Hip Labral Tear - Knee & Sports

Introduction

Traumatic tear of the acetabular labrum that may lead to
- pain
- intra-articular snapping hip
Epidemiology
- incidence
  - highest incidence in patients with acetabular dysplasia
- demographics
  - seen in all age groups
  - patients commonly active females
- location
  - anterosuperior labrum most common location
Pathophysiology
- etiology
  - 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
Innervation
- 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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(SAE07HK.78) A 28-year-old woman who is an avid runner reports pain about the left hip with activities. Nonsurgical management has failed to provide relief. An MRI arthrogram is shown in Figure 47. What is the most likely diagnosis? Review Topic

QID: 6038

FIGURES:

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Osteonecrosis

(1/150)

Transient osteoporosis

(0/150)

Loose chondral fragment

(14/150)

Labral tear

86%

(129/150)

Femoral neck stress fracture

(6/150)

L 2

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