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Thursday, November 20, 2008
Updated: November 21, 1:49 PM ET
Chase Utley Not So Hip


The Phillies announced Thursday that their star second baseman, Chase Utley, will undergo a surgical procedure for "arthroscopic evaluation with treatment of any labral or bony injury" in his hip. Aside from informing us that the surgery will be on Utley's right hip and saying he could potentially be out until June of 2009, they haven't told us much. And to be fair, there isn't that much to tell at this point.

The reason for the wide time frame range is simple; surgeons will not realize the full extent of damage, and consequently the extent of necessary repair, until they can visualize Utley's hip in surgery. This is fairly commonplace when it comes to the hip as X-rays, MRIs and clinical examination can only reveal so much in advance.

So what are the possibilities? First, there is the possibility that Utley has a labral tear in his hip. The labrum is a fibrocartilaginous ring that helps provide stability and ensures smooth joint mechanics within the hip. It has a very similar function to the labrum in the shoulder, and if damaged or torn, the labrum can catch or pinch within the joint, resulting in pain and limited motion. Red Sox third baseman Mike Lowell underwent surgery -- performed by Dr. Bryan Kelly of the Hospital for Special Surgery in New York -- for a similar condition immediately after his season ended. According to a report by ESPN's Jayson Stark, Dr. Kelly will also be performing Utley's surgery.

It sounds as if there is suspicion of labral pathology in Utley's case, which in and of itself, would warrant surgery. During surgery the damaged piece of labrum is either repaired or resected (removed), depending on the extent and location of damage. Since the labrum does provide some protection for the joint surface itself, surgeons aim to preserve as much of the healthy tissue as possible. Following surgery, the athlete is required to go through a "protective" phase of rehab in which the amount of weight bearing is limited to allow the tissue to heal, and range of motion and strengthening exercises are increased incrementally. Later in rehab, the athlete is returned to weight bearing exercises, which then get more complex in scope (meaning they start to look like sport-specific, or baseball-type exercises in Utley's case, as opposed to basic leg strengthening exercises). Once the athlete has demonstrated sufficient strength and stability he can return to sports drills, and eventually return to play. Complete recovery from a labral resection or repair typically ranges from 10 to 16 weeks.

The picture becomes more complicated if there are any bony or cartilage issues that need to be addressed during surgery. Specifically, there is a condition referred to in the medical field as FAI (Femoro-Acetabular Impingement). In basic terms, it describes a scenario in which the femur (thigh bone) and the acetabulum (the bone that forms the hip "socket" for the femur) repeatedly come into abnormal contact in certain hip positions as a result of an athlete's particular anatomy combined with the demands of his sport. That repeated abnormal contact, or impingement, can lead to bony issues such as spurring, and ultimately can result in damage to the labrum, as well as the cartilage surface, over time. If this is the case, then during surgery to repair or resect the labrum, these issues will also be addressed. The bone can be burred, or remodeled, to eliminate the presence of impingement, but the bone is more fragile initially after this procedure and thus the rehab is slowed accordingly to allow proper healing.

If the cartilage surfaces that protect the bony ends are found to be significantly damaged during surgery, then a microfracture procedure may also be in order. Microfracture is performed to help the body create new cartilage in the defective region. Although not quite identical to the original cartilage surface, the new surface provides joint protection and helps eliminate pain. There have been many good results, including athletes returning to play at an elite level, following this type of procedure. The cartilage surface is very delicate as it is forming, however, and consequently the rehab time is substantially longer and the process less aggressive in order to ensure success. In the scenario where bony and/or cartilage tissue is also involved, returning to sport can extend out as far as eight months, although the typical window for recovery is four to six months.

The Phillies' projected timeline allows for the possibility of any and all scenarios. Working in Utley's favor is that he is young, otherwise healthy and has an excellent work ethic, which will serve him well during the tedious aspects of rehab. Assuming that he does not have an extreme amount of damage within the hip -- and it seems unlikely that he would, given that he was actually able to finish the season -- Utley, upon completion of his rehabilitation process, should be able to resume the intense, driven style of play that Philly fans have come to know and love.