From the Guidelines
Multiple full thickness labral tears are unlikely to heal completely without surgery due to the labrum's poor blood supply and limited natural healing capacity. The labrum is a fibrocartilaginous structure that, once torn completely through, generally lacks the ability to regenerate or reconnect on its own 1. Conservative treatment can help manage symptoms and may be appropriate for some patients, particularly those with minimal symptoms, low activity demands, or who are poor surgical candidates. Non-surgical management includes:
- Rest
- Activity modification
- Physical therapy focusing on strengthening surrounding muscles
- Anti-inflammatory medications like ibuprofen (400-800mg three times daily with food)
- Possibly corticosteroid injections
However, patients should understand that while non-surgical treatment may help control pain and improve function, it typically doesn't result in anatomical healing of the tear itself. For active individuals or those with persistent symptoms despite conservative measures, surgical repair is often necessary to restore stability and function to the joint and prevent further damage to surrounding structures, as seen in studies on joint-preserving surgical options for management of chondral injuries of the hip 1.
From the Research
Labral Tears and Healing
- Multiple full thickness labral tears can be a challenging condition to treat, and the likelihood of healing without surgery is a topic of interest.
- According to 2, initial treatment consisting of partial weight-bearing may respond if initiated early, suggesting that some labral tears may heal without surgery.
- However, the same study notes that arthroscopy currently represents the gold standard in both the diagnosis and treatment of labral tears, implying that surgery may be necessary for some cases.
Treatment Options
- Conservative management, including physical therapy and nonsteroidal anti-inflammatory drugs, is often the first line of treatment for labral tears, as mentioned in 3.
- If conservative management fails, patients may become candidates for arthroscopic labral repair, as described in 3 and 4.
- Other treatment options include debridement, repair, and reconstruction, with repair of the labrum showing better results than debridement, according to 5.
Nonoperative Management
- A study on nonoperative management of labral tears in adolescent athletes found that physical therapy and intraarticular injection were common interventions, as reported in 6.
- However, the same study noted that athletes with femoroacetabular impingement (FAI) had a significantly greater proportion of surgical cases after nonoperative treatments, suggesting that surgery may be necessary for some cases.
Healing Without Surgery
- While some studies suggest that labral tears may heal without surgery, especially with early treatment and conservative management, the likelihood of healing without surgery is not clearly established.
- The decision to pursue surgical or nonoperative treatment depends on various factors, including the severity of the tear, the presence of underlying conditions such as FAI, and the patient's overall health and activity level, as mentioned in 2 and 6.