From the Guidelines
For the treatment of a labral tear, I strongly recommend a stepwise approach starting with conservative measures, including rest, activity modification, and over-the-counter pain relievers, as this approach has been shown to be effective in managing symptoms and improving quality of life 1. When it comes to diagnosing labral tears, MRI with or without arthrography is the most sensitive and specific imaging modality, and it should be the first imaging technique used after radiographs 1. Some key points to consider in the management of labral tears include:
- The use of high-resolution 3 Tesla (T) MRI may improve the visualization of the acetabular labrum and the hyaline articular cartilage, potentially obviating the need for intra-articular contrast 1.
- Physical therapy is crucial in the conservative management of labral tears, typically involving 2-3 sessions weekly for 6-8 weeks, focusing on strengthening the muscles around the affected joint and improving stability.
- For persistent pain, a corticosteroid injection into the joint may be considered, and surgery is generally reserved for cases that don't respond to conservative treatment after 3-6 months or for severe tears causing mechanical symptoms like catching or locking 1. The labrum plays a critical role in deepening the joint socket, providing stability, and helping distribute pressure evenly across the joint, and tears often result from trauma, repetitive motions, or structural abnormalities that cause impingement of the joint 1. In terms of surgical options, several joint-preserving strategies are available, including microfracture, articular cartilage repair, autologous chondrocyte implantation, mosaicplasty, and osteochondral allograft transplantation, although the literature is still not sufficiently robust to draw firm conclusions regarding best practices for chondral defects 1.
From the Research
Definition and Causes of Labral Tear
- A labral tear is a type of injury that occurs in the labrum, a ring of cartilage that surrounds the socket of the hip or shoulder joint 2, 3.
- The causes of labral tear can be secondary to femoroacetabular impingement, trauma, dysplasia, capsular laxity, and degeneration 2.
- In overhead athletes, labral tears are common as either acute or chronic injuries, particularly superior labral anterior-posterior (SLAP) tears 3.
Symptoms and Diagnosis of Labral Tear
- Patients with labral tear often complain of anterior hip or groin pain, and a positive anterior hip impingement test is a consistent physical examination finding 2.
- Magnetic resonance arthrography is a reliable radiographic examination, while arthroscopy is considered the gold standard for diagnosis 2.
- Physical examination tests, such as the O'Brien test, can aid in diagnosis, and combinations of tests may be helpful in confirming a SLAP lesion 3, 4.
Treatment and Management of Labral Tear
- Conservative treatment consists of rest, non-steroidal anti-inflammatory medication, pain medications, modification of activities, physical therapy, and intra-articular injection 2, 4.
- Nonoperative treatment, including rehabilitation and scapular stabilization exercises, can result in improved pain relief and functional outcomes compared to pretreatment assessments 4.
- Surgical treatment, including labral debridement, labral repair, and labral reconstruction, is often indicated when conservative treatment fails, and can result in high levels of satisfaction and return of joint function 2, 3.
- A consensus statement among sports medicine physicians recommends considering prognostic factors, such as age and pain severity, when determining the likelihood of surgical success, and employing a minimum of 6 months of nonoperative management before considering surgery 5.
Return to Play and Rehabilitation
- Return to play guidelines for athletes with labral tears vary, but most researchers agree that a trial of nonoperative treatment may be considered before surgical intervention 3, 4.
- Rehabilitation should address deficits in joint mobility, strength, and neuromuscular control, and sport-specific training can begin after a minimum of 6 months of nonoperative management or after surgical treatment 5.
- The ability to return to sport varies widely, with 20% to 94% of patients returning to their sport after surgical or nonoperative management, and overhead athletes having a lower average return to play rate 3.