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A labral tear is a condition characterized by tearing of the connective tissue within the hip joint known as the labrum. Hip labral tears are increasingly a common finding in the last 10 years with the improvement of diagnostic and treatment procedures. The etiology of labral tears include trauma, repetitive movements that cause wear-and-tear on your hip joint, or degeneration, such as from osteoarthritis. Labral tears present with anterior hip or groin pain, and less commonly buttock pain. Frequently, there are also mechanical symptoms including clicking, locking, and giving way. Symptoms typically increase with weight bearing activity and twisting movements of the hip.
Anatomy
The labrum of the hip is a ring of cartilage that attaches to the circular outer edge of the acetabulum (hip socket). It acts to deepen the “socket” in the ball-and-socket joint of the hip joint and provide stability. The hip labrum has many functions, including shock absorption, joint lubrication, pressure distribution, and aiding in stability. The inner two-thirds is lacking in blood supply and is thought to impede healing after injury.
What is the best treatment?
Non-surgical treatment is always the first choice in treating these types of injuries. Many labral tears become asymptomatic with correction of biomechanical problems such as muscle weakness. Physiotherapy is used to improve hip range of motion and strengthen the muscles around the hip joint and pelvis. Pain medications such as anti-inflammatories can be used to decrease inflammation around the labrum and provide pain relief. However, for people with persistent pain from labral tears, there are other treatment options.
Cortisone injections are used to reduce the inflammation around the labral tear and are accurately positioned using ultrasound as a guide.
Surgery for labral tears is generally minimally invasive and typically involves a hip arthroscope. The surgery is usually done as a day procedure. A patient will have a general anaesthetic and the procedure will take 30-40 minutes to complete. The torn labrum can be debrided using a shaver and in some cases the surgeon may elect to repair the loose cartilage with an anchor.
Post-operatively, there is usually 4-5 days of relative rest before a gradual return to weight bearing is allowed. Swimming and cycling are encouraged initially to give the hip joint a chance to mobilize without compression of the joint. Hip arthroscopic surgery is reported to improve symptoms by 60-90%. The treating physiotherapist will refer to a specialist if surgery is indicated. Physiotherapy and rehabilitation is then required following surgery to ensure an optimal outcome and enable a safe return to sport or activity.
Links
For more information regarding hip labral tears see:
http://hiplabraltear.com/nm-Hip_Labral_Tear_Treatment-cp-5
http://www.mayoclinic.com/health/hip-labral-tear/DS00920
http://www.sportsmedicineclinicdelhi.com/hips.htm
References:
Kang C, Hwang DS, Cha SM. Acetabular labral tears in patients with sports injury. Clin Orthop Surg. 2009 Dec;1(4):230-5. Epub 2009 Nov 25.
Groh MM, Herrera J. A comprehensive review of hip labral tears.
Curr Rev Musculoskelet Med. 2009 Jun;2(2):105-17. Epub 2009 Apr 7