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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