Labral Tears and Femoroacetabular Impingement (FAI)
The hip joint is a “ball and socket” joint composed of two bones. The ball is called the femoral head. The femoral head is connected to the shaft of the femur (thigh bone) by the femoral neck. The cup-shaped socket is called the acetabulum which is a part of the pelvis. Covering the bones of the hip is a shiny cartilage called articular cartilage. This is the type of cartilage you see on the end of a chicken bone.
The articular cartilage is important for providing a cushion and a smooth surface when the bones move on one another. Surrounding the cup (acetabulum) is another cartilage called the labrum, which forms a ring around the cup like a gasket. It helps to form a suction seal between the ball and cup similar to suction cup.
What is Femoroacetabular Impingement (FAI)?
Femoroacetabular impingement occurs when the ball (femoral head) does not have its full range of motion in the cup (acetabulum). Imagine a perfectly round ball fitting into a perfectly round half-circle cup. If you were to roll the ball in the cup it would spin around very smoothly. Now imagine an egg shape placed into the cup. When you roll the egg, it will keep hitting the edge of the cup. That is the basic concept of femoroacetabular impingement. Bone irregularities in your hip can occur on either the femoral head (ball) or the acetabular rim (cup) which can limit motion and put the hip at risk for injury.
Pincer and Cam Impingement
The extra bone located on the head of the femur is called “cam impingement,” where an extension of the acetabular rim is called “pincer impingement.” These impinging lesions can occur separately or in conjunction with one another.
Why Does This Cause Pain?
When the extra bone on the femoral head and/or acetabular rim bump against each other they can cause damage to the labrum and articular cartilage. The labrum is the cartilage that surrounds the rim of the acetabulum. The labrum can fray or tear with repeated rubbing and contact of the bump against the rim. When the labrum tears, pain can be felt most commonly in the groin and continued rubbing of the bump can lead to further tearing of the labrum and damage to the articular cartilage. Tears or damage to the articular cartilage is also called arthritis.
What are the Symptoms of FAI and Labral Tears of the Hip?
Impingement can occur in patients from teenagers through adulthood. On average the presence of a cam lesion occurs in approximately 10% of people, but it is more frequently found in young athletes.
Patients who are symptomatic will often complain of groin pain that started insidiously. In athletes, the pain is often worse with activities that include cutting, pivoting and high hip flexion. The presence of this pain can progress to affect activities of daily living such as simple things like putting on your socks, sitting Indian style, squatting to tie your shoe or walking. Symptoms of pain in the groin, lateral hip and buttock are common. The pain can be sharp like a pinch or a dull ache. Locking and popping in the hip can also occur.
How Do I Know if I Have FAI and a Labral Tear?
The diagnosis of FAI begins with a consultation with Dr. Peter Gambacorta where he will ask you several questions about your history and pain. A physical examination will be performed on your affected hip. Frequently pain can be reproduced when your hip is flexed and rotated inward. Radiographs (x-rays) are taken in the office and are often helpful in visualizing the bumps on the bones and a special type of MRI is often performed which includes the use of an injected contrast dye in order to see a torn labrum.
What are My Treatment Options?
Not all patients with FAI and labral tears need surgery. Initial treatment often includes activity modification, use of non-steroidal anti-inflammatory medications (NSAIDs) and physical therapy. Injections with numbing medicine and cortisone into the hip joint may also be recommended to help diagnosis and treat the pain.
If your pain does not improve after conservative treatment and your hip becomes more painful, stiff or locked, you may need surgical repair. Hip arthroscopy is a less invasive surgical alternative for hip procedures that would otherwise require open surgical dislocation. This procedure has been recognized in Europe for the past 20 years, but has only recently gained recognition in the United States in the past 5 to 10 years, thus few orthopedic surgeons have advanced training in hip arthroscopy.
Depending upon the type of FAI, whether you also have a labral tear, your age and other factors, Dr. Gambacorta may recommend surgery with the use of an arthroscope to either place sutures to repair the labrum or to use small instruments to trim off damaged pieces of cartilage, addressing the bone bumps, articular cartilage damage and other problems found at that time.
If you decide to have arthroscopic surgery to treat your FAI and labral tear, you may be asked to have a complete physical with your family physician before surgery to assess your health and to rule out any conditions that could interfere with your surgery.
Prior to surgery tell your doctor about any medications that you are taking. You will be informed which medications you should stop taking before surgery. This typically includes aspirin and anti-inflammatory medications such as Advil®, ibuprofen, Motrin®, Naprosyn® or Aleve®, all of which should be stopped 10 days before surgery. Tylenol® can be taken in the week preceding your surgery, but be sure not to exceed the recommended daily dose. Tests, such as blood samples or a cardiogram, may be ordered by your doctor to help prepare for your procedure.
After surgery you will be given written instruction sheets, pictures of your surgery, prescriptions for medication, and a copy of rehabilitation guidelines. This information will answer most of the questions you may have during your recovery.
You will be going to physical therapy (PT) after your surgery. At the initial evaluation you will meet with the physical therapist or athletic trainer (ATC) who will be responsible for your rehabilitation. During this visit, you will be instructed in exercises, wound care and how much weight you should place on your operated leg. In addition, your therapist will ask you to help set your goals for rehabilitation.
The entire rehabilitation process often takes three to six months but may take longer in some patients. During the early phase of your rehabilitation you will be closely monitored. As you progress, you will be able to do more exercises on your own. If you have any questions concerning your rehabilitation process, they should be directed to your rehabilitation team.
This information is intended for eduction of the reader about medical conditions and current treatments. It is not a substitute for examination, diagnosis and care provided by your physician or a licensed healthcare provider. If you believe that you, your child, or someone you know has the condition described above, please see your healthcare provider. Do not attempt to treat yourself or anyone else without proper medical attention.