Hip Labral Tears / FAI
Background
The hip is a ball and socket joint. The labrum is a ring of cartilage around the edge of the socket that helps create a seal and support the joint. A labral tear can develop after an injury or gradually with repeated hip movement.
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Femoroacetabular impingement, or FAI, describes a mismatch in the shape of the ball and socket that can cause them to contact each other during certain movements. Extra bone at the femoral head and neck is called a cam lesion. Extra coverage at the edge of the socket is called a pincer lesion. Some patients have both. This contact can irritate the labrum and surrounding cartilage, particularly during deep bending or twisting.
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Cam and pincer shapes can also be present in people who have no pain. Treatment is based on the patient’s symptoms and examination as well as imaging findings.
Symptoms
Patients with a hip labral tear or FAI may experience:
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Pain in the groin or front of the hip
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Pain with squatting, running, pivoting, or prolonged sitting
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A pinching sensation when bringing the knee toward the chest
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Clicking, catching, or locking in the hip
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Stiffness or reduced hip motion
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Pain that limits exercise or sport
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Hip pain can also come from muscles, tendons, the lower back, or other conditions, so the location of pain alone does not establish the diagnosis.
Diagnosis
Diagnosis begins with a discussion of symptoms and activities, followed by an examination of hip motion and movements that reproduce pain. X-rays help evaluate the shape of the hip and look for arthritis or other bone conditions. An MRI can provide more detail about the labrum and cartilage.
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In some cases, an injection of anesthetic into the hip joint can help determine whether the pain is coming from inside the joint. The goal is to match the imaging findings with the patient’s symptoms before recommending treatment.
Treament Options
Treatment depends on the source of pain, the condition of the cartilage, the patient’s activity goals, and how symptoms respond to initial care.
Nonoperative Treatment
Treatment commonly begins with:
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Physical therapy to improve hip and core strength, movement control, and flexibility
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Changes to activities or positions that repeatedly cause pinching
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Anti-inflammatory medication when appropriate
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An image-guided injection in selected cases
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Many patients can improve with a structured rehabilitation program. Surgery may be considered when symptoms continue to limit activity despite appropriate nonsurgical treatment.
Hip Arthroscopy
Hip arthroscopy uses a camera and small instruments to treat problems inside the joint. When appropriate, surgery may include repairing the labrum and reshaping the areas of bone causing impingement. If the labrum is too damaged to repair, labral reconstruction may be performed using a tendon graft to replace the damaged tissue. Cartilage damage and other findings are assessed at the same time.
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The specific procedure depends on the condition of the labrum, the shape of the hip, and whether arthritis or other joint changes are present. These factors can also influence how much improvement a patient can expect.
Return to Sport
Return to exercise progresses from restoring comfortable motion and strength to running, cutting, and sport specific movements. After hip arthroscopy, some athletes begin returning to sport around four to six months, while the average return is approximately seven months. Cutting sports may take longer. Clearance depends on hip strength, movement quality, symptoms, and the demands of the activity rather than time alone.