From the Guidelines
For a labral tear, the most effective treatment approach is to start with conservative measures, including rest, ice, and over-the-counter anti-inflammatory medications, followed by physical therapy, and considering surgery only if these measures fail, as recommended by the most recent and highest quality study 1.
Treatment Approach
The treatment of a labral tear should prioritize conservative management to minimize morbidity and improve quality of life. This includes:
- Rest and ice to reduce inflammation
- Over-the-counter anti-inflammatory medications like ibuprofen (400-600mg three times daily with food) or naproxen (500mg twice daily with food) for 1-2 weeks
- Physical therapy for 6-12 weeks to strengthen surrounding muscles and improve joint stability
Diagnostic Imaging
For diagnostic purposes, imaging should never be used in isolation but combined with the patient’s symptoms and clinical signs 1. The recommended initial diagnostic imaging includes anteroposterior (AP) pelvis and lateral femoral head–neck radiographs, with MRI/magnetic resonance arthrogram (MRA) or CT scan used when three-dimensional morphological assessment is indicated.
Surgical Intervention
Surgery, such as arthroscopic repair, is considered only after conservative treatments fail. The decision for surgery should be based on the severity of symptoms, the extent of the tear, and the patient's overall health status. Recovery from surgery requires 4-6 months of rehabilitation.
Importance of the Labrum
The labrum is crucial for deepening the joint socket, providing stability, and creating a vacuum seal for proper joint function. Tears in the labrum can result from repetitive motions, trauma, or degenerative changes, leading to symptoms such as pain, catching sensations, limited range of motion, and joint instability.
Evidence-Based Practice
The treatment approach for a labral tear should be guided by the most recent and highest quality evidence, prioritizing patient-centered outcomes such as morbidity, mortality, and quality of life 1. This ensures that patients receive the most effective and appropriate care for their condition.
From the Research
Definition and Causes of Labral Tear
- A labral tear is a damage to the labrum, a cartilage structure that surrounds the socket of the hip joint, with functions including shock absorption, joint lubrication, pressure distribution, and aiding in stability 2.
- The etiology of labral tears includes trauma, femoroacetabular impingement (FAI), capsular laxity/hip hypermobility, dysplasia, and degeneration 2, 3.
Symptoms and Diagnosis of Labral Tear
- Labral tears present with anterior hip or groin pain, and less commonly buttock pain, with mechanical symptoms including clicking, locking, and giving way 2, 3.
- The most consistent physical examination finding is a positive anterior hip impingement test 2, 3.
- Evaluation usually begins with plain radiographs to assess for dysplasia, degeneration, and other causes of pain, while magnetic resonance arthrography (MRA) is the diagnostic test of choice, with arthroscopy being the gold standard 2, 3.
Treatment of Labral Tear
- Treatment begins conservatively with relative rest and non-steroid anti-inflammatory agents, with physical therapy (PT) being controversial, and often, surgical treatment is necessary, which entails arthroscopic debridement of labral tears and surgical repair of associated structural problems 2, 3.
- Nonoperative treatment of labral tears in athletes can be successful, especially in the subset of patients who are able to complete their rehabilitation program before attempting a return to play 4.
- Arthroscopic acetabular labral repair with postoperative physical therapy led to better outcomes than physical therapy alone in patients older than 40 years with limited osteoarthritis 5.
Management and Rehabilitation of Labral Tear
- A consensus statement among Canadian nonoperative/operative sports medicine physicians via a modified Delphi process established that several prognostic factors, including age, pain severity, dysplasia, and degenerative changes, should be taken into consideration with regard to the likelihood of surgical success 6.
- There was strong agreement that 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, and that a diagnostic injection should be performed if there is uncertainty that the pain is intra-articular in origin 6.