Hip Labral Tear and Femoroacetabular Impingement (FAI)

The hip is a ball in a socket. A healthy hip has a round femoral head in an acetabulum that covers it well but not too much, so the two glide without contact at the edges.

The labrum is a ring of dense fibrocartilage around the socket rim. It deepens the socket, adds stability, and forms a suction seal that keeps pressurized fluid between the surfaces. When the seal fails, load concentrates at the rim instead of spreading across the joint, which is why labral tears matter beyond the pain they cause.

Femoroacetabular impingement is a shape problem. In cam impingement, extra bone at the femoral head-neck junction makes the ball non-round, so it jams into the socket rim in deep flexion. In pincer impingement, the socket covers the ball too far, and the rim strikes the neck. Many hips have a mix of both.

A labral tear is what that repeated contact produces. The labrum is crushed or peeled off the rim, most often at the front and upper socket, and the cartilage just inside it often begins to peel away with it.

Cam-shaped bone is not something you did wrong. It largely develops during adolescence, while the growth plate is still open, and is more common in people who played high-volume cutting sports as teenagers.

• Ice hockey, soccer, lacrosse, basketball, and football during growth years
• Deep-flexion activities: rowing, cycling, squatting, dance, martial arts
• Inherited variation in socket depth or version
• Prior hip conditions in childhood, including a slipped growth plate
• An acute injury superimposed on a hip that was already shaped this way

Most patients describe pain deep in the front of the hip or groin, often gripping the hip with a C-shaped hand. Typical patterns:

• Pain that builds after sitting, driving, or flying
• A sharp pinch at the bottom of a squat or when pulling on socks
• Clicking, catching, or locking inside the joint
• Stiffness and loss of internal rotation compared with the other side
• Aching in the buttock or low back after activity

Examination compares motion side to side and reproduces symptoms with flexion, adduction, and internal rotation. Because the low back, pelvis, core, and abdominal wall all refer pain to the groin, they are examined as well.

Imaging starts with a proper radiographic series: a well-centered AP pelvis, a Dunn or cross-table lateral, and a false profile view. These reveal cam and pincer shape, socket coverage, and remaining cartilage space. MRI, often with contrast, shows the labral tear. A diagnostic injection helps confirm the hip is the true pain source.

This deserves an honest answer. Cam morphology shows up on imaging in many athletes with no hip pain at all, and labral tears are found in people who never complain about their hips. An abnormal image alone is not a reason to operate. Surgery is for people whose symptoms, examination, and imaging tell the same story.

Nonoperative care comes first: activity modification, a structured program for gluteal and core strength, and sometimes an injection. Many people improve enough that surgery never becomes necessary. Surgery is reasonable once that program has had a fair trial of two to three months, symptoms still limit you, and the cartilage space is well preserved.

Hip dysplasia is the important exception. When the socket is significantly under-covered, the labrum is doing stabilizing work it was never built for, and trimming the rim can leave the hip less stable rather than more. Those patients are assessed for a periacetabular osteotomy and referred to a surgeon who performs it.

• Stop nicotine entirely; it impairs soft-tissue and bone healing.
• Hold anti-inflammatories and blood thinners as directed.
• Keep working on hip and core strength right up to surgery.
• Book physical therapy so your first session falls within days.
• Arrange a driver, crutches, and a bed that does not require stairs.

1. Anesthesia. General anesthesia with muscle relaxation, usually with a regional block.
2. Access. Gentle traction opens the joint, portals are placed under X-ray guidance, and a capsular window is created.
3. Inspection. The tear, cartilage, and rim are assessed directly, often more informative than the MRI.
4. Rim work. Where pincer over-coverage exists, the labrum is elevated and a precise amount of rim bone removed.
5. Labral repair. The labrum is secured to the rim with suture anchors, restoring the seal. An irreparable labrum may be reconstructed with a graft.
6. Cam correction. Traction is released and the bump at the head-neck junction is reshaped until the hip moves through a full arc without impingement, confirmed on X-ray.
7. Closure. The capsule is repaired and you go home the same day.

Weeks 0 to 2

Crutches with partial weight bearing protect the repair. Therapy begins within days, focused on gentle motion, a stationary bike, and swelling control. Active hip flexion and end-range rotation are restricted.

Weeks 2 to 6

Crutches come off once your gait is smooth. Motion restrictions ease and closed-chain strengthening begins.

Weeks 6 to 12

Serious gluteal, deep rotator, and core strengthening, plus elliptical and pool work.

Months 3 to 5

A graded running progression once strength is symmetric, followed by agility and change-of-direction work.

Months 4 to 9

Return to sport is criteria-based: pain-free deep flexion, strength close to the other side, and a completed sport-specific progression. Hips often keep improving through the first year.

Possible complications include temporary numbness in the groin or outer thigh from traction, infection, bleeding, blood clot, and heterotopic ossification, which is why a short course of anti-inflammatory medication is commonly prescribed. Less common are failure of the repair to heal, under-correction or over-resection of bone, femoral neck fracture, stiffness, and persistent pain.

Correcting impingement does not undo cartilage damage already done. Where wear is advanced, symptoms may persist and further surgery may be needed. No surgeon can guarantee an outcome, and part of the evaluation is telling you honestly how likely you are to benefit.