Review Question - QID 219957

This young, active patient presents with a symptomatic hip labral tear. After conservative management, hip arthroscopy can be performed to treat intra-articular hip pathology. Labral repair and reconstruction perform better than debridement regarding patient-reported outcome measures and function (Answer 2).

The labrum is an integral anatomic structure to maintain hip joint stability. The sealant effect of the labrum maintains a negative pressure and helps encapsulate synovial fluid from the joint. Biomechanical studies have demonstrated that hip joints without a labrum experience higher forces on the cartilage of the femoral head and the acetabulum, while also experiencing decreased resistance to femoral head distraction forces. When treating symptomatic labral pathology with hip arthroscopy, labral repair is preferred over debridement. In the event of irreparable tears, reconstruction is the treatment of choice. Patients undergoing labral repair and reconstruction have better patient-reported outcome measures and less pain than those who undergo debridement alone.

Domb et al. provide a review of the treatment algorithm for hip labral tears. They review the current literature and suggest that both repair and reconstructive options are superior to debridement alone. In patients with concomitant cam or pincer-type lesions, they recommend acetabuloplasty or femoroplasty in addition to labral repair or reconstruction. They suggest that with appropriate selection and technique, arthroscopy can be successful in treating labral tears in non-arthritic hips.

Harris reviews options and outcomes of hip labral repair. He reviews the indications for labral repair to include patients with persistent symptoms refractory to nonoperative management. Contraindications to hip preservation attempts include Tonnis grade 2 or 3 hips or patients with less than 2 mm of joint space remaining on weight-bearing radiographs. In patients with concomitant femoroacetabular impingement treatment, labral repair has consistently demonstrated better Harris hip scores, SF-12, and VAS scores at long-term follow-up. He recommends labral repair in non-arthritic patients in conjunction with other hip preservation-type procedures.

Figure A is the arthroscopic view of a right hip through the anterolateral viewing portal, demonstrating a large labral tear.

Incorrect Answers:
Answer 1: Labral repair has not been shown to lead to an increased risk of arthritis over debridement. On the contrary, labral repair may improve the biomechanical function of the hip joint.
Answer 3: Labral repair has been shown to improve patient-reported outcome measures in comparison to debridement.
Answer 4: Labral repair has been shown to improve postoperative pain in comparison to debridement.
Answer 5: There is no reported difference in neurologic injuries in patients who undergo arthroscopic labral repair over debridement.