Treatment for Labral Tears
Most labral tears should initially undergo conservative management with physical therapy, NSAIDs, and activity modification for at least several weeks to months before considering surgery, as soft-tissue injuries including labral tears can respond to non-operative treatment. 1
Location Matters: Hip vs Shoulder
The treatment approach differs significantly based on whether the labral tear is in the hip or shoulder, as these are anatomically and functionally distinct injuries.
Hip Labral Tears
Initial Conservative Management
- Start with non-operative treatment including rest, NSAIDs, activity modification, and physical therapy focused on hip stabilization 2, 3
- Consider diagnostic and therapeutic intra-articular injection of anesthetic and corticosteroid (rated 5/9 - may be appropriate) 4
- Conservative management produces measurable improvements in pain and function in many patients, though evidence quality is limited 5
- For painful, tense effusions after acute injury, aspiration should be considered 6
Surgical Indications
Proceed to surgery when conservative management fails after an adequate trial (typically 3-6 months) or when there is significant mechanical dysfunction. 3
Surgical Technique
- Arthroscopic labral repair with suture anchors is the preferred technique over simple debridement, as it preserves the labral seal and load distribution function 2, 7
- Concurrent correction of femoroacetabular impingement (FAI) is essential when present, as FAI is a common causative factor 2, 3
- For associated small delaminated cartilage lesions (<3 cm²): perform debridement followed by microfracture of exposed subchondral bone, or repair healthy-appearing cartilage with sutures or fibrin adhesive 2, 6
- For larger cartilage lesions (>3 cm²): more complex management is required with limited evidence for specific techniques 6
Diagnostic Imaging
- Start with plain radiographs to evaluate for dysplasia, FAI, joint space narrowing, and bony pathology 2
- MR arthrography is the gold standard for confirming labral tears (rated 9/9 - usually appropriate) 2, 6, 4
- Direct MR arthrography with intra-articular gadolinium provides superior visualization compared to standard MRI (rated only 6/9) 2, 4
- CT arthrography is an alternative (rated 7/9) if MRI is contraindicated 2, 4
Prognostic Factors
- Untreated labral tears lead to persistent pain, progressive cartilage damage, and osteoarthritis development 2, 6, 4
- Patients with extensive cartilage damage have less favorable surgical outcomes and may require additional interventions 2, 6
- Early diagnosis and treatment is important to prevent progression to osteoarthritis 8, 3
Shoulder Labral Tears (SLAP Lesions)
Conservative Management
- Non-operative treatment with NSAIDs and physical therapy focused on scapular stabilization exercises and posterior capsular stretching should be the initial approach 1, 9
- At average 3-year follow-up, successful non-operative treatment results in significant improvements in pain (VAS 4.5 to 2.1), function (ASES 58.5 to 84.7), and quality of life 9
- Return to sports is achievable in most patients, though only 66% of overhead athletes return to pre-injury level 9
Surgical Considerations
- Approximately 51% of patients may ultimately require surgery after failed conservative management 9
- In overhead athletes or when pain relief and functional improvement is not achieved with conservative treatment, surgical intervention should be considered earlier 9
Common Pitfalls to Avoid
- Do not rush to surgery without an adequate trial of conservative management, as many patients improve with non-operative treatment 1, 5, 9
- Do not perform simple labral debridement when repair is feasible, as this compromises the biomechanical function of the labrum 2, 7
- Do not repair hip labral tears without addressing underlying FAI when present, as this leads to re-tearing 2, 3
- Avoid stem cell injections for cartilage regeneration due to lack of standardization 2
- Do not rely on standard MRI alone for hip labral tears; MR arthrography provides superior diagnostic accuracy 2, 4