What is the treatment for a hip anterior labral tear?

Treatment for Hip Anterior Labral Tear

Arthroscopic repair is the recommended treatment for symptomatic anterior labral tears of the hip that have failed conservative management. 1, 2

Initial Conservative Management

• Begin with non-surgical approaches for 4-6 weeks before considering surgical intervention:
  • Relative rest and activity modification to avoid aggravating movements 2
  • Non-steroidal anti-inflammatory medications for pain and inflammation control 2
  • Physical therapy focusing on core strengthening and hip stabilization (though its efficacy remains controversial for labral tears specifically) 2
  • Consideration of aspiration for painful, tense effusions after injury 3

Surgical Management Indications

• Persistent pain despite conservative management 1
• Mechanical symptoms (clicking, locking, giving way) 2
• Evidence of progressive cartilage damage on imaging 1
• Potential to prevent development of osteoarthritis if treated early 1

Diagnostic Evaluation

• MR arthrography is the gold standard for confirming labral tears and associated pathology 1
• Direct MR arthrography with intra-articular gadolinium provides reliable diagnosis 1
• Arthroscopy remains the definitive diagnostic tool when imaging is inconclusive 2, 4

Surgical Options

Arthroscopic Labral Repair (Preferred)

• First-line surgical treatment for repairable labral tears 5
• Technique involves:
  • Minimally invasive arthroscopic approach 1
  • Direct visualization of the pathology 1
  • Repair using suture anchors to reattach the labrum to the acetabular rim 5
  • Addressing any associated pathology (e.g., femoroacetabular impingement) 2

Management of Delaminated Cartilage (Often Associated with Anterior Labral Tears)

• For small delaminated cartilage lesions (<3 cm²):

  • Debridement followed by microfracture of the exposed subchondral bone 3
  • Repair of healthy-looking delaminated cartilage using sutures or fibrin adhesive 3

• For larger delaminated cartilage lesions (>3 cm²):

  • More complex management is required 3
  • Limited evidence exists for specific techniques in the hip despite relatively favorable outcomes 3

Labral Reconstruction

• Indicated when repair is not possible due to extensive damage 6
• Uses autografts such as iliotibial band, ligamentum teres capitis, or gracilis tendon 6
• Can be performed using all-arthroscopic techniques to minimize scarring and complications 6

Outcomes and Prognosis

• Arthroscopic labral repair shows good to excellent outcomes in 56-66% of patients 7
• 84% of patients can return to sports or equivalent level of preoperative activity 7
• Positive predictors of good outcomes include:
  • Higher preoperative activity level 7
  • Shorter duration of symptoms (less than 18 months) 7
• Negative predictors include:
  • Smoking 7
  • Secondary gain issues 7
  • Traumatic cause of labral tear (for return to activity) 7

Potential Complications

• Transient nerve palsies (reported in 7.7% of cases) 7
• Infection, adhesive capsulitis 1
• Progression to requiring total hip arthroplasty (5.8% of cases) 7

Follow-up Care

• Structured rehabilitation protocol following surgical intervention
• Regular monitoring for symptom recurrence or progression
• Assessment of functional outcomes using validated measures such as the modified Harris Hip Score 7