Terrible news for the Celtics today as they announced that point guard Isaiah Thomas is finished for the post-season due to re-aggravation of a hip injury.
Isaiah Thomas will miss the remainder of this year’s postseason following re-aggravation of a right femoral-acetabular impingement with labral tear during Game 2 of the Eastern Conference Finals against Cleveland. Thomas initially injured the hip during the third quarter of the Celtics’ March 15 game against Minnesota, forcing him to miss the next two regular season contests. The injury was further aggravated during Game 6 of the Eastern Conference Semifinals at Washington on May 12.
“Isaiah has worked tirelessly to manage this injury since it first occurred,” said Celtics Chief Medical Officer Dr. Brian McKeon. “The swelling increased during the first two games against Cleveland, and in order to avoid more significant long-term damage to his hip, we could no longer allow him to continue.”
Thomas did not travel with the team to Cleveland and is currently evaluating treatment options. A further update will be provided as soon as one is available.
Here’s a quick review of hip anatomy to help make sense of Thomas’ injury. The hip is a ball and socket joint. A fibrous rim of cartilage called the “labrum” sits around the edge of the socket. The labrum’s purpose is to stabilize the femoral head (ball) in the pelvic acetabulum (socket).
Photo credit to the American Academy of Orthopedic Surgeons and their excellent patient website http://orthoinfo.aaos.org/ (I added the labrum)
The Celtics disclosed that Isaiah Thomas has a labrum tear as a result of a condition called “femoroacetabular impingement” (FAI). Sounds super technical, but it’s not. It means that the ball=femoral head and the socket=acetabulum are “pinching” (impingement). The images below represent hips with FAI.
Photo credit to the AAOS
In the hip on the left there is an extra prominence of bone (in red) along the rim of the acetabulum (socket). This is called “pincer-type” FAI. In the hip on the right there is an extra bump of bone on the head (ball) of the femur. This is called “Cam-type” FAI. Many patients with FAI have some sort of a combination of the two. When the hip flexes, the extra bone rubs against the normal bone and, often times, the labrum gets stuck in the middle. This can lead to tearing of the labrum.
We don’t necessarily know why FAI occurs. We think that many patients are born with a mis-matched shape between the ball and socket. There is also a theory that certain repetitive movements of the hip could increase the risk of development of FAI. For example, we see higher than typical rates of FAI requiring surgery in butterfly-style hockey goalies.
Treatment of FAI with labrum tears begins with anti-inflammatories and physical therapy to stabilize and improve function of the hip joint. If this is unsuccessful, a corticosteroid injection into the hip joint may sometimes be considered. I suspect that Isaiah Thomas has been working with trainers on physical therapy. The team has not said if he has tried a steroid injection. Occasionally a steroid injection can help with controlling pain associated with FAI and labral tears long-term. However, in general, a steroid injection often provides only short-term relief. That is why I suspect that Thomas will likely have surgery to treat both his impingement and the resulting labrum tear.
There are a few possibilities for how a surgeon might approach Thomas’ hip. Typically the surgery is performed arthroscopically, where tiny incisions are made around the hip and a camera is inserted into the joint to visualize the injury and repair. Sometimes the surgery is done through a larger “open” incision. Surgeons commonly repair the labrum tear and shave down any extra bony prominences which are causing the impingement so that the labrum does not tear again. This is what a labrum tear looks like to the surgeon on a video screen during hip arthroscopy.
Photo courtesy of my colleague, Dr. Michael Kain. Dr. Kain is an orthopedic surgeon who specializes in hip arthroscopy. He treats athletes of all ages with FAI and labrum tears at Lahey Hospital & Medical Center.
Occasionally, athletes with FAI and labrum tears are found to have early arthritis in the hip joint. Arthritis is the wearing away of the shiny lacquer paint-like covering of the ball and socket. FAI is associated with an increased risk of early arthritis in the hip. If Thomas is found to have early arthritis in the hip this might be addressed surgically as well with a procedure called “microfracture.” With a microfracture therapy the surgeon tries to promote growth of a scar-type cartilage in an area where the normal cartilage of the hip has worn away.
The best-case scenario for Isaiah Thomas is that he responds to rest from basketball, more physical therapy, and possibly one steroid injection. If he has already exhausted these options or if his medical team decides that he needs a more aggressive approach, then hip surgery would be the next step. Recovery from surgery could be anywhere from 6-9 months, depending on what is done and how he responds. The good news is that over 80% of athletes return to prior level of play after hip arthroscopy, although there is no specific data for NBA athletes. The bad news is if Thomas does require surgery it will likely impact the beginning of the 2017-18 season for an athlete who has shown himself to be the heart of the Celtics team.
I can’t write this entry without a personal note. Isaiah Thomas just finished up a tremendous season. The way that he handled himself after the loss of his sister was inspiring. He has shown amazing focus and heart during a very difficult time for him and his family. I wish him nothing but the best and can’t wait to see him out on the court again next season. Doesn’t seem right to call him the “little guy” anymore.