What is the treatment for a torn labrum?

Treatment for a Torn Labrum

The optimal treatment for a torn labrum begins with conservative management including physical therapy and NSAIDs, progressing to arthroscopic repair only when conservative measures fail, particularly in cases with persistent pain and functional limitations. 1

Diagnostic Approach

Before initiating treatment, proper diagnosis is essential:

1. Initial Imaging:

   • Start with plain radiographs (AP pelvis and lateral femoral head-neck views) 2
   • Advanced imaging when indicated:
     • MRI/MR arthrography is the gold standard for labral tear diagnosis 2
     • Direct MR arthrography with intra-articular gadolinium has been established as a reliable technique for diagnosing acetabular labral tears 2
     • High-resolution 3T MRI may improve visualization and potentially eliminate the need for contrast 2

2. Clinical Correlation:

   • Diagnosis should never be made on imaging alone 2
   • Positive clinical signs (such as FADIR test) combined with appropriate imaging findings are necessary for diagnosis 2

Treatment Algorithm

Step 1: Conservative Management (First-Line Treatment)

• Physical Therapy:

  • Progressive ROM exercises
  • Strengthening of surrounding musculature
  • Scapular stabilization exercises
  • Typically requires 20+ sessions for successful outcomes 3

• Pain Management:

  • NSAIDs for pain control
  • Activity modification to avoid painful movements
  • Ice, heat, and soft tissue massage may provide symptomatic relief

• Duration: Conservative management should be attempted for at least 3 months before considering surgical options

Step 2: Surgical Management (When Conservative Treatment Fails)

Indications for surgical intervention:

• Failure of conservative management after 3 months
• Persistent pain and functional limitations
• Mechanical symptoms (catching, locking)
• High-demand athletes with specific performance requirements

Surgical options:

1. Arthroscopic Labral Repair:

   • Preferred approach for most repairable labral tears
   • Uses suture anchors to reattach the labrum to the acetabular rim 1, 4
   • Must address any underlying morphological abnormalities (such as femoroacetabular impingement) during the same procedure 4

2. Labral Reconstruction:

   • Indicated when labral tissue is inadequate for repair
   • Uses autograft (commonly iliotibial band) to reconstruct the labrum 4

3. Debridement:

   • May be appropriate for degenerative tears with minimal tissue disruption
   • Less optimal than repair in most cases

Special Considerations

1. Athletes:

   • Return to play rates following conservative management range from 53.7% overall to 78% in those who complete full rehabilitation protocols 3
   • Return to prior performance levels is approximately 42.6% overall, increasing to 72% with completed rehabilitation 3
   • Throwing athletes may require specialized rehabilitation protocols 5

2. Age-Based Approach:

   • Younger patients (<40 years) with traumatic tears may benefit more from labral repair
   • Older patients (>40 years) might be candidates for combined procedures 5

3. Factors Associated with Failed Conservative Management:

   • Older age
   • Participation in overhead sports
   • Traumatic injury mechanism
   • Concomitant rotator cuff injury
   • Longer symptomatic period 3

Follow-up Protocol

• Initial follow-up at 1-2 weeks after treatment initiation
• Clinical reassessment at 6 weeks to evaluate progress
• Comprehensive evaluation at 3 months
• Consider surgical consultation if no improvement after 3 months of appropriate rehabilitation

Remember that proper diagnosis combining clinical examination and appropriate imaging is crucial, as labral tears often coexist with other hip pathologies that may require simultaneous treatment for optimal outcomes.