflammatory arthritis or active synovitis-dominant disease patterns where cartilage damage is part of a broader process (management priorities may differ)
Active infection in or around the joint (procedures are typically deferred until addressed)
Poor bone quality or substantial subchondral bone collapse, where outcomes of some restorative techniques may be limited
Large, uncontained defects (edges not supported by healthy cartilage), which can be technically more challenging and may shift procedure choice
Inability to follow postoperative restrictions or rehabilitation, when a planned intervention depends on protected weight-bearing or structured rehab (varies by clinician and case)
Advanced comorbidity burden that increases procedural risk, where nonoperative strategies may be emphasized (varies by clinician and case)

How it works (Mechanism / physiology)

Core concept: cartilage is a low-friction load distributor

Articular cartilage is the smooth, resilient tissue covering the ends of bones inside synovial joints. Its main roles are to:

Provide a low-friction gliding surface
Distribute forces across the joint (shock absorption and load sharing)
Protect underlying bone during motion and impact

A Cartilage lesion disrupts that surface. Depending on depth and size, this can increase contact stress on remaining cartilage and on the subchondral bone beneath it.

Relevant hip anatomy (and why the hip is commonly discussed)

In the hip, articular cartilage covers:

The femoral head (ball)
The acetabulum (socket)

The hip also includes the labrum, a fibrocartilaginous rim that deepens the socket and helps maintain joint fluid pressurization. Many hip cartilage lesions occur alongside labral tears or bony shape differences (such as cam or pincer morphology in FAI). When cartilage wear reduces the joint’s ability to maintain smooth motion and fluid film lubrication, symptoms can become more noticeable during pivoting, deep flexion, or prolonged loading.

Pain and symptoms: cartilage vs surrounding tissues

Articular cartilage has limited direct pain sensing, so pain commonly relates to:

Subchondral bone stress (bone is well innervated)
Synovial inflammation (synovitis)
Mechanical irritation from unstable cartilage flaps or loose fragments
Associated injuries (labrum in the hip, meniscus in the knee, ligament sprains)

Onset, progression, and reversibility

Onset can be acute (injury) or gradual (degeneration/overuse).
Natural history varies widely: some focal lesions remain stable, while others enlarge or contribute to degenerative change over time.
Reversibility is limited because mature articular cartilage has restricted intrinsic healing. Some procedures aim to reduce symptoms or improve the joint surface environment, but no single approach restores “normal” cartilage in every case. Outcomes vary by clinician and case.

Cartilage lesion Procedure overview (How it’s applied)

A Cartilage lesion is primarily a diagnosis and an anatomic description, but it often leads to a structured evaluation and, in some cases, a procedure. A typical high-level workflow looks like this:

Evaluation / exam – History (location of pain, mechanical symptoms, swelling patterns, prior injury) – Physical exam (range of motion, provocative tests, gait and functional assessment) – Screening for referred pain sources (lumbar spine, pelvis, soft tissue)
Preparation (diagnostic planning) – Initial imaging often includes X-rays to assess alignment, joint space, and bony morphology – MRI is commonly used to evaluate cartilage, labrum (hip), meniscus (knee), and bone marrow changes – In some cases, clinicians use additional imaging sequences or contrast-enhanced studies depending on the joint and question (varies by clinician and case)
Intervention / testing (if needed) – Nonoperative care may be trialed first in many presentations (education, rehabilitation strategies, symptom-control measures) – If symptoms persist or mechanical features are prominent, arthroscopy may be used to directly inspect cartilage and treat associated problems – During arthroscopy, clinicians may document lesion size, location, stability, and depth, and may perform smoothing/debridement or consider restorative techniques in selected cases
Immediate checks – Post-assessment review of findings and functional status – Confirmation of associated diagnoses (for example, labral tear, impingement morphology, loose body)
Follow-up – Reassessment of pain, function, swelling, and activity tolerance – Monitoring response to rehabilitation or recovery milestones after a procedure – Repeat imaging is not always necessary and is typically driven by symptoms and clinical goals (varies by clinician and case)

Types / variations

Cartilage lesions are commonly described using several overlapping classification approaches.

