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Maryland Orthopedic Specialists
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Hip

Hip Labral Tear & Femoroacetabular Impingement (FAI)

Hip labral tears and femoroacetabular impingement (FAI) are among the most common — and most commonly missed — sources of hip and groin pain in active adults. At Maryland Orthopedic Specialists, patients have direct access to Dr. John Christoforetti, a fellowship-trained hip preservation surgeon and President of the International Society for Hip Arthroscopy (ISHA) in 2024, who has devoted his career to non-replacement hip surgery. Whether your symptoms began with sport, repetitive activity, or have developed gradually over years, our team uses advanced diagnostics and individualized treatment to restore function and protect your hip long-term.

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What is hip labral tear & femoroacetabular impingement (fai)?

### The Acetabular Labrum The labrum is a ring of fibrocartilage that lines the rim of the acetabulum (hip socket). It deepens the socket, provides a suction-seal that centralizes the femoral head, distributes load across the articular surface, and maintains intra-articular fluid pressurization — the mechanism that keeps cartilage nourished and the joint surfaces separated under load.

The Acetabular Labrum

The labrum is a ring of fibrocartilage that lines the rim of the acetabulum (hip socket). It deepens the socket, provides a suction-seal that centralizes the femoral head, distributes load across the articular surface, and maintains intra-articular fluid pressurization — the mechanism that keeps cartilage nourished and the joint surfaces separated under load. When the labrum is torn, this pressurization seal is lost, which accelerates cartilage wear and increases the risk of early osteoarthritis.

Femoroacetabular Impingement (FAI)

FAI occurs when abnormal bony contact between the femoral head-neck junction and the acetabular rim produces repetitive mechanical damage to the labrum and cartilage. There are three recognized morphologies:

  • Cam impingement: An aspherical, enlarged femoral head-neck junction — often described as a "bump" — that jams into the socket during hip flexion and internal rotation. Cam lesions are more common in young male athletes and cause shear-type labral tears at the chondrolabral junction.
  • Pincer impingement: Overcoverage of the femoral head by the acetabular rim, either globally (coxa profunda, protrusio) or focally (acetabular retroversion). Repetitive contact causes crushing of the labrum against the rim and can produce contrecoup cartilage damage posteroinferiorly.
  • Combined impingement: Cam and pincer morphologies co-exist; this is the most common pattern seen in clinical practice.

Who Gets FAI and Labral Tears?

FAI morphology is a developmental variant — bone shape is established during adolescent skeletal growth, which is why activities involving high-volume hip loading during the teenage years (hockey, soccer, football, gymnastics, dance) are strongly associated with cam development. Labral tears occur across a wide spectrum:

  • Young athletes and active adults (ages 15–45): typically cam or combined FAI causing labral detachment or complex tears
  • Dancers and gymnasts: repetitive end-range motion with pincer or combined morphology
  • Middle-aged and older adults: degenerative labral fraying and tearing, often without frank FAI, associated with early cartilage loss and hip osteoarthritis

Treatment options

Treatment is individualized based on symptom duration, severity of FAI morphology, labral tear characteristics, cartilage status, patient age, and functional goals.

Non-Operative Treatment

Non-operative management is appropriate as initial treatment for patients with mild-to-moderate symptoms, early presentation, or as a bridge to surgery when indicated: Physical therapy — periacetabular strengthening: Targeted strengthening of the gluteus medius, gluteus maximus, deep external rotators, and hip flexors reduces dynamic impingement forces and offloads the labrum during functional activity. The 2019 ISHA physiotherapy consensus provides the evidence base for this approach. Activity modification: Avoiding end-range hip flexion and provocative loading during the acute phase reduces symptom burden. Intra-articular corticosteroid injection: Image-guided injection of the hip joint provides diagnostic confirmation of intra-articular pain source and can provide months of symptom relief, particularly useful in patients who wish to delay surgery or optimize condition before an elective procedure. Non-operative treatment does not correct the underlying bony morphology. In the presence of significant FAI with symptomatic labral tear, conservative care reduces pain but does not eliminate the impingement mechanism — meaning the risk of ongoing labral and cartilage damage persists if the bony deformity is not addressed.

Surgical Procedure

Hip Arthroscopy

Minimally invasive hip scope performed at our ambulatory surgery center, addressing labral tears, cartilage defects, femoroacetabular impingement, loose bodies, and synovial disease through small portals with same-day discharge.

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Hip Labral Repair

Arthroscopic suture anchor repair that reattaches a torn labrum to the acetabular rim, restoring its role as the hip joint's primary seal and stabilizer. Native labral tissue is preserved whenever the tear pattern allows.

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Hip Labral Reconstruction

Graft-based reconstruction of a hip labrum that is too damaged or deficient to repair, using iliotibial band autograft or allograft to restore the labrum's sealing function and contribute to joint stability.

