What is the treatment for a labral tear in the hip?

Treatment of Hip Labral Tears

Begin with conservative management for 6-12 weeks, and if symptoms persist, proceed to arthroscopic labral repair using suture anchors, as labral debridement alone has inferior outcomes and untreated tears lead to progressive cartilage damage and osteoarthritis. 1, 2, 3

Initial Conservative Management (First-Line Treatment)

Conservative treatment should always be attempted first before considering surgery 4, 5, 6:

• Rest and activity modification with relative rest from aggravating activities 5, 6
• NSAIDs for pain and inflammation control 2, 5, 6
• Diagnostic and therapeutic intra-articular injection of anesthetic and corticosteroid serves dual purposes: confirms the hip joint as pain source and provides temporary relief 2, 3
• Physical therapy remains controversial in the literature, though commonly prescribed 5

Duration: If conservative management fails after an appropriate trial period, surgical intervention becomes indicated 6.

Diagnostic Imaging Algorithm

Start with plain radiographs to evaluate for dysplasia, femoroacetabular impingement (FAI), joint space narrowing, and other bony pathology 7, 5:

• MR arthrography is the gold standard for confirming labral tears, rated 9/9 (usually appropriate) by the American College of Radiology 2, 3
• Direct MR arthrography with intra-articular gadolinium injection provides superior visualization compared to standard MRI (rated only 6/9) 1, 3
• CT arthrography is an alternative (rated 7/9) if MRI is contraindicated 3
• High-resolution 3T MRI may improve visualization and potentially eliminate need for arthrography in select cases 1, 3
• Arthroscopy remains the gold standard for definitive diagnosis 5, 6

Surgical Treatment (When Conservative Management Fails)

Primary Surgical Approach

Arthroscopic labral repair with suture anchors is the preferred technique over simple debridement 1, 4:

• Labral repair preserves the labral seal and load distribution function of the hip joint 4
• Partial labrectomy (debridement) should be reserved for irreparable tears, as it provides only 67% patient satisfaction at 3.5 years and resolves mechanical symptoms in only 50% of cases 8
• Arthroscopy allows minimally invasive access with direct visualization of pathology 1, 2

Management of Associated Cartilage Damage

Labral tears are frequently associated with chondral injuries (59% located in anterior acetabulum) 7:

• For small delaminated cartilage lesions (<3 cm²): Perform debridement followed by microfracture of exposed subchondral bone, or repair healthy-appearing delaminated cartilage with sutures or fibrin adhesive 1, 2, 3
• For larger lesions (>3 cm²): More complex management required, though evidence for specific hip techniques remains limited 1, 3
• Microfracture indications extrapolated from knee literature: minimal osteoarthritis, focal contained lesion <4 cm² 7

Addressing Underlying Structural Abnormalities

Surgical repair must address associated structural problems including FAI, dysplasia, or capsular laxity to prevent recurrence 5, 6:

• Femoroacetabular impingement is a common causative factor requiring concurrent correction 7, 5
• Hip dysplasia may require additional procedures beyond labral repair 5

Prognostic Factors and Patient Selection

Best surgical outcomes occur in non-workers' compensation patients with isolated labral tears lacking severe arthritis or dysplasia 8:

• Patients with extensive cartilage damage have less favorable outcomes and may require additional interventions 1, 2
• Untreated labral tears lead to persistent pain, progressive cartilage damage, and osteoarthritis development 1, 2, 3
• Early diagnosis and treatment are critical to prevent progression to hip osteoarthritis 9

Postoperative Rehabilitation

Structured rehabilitation protocol is essential following surgical intervention 1, 2:

• Regular monitoring for symptom recurrence or progression is required 1, 2
• Chondromalacia may progress to osteoarthritis if not properly managed, necessitating long-term surveillance 2

Common Pitfalls and Caveats

• Hip arthroscopy has a steep learning curve requiring proper technique to minimize morbidity 4
• Labral tears frequently go undiagnosed for extended periods due to vast differential diagnosis and need for specialized diagnostic tools 5
• Most consistent physical exam finding is positive anterior hip impingement test 5, 6
• Avoid stem cell injections for cartilage regeneration due to lack of standardization 2
• Workers' compensation status is associated with poorer outcomes 8