Hip Labral Tears and FAI: What Arthroscopic Repair Fixes

The hip labrum is a ring of fibrocartilage that lines the rim of the acetabulum (the hip socket). It deepens the socket by roughly 22%, improves joint stability, distributes pressure and creates a fluid seal that helps lubricate the joint. When it tears, patients typically experience groin pain, clicking and reduced hip function.

How Labral Tears Happen

Most labral tears are associated with femoroacetabular impingement (FAI), a structural mismatch between the femoral head and the acetabulum:

Less commonly, labral tears result from acute trauma (hip dislocation, falls), repetitive athletic loading (ballet, hockey, soccer, martial arts) or underlying hip dysplasia (a shallow socket that overloads the labrum).

Diagnosis

Physical examination includes provocative tests like the FADIR (flexion, adduction, internal rotation) test, which reproduces groin pain by compressing the labrum. The FABER test assesses for hip and SI joint pathology. MRI with intra-articular contrast (MRA) is the gold standard for imaging, with sensitivity around 90% for labral tears versus 65-70% for standard MRI.

Conservative Treatment

A trial of conservative management is typically recommended before considering surgery, especially for patients with smaller tears and minimal mechanical symptoms:

• Activity modification: Reducing deep hip flexion activities, pivoting and prolonged sitting.
• Physical therapy: Core and hip abductor strengthening, posterior chain activation, addressing any movement compensations. Programs typically run 8 to 12 weeks.
• Intra-articular injection: A diagnostic and therapeutic cortisone injection into the hip joint can confirm the pain source and provide temporary relief. If the injection eliminates pain, the joint is likely the problem.
• NSAIDs: Short-term anti-inflammatory use for symptom management.

When Arthroscopic Surgery Helps

Hip arthroscopy for labral repair and FAI correction is indicated when:

• Conservative treatment has failed after 3 to 6 months.
• Mechanical symptoms (catching, locking) persist.
• Imaging confirms a repairable labral tear with associated FAI morphology.
• The patient's joint space is preserved (greater than 2mm on X-ray). Patients with significant arthritis have poor arthroscopic outcomes.

What the Surgery Involves

The procedure is performed through 2 to 3 portals, using specialized instruments and traction to access the hip joint. The typical arthroscopy includes:

1. Labral repair: The torn labrum is reattached to the acetabular rim using suture anchors. Repair has replaced debridement (trimming) as the standard, because preserving the labrum maintains the hip's fluid seal and stability.
2. Cam resection (femoroplasty): The bony bump on the femoral head is shaved to eliminate the impingement mechanism. Without this step, the labrum will retear.
3. Pincer resection (acetabuloplasty): If overcoverage is present, a small amount of the acetabular rim is removed.

Recovery After Hip Arthroscopy

Most patients use crutches for 2 to 4 weeks after labral repair, with partial weight-bearing. A brace limiting hip flexion and rotation may be used for the first 2 to 3 weeks. Physical therapy begins within days of surgery but follows a slow progression to protect the repair. Full return to sport typically takes 5 to 7 months.

Outcomes and What the Data Shows

Systematic reviews of hip arthroscopy outcomes report:

The strongest predictor of a poor outcome is pre-existing hip arthritis. If the cartilage surfaces are already damaged, correcting the impingement and repairing the labrum rarely resolves symptoms. This is why imaging and clinical assessment of joint space are critical before committing to arthroscopy.