Treatment of Paralabral Cysts
Surgical intervention with arthroscopic decompression of the paralabral cyst combined with labral repair is the preferred treatment approach for symptomatic paralabral cysts that fail conservative management. 1
Diagnosis and Assessment
- MR arthrography is the gold standard for evaluating labral tears and associated paralabral cysts
- High-resolution 3T MRI improves visualization of the acetabular labrum and associated pathology
- Ultrasound-guided diagnostic hip injections can confirm the hip as the source of pain
Treatment Algorithm
Step 1: Conservative Management (for mild symptoms)
- Trial for 6 weeks including:
- Physical therapy
- Anti-inflammatory medications
- Activity modification
Step 2: Surgical Intervention (when indicated)
Indications for surgery:
- Persistent symptoms despite 6 weeks of conservative management
- Neurological symptoms (e.g., sciatica, obturator neuropathy)
- Compression of neurovascular structures (e.g., femoral vein compression)
Surgical Approach
Arthroscopic decompression with labral repair is superior to cyst aspiration alone due to:
- Lower recurrence rates 2
- Addresses both the cyst and the underlying labral tear
- Allows treatment of any underlying femoroacetabular impingement
Evidence for Treatment Approaches
Conservative Management
Conservative management alone may be successful in some cases with mild symptoms. A case report demonstrated improvement in a patient with obturator neuropathy caused by a paralabral cyst after 1 month of conservative therapy 3. However, this approach has limited evidence for long-term success.
Cyst Aspiration
Sono-guided cyst aspiration has been reported as a treatment option 4, but when used alone without addressing the underlying labral tear, it carries a high risk of recurrence, similar to what has been observed with paralabral cysts in the shoulder and knee 2.
Arthroscopic Treatment
Arthroscopic decompression combined with labral repair has shown excellent clinical outcomes:
- Studies report satisfactory outcomes at 2-3 years post-surgery 5
- Complete decompression of paralabral cysts confirmed on follow-up MRI 5
- Effective for cases with neurovascular compression, including femoral vein compression causing deep vein thrombosis 6
Clinical Pearls and Pitfalls
- Paralabral cysts are often associated with underlying labral tears and femoroacetabular impingement
- Failure to address the underlying labral tear may result in cyst recurrence
- Rare but serious complications of untreated paralabral cysts include:
- MRI follow-up may be necessary to confirm cyst resolution after treatment
By following this treatment algorithm and recognizing the importance of addressing both the cyst and underlying labral pathology, patients with paralabral cysts can achieve excellent outcomes with minimal risk of recurrence.