Mechanical engineering has the French word “amortisseur” (shock absorber) to describe the component which reduces oscillations and vibrations, thus ensuring the stability of the vehicle. The human body has a similar “accessory” in the joints, but, in medicine, instead of the word “shock absorber”, the term which is used is “cartilage”.
The articular cartilage is a hard and elastic “material” of water, collagen, proteins and lipids, which covers the ends of the bones. Another fibrous structure, like a ring, is found in the hip joint, which contributes to the stability and layering of the joint. It is the labrum, which deepens the acetabulum.
The wearing of both of these anatomical elements means that the acetabulum (part of the large pelvic bone and the “socket” of the femoral head) “rubs” against the femoral head, the upper ball-shaped end of the femur. At the same time, a hardening of the surfaces is observed, while cysts and osteophytes are formed.

In some individuals with bone anomalies, the cartilage can be torn simply because of repetitive collisions during the normal hip movement - this is called the iliotibial band impingement syndrome. In recent years, studies have shown that it frequently appears in young and middle-aged individuals who have adopted an intense athletic activity. Symptoms of this relatively new diagnostic entity include pain and motion limitation in the anterior, oblique, and, rarely, in the posterior region of the hip.
When the femoral head loses its sphericity and strikes the acetabular rim, we are talking about a CAM-type impingement (CAM lesions – femoral head problems), which is related to young male athletes in the literature. However, when there is a significant increase in the borders of the acetabular rim, or it is too deep, or its posterior inclination is increased, the normal femoral head “rubs” against it. We are then talking about a Pincer-type impingement (Pincer lesions – problems of the acetabulum), and is usually related to middle-aged female gymnasts. In addition, there is the mixed-type impingement (CAM & Pincer), which is the most common one.

Although the hip labral tears may “contribute” to the early development of osteoarthritis, the role of this anatomical structure has remained underestimated, until recently - contrariwise, the focus of interest was the articular cartilage. Recent studies, however, issue a warning call, underlining that hip labral tears at the early stages may be asymptomatic, and indicate that they are mainly related to ice hockey, karate, jiu-jitsu, soccer, football and golf athletes, but also ballet dancers.

Initially, it is recommended to limit activities and lose weight, in order to unburden the joint. The American Academy of Orthopedic Surgeons, in a list of guidelines issued in April 2017 for the first time, recommends the option of the injection of corticosteroids, physiotherapy, and non-steroidal anti-inflammatory drugs, before resorting to surgery.
Depending on the patient, their age, activity level, medical history, and especially in cases where conservative treatment has failed, arthroscopy is an effective. During arthroscopy, the surgeon is able to make a more general assessment of hip joint, through very small incisions, and using a camera - the aim is to treat the painful symptoms, as well as to prevent arthritis. The purpose is to preserve as much tissue as possible, to remove or smooth the torn edges of the cartilage, or to suture the tear with absorbable sutures, or to fix it upon the acetabulum with special anchors. In addition, if necessary, damages to the adjacent articular cartilage are repaired.
The first physical therapies are performed immediately after surgery. The patient shall have to use crutches for 3-5, weeks so that the joint is not burdened. Full motion rehabilitation takes place within 9-12 weeks, and athletes may return to action within 3-4 months.

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