What is the recommended treatment for a patient with a left hip labral tear?

Treatment of Left Hip Labral Tear

Initial conservative management with physical therapy, NSAIDs, and activity modification for at least 6 months should be attempted before considering surgery, followed by arthroscopic labral repair with suture anchors (not debridement) if conservative treatment fails. 1

Initial Diagnostic Workup

Imaging Sequence

• Start with plain radiographs including standing anteroposterior pelvis and 45° Dunn view to evaluate for dysplasia, femoroacetabular impingement (FAI), joint space narrowing, and other bony pathology 2, 1, 3
• MR arthrography is the gold standard for confirming labral tears (rated 9/9 by the American College of Radiology), with direct intra-articular gadolinium injection providing superior visualization compared to standard MRI which is rated only 6/9 2, 1, 4
• CT arthrography is an alternative (rated 7/9) if MRI is contraindicated 1, 4
• High-resolution 3T MRI may eliminate the need for arthrography in select cases 2, 4

Clinical Examination Findings

Look for this specific cluster of symptoms that makes labral tear diagnosis more likely:

• Anterior groin pain 3
• Pain with hip hyperflexion 3
• Sharp catching pain with rotation 3
• Positive anterior hip impingement test (pain with internal rotation at 90° flexion) 5, 6
• Pain with axial compression at 90° flexion and slight adduction 6
• Tenderness posterior to the greater trochanter 6

Conservative Management (First-Line Treatment)

Trial conservative management for minimum 6 months before surgery 1, 3:

• Rest and activity modification 1, 5
• NSAIDs 1, 5
• Physical therapy focused on hip stabilization 1
• Pain medications as needed 5

Diagnostic/Therapeutic Injection

• Consider intra-articular injection of anesthetic and corticosteroid (rated 5/9 - may be appropriate) if uncertainty exists about whether pain is intra-articular in origin 1, 4, 5
• This serves both diagnostic and therapeutic purposes 4
• For painful, tense effusions after acute injury, aspiration should be performed 1

Surgical Management (When Conservative Treatment Fails)

Surgical Technique

Arthroscopic labral repair with suture anchors is mandatory over simple debridement because it preserves the labral seal and load distribution function of the hip joint 2, 1, 7:

• The labrum forms a continuous ring that provides a seal and increases surface area for load distribution during weight-bearing 7
• Simple debridement compromises biomechanical function and should be avoided when repair is feasible 1

Critical: Address Underlying FAI

Do not repair the labrum without correcting concurrent femoroacetabular impingement when present - this is essential as FAI is a common causative factor and failure to address it leads to re-tearing 2, 1

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 delaminated cartilage with sutures or fibrin adhesive 2, 1, 4
• For larger cartilage lesions (>3 cm²): More complex management is required with limited evidence for specific techniques 1

Prognostic Factors Affecting Surgical Success

Consider these factors when counseling patients about surgical outcomes 3:

• Age (older patients have worse outcomes)
• Pain severity
• Presence of dysplasia
• Extent of degenerative changes
• Patients with extensive cartilage damage have less favorable outcomes and may require additional interventions 2, 1

Critical Pitfalls to Avoid

• Do not rush to surgery without adequate 6-month trial of conservative management 1, 3
• Do not perform simple labral debridement when repair is feasible 1
• Do not repair without addressing underlying FAI when present 1
• Avoid stem cell injections for cartilage regeneration due to lack of standardization 2, 1
• Do not rely on standard MRI alone - MR arthrography provides superior diagnostic accuracy 1, 4

Postoperative Management

• Implement structured rehabilitation protocol 1
• Wait minimum 6 months after surgery before reinvestigating for persistent symptoms 3
• Regular monitoring for symptom recurrence or progression 1

Natural History if Untreated

Untreated labral tears lead to persistent pain, progressive cartilage damage, and osteoarthritis development 2, 1, 4, 8, making early diagnosis and appropriate treatment important for long-term joint preservation.