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FAI Correction (Femoroacetabular Impingement)

Arthroscopic reshaping of the femoral head-neck junction (cam osteoplasty) and/or trimming of the acetabular rim (pincer resection) to eliminate the mechanical impingement causing hip pain and labral injury.

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Frequently Asked Questions

Do I need surgery for a hip labral tear?
Not necessarily. Many patients improve with physical therapy and activity modification, particularly if FAI morphology is mild and cartilage is preserved. However, when a structural labral tear is confirmed on MRI arthrogram and symptoms persist despite at least 3 months of targeted physical therapy, surgery is usually the most reliable path to durable pain relief and return to full activity. Prolonged delay in the setting of significant FAI carries the risk of ongoing cartilage damage.
What exactly is FAI?
FAI (femoroacetabular impingement) is an abnormal bony contact between the femur and the hip socket caused by a developmental variation in hip bone shape — specifically an aspherical femoral head (cam), an overly prominent acetabular rim (pincer), or both. This contact occurs during normal hip motion and over time tears the labrum and damages the articular cartilage.
Can I make my hip worse by waiting?
Yes, in cases of significant FAI with an active labral tear, delay can result in progression of cartilage damage. Studies comparing surgically and non-surgically treated patients demonstrate that those who do not have their FAI corrected face a higher risk of osteoarthritis progression over time. If you have been told you have a labral tear with FAI, a timely evaluation is advisable.
What is hip arthroscopy, and is it major surgery?
Hip arthroscopy is a minimally invasive procedure performed through 2–3 small portal incisions, using a camera and small instruments. It does not require hip dislocation or large incisions. Most patients go home the same day. Recovery is measured in months rather than weeks for full return to sport, but the procedure itself carries substantially lower morbidity than open hip surgery.
When is hip replacement needed instead of arthroscopy?
Total hip arthroplasty (THA) is the appropriate choice when significant joint-space narrowing or advanced osteoarthritis (Tönnis grade 2–3) is present. In that setting, hip preservation surgery is unlikely to provide meaningful relief and THA delivers excellent outcomes. Dr. Christoforetti evaluates the degree of arthritis carefully on imaging before recommending any surgical approach.
Will I develop arthritis if I have FAI?
FAI is a risk factor for early hip osteoarthritis, particularly when labral damage and cartilage loss are already present. Research demonstrates that correcting FAI with hip arthroscopy reduces — though does not eliminate — the risk of OA progression compared with non-surgical management. Early intervention before significant cartilage loss offers the best chance of long-term joint preservation.

Meet the specialists

John J. Christoforetti, MD

John J. Christoforetti, MD

Orthopedic Surgery · Sports Medicine · Hip Preservation Surgery

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Related conditions

Hip Osteoarthritis
Medically reviewed by John J. Christoforetti, MD, MD, FAAOS
Last reviewed May 1, 2026

References

  1. Menge TJ, Briggs KK, Dornan GJ, McNamara SC, Philippon MJ. Survivorship and Outcomes 10 Years Following Hip Arthroscopy for Femoroacetabular Impingement: Labral Debridement Compared with Labral Repair. J Bone Joint Surg Am. 2017;99(12):997–1004. doi:10.2106/JBJS.16.01060
  2. Dornan GJ, Ruzbarsky JJ, Comfort SM, et al. Two-Year Outcomes of Primary Arthroscopic Surgery in Patients with Femoroacetabular Impingement: A Comparative Study of Labral Repair and Labral Reconstruction. J Bone Joint Surg Am. 2024;106(19):1757–1766. doi:10.2106/JBJS.23.00966
  3. Husen M, Leland DP, Melugin HP, et al. Progression of Osteoarthritis at Long-term Follow-up in Patients Treated for Symptomatic Femoroacetabular Impingement With Hip Arthroscopy Compared With Nonsurgically Treated Patients. Am J Sports Med. 2023;51(11):2986–2995. doi:10.1177/03635465231188114
  4. Jan K, Fenn TW, Kaplan DJ, Nho SJ. Patients Maintain Clinically Significant Outcomes at 5-Year Follow-Up After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Systematic Review. Arthroscopy. 2023;39(8):1869–1881. doi:10.1016/j.arthro.2023.04.021
  5. Tiao J, Ranson W, Ren R, et al. Assessment of Risk Factors and Rate of Conversion to Total Hip Arthroplasty Within 2 Years After Hip Arthroscopy Utilizing a Large Database of Commercially Insured Patients. Orthop J Sports Med. 2024;12(2). doi:10.1177/23259671231221788
  6. Griffin DR, Dickenson EJ, O'Donnell J, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med. 2016;50(19):1169–1176. doi:10.1136/bjsports-2016-096743
  7. ISHA — The Hip Preservation Society. Patient Information: Femoroacetabular Impingement (FAI). https://www.ishasoc.net/patient-information-fai/
  8. American Academy of Orthopaedic Surgeons. Hip Labral Tear. OrthoInfo. https://orthoinfo.aaos.org/en/diseases--conditions/hip-labral-tear/