Kesler: Terrible hip pun available on request.

The Vancouver Canucks announced today that interview-bombing center Ryan Kesler has had a successful repair on his hip labrum. Kesler is no stranger to hip injuries, having had a labrum repair once already in 2007. Frantic googling and help from @ArtemChubarov via @BotchonCanucks seems to indicate that the repair in 2007 was on the right hip, and today’s procedure was on the left.

 

What’s a hip labrum?

Back it up. First let’s look at how the hip is built. The hip joint is a ball-and-socket joint, which is exactly what it sounds like. There’s a socket on the side of the pelvis, and a ball on top of the femur (thigh bone) that fits in there. The femoral head (the ball) and the acetabulum (the socket) are both covered in cartilage. The cartilage provides cushioning as well as allowing the bones to articulate – bone on bone doesn’t slide too well (and hurts like a bitch). In addition to the articular cartilage of the bones that make up the hip joint, there’s a ring of fibrous cartilage around the outside of the acetabulum (that’s the labrum) that adds to the stability of the hip joint. The labrum deepens the socket, provides extra surface area to spread out the load the hip is carrying, and essentially provides a seal around the joint that keeps the femoral head in place (with help from a whole lot of ligaments).

 

The hip joint

 

So how do you tear your labrum?

Labral tears are common in sports with a lot of hip flexion (that’s the motion you get when you pull your leg up to your chest), external rotation (rotation of the leg so the toes point out) and twisting (duh). The usual culprits are hockey, soccer, dance (not a sport, I don’t care what the IOC says) and golf (the twistiest of the twisty sports).

 

Oh look, hip flexion.

 

How do I know if I’ve torn my labrum?

The most common symptom of a torn labrum is hip pain – most often in the front of the hip. There can also be limitation of range of motion of the joint, as well as joint weakness, clicking, catching and locking. Frequently labral tears go undiagnosed for a while (typically as much as two years), as the symptoms can be very non-specific and there’s usually not one particular incident that the patient can identify as the cause of the injury.

When Kesler had his hip problem in 2007, he was having issues with joint stiffness and locking, and was said to have been unable to walk up a flight of stairs prior to his repair. This time the Canucks revealed after the playoffs ended that he’d been playing with a hip injury sustained in game 5 of the series with the Sharks. Kesler had been trying to avoid surgery with therapy, but team management and medical staff decided that a repair now was better than compounding problems later.

The diagnosis is usually made with an MRI, although in 2007 Kesler’s hip was diagnosed with an MRI arthrogram – where dye is injected into the joint.

 

So how do you fix a labrum?

The definitive treatment is surgery, and there are several options. Depending on the extent of the damage, it could be as simple as an outpatient arthroscopy (little cameras poked through little holes) to trim off the torn cartilage. Other options would be a repair using sutures or other anchoring devices (similar to what we saw in Huselius’ pectoral repair). The worst case scenario involves damage to the articular cartilage, and not just the labrum. In that case, there could be a need for what’s called microfracture surgery – where small holes are drilled in the bone underlying the cartilage, stimulating the growth of new cartilage. Microfracture requires no weightbearing for 6 to 8 weeks after the procedure, and 4 to 6 months before a return to play can even be contemplated. The worst WORST case scenario would be a total hip replacement.

 

Torn labrum

 

In the picture above you can just see the smooth femoral head on the left, and the labrum hanging off the acetabulum (which the probe is hooked around). This is bad.

 

What’s ahead for Kesler?

It takes about 4 to 6 weeks for the repaired cartilage to really re-attach to acetabulum. Generally you’d be looking at anywhere from an 8 week to 6 month recovery time, but Kesler came back in only 10 weeks last time (only to break his finger 3 days later). The earliest you could reasonably expect him to be back would likely be mid to late October.

It’s also a safe assumption that Kesler’s injury and surgery won’t be keeping him from his finely-honed interview bombing techniques.