What is a Hip Labral Tear?
A hip labral tear is a tear involving the ring of the cartilage (called acetabular labrum) that runs around the outside rim of your hip socket. The labrum acts like a gasket to help keep the top rounded ball of the thighbone (femoral head) securely within your hip socket. It deepens and stabilizes your hip socket as well as cushions your hip joint, preventing the bones from rubbing against each other.
What Causes Labral Tears?
Various factors can damage the hip labrum. These include:
- Trauma to the hip joint such as during car accidents or trips and falls
- Athletes playing contact sports such as soccer, football, ice hockey, golf, and ballet that require frequent twisting motions of the hip
- Hip dysplasia — where the hip socket is not aligned well to fit the femoral head — can also damage the labrum over time
- Degenerative changes in your hip joint where the cartilage throughout hip joint becomes rough and torn
- Hip impingement where extra bone grows alongside one or both the bones that form the hip joint — imparting the bones an abnormal shape. This condition has a few varieties. It may involve the hip socket, the junction of the thigh bone head and neck, and more commonly a combination of both. The irregular shape causes the labrum to be pinched or rubbed during normal movement leading to tearing and degeneration.
What are the Symptoms of a Labral Tear?
In some cases, a labral tear causes no symptoms. However, most people will report:
- pain in the groin region, or sometimes on the side of the hip, or even deep in the buttocks area
- a feeling of your leg “catching” or “clicking” in the affected hip socket when you move
- a feeling of “giving way” within the hip
- worsening of pain while twisting or sleeping on the hip
How is a Labral Tear Diagnosed?
When you present with the above symptoms, your doctor will do a thorough clinical examination and perform certain maneuvers to elicit pain in your groin. The range of motion of your hip will also be checked at the extremes of movement.
You may then undergo:
Imaging
- Plain X-ray
- CT scan, or
- MRI of the affected hip
- Magnetic resonance arthrography (MRA) — a special MRI to view the inside of your joint after injecting a special dye — is the test of choice for diagnosing a labral tear.
Hip arthroscopy
It is the gold standard for diagnosing as well as repairing a torn labrum. An arthroscope is a pencil-sized tool that contains a light source and a small camera lens at its tip. It helps project images of the inside of your joint on a monitor, allowing your surgeon to get a detailed view.
What are the Treatment options for a Labral Tear?
Non-surgical measures
Typically, non-surgical therapies may be tried at first. These include:
- Relative rest
- Anti-inflammatory and pain pills as necessary
- A focused physical therapy protocol
You may experience less pain during the periods of restricted activity. However, there is a high chance that your pain will recur after you resume your normal activities. This is because hip labral tears do not heal easily. Hence, Dr. Downer recommends surgically repairing a torn labrum sooner or later.
Surgical measures
The goal of surgery is to improve hip stability, mobility, and function, minimize hip pain, and prevent any further damage to your hip joint.
While open surgery is also available, hip labral tears are typically repaired using arthroscopy. This is because arthroscopy is a minimally invasive and less painful procedure.
There are two ways of performing arthroscopy for hip labral tears:
- Debridement — removing torn tissue
- Done for shredded and complex tears and typically in older patients
- Not suitable for patients with significant associated structural abnormalities
- Fraying from labral tears is removed with motorized shavers or radiofrequency probes
- Repair — sewing the torn labrum together
- Done for larger tears, typically in younger patients
The arthroscopic repair of labral tears consists of the following steps:
- The surgeon makes several small cuts in the skin above the hip.
- An arthroscope is passed through one of the cuts into the hip joint to get a detailed picture of the structures within your hip joint.
- The surgeon then implants tiny metal or plastic “anchors” through a second small incision to reattach the torn labrum to your hip socket.
- The labrum is secured by looping a thread through the anchors and around the labrum.
- Any bony abnormalities are finally corrected that have caused the labral tear in the first place (this is usually possible with hip arthroscopy but may require more invasive procedures to correctly address the underlying bony problem).
Will Hip Arthroscopy fix your problem?
Hip arthroscopy can help relieve pain from a labral tear and restore hip function. In many cases, you may expect complete recovery within 4 to 6 months. As compared to debridement, repair of hip labrum has appeared to more promising with good to excellent results seen in around 92% of patients.
Dr. Philip Downer is a board-certified orthopedic surgeon with a special interest in hip preservation and other hip surgeries. He has become a leader among the medical community for his specialty in and around the Seattle area. Contact Orthopedic Specialists of Seattle to schedule an appointment with Dr. Philip Downer.
