What are the symptoms and treatment options for a hip labral tear (acetabular labral tear)?

From the Guidelines

Hip labral tears should be managed with a multidisciplinary approach, starting with conservative management including rest, activity modification, and physical therapy, and progressing to arthroscopic surgery if necessary, to minimize morbidity, mortality, and improve quality of life. The management of hip labral tears can be complex and challenging, especially when associated with other intra-articular pathologies such as chondral injuries or femoroacetabular impingement (FAI) 1.

Key Considerations

• Conservative management is the initial approach for mild to moderate tears, including rest, activity modification, and over-the-counter pain relievers like ibuprofen (400-800mg three times daily with food) or naproxen (220-500mg twice daily) 1.
• Physical therapy is crucial and should focus on core strengthening, hip stabilization, and range of motion exercises for 6-8 weeks.
• If conservative treatment fails after 6-12 weeks, consider a corticosteroid injection into the hip joint for temporary relief.
• For severe tears causing significant pain or functional limitations, arthroscopic surgery may be necessary to repair or remove the damaged labrum, with recovery typically taking 4-6 months with dedicated rehabilitation 1.

Diagnostic Approach

• Proper diagnosis usually requires an MRI with contrast, which can detect labral tears and other associated pathologies such as chondral injuries or FAI 1.
• Other imaging modalities such as CT, ultrasound, and nuclear medicine studies may also be useful in certain cases, but MRI remains the gold standard for diagnosing hip labral tears.

Treatment Goals

• The primary goal of treatment is to alleviate pain, improve function, and prevent further degeneration of the hip joint.
• Early intervention is important to prevent the progression of hip labral tears to hip osteoarthritis, which can significantly impact quality of life.
• A multidisciplinary approach, including orthopedic surgeons, physical therapists, and pain management specialists, is essential for optimal management of hip labral tears.

From the Research

Hip Labral Tear Overview

• A hip labral tear is a condition where the labrum, a ring of cartilage that surrounds the socket of the hip joint, is damaged 2, 3.
• The hip labrum has several functions, including shock absorption, joint lubrication, pressure distribution, and aiding in stability 2.
• Damage to the labrum is associated with osteoarthritis, and labral tears can present with anterior hip or groin pain, as well as mechanical symptoms such as clicking, locking, and giving way 2, 3.

Etiology of Labral Tears

• The etiology of labral tears includes trauma, femoroacetabular impingement (FAI), capsular laxity/hip hypermobility, dysplasia, and degeneration 2, 3.
• Labral tears can be secondary to various factors, and the mechanism of labral tear has been well explained in the literature 3.

Diagnosis of Labral Tears

• The diagnosis of labral tears can be challenging due to the vast differential diagnosis and the need for specialized diagnostic tools 2.
• 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, 3.

Treatment of Labral Tears

• Treatment of labral tears 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, 3.
• Arthroscopic acetabular labral repair with postoperative physical therapy has been shown to lead to better outcomes than physical therapy alone in patients older than 40 years with limited osteoarthritis 4, 5.

Management of Labral Tears

• A consensus statement has been established among Canadian nonoperative/operative sports medicine physicians on the diagnosis, nonoperative and operative management, and rehabilitation and return to play (RTP) of those with labral tears in the hip 6.
• The statement includes recommendations on the timing of RTP after surgery, prognostic factors affecting surgical success, and the timing to begin sport-specific training after nonoperative management 6.