Symptoms of Acetabular Tear Defect
The primary symptom of an acetabular tear (labral tear) is groin pain that is activity-related and often accompanied by mechanical symptoms such as clicking or catching sensations in the hip. 1
Primary Pain Location and Character
- Groin pain is the hallmark symptom, present in 92% of patients with acetabular labral tears, and should be the primary diagnostic consideration when evaluating this condition 2
- Pain is predominantly activity-related (91% of patients), worsening with hip flexion, adduction, and internal rotation movements 2
- Night pain occurs in 71% of patients with labral tears, representing a significant functional impairment 2
- Pain may radiate to the buttock or thigh in addition to the groin, though groin pain remains the dominant feature 1, 3
Mechanical Symptoms
- Clicking or catching sensation in the hip is highly sensitive (100%) and specific (85%) for acetabular labral tears, making it the most reliable clinical symptom 4
- Hip locking or catching sensations occur frequently and help distinguish labral pathology from other hip conditions 1
- Mechanical hip pain following relatively minor injury with an associated click is characteristic of the presentation 5
Physical Examination Findings
- Positive impingement sign (FADIR test: flexion-adduction-internal rotation) is present in 95% of patients with labral tears 2
- Pain with internal rotation at 90 degrees of hip flexion is highly indicative of acetabular labral pathology 6
- Trendelenburg sign is positive in 38% of patients, indicating hip abductor weakness 2
- Limp is observed in 39% of patients with symptomatic labral tears 2
- Tenderness posterior to the greater trochanter is a useful clinical finding 6
Onset Patterns
- Insidious onset without clear trauma occurs in approximately 61% of cases 2
- Low-energy acute injury accounts for 30% of presentations 2
- Major trauma is responsible for only 9% of acetabular labral tears 2
Associated Pathology
- Most acetabular labral tears (59%) are located in the anterior quadrant of the acetabulum and are frequently associated with chondral injuries 1
- Labral tears commonly coexist with femoroacetabular impingement (FAI), acetabular dysplasia, or chondral delamination injuries 1
- The posterior portion of the labrum is torn in approximately 70% of arthroscopically confirmed cases, with anterior tears in 40% 6
Common Diagnostic Pitfalls
- The diagnosis is frequently delayed, with an average of 21 months from symptom onset to definitive diagnosis 2
- Patients typically see an average of 3.3 healthcare providers before the correct diagnosis is made 2
- 17% of patients are recommended surgery on another anatomic site before the labral tear is identified 2
- Lumbar spine pathology must be excluded, as radicular pain can mimic acetabular labral tear symptoms 7, 3
- Plain radiographs are often nonspecific and may appear normal despite symptomatic labral pathology 2
Functional Limitations
- Difficulty with activities requiring hip flexion and rotation, such as putting on shoes/socks and getting in/out of cars 3
- Reduced muscle strength in hip adduction, abduction, flexion, internal rotation, and external rotation 3
- Moderate to severe pain reported by 86% of patients, significantly impacting daily activities 2