Hip Labral Tears: What Athletes and Active Patients Need to Know | Zachary McVicker, MD

Welcome back to another episode of the Paley podcast. Today we're focusing on a silent but serious issue affecting athletes and active individuals. Hip, laboral tears. Often overlooked or misdiagnosed as simple tightness or strain, laboral injuries can lead to chronic hip pain and instability if left untreated. Joining us is Dr. Zachary McVicar, a sports medicine specialist at the Paley Orthopedic and Spine Institute in West Palm Beach, Florida. Dr. McVicar brings advanced expertise in arthroscopic joint preservation techniques for the hip, knee, shoulder, and elbow, helping patients recover from injury and return to peak performance. In this episode, Dr. McVicar walks us through what a laboral tear is, how it's diagnosed, when surgery is recommended, and what patients can expect from recovery. My name is Zachary McVicar. I grew up in the Toledo, Ohio area and went to undergrad and medical school in that region and then went to the University of Rochester, New York, where I did my orthopedic surgery residency and took special interest to sports medicine while I was there. It happens to be a big pipeline to a curling job orthopedic clinic, which is the original sports medicine fellowship program in the country. That's where I ended up going in 2019, 2020, and I developed a special interest in hip preservation, hip arthroscopy. That kind of led me down to this path, you know, found an area where there was a need for some more hip arthroscopists and hip preservation. I started off in practice at a private practice in Jupiter, another sports medicine doctor. The hip portion of my practice grew very quickly and you know, just started to develop my own techniques and things. And you know, as my practice grew, I moved on to the Paley Institute and with more opportunities for joint preservation and hip preservation specifically as well as the whole field of sports medicine. A hip labrum is essentially an extension of your carloge off your hip. It's a piece of tissue that acts like a gasket. If you think about two pipes, you know, it creates a seal around the hip. So anytime you tear that gasket, you know, you lose some of the function of that seal. In certain positions, it becomes a little more prevalent and painful. So the laborum has nerve endings. It can give pain sensation. So when you tear that, you know, it can be quite debilitating and especially in certain positions, you know, depending on what your hip pathology is. So, you know, commonly like squads, deep bends, sitting for long periods of time, running, things like that. But yeah, if you think about the gasket, I mean, that's really the best analogy that we have for the laborum because it does create a seal on your hip. Yeah, so there's two main reasons for hip laboral tears. So the, you know, one of the more common ones is called femoral ass tabular impingement. Basically, that means that the, you basically have like an oval peg in a round hole. So the ball is not fitting into the cup correctly. And so when you get in a certain positions, like, you know, flexing your hip up, that part of the bone comes up and makes contact with the laborum. And it starts to delaminate the laborum from the rim. And it also starts to peel the cartilage off. So, you know, if you think of a normal hip, you know, you got this nice bend, you know, people with impingements more like this comes up and makes contact. And so the laborum just kind of just gets crushed, it gets delaminated, like I said. And it actually leads to arthritis over time if left unchecked. And that's actually, that's extremely common in America. That is the biggest reason for a total hip replacement is unchecked F.A.I. which leads to the, to that arthritic process. The other reason is, is hip dysplasia. So that means that the ball is not completely covered by the cup. And what that does is then you start edge loading because the surface area is not not fully covered here. So you're, you're just edge loading. And so then the laborum expands to try to help with that. It gets thickened. And it starts to see too much pressure and then eventually tears. So in both ways, a little bit different mechanism, but both equally as painful. This can happen to anybody. It doesn't have to be just an athlete. It can be, it can be anybody. And what they present with is, is severe growing pain. You know, a lot of people will, will say that, you know, if I sit for a long period of time, my growing starts to really throb. And it's kind of towards the front of the hip. Other people will see other issues around their pelvis. The secondary things that happen, you know, your spine can be, can be painful too and your SI joint. But that growing pain is pretty consistent. You know, very common thing that I see, especially in young athletes, is their trainers will tell them you have a hip flexor strain. And it's actually not that at all. That's, that's pretty rare. You know, they have an isolated hip flexor strain. It's usually more from that impingement, that laboral tear. And if it's persistent, something that just is there for many, many weeks, it's really starting to interfere with how you move your athlete, how you play your sport. That's dangerous. Secondly, to other injuries as well. So if there's ever a question, if it's hurting and it's not going away and is very persistent, then that's when you should seek some care. The history of physical is always the most important thing for me. I'd see what hurts them, why it hurts them. The physical exam maneuvers and things, there's certain tests that is very specific for a laboral tear and hip pain. And so, you know, if that elicits pain, then we're pretty sure we know they've got something going on in their hip. We get x-rays, you know, very specific set of x-rays. And then usually at least when MRI to diagnose the laboral tear. Depends how