By depth (how much thickness is involved)

Partial-thickness (chondral) lesion: damage that does not extend through the full cartilage layer
Full-thickness (chondral) lesion: cartilage loss down to subchondral bone

By tissue involvement

Chondral lesion: primarily cartilage
Osteochondral lesion: cartilage plus underlying bone involvement (may include a fragment or crater)

By stability and surface appearance

Softening/fibrillation: early surface wear
Flap lesion: a section of cartilage partially detached and potentially mechanically symptomatic
Delamination: separation of cartilage from underlying bone at the cartilage–bone interface
Loose body: detached cartilage or osteochondral fragment moving within the joint

By cause or clinical context

Traumatic: following acute injury (twist, impact, dislocation)
Degenerative: gradual wear associated with aging, repetitive loading, or early osteoarthritis
Structural-mechanical contributors: associated with alignment or shape issues (for example, FAI in the hip)
Post-surgical or iatrogenic: after prior procedures (less common, context-dependent)

By location (important for symptoms and planning)

Hip: acetabular cartilage (often anterosuperior region in FAI patterns) and femoral head cartilage
Knee: femoral condyles, patella, trochlea
Ankle: talar dome
Location influences contact pressures, access for arthroscopy, and potential containment of the defect.

By grading systems (documentation tools)

Clinicians may use standardized grading systems (such as Outerbridge or ICRS grades) to describe severity. These systems help communication but do not perfectly predict symptoms or outcomes on their own.

Pros and cons

Pros:

Provides a clear anatomic explanation for some patterns of joint pain and mechanical symptoms
Helps standardize communication across radiology, therapy, and surgical teams
Supports structured documentation of severity (size, depth, stability, location)
Guides selection among nonoperative care, injections, arthroscopy, or cartilage restoration options
Encourages evaluation of contributing factors (alignment, impingement, instability, meniscal/labral pathology)
Helps set realistic expectations that cartilage healing and symptom response can be variable

Cons:

Symptoms do not always correlate with imaging findings; some lesions are incidental
Cartilage has limited intrinsic healing capacity, so improvement may be gradual or incomplete
Imaging can under- or over-estimate lesion size or depth compared with arthroscopic findings
Many cases involve combined problems (cartilage plus labrum/meniscus/bone), complicating decision-making
Procedures aimed at cartilage may require prolonged rehabilitation and activity restrictions (varies by clinician and case)
Long-term durability of symptom relief can vary with lesion type, joint mechanics, and patient factors

Aftercare & longevity

Aftercare depends on whether the cartilage lesion is managed nonoperatively or with a procedure, and on the joint involved. In general, “longevity” refers to how long symptom control and function remain acceptable, not a guaranteed duration of tissue repair.

Factors that commonly influence outcomes include:

Severity and morphology of the lesion: depth, size, containment, and whether subchondral bone is involved
Location and joint mechanics: high-load zones may be more sensitive to recurrent symptoms
Associated diagnoses: labral tears (hip), meniscal tears (knee), ligament instability, impingement morphology, or malalignment can affect durability if not addressed
Rehabilitation quality and consistency: restoring strength, motion, and movement control can influence joint loading patterns
Weight-bearing status and return-to-activity pacing: often individualized after procedures; timelines vary by clinician and case
Body weight and overall conditioning: higher joint loads can increase symptom recurrence risk, though the relationship varies widely
Comorbidities: inflammatory arthritis, metabolic factors, smoking status, and diabetes may affect healing environment (varies by clinician and case)
Procedure and material choices: when implants, scaffolds, or grafts are used, performance can vary by material and manufacturer

Follow-up typically focuses on function (walking tolerance, stairs, sport demands), swelling patterns, and whether pain is activity-linked or persistent at rest. Repeat imaging is sometimes used, but many clinicians prioritize clinical progress over imaging changes unless symptoms evolve.

Alternatives / comparisons

Because a Cartilage lesion is a diagnosis rather than a single intervention, comparisons usually involve management strategies.

Observation and monitoring

Appropriate when symptoms are mild, function is acceptable, and there are no concerning mechanical symptoms.
Emphasizes tracking changes over time rather than immediate procedural intervention.

