Management of Labral Tears
Initial conservative management with physical therapy, NSAIDs, and activity modification for several weeks to months is the recommended first-line approach for most labral tears before considering surgical intervention. 1
Initial Conservative Management (First-Line Treatment)
Start with non-operative treatment for at least several weeks to months, which includes:
- Rest and activity modification to avoid provocative movements 1, 2
- NSAIDs for pain control and inflammation reduction 1, 2
- Physical therapy focused on hip stabilization exercises (for hip labral tears) or scapular stabilization with posterior capsular stretching (for shoulder SLAP lesions) 1
- Intra-articular corticosteroid injection (rated 5/9 - may be appropriate) can be considered for both diagnostic confirmation and therapeutic pain relief 1, 3
- Aspiration should be performed for painful, tense effusions after acute injury 1, 4
Important caveat: While conservative management produces measurable improvements in many patients, the evidence quality supporting this approach is limited. 1
Diagnostic Imaging Algorithm
For Hip Labral Tears:
Begin with plain radiographs to evaluate for hip dysplasia, femoroacetabular impingement (FAI), joint space narrowing, and other bony pathology 1, 5
MR arthrography is the gold standard (rated 9/9 - usually appropriate) for confirming labral tears 6, 1, 5
CT arthrography (rated 7/9) is an acceptable alternative if MRI is contraindicated 1, 5
Do not rely on standard MRI alone - it has inferior sensitivity compared to MR arthrography for detecting labral tears. 1
Surgical Indications and Techniques
When to Proceed to Surgery:
Surgery is indicated when conservative management fails after an adequate trial period of several weeks to months. 1, 2, 7
Hip Labral Tear Surgical Approach:
Arthroscopic labral repair with suture anchors is the preferred technique over simple debridement, as it preserves the labral seal and load distribution function. 1, 5, 8
Critical surgical principles:
Concurrent correction of FAI is essential when present, as FAI is a common causative factor - failure to address underlying FAI leads to re-tearing 1, 5
For small delaminated cartilage lesions (<3 cm²): Perform debridement followed by microfracture of exposed subchondral bone, or repair healthy-appearing cartilage with sutures or fibrin adhesive 1, 4, 5
For larger cartilage lesions (>3 cm²): More complex management is required with limited evidence for specific techniques 1, 4
Shoulder Labral Tears (SLAP Lesions):
Non-operative treatment with NSAIDs and physical therapy focused on scapular stabilization exercises and posterior capsular stretching should be the initial approach. 1
Prognostic Factors
Patients with extensive cartilage damage have less favorable surgical outcomes and may require additional interventions. 1, 5
Untreated labral tears lead to:
Common Pitfalls to Avoid
Do not rush to surgery without an adequate trial of conservative management (several weeks to months), as many patients improve with non-operative treatment 1
Do not perform simple labral debridement when repair is feasible - this compromises the biomechanical function of the labrum 1
Do not repair hip labral tears without addressing underlying FAI when present - this leads to re-tearing 1
Avoid stem cell injections for cartilage regeneration due to lack of standardization 1, 5
Do not rely on standard MRI alone for hip labral tears - MR arthrography provides superior diagnostic accuracy 1
Postoperative Management
Implement a structured rehabilitation protocol following surgical intervention with regular monitoring for symptom recurrence or progression. 1, 4, 5