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Updated: Jun 1 2021

Hip Labral Tear

Images image.jpg arthrogram.jpg body.jpg
  • Summary
    • A hip labral tear is a traumatic tear of the acetabular labrum, mostly common seen in acetabular dysplasia, that may lead to symptoms of internal snapping hip as well hip locking with hip range of motion. 
    • Diagnosis generally requires an MR arthrogram of the hip joint in question. 
    • Treatment is a nonoperative trial to include NSAIDs, rest and physical therapy. Arthroscopic labral debridement versus repair is indicated for patients with progressive symptoms who failed nonoperative management. 
  • Epidemiology
    • Incidence
      • highest incidence in patients with acetabular dysplasia
    • Demographics
      • seen in all age groups
      • patients commonly active females
    • Anatomic location
      • anterosuperior labrum most common location
  • Etiology
    • Pathophysiology
      • femoroacetabular impingement
      • hip dysplasia
        • floppy labrum more susceptible to tearing
      • trauma
        • hip dislocations/subluxations are a common cause
      • capsular laxity
        • increased translational forces across labrum due to joint hypermobility
      • joint degeneration
        • causes acetabular edge loading
  • Anatomy
    • Structure
      • horse-shoe shaped structure continuous with transverse acetabular ligament
      • 2 parts
        • articular
          • fibrocartilage
        • capsular
          • dense connective tissue
    • Vascularity
      • capsule and synovium at acetabular margin
        • only peripheral 1/3rd of the labrum is vascularized 
    • Innervation
      • highly innervated with mechanoreceptors and nocioreceptors
      • branch of nerve to the quadratus femoris
      • obturator nerve
  • Presentation
    • Symptoms
      • mechanical hip pain and snapping
      • may have vague groin pain
      • may be associated with a sensation of locking
    • Physical exam
      • provocative tests
        • anterior labral tear
          • pain if hip is brought from a fully flexed, externally rotated, and abducted position to a position of extension, internal rotation, and adduction
        • posterior labral tear
          • pain if hip is brought from a flexed, adducted, and internally rotated position to one of abduction, external rotation, and extension.
  • Imaging
    • Radiographs
      • useful to exclude other types of hip pathology
      • may show
        • hip dysplasia
        • arthritis
        • acetabular cysts
    • MRI arthrogram
      • imaging study of choice
        • 92% sensitive for detecting labral tears
        • may be combined with intra-articular injections of lidocaine and steroid for diagnostic and therapeutic purposes
  • Treatment
    • Nonoperative
      • rest, NSAIDS, physical therapy, steroid injections
        • indications
          • initial treatment of choice for all patients with labral tears
        • outcomes
          • no long-term follow-up data on conservative management
    • Operative
      • arthroscopic labral debridement
        • indications
          • symptoms that have failed to improve with nonoperative modalities
          • labral tear not amenable to repair
        • technique
          • remove any unstable portions of the labrum and associated synovitis
          • underlying hip pathology (e.g. FAI) should also be addressed at time of surgery
          • post-operative care
            • limited weight-bearing x4 weeks
            • flexion and abduction are limited for 4 to 6 weeks
        • outcomes
          • 70-85% experience short-term relief of symptoms following arthroscopic debridement
          • long-term follow-up data not available
      • arthroscopic labral repair
        • indications
          • symptoms that have failed to improve with nonoperative modalities
          • full-thickness tears at the labral-chondral junction
        • outcomes
          • unknown at this time
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