How do you repair a tear of the labrum (labral tear)?

From the Guidelines

Repairing a labrum tear typically requires a combination of non-surgical and surgical approaches, with arthroscopic surgery being the most effective treatment for severe tears, as it allows for the repair of the torn labrum by reattaching it to the socket using small anchors and sutures, or debriding the area by removing damaged tissue. The initial diagnosis of a labrum tear often involves MR arthrography, which has been reported to have high sensitivity for detection of labral injury, ranging from 86% to 100% 1. For minor tears, conservative treatment is recommended first, including rest, physical therapy, anti-inflammatory medications like ibuprofen (400-800mg three times daily with food), and possibly corticosteroid injections.

• Key aspects of conservative treatment include:
  • Physical therapy focusing on strengthening the surrounding muscles and improving joint stability, usually requiring 2-3 sessions per week for 6-8 weeks
  • Use of anti-inflammatory medications to reduce pain and inflammation
  • Possible use of corticosteroid injections to further reduce inflammation If conservative measures fail or the tear is severe, arthroscopic surgery is often necessary.
• The surgical approach involves:
  • Repairing the torn labrum by reattaching it to the socket using small anchors and sutures
  • Debriding the area by removing damaged tissue Recovery after surgery involves wearing a sling for 2-4 weeks, followed by a structured rehabilitation program lasting 3-6 months.
• The rehabilitation process progresses from:
  • Passive range of motion exercises
  • Active strengthening
  • Eventually, sport-specific activities Surgical repair is particularly important for athletes and younger patients, as it helps restore joint stability and prevents further damage to the cartilage and surrounding structures, which could otherwise lead to chronic pain and early-onset arthritis, thus prioritizing morbidity, mortality, and quality of life as the primary outcomes 1.

From the Research

Repairing a Labrum Tear

To repair a labrum tear, several techniques can be employed, including:

• Labral repair with suture anchors for the torn labrum 2
• Labral reconstruction using an iliotibial band autograft when the labrum cannot be repaired due to lack of adequate or quality tissue 2 It is essential to correct any abnormal joint morphology, such as femoroacetabular impingement, at the same time as treating the labral tear 2.

Treatment Options

Treatment options for labral tears include:

• Conservative treatment:
  • Rest
  • Non-steroidal anti-inflammatory medication
  • Pain medications
  • Modification of activities
  • Physical therapy
  • Intra-articular injection 3
• Surgical treatment:
  • Labral debridement
  • Labral repair
  • Labral reconstruction 3

Diagnosis and Causes

Labral tears are often secondary to:

• Femoroacetabular impingement
• Trauma
• Dysplasia
• Capsular laxity
• Degeneration 3 Diagnosis can be made using:
• Magnetic resonance arthrography
• Arthroscopy, which is the gold standard 3