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
QUESTIONS 1 of 6 1 2 3 4 5 6 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (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: A Type & Select Correct Answer 1 Labral tear 90% (1632/1811) 2 Femoral neck stress fracture 1% (14/1811) 3 Trochanteric bursitis 4% (71/1811) 4 Avascular necrosis of the femoral head 2% (44/1811) 5 Sacroiliitis 1% (27/1811) L 1 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (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: A Type & Select Correct Answer 1 Osteonecrosis 1% (5/579) 2 Transient osteoporosis 2% (12/579) 3 Loose chondral fragment 7% (40/579) 4 Labral tear 85% (491/579) 5 Femoral neck stress fracture 5% (30/579) L 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic
All Videos (9) Podcasts (0) Login to View Community Videos Login to View Community Videos 2018 Chicago Sports Medicine Symposium: World Series of Surgery Treatment of Massive Gluteus Medius Tears - Thomas H. Wuerz, MD (CSMS #98, 2018) Thomas Wuerz Knee & Sports - Hip Labral Tear B 11/25/2018 152 views 4.0 (1) Login to View Community Videos Login to View Community Videos 2018 Chicago Sports Medicine Symposium: World Series of Surgery Labral Reconstruction: Fact or Fiction - Michael Ellman, MD (CSMS #94, 2018) Michael Ellman Knee & Sports - Hip Labral Tear B 11/25/2018 227 views 4.0 (3) Login to View Community Videos Login to View Community Videos 2016 Chicago Sports Medicine Symposium Labrum: When to Repair, Resect, or Reconstruct - Richard C. Mather III, MD (CSMS #78, 2016) Richard Mather Knee & Sports - Hip Labral Tear B 10/26/2016 427 views 5.0 (2) See More See Less