Rehabilitation-based care (physical therapy–led)

Often focuses on strength, mobility, gait mechanics, and graded return to activity.
Particularly relevant when cartilage damage coexists with movement impairments or hip impingement patterns.
May be used alone or as a foundation before/after other treatments.

Medications for symptom control

Non-opioid pain relievers and anti-inflammatory medications are sometimes used to reduce pain and inflammation, when appropriate and tolerated.
These do not restore cartilage but may help symptom control during rehab (varies by clinician and case).

Injections (symptom-modulating options)

Options may include corticosteroid, hyaluronic acid, or biologic-based injections (such as PRP), depending on joint and practice setting.
Goals are typically pain reduction and improved function rather than cartilage “regrowth.”
Evidence and indications vary by injection type and condition; recommendations vary by clinician and case.

Arthroscopy and cartilage-directed procedures

Arthroscopy can confirm lesion characteristics and treat coexisting problems (labrum/impingement in the hip, meniscus in the knee).
Cartilage procedures range from smoothing unstable cartilage to marrow-stimulation or graft-based restoration in selected defects.
These approaches may involve longer recovery and are more dependent on lesion features.

Joint replacement (for advanced degeneration)

When cartilage loss is widespread and joint degeneration is advanced, arthroplasty may be considered in appropriate candidates.
This is generally a different treatment category than focal cartilage lesion care.

Cartilage lesion Common questions (FAQ)

Q: Is a Cartilage lesion the same thing as arthritis?
A: Not always. A cartilage lesion can be a focal defect from injury, while osteoarthritis typically involves broader, progressive cartilage loss plus changes in bone and other joint tissues. A focal lesion can exist without established arthritis, but it may be one feature seen along a degenerative spectrum.

Q: Can a Cartilage lesion cause pain if cartilage has little nerve supply?
A: Yes, it can. Pain may come from subchondral bone stress, synovial inflammation, or associated injuries (like a hip labral tear). Mechanical irritation from unstable cartilage or loose bodies can also contribute.

Q: How is a Cartilage lesion diagnosed?
A: Diagnosis often combines history, physical exam, and imaging. X-rays assess bone shape and joint space, while MRI evaluates cartilage and related soft tissues. In some cases, arthroscopy provides the most direct assessment of the cartilage surface.

Q: Does every Cartilage lesion need surgery?
A: No. Many are managed with nonoperative strategies focused on symptoms and function. Whether a procedure is considered depends on factors like lesion size, stability, mechanical symptoms, associated structural issues, and patient goals—varies by clinician and case.

Q: How long do results last after treatment for a Cartilage lesion?
A: Durability varies. It depends on the lesion type, joint mechanics, whether underlying contributors (like impingement or instability) are addressed, and rehabilitation factors. Some people do well long-term, while others may have recurrent symptoms or progression over time.

Q: Is treatment for a Cartilage lesion “safe”?
A: All treatments have potential risks and benefits. Nonoperative care generally has lower procedural risk, while injections and surgeries add specific risks related to the technique and patient health factors. Safety considerations are individualized and vary by clinician and case.

Q: Will a Cartilage lesion show up on MRI?
A: Many lesions are visible on MRI, but sensitivity can vary by joint, imaging quality, and lesion type. Some cartilage defects are underestimated or missed, and arthroscopy may reveal more detail. Clinicians often interpret MRI findings alongside symptoms and exam.

Q: What does a Cartilage lesion mean for walking, driving, or work?
A: Impact varies with symptom severity and job demands. Many people can continue daily activities with modifications, while others may find prolonged standing, lifting, or deep flexion more provocative. After procedures, restrictions on driving and work tasks depend on the joint treated, side involved, and weight-bearing status—varies by clinician and case.

Q: Will I be non-weight-bearing if a Cartilage lesion is treated surgically?
A: Sometimes, but not always. Weight-bearing recommendations depend on the procedure type (simple debridement versus restoration techniques), lesion location, and surgeon preference. Protocols differ substantially—varies by clinician and case.

Q: What does “full-thickness” versus “partial-thickness” mean?
A: Partial-thickness means the damage does not extend through the entire cartilage layer. Full-thickness means the cartilage is worn down to the underlying bone. This distinction can influence symptoms, prognosis, and which treatments may be considered.