What are the treatment options for a hip labral tear?

Hip Labral Tear Treatment

Start with conservative management including physical therapy focused on hip stabilization, NSAIDs, and activity modification for several weeks to months before considering surgery, as this approach produces measurable improvements in pain and function in many patients. 1, 2

Initial Conservative Management

First-Line Treatment

• Implement rest, NSAIDs, activity modification, and physical therapy focused on hip stabilization exercises as initial treatment 1
• Continue conservative management for at least several weeks to months before surgical consideration 1
• For painful, tense effusions after acute injury, perform aspiration 1, 3

Adjunctive Interventions

• Consider diagnostic and therapeutic intra-articular injection of anesthetic and corticosteroid (rated 5/9 appropriateness) 1
• This injection can help confirm the hip as the pain source and provide temporary relief 1

Evidence Quality Note

While conservative management produces measurable improvements in pain and function, the evidence quality is limited and primarily consists of lower-level studies 1, 2. However, the consistent findings across multiple studies support this initial approach 2.

Diagnostic Imaging Algorithm

Step 1: Plain Radiographs

• Obtain plain radiographs of the pelvis and hip as the first imaging test 4, 1, 5
• Evaluate specifically for hip dysplasia, femoroacetabular impingement (FAI), joint space narrowing, and other bony pathology 1, 5

Step 2: Advanced Imaging When Radiographs Are Negative/Equivocal

• MR arthrography is the gold standard for confirming labral tears (rated 9/9 - usually appropriate) 4, 1, 5
• Direct MR arthrography with intra-articular gadolinium injection provides superior visualization compared to standard MRI, which is rated only 6/9 1, 5
• CT arthrography is an alternative (rated 7/9) if MRI is contraindicated 4, 1, 5
• High-resolution 3T MRI may improve visualization and potentially eliminate the need for arthrography in select cases 5

Surgical Indications and Techniques

When to Proceed to Surgery

• Failure of conservative management after adequate trial (several weeks to months) 1
• Presence of mechanical symptoms (clicking, locking, giving way) that persist despite conservative treatment 6
• Critical consideration: Patients with FAI have significantly greater proportion of surgical cases after nonoperative treatment failure 7

Surgical Technique Priorities

Labral Repair (Preferred Over Debridement)

• Perform arthroscopic labral repair with suture anchors rather than simple debridement, as repair preserves the labral seal and load distribution function 1, 5, 8
• Simple debridement compromises biomechanical function and should be avoided when repair is feasible 1

Concurrent FAI Correction (Essential)

• Always correct femoroacetabular impingement when present, as FAI is a common causative factor and failure to address it leads to re-tearing 1, 5
• Approximately 60.5% of hip labral tears have concurrent FAI 7

Management of Associated Cartilage Lesions

• For 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 1, 3, 5
• For larger cartilage lesions (>3 cm²): More complex management is required with limited evidence for specific techniques 1, 3

Prognostic Factors

Favorable Outcomes

• Patients without extensive cartilage damage have better surgical outcomes 1, 5
• Early diagnosis and treatment prevent progression to osteoarthritis 9, 6

Unfavorable Outcomes

• Patients with extensive cartilage damage have less favorable outcomes and may require additional interventions 1, 3, 5
• Untreated labral tears lead to persistent pain, progressive cartilage damage, and osteoarthritis development 1, 5

Postoperative Management

• Implement a structured rehabilitation protocol following surgical intervention 1, 3
• Perform regular monitoring for symptom recurrence or progression 1, 3

Critical Pitfalls to Avoid

• Do not rush to surgery without an adequate trial (several weeks to months) of conservative management 1
• Do not perform simple labral debridement when repair is feasible, as this compromises biomechanical function 1
• Do not repair hip labral tears without addressing underlying FAI when present, as this leads to re-tearing 1, 5
• Do not rely on standard MRI alone; MR arthrography provides superior diagnostic accuracy (9/9 vs 6/9 rating) 1, 5
• Avoid stem cell injections for cartilage regeneration due to lack of standardization 1, 5