Hip Labral Tear
The labrum is a soft tissue structure that attaches nearly circumferentially to the rim and adjacent cartilage of the socket of the hip joint. It is normally a few millimeters thick. The labrum plays a vital role in helping to seal the hip joint trapping fluid in the joint that lubricates and protects the cartilage. When the labrum separates from its attachment to the rim and/or adjacent cartilage, this is called a labral tear. Labral tears can be isolated during forceful hip flexion and rotation in the cases of trauma, but more commonly occur in the setting of femoral acetabular impingement (FAI).
FAI is a hip condition in which extra bone forms at the junction between the ball (femoral head) and the adjacent neck at the top of the thigh bone. Parts of the rim of the acetabulum may also overgrow; this is called a pincer lesion. Bone can also form above the rim and below a bony prominence in the pelvis called the anterior inferior iliac spine. This excess bone growth is called a CAM lesion or CAM impingement. After a CAM and/or pincer is formed, hip flexion and rotation causes the bony prominences to pinch soft tissue structures in between. The predominant structure that gets pinched is the labrum. With repetitive pinching, the labrum can separate from its attachment to the rim and the adjacent cartilage.
This condition often limits people from being able to exercise and participate in activities that involve deep hip flexion and rotation, such as squats or lunges. Patients may also develop painful catching in their hip from a labral tear and/or cartilage injury. Patients with FAI and labral tears are usually first treated with physical therapy and anti-inflammatory pain medication, but since labral tears infrequently heal on their own due to a poor blood supply, surgery is usually the best and most definitive option. Minimally invasive techniques (i.e. hip arthroscopy) are used to reshape the bone on both the femoral and acetabular side as well as reattach the torn labrum. With surgery, there is a high rate of return to previous activities and success with helping patients recover their function and quality of life.
- Pain localized to the groin that may radiate to the side and back of the hip
- Painful catching or clicking upon hip range of motion
- Decreased hip range of motion, particularly with hip flexion and rotation
- Weakness from pain
- Physical Therapy - Many labral tears do not cause symptoms such as pain or catching. In cases of a symptomatic labral tear, a formal course of physical therapy can help patients regain their strength and range of motion. Strengthening muscles around the hip can take pressure of the hip joint alleviating pain.
- Injections - Steroid injections into the hip are rarely used in cases of a labral tear because steroids can interfere with healing if surgery is needed and don’t eliminate the tear. Steroid injections are usually reserved for patients who cannot have surgery.
- Anti-inflammatories - Nonsteroidal anti-inflammatory medications such as Ibuprofen or Aleve can help decrease inflammation and pain caused by a labral tear. This can be beneficial in addition to physical therapy, so patients can have less pain while regaining their motion and strength. Prescription-strength anti-inflammatory medications are occasionally prescribed if over-the-counter medications are not working.
- Surgery - Because the labrum has a poor blood supply, it infrequently heals on its own. The cartilage adjacent to the labral tear can also be affected. Surgery to reattach the torn labrum is often the best option to alleviate pain and help patients regain their function and quality of life. In some cases the labrum can simply be debrided so it is no longer catching and causing pain in the joint.
After taking a detailed history, obtaining x-rays, and performing a thorough exam, if a labral tear is suspected, an MRI with IV contrast will likely be ordered. An MRI evaluates soft tissue structures of the hip such as the labrum and cartilage.
Treatment for this condition depends on a patient’s age, activity levels, goals, and presence of any arthritis. Because labral tears infrequently heal on their own, surgery is usually recommended to repair the labrum; however, if the labral tear does not cause symptoms, it can be observed.
The most common risks are stiffness, persistent pain, and weakness. Patients with a labral tear commonly use their injured hip less, which causes the hip muscles to weaken and leads to decreased function function and confidence with more vigorous activities.