What is the best treatment for a degenerative superior labrum (labral) tear of the hip?

From the Guidelines

The best treatment for a degenerative superior labrum tear of the hip typically begins with conservative management, including rest, activity modification, and over-the-counter anti-inflammatory medications, with surgical intervention considered if conservative measures fail after 3-6 months. Initial treatment includes rest, activity modification to avoid painful movements, and over-the-counter anti-inflammatory medications such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks to reduce pain and inflammation 1. Physical therapy is crucial and should focus on strengthening the hip muscles, improving core stability, and enhancing range of motion through a structured 6-8 week program. Corticosteroid injections into the hip joint, such as methylprednisolone (40-80mg) mixed with local anesthetic, may provide temporary relief for moderate to severe pain. If conservative measures fail after 3-6 months, surgical intervention may be considered, typically through hip arthroscopy to repair or debride the torn labrum. The decision for surgery should be based on the severity of symptoms, functional limitations, and response to non-surgical treatments. Recovery from surgery requires a comprehensive rehabilitation protocol lasting 3-6 months. This approach is recommended because the hip labrum has limited healing capacity due to poor blood supply, and degenerative tears often respond well to conservative management before considering more invasive options.

Some key points to consider in the management of degenerative superior labrum tears of the hip include:

• The importance of a thorough physical examination to identify intra-articular and extra-articular causes of pain 1
• The use of plain radiography to detect joint space narrowing, although it may not detect focal chondral injuries 1
• The potential benefits of osteochondral allograft transplantation (OAT) for managing large osteochondral defects of the hip, although it is associated with risks such as disease transmission and limited donor tissue availability 1
• The consideration of total hip arthroplasty (THA) in patients with refractory pain or disability and radiographic evidence of structural damage, independent of age 1
• The importance of tailoring treatment according to individual patient factors, including hip risk factors, general risk factors, level of pain intensity, disability, and handicap, location and degree of structure damage, and patient wishes and expectations 1.

Overall, the management of degenerative superior labrum tears of the hip requires a comprehensive and individualized approach, taking into account the patient's specific needs and circumstances.

From the Research

Treatment Options for Degenerative Superior Labrum Tear of the Hip

• The treatment for a degenerative superior labrum tear of the hip typically begins conservatively with relative rest and non-steroid anti-inflammatory agents, with physical therapy (PT) being controversial 2.
• Surgical treatment is often necessary, which entails arthroscopic debridement of labral tears and surgical repair of associated structural problems 2.
• Several prognostic factors, including age, pain severity, dysplasia, and degenerative changes, should be taken into consideration with regard to the likelihood of surgical success 3.

Diagnostic Approach

• Evaluation usually begins with plain radiographs to assess for dysplasia, degeneration, and other causes of pain 2.
• Magnetic resonance arthrography (MRA) is the diagnostic test of choice, with arthroscopy being the gold standard 2.
• Radiographs, including a minimum of a standing anteroposterior pelvis and 45° Dunn view, should be obtained in all patients presenting with a suspected labral tear 3.
• A diagnostic injection should be performed if there is uncertainty that the pain is intra-articular in origin 3.

Post-Treatment Management

• A minimum of 6 months should elapse after surgical treatment before reinvestigation for persistent symptoms 3.
• There is unanimous consensus on the timing of return to play (RTP) after surgery, prognostic factors affecting surgical success, and the timing to begin sport-specific training after nonoperative management 3.