Articular cartilage lesions of the hip represent a complex and progressive condition with limited intrinsic healing capacity, often leading to degenerative joint disease if left untreated. These lesions commonly result from femoroacetabular impingement (FAI), developmental dysplasia of the hip (DDH), avascular necrosis (AVN), labral tears, or osteoarthritis (OA). Early diagnosis and targeted intervention are crucial to preserve joint function and delay degeneration. Preoperative imaging plays a key role but remains limited in accuracy due to the hip’s thin cartilage and spherical anatomy. Advanced magnetic resonance imaging (MRI) techniques—such as T2 mapping, delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), and MR arthrography—enhance detection, though diagnostic arthroscopy remains the gold standard for direct visualization and grading. Classification systems including the International Cartilage Repair Society (ICRS), Acetabular Labrum Articular Disruption (ALAD), and Bern Chondrolabral classifications assist in defining lesion severity, though inconsistencies in reproducibility persist. Surgical intervention is indicated in patients with persistent pain or mechanical symptoms unresponsive to conservative therapy, particularly when lesions exceed 2 cm2 or reach ICRS Grade 3–4 or ALAD Grade 3. Nonoperative measures—such as physiotherapy, platelet-rich plasma (PRP), and hyaluronic acid injections—are reserved for early-stage disease. Arthroscopic techniques, including microfracture (MFx), remain the first-line treatment for small lesions, stimulating fibrocartilage repair through bone marrow activation. Advanced methods like autologous matrix-induced chondrogenesis (AMIC), and scaffold-based approaches such as CarGel or ChondroFiller, improve the quality and durability of repair tissue. For larger or recurrent defects, autologous chondrocyte transplantation (ACT) and matrix-assisted ACI (MACT) facilitate the formation of hyaline-like cartilage but require two stages and carry higher costs. Newer single-step biological approaches—such as minced cartilage implantation (MCI) and micro-fragmented adipose tissue transplantation (MATT)—offer promising, minimally invasive alternatives that enhance cellular regeneration and integration. Complication rates vary across techniques, with subchondral cysts, graft delamination, and residual pain being the most common. Despite encouraging outcomes exceeding 80% success in recent studies, the literature remains limited by heterogeneous designs and short-term follow-up. Future directions include biologically enhanced scaffolds, gene-based regenerative therapies, and precision medicine approaches integrating biomechanics and cell biology to achieve durable cartilage restoration and long-term joint preservation.