What is the appropriate management for a left acetabular labral tear?

Management of Left Acetabular Labral Tear

Initial management should begin with conservative treatment including physical therapy focused on hip and lumbopelvic stabilization, NSAIDs, and activity modification for several weeks to months before considering surgical intervention. 1

Initial Conservative Management

Conservative treatment produces measurable improvements in pain and function in patients with acetabular labral tears and should be the first-line approach. 1, 2, 3

Conservative Treatment Components

• Rest, NSAIDs, and activity modification form the foundation of initial management 1
• Physical therapy protocol should include three phases: 3
  • Phase 1: Pain control, trunk stabilization education, and correction of abnormal joint movement 3
  • Phase 2: Muscular strengthening (particularly hip flexors, abductors, and extensors), recovery of normal ROM, and initiation of sensory motor training 3
  • Phase 3: Advanced sensory motor training with sport-specific functional progression 3

Diagnostic Injections

• Diagnostic and therapeutic intra-articular injection of anesthetic and corticosteroid may be appropriate to confirm the pain source and provide temporary relief 1
• For painful, tense effusions after acute injury, aspiration should be considered 4, 1

Diagnostic Imaging Approach

Start with plain radiographs to evaluate for hip dysplasia, femoroacetabular impingement (FAI), joint space narrowing, and bony pathology. 1

Advanced Imaging

• MR arthrography is the gold standard for confirming labral tears (rated 9/9 - usually appropriate) 4, 1
• Direct MR arthrography with intra-articular gadolinium injection provides superior visualization compared to standard MRI (rated only 6/9) 5, 4, 1
• High-resolution 3 Tesla MRI may improve visualization of the acetabular labrum and hyaline articular cartilage, potentially obviating the need for intra-articular contrast 5, 4
• CT arthrography is an alternative (rated 7/9) if MRI is contraindicated 1

Surgical Management

Surgery should be considered only after failure of conservative management for several weeks to months. 1

Surgical Technique

• Arthroscopic labral repair with suture anchors is superior to simple debridement because it preserves the labral sealing function and load distribution in the hip joint 6, 1
• Concurrent correction of FAI is essential when present, as FAI is a common causative factor for labral tears 6, 1
• Arthroscopic techniques allow for minimally invasive access with direct visualization of the pathology 4

Management of Associated Cartilage Damage

For small delaminated cartilage lesions (<3 cm²): 4, 6, 1

• Perform debridement followed by microfracture of exposed subchondral bone, OR
• Repair healthy-appearing delaminated cartilage using sutures or fibrin adhesive

For larger cartilage lesions (>3 cm²): more complex management is required with limited evidence for specific techniques 4, 6, 1

Surgical Risks

• Potential complications include infection, nerve injury, and adhesive capsulitis 4

Prognostic Factors

• Untreated labral tears lead to persistent pain, progressive cartilage damage, and potential development of osteoarthritis 4, 1
• Patients with extensive cartilage damage have less favorable outcomes and may require additional interventions 4, 6, 1
• The extent of cartilage damage is the most important determinant of surgical outcome 6

Postoperative Rehabilitation

• A structured rehabilitation protocol following surgical intervention is essential 4, 6, 1
• Regular monitoring for symptom recurrence or progression is required, as chondromalacia can progress to osteoarthritis if not managed properly 6, 1

Critical 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, 2, 3
• Do not perform simple labral debridement when repair is feasible, as this compromises the biomechanical function of the labrum 1, 7
• Do not repair labral tears without addressing underlying FAI when present, as this leads to re-tearing 1
• Avoid stem cell injections for cartilage regeneration due to lack of standardization 6, 1
• Do not rely on standard MRI alone; MR arthrography provides superior diagnostic accuracy 5, 1