What treatment options are available for a patient with an acetabular labrum (labral) tear who is not experiencing relief from analgesia (pain medication)?

Treatment of Acetabular Labral Tear Pain Refractory to Analgesia

For patients with acetabular labral tears not responding to analgesics, proceed directly to arthroscopic surgical repair, as this provides definitive treatment with 89-91% success rates for pain relief and functional improvement. 1, 2

Initial Diagnostic Confirmation

Before proceeding to surgery, confirm the diagnosis with:

• MR arthrography (gold standard): This is rated 9/9 by the American College of Radiology for diagnosing labral tears, with intra-articular gadolinium providing superior visualization of the tear 3, 1, 4
• Clinical examination findings: Look specifically for positive anterior hip impingement test (FADIR test), pain with internal rotation at 90° flexion, pain with axial compression at 90° flexion with slight adduction, and tenderness posterior to the greater trochanter 4, 5

Treatment Algorithm

Conservative Management (Limited Role Once Analgesia Fails)

While some patients may respond to conservative therapy, if pain persists despite adequate analgesia, conservative management has limited utility 6:

• A structured physical therapy program emphasizing hip/lumbopelvic stabilization, correction of muscle imbalances, and biomechanical control showed improvement in only 4 documented cases 6
• This approach requires 3 phases focusing on pain control, strengthening (particularly hip flexors, abductors, extensors), ROM recovery, and sport-specific progression 6
• However, 2 patients treated conservatively in one series failed to achieve symptom resolution, while all surgical patients improved 5

Surgical Intervention (Definitive Treatment)

Arthroscopic surgery is the treatment of choice for refractory acetabular labral tears 1, 2, 5:

• Success rate: 89-91% of patients achieve pain relief and functional improvement with surgical treatment 2, 5
• Technique: Arthroscopic partial limbectomy or labral repair, depending on tear characteristics 1, 5
• Timing: Early surgical repair after acute injury is an option, particularly within 3 weeks of trauma, though this applies primarily to acute traumatic tears 3

Surgical Considerations by Tear Type

• Posterior labral tears (most common location): Arthroscopic partial limbectomy provides prompt pain relief 5
• Anterior inferior labral tears with cysts: Arthroscopic techniques allow minimally invasive access with direct visualization 1
• Associated cartilage damage:
  • Small delaminated lesions (<3 cm²): Debridement with microfracture or repair with sutures/fibrin adhesive 1
  • Large lesions (>3 cm²): More complex management required; these patients may have less favorable outcomes 1

Surgical Risks

Be aware of potential complications including infection, nerve injury, and adhesive capsulitis 1

Post-Surgical Management

• Structured rehabilitation protocol following arthroscopic intervention is essential 1
• Regular monitoring for symptom recurrence or progression 1
• Patients with extensive cartilage damage may require additional interventions 1

Key Clinical Pitfall

Do not delay surgical referral in patients failing conservative management: Untreated labral tears lead to persistent pain, progressive cartilage damage, and potential development of osteoarthritis 1. The biomechanical data shows that even small radial tears alter labral strain patterns and tears ≥2 cm significantly decrease hip stability 7.