Hip Labral Tears
Tears of the hip labrum (acetabular labrum) are increasingly common causes for hip pain in teenagers through adults in middle age.
The hip is a ball and socket joint. The labrum is an "O-ring" cartilage around the socket. It can become torn for a variety of reasons, but the most common is femoroacetabular impingement, wherein bone spurs on either the femur (ball) or acetabulum (socket) rub on the labrum and cause it to tear. Other causes of labral tears include trauma or arthritis. Traumatic tears are usually caused by planting the leg on the ground and twisting; more major trauma such as motor vehicle accidents can also tear the labrum. As people develop arthritis, they can also develop labral tears.
Symptoms of a hip labral tear include pain in the groin, clicking/popping, or catching of the hip. Sometimes the pain is not limited to the groin and can be on the side of the hip, or in the posterior buttocks area.
Diagnosis is made by obtaining a patient history, performing a physical examination, obtaining plain X-rays, and often, an MRI arthrogram (in which a contrast dye is injected into the hip prior to performing the MRI). Unfortunately, even the most sensitive test for labral tears can sometimes be negative, and the diagnosis is made clinically.
Non-operative treatment includes non-steroidal anti-inflammatory medications (NSAIDs), injections, physical therapy, and rest from aggravating activities. Unfortunately, in many cases, non-operative treatment is not successful for this mechanical problem and surgery is necessary. While open surgery is an option, it involves large incisions and many risks of complications. We recommend arthroscopic hip surgery for patients who do not have significant amounts of arthritis.
Arthroscopic surgery consists of either trimming the torn labrum or a repair of the labrum (i.e., sewing it back to the acetabulum).
Generally, we prefer to repair the labrum when at all possible, by suturing the torn labrum to small plastic anchors placed in the acetabular rim. However, many tears are smaller tears, or "shredded" and in those cases, simply trimming the torn tissue provides good symptom relief. Furthermore, most labral procedures are accompanied by other procedures such as femoroplasty or acetabular rim trimming, to treat the underlying femoroacetabular impingement cause of the tear.
Arthroscopic hip surgery typically takes 45 to 90 minutes, and is performed on an outpatient basis. Patients are asked to use crutches for 1-3 weeks with partial (50%) weight-bearing (depending on the nature of the procedure, as well as patient specific factors; most patients are on crutches for just one week). Patients will start early range of motion during these early weeks, as well as physical therapy (which can be done close to home). Most patients are encouraged to use a stationary bike with no resistance one week after surgery. Swimming can often begin at 2-3 weeks post-operatively. At approximately six (6) weeks post-operative, patients are usually jogging on a treadmill. We usually recommend avoidance of twisting sports for at least three (3) months. Relief of pain is variable — some patients note almost immediate relief of pain. Most patients have excellent symptomatic relief by three (3) months post-operative. Some patients may take up to six (6) months to note improvements of symptoms, especially if they had repair of a larger tear, or other procedures such as microfracture.