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Patients are often referred to me because they have a hip labral tear. However, the real problem they have is typically #HipFAI, which caused the labral tear. Here’s a belly flop (as opposed to a deep dive) on the evolution of #Hiparthroscopy.
Way back in the 1990’s, #HipArthroscopy was in its infancy. It was considered a technical feat just to get inside the hip joint, and there were few indications for scoping a hip. Therefore, hip scopes were only done in rare cases (like taking out a bullet) https://pubmed.ncbi.nlm.nih.gov/23741592/
As the small #HipArthroscopy community gained experience with this procedure, it was noticed that there were tears in the hip labrum, and when these tears were removed, symptoms such as hip pain, catching, & locking improved. https://pubmed.ncbi.nlm.nih.gov/10210068/
Around the same time, Professor Reinhold Ganz was trying to figure out why young people (in their 20’s and 30’s) were developing #HipArthritis), and showed a correlation between #HipFAI and cartilage damage leading to hip arthritis.
Professor Ganz developed an open surgical technique to address both types of #HipFAI (cam and pincer). His early papers noted improvement in function with this operation.
Here’s a pic that shows both. Top arrow is pincer, bottom arrow is cam.
Here’s a pic that shows both. Top arrow is pincer, bottom arrow is cam.
Surgeons started to incorporate the findings of Ganz into the burgeoning field of #HipArthroscopy.
Techniques were developed to mimic the Ganz open surgical dislocation, but with a minimally invasive approach.
Here’s the same hip after a hip scope.
Techniques were developed to mimic the Ganz open surgical dislocation, but with a minimally invasive approach.
Here’s the same hip after a hip scope.
It is now widely accepted that most hip labral tears have some underlying bony, biomechanical cause such as #HipFAI or #HipDysplasia (which would need its own tweetorial!). Traumatic labral tears without bony deformity occur, but they’re rare (like Bigfoot sightings)
So, most #HipArthroscopy for labral tears should INCLUDE correction of the underlying cause.
So, if a patient has a labral tear like this...
So, if a patient has a labral tear like this...
The surgeon needs to carefully evaluate the bony structure (same patient’s X-Rays, which shows an increased alpha angle (cam #HipFAI) and extra bone off the acetabulum (pincer-yellow arrow)
For this labral tear, optimal results occur when addressing the labral tear and addressing the cause of the damage. #HipArthroscopy pic showing repaired labral. X-ray showing surgical correction of #HipFAI.
This is why patients may see me thinking that the labral tear is the problem. In actuality, the labral tear is the symptom, and #HipFAI may be the cause.
