What is a labral tear?

Hip Labral Tear: Definition and Management

A labral tear is a damage to the fibrocartilaginous structure (labrum) that extends the acetabular rim of the hip joint, which normally provides joint stability and maintains a suction seal around the femoroacetabular interface. 1

Anatomy and Function

The acetabular labrum is a specialized structure that:

• Extends the acetabular rim of the hip joint
• Creates a suction seal between the femoral head and acetabulum
• Aids in hip joint stabilization, particularly during motion
• Contributes to proper joint lubrication and pressure distribution 2

Causes of Labral Tears

Labral tears are generally secondary to:

• Femoroacetabular impingement (FAI) - most common cause
• Trauma
• Hip dysplasia
• Capsular laxity/hip hypermobility
• Degeneration
• Iliopsoas impingement - a less common but distinct cause 3, 4

Most chondral injuries in the hip joint are associated with labral tears, with 59% located in the anterior quadrant of the acetabulum 5.

Clinical Presentation

Patients with labral tears typically present with:

• Anterior hip or groin pain (most common)
• Mechanical symptoms such as clicking, locking, or giving way
• Reduced range of motion
• Disruption to sports and daily activities 1, 6

The most consistent physical examination finding is a positive anterior hip impingement test 3.

Diagnosis

The diagnostic approach includes:

1. Initial Imaging: Plain radiographs to assess for dysplasia, degeneration, and other causes of pain

2. Advanced Imaging:

   • MRI without IV contrast is preferred after negative radiographs
   • MR arthrography is the gold standard for diagnosing labral tears (90-95% sensitivity)
   • High-resolution 3T MRI may improve visualization without requiring contrast 1

3. Definitive Diagnosis: Arthroscopy remains the gold standard for diagnosis 3

Important: Diagnosis should never be made on imaging alone but combined with clinical symptoms and examination findings. Incidental labral tears are common in asymptomatic individuals. 1

Treatment Approach

Conservative Management (First-Line)

A structured 3-month conservative management approach includes:

• Physiotherapist-led rehabilitation focusing on core strengthening
• Active exercises for at least 6-12 weeks (minimum 3 times/week for 30 minutes)
• Pain management with:
  • Paracetamol (up to 4g/day) as first-line analgesic
  • NSAIDs for short-term pain relief if paracetamol is insufficient
  • Opioids only when other options are contraindicated or ineffective 1

Surgical Management

If symptoms persist despite 3 months of appropriate conservative management, surgical options include:

1. Labral Repair: Superior to debridement, involves labral refixation with suture anchors into the acetabular rim, often combined with correction of underlying pathology 1, 6

2. Labral Debridement: Less favorable long-term outcomes compared to repair 6

3. Labral Reconstruction: For irreparable tears 3

For associated chondral injuries:

• Small lesions (<2.5 cm²): Arthroscopic debridement with curettage or mosaicplasty
• Large lesions (>2.5 cm²): Osteochondral allograft transplantation 1

Follow-up and Monitoring

• Treatment response should be evaluated after 3 months of conservative management
• Regular follow-up (at least annually) is recommended to monitor for progression of symptoms or development of early osteoarthritis 1

Common Pitfalls and Caveats

1. Delayed Diagnosis: Due to the vast differential diagnosis and need for specialized diagnostic tools, labral tears frequently go undiagnosed for extended periods 2

2. Posterior Tears: While anterior tears are often discussed, tears involving some portion of the posterior labrum may constitute up to 74% of tears and more often present with pain rather than instability 7

3. Incidental Findings: Not all labral tears are symptomatic; correlation with clinical presentation is essential 1

4. Associated Pathologies: Labral tears often coexist with other hip pathologies like FAI that must be addressed for optimal outcomes 1, 6