Updated: 6/1/2021

Hip Labral Tear

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  • 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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(SBQ16HK.6) Figure A is the radiograph of an otherwise healthy 33-year-old female soccer player with a history of hip dysplasia. She reports 6 weeks of left groin pain that has not improved with physical therapy. She endorses snapping and clicking in the left hip with certain movements. On exam, she has pain if the hip is brought from a flexed, externally rotated and abducted position to a position of extension, internal rotation, and adduction. An intraarticular steroid injection temporarily improved her symptoms. What is the most likely diagnosis?

QID: 211174
FIGURES:
1

Labral tear

90%

(1706/1894)

2

Femoral neck stress fracture

1%

(16/1894)

3

Trochanteric bursitis

4%

(76/1894)

4

Avascular necrosis of the femoral head

2%

(45/1894)

5

Sacroiliitis

1%

(28/1894)

L 1 A

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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?

QID: 6038
FIGURES:
1

Osteonecrosis

1%

(10/672)

2

Transient osteoporosis

2%

(13/672)

3

Loose chondral fragment

7%

(45/672)

4

Labral tear

85%

(568/672)

5

Femoral neck stress fracture

5%

(35/672)

L 2 E

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Evidence (8)
VIDEOS & PODCASTS (9)
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