Best-Case, Worst-Case Scenarios for Ed Reed Following Hip Labrum Repair Surgery

Dave Siebert, M.D.@DaveMSiebertFeatured ColumnistMay 9, 2013

SAN DIEGO, CA - NOVEMBER 25:  Ed Reed #20 of the Baltimore Ravens waits for the start of the game against the San Diego Chargers at Qualcomm Stadium on November 25, 2012 in San Diego, California.  (Photo by Harry How/Getty Images)
Harry How/Getty Images

Last week, John McClain of the Houston Chronicle reported that Houston Texans safety Ed Reed underwent arthroscopic surgery to repair a torn labrum in his hip.

According to the Chronicle's Tania Ganguli, Texans head coach Gary Kubiak stated the surgery did not involve Reed's previously injured hip. He underwent a prior hip labral repair in 2010.

Depending on the exact nature of Reed's injury, his recovery timetable and prognosis could vary tremendously. On the one hand, he could completely recover without much difficulty, but on the other, the injury could represent the beginning of further, chronic hip troubles.

A Primer on Hip Anatomy

To understand what Reed may or may not face in the weeks and months ahead, it helps to review some basic hip anatomy.

The hip joint consists of where the femur—the thigh bone—meets the pelvis. More specifically, the rounded head of the femur inserts into a shallow pocket in the pelvis called the acetabulum.

For a better picture, imagine a beach ball sitting about halfway down inside a bucket. The beach ball represents the head of the femur, and the bucket represents the acetabulum.

Where does the labrum come into play?

A ring of cartilage sitting around the rim of the acetabulum "bucket," the hip labrum—called the acetabuluar labrum—extends the surface area of contact between the femur and pelvis. By doing so, it helps supports the joint and allows for the complex motions of which it is capable.

In other words, it helps keep the beach ball in place.

Injury Possibility No. 1: Traumatic Acetabular Labral Tear

Very generally speaking, acetabular labral tears occur via one of two mechanisms.

In the first type, a direct blow to the hip or hip dislocation causes a partial or complete break in the cartilage ring. Sometimes, the ring can partially separate from the pelvis.

With damaged or displaced cartilage, the head of the femur cannot move as smoothly within the acetabulum, resulting in pain and swelling. In severe tears, the altered landscape of the hip can limit its range of motion or even cause it to lock up altogether.

If conservative treatment fails—such as rest, physical therapy and potentially steroid injections—a traumatic tear may require surgery for definitive repair.

By inserting a small camera and other tools into the hip joint, an orthopedic surgeon can directly visualize the tear, thereby determining its exact nature. He or she will then stitch the ring back together, re-attach it to the pelvis or both.

Recovery from a surgically repaired traumatic tear usually requires at least 12 weeks of physical therapy. However, more extensive repairs may need double that time or more.

Injury Possibility No. 2: Femoral Acetabular Impingement and a "Wear and Tear" Acetabular Labral Tear

Athletes are particularly vulnerable to the second broad category of labral injury: overuse tears.

Over a long athletic career, repetitive, maximum-intensity twisting motions will eventually take their toll on even the healthiest of hips. The labrum will fray, and the cartilage within the joint will wear down.

When labrum damage reaches a critical point, pain and the aforementioned range-of-motion problems can develop. In a similar vein, cartilage destruction leads to hip arthritis—a chronic, progressive condition characterized by similar symptoms.

Some hips are more prone to wear and tear than others. For instance, during certain leg movements, the space between the head of the femur and pelvis narrows. However, the degree of narrowing differs from person to person.

Moreover, in athletes born with an unusually shallow hip socket or an abnormally shaped femur head, extreme narrowing "pinches" the tissue within the hip joint—a process called femoral acetabular impingement (FAI). Current theory states FAI can lead to developing hip labral and cartilage damage at an accelerated rate, possibly speeding the arrival of arthritis.

Lingering labral tears can also contribute to the development of arthritis in their own right.

As in a traumatic tear, initial treatment for a "wear and tear" labral injury consists of conservative measures such as anti-inflammatory medications and rest.

If symptoms persist, surgery is next. During surgery, doctors will again attempt to directly repair any obvious tears using the arthroscopic technique described above.

Unlike traumatic tears, though, "wear and tear" labral injuries do not always have defined borders. In such a scenario, instead of re-attaching one piece of cartilage to another, surgeons trim away uneven or damaged tissue edges and remove any free-floating pieces of cartilage. Doing so helps resolve pain and swelling as well as delay the onset of further joint damage.

Nevertheless, surgical treatment represents a stopgap more than anything else. In many cases, symptoms will return. The only unknown is when.

Best-Case Scenario: Reed Recovers from a Minor "Wear and Tear" Injury in Time for Training Camp

According to the Houston Chronicle reports, the Texans hope Reed will return by the beginning or middle of training camp, meaning they expect a recovery time of approximately two-and-a-half months.

As always, exact medical details are unavailable. However, Dr. Andrew Blecher—a sports medicine specialist at the Southern California Orthopedic Institute—weighed in the situation. Based on the available information, he believes Reed's injury more likely to be of the "wearing down" variety.

"If the Texans are reporting Reed may be back by training camp, he probably didn't have a traumatic labral repair. Rather, he had a debridement (trimming of the labrum)," Dr. Blecher offered. "On the other hand, if Reed needed a pure labrum repair, he'd likely be good as new but not back to football for up to six months."

Following a debridement, Reed needs intensive physical therapy aimed at strengthening his hip to take stress off his recovering tissue. Following several rounds, a hopefully pain-free injury then enters a holding pattern until further intervention is needed.

Worst-Case Scenario: Reed's Labrum Issues Stem from Chronic Degenerative Changes

Unfortunately, Reed's hip injury history rings several alarm bells.

"Given Reed's bilateral hip problems, he likely has FAI," Dr. Blecher explained. "If that is the case, given his age and occupation, he also likely has hip osteoarthritis. The osteoarthritis isn't going away and sometimes can be worse after arthroscopic hip surgery."

Reed's age also comes into play, and his 34-year-old hips may need continued treatment in the years to come.

"If he does indeed have osteoarthritis and remains symptomatic, the next line of treatment is hip injections," Dr. Blecher continued. "Either cortisone, viscosupplementation or even PRP."

All three injections could alleviate symptoms. Cortisone works as a potent anti-inflammatory, and viscosupplementation serves as a joint lubricant of sorts.

PRP, or platelet-rich plasma, on the other hand, remains controversial. Some believe it helps heal or even re-grow damaged cartilage by using growth factors released by a patient's own platelets, but the jury's still out.

Nevertheless, as is the theme with chronic diseases, treatments only buy time. They cannot cure the condition.

"Hopefully, Reed can keep his symptoms under control until he retires," Dr. Blecher added. "I think since his career is near over anyway, he will make it through. But if this were earlier in his career, he might be in trouble."

Dave Siebert is a medical writer for Bleacher Report who will join the University of Washington as a resident physician in June. Except when otherwise cited, medical information discussed above is based on his own knowledge, and quotes were obtained firsthand unless otherwise noted.

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