Child Orthopedics

Frequently Asked Questions

Our 16-year-old daughter injured her hip when sliding into home plate during a softball game. The team won the divisional playoffs with that final run but she ended up with a labral tear of the hip. The surgeon has recommended a wait-and-see rehab approach. How likely is it that this tear can heal itself?

The labrum is a dense ring of fibrocartilage that is attached around the rim of the acetabulum (hip socket). It helps make the socket deeper and more stable for the femoral head. The femoral head is the round ball of bone at the top of the femur (thigh bone). The head fits in the socket to form a ball-and-socket type of joint (as opposed to a hinge joint). Small labral tears can be treated conservatively. In fact, nonoperative care is always recommended first. This usually consists of at least six weeks of nonsteroidal antiinflammatory drugs (NSAIDs), steroid injections, physical therapy, and activity modification. Athletes who continue to have disabling pain despite conservative care may consider surgery as the next option. Pain severe enough to keep an athlete on the bench and unable to participate is the most common reason for surgery to correct this problem. If the labrum is frayed or a small piece of tissue has pulled away and formed a flap, there may still be enough normal, healthy tissue to function as nature intended. Surgery to shave or smooth down the edges of the labrum may be necessary. A severe tear can be repaired using suture anchors. These procedures don't restore the tissue to normal. But it makes it possible for the joint to keep moving smoothly and painfree through its various motions. The healing ability of the labrum remains under question. Animal studies show it has a promising ability to heal after surgical repair. Human studies are more difficult to conduct. Fibrosis, adhesions, and scar tissue in and around the labrum can help stabilize the joint, but can also cause motion restrictions and pain. Surgical repair may be accompanied by less chaotic and more evenly distributed scar tissue. Motion, strength, and function can be restored fully. Athletes are able to return-to-sport at a level equal to sports participation prior to the injury.

Marc J. Philippon, MD, et al. Early Outcomes After Hip Arthroscopy for Femoroacetabular Impingement in the Athletic Adolescent Patient. A Preliminary Report. In Journal of Pediatric Orthopaedics. October/November 2008. Vol. 28. No. 7. Pp. 705-710.

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