long they've they've had it and how debilitating it is and what the underlying pathology is. Some very mild impingement with small tear, it's not too painful, it's just kind of nagging. Certainly try some conservative treatment. Injections are an option depending on age. I don't like to give steroids and younger people. But athletes try to get through a season, you know, that's sometimes an option. We do a PRP or platelet-rich plasma as well. That's kind of hit or miss for a laboral tear. Some people, it's pretty effective. You know, physical therapy to really try to see if we can correct some of the problems with their pelvic tilt and things like that that is helpful and strengthen their glutes and core. But depending on the pathology, meaning the bony problem that's there, if it's really large and if they have dysplasia, things like that, that's usually when we jump into surgery a little bit quicker because it's just not going to fix itself. It's a, you know, it's an anatomic problem. It's not going anywhere. If it's been nagging for a long time, then we just go ahead and fix it. So usually there's an instance where my hips start hurting after this. I don't really know what happened, but it started hurting after this day. And people are pretty aware of when it happened. It's not often where it's like you felt a pop and it just started hurting, like other injuries, but you certainly know when it started. I always, you know, repair the labor, I'm more reconstructed, you know, never is it an instance where I'm just debrising it or cutting it out. Because you're not changing the function, you're not restoring the function that I had before. So for me, it's a couple little poke holes around the, on the outside of the hip. We do this all through a camera. And so it takes about an hour to two hours depending on how complicated the surgery is. And so what we do is going in first, we look at all the cartilage in the hip, make sure that there's nothing else going on. And then we fix the labor on a couple suture anchors anywhere from two to seven or more anchors around the rim, but to fix the labor back to the to the to the cup to ask to tag them. And then after that, you know, we let the we pull traction to kind of get to the labor and then let the traction down and let the hip go back. And we fix the bony deformity after that. So that's the most important part of this is to fix why you got a labor tear in the first place. And so we're really diligent about making sure that that looks perfect by the end of the case because we don't want this to happen again. To give people kind of a conservative estimate, what I tell them the first month is pretty inconvenient. You know, you're on crutches, you're in a brace, you've got this machine that moves you at nights, call the CPM. So I keep your hip moving, so you don't get too stiff. And you know, you're doing PT, but it's all pretty passive motion type things. So you're not getting too stiff and allowing that labor on the heel. After the first month, we start to ramp things up a little bit. You start doing a little bit more as far as exercising in PT in a smart way. The general overview is, you know, you're on a bike from day one, you know, you start doing a little more like muscle building exercises towards week six. And then at 12 weeks, you're running on a treadmill. And then so return to sport is generally five to seven months, depending on what you're doing. It just depends, you know, the I've seen people in my clinic who have had injections in the past. And, you know, they did really, really well for many years. And then the disease kind of progresses, meaning they got a little bit more arthritis at that point. And that's becoming more painful. So that's the typical progression is that, you know, if this goes on for many years on checked, you're going to have hip arthritis just to what degree. And we just, you know, obviously you don't know how quickly that's going to happen. But that's that's generally what I see is they were pain free for a long time. They have any issues. And then they came back in for more imaging because it started bothering them again and sure enough, they have a little bit of arthritis. The size of the labor and terror does not matter. They're like, well, is it a small terror? You know, that that doesn't matter. You either having a struggling joint where it's starting to give you pain or you don't, you know, you have a labor terror. You don't. And it's the same thing. Like if you think of a gasket, you get a you get a pinhole tear in that gasket. It's not going to work properly. If there's a pathology there, meaning an injury and bony deformity, it's, it's going to it's going to affect you. So the size of the labor there doesn't matter. The other one is, you know, it's the same name as a shoulder labor, but it's a different function. So this is, this is truly that gasket analogy. It creates a negative pressure in your hip to spread out that that contact pressure. So it's not the same, you know, kind of ordeal as a shoulder labor and injury, even though they have the same name. So you can either look online, you know, on the the Pali Institute website. I have a website too. It's sports medicine. and Palm Beach dot com and you know you can get linked up through there through an online request. But you'll be when you call or have an email request and you'll be directed to my assistant, Lisa Lewis, who's fantastic. If you read any of my reviews, she's on there as much as I am. You'll be in good hands. That brings us to the end of today's episode of the Paley podcast. Thanks to Dr. McVicar for sharing his expertise on hip-laboral tears and how modern sports medicine is improving outcomes for active patients. To learn more or schedule a consultation, visit paleinstitute.org or call the office directly at 5618-445255. Thanks again for listening and we'll see you next time on the Paley podcast.