From the Guidelines
Hip labral tears should be treated with conservative measures, including rest, activity modification, and anti-inflammatory medications, before considering surgical options, as this approach prioritizes minimizing morbidity and mortality while improving quality of life. The management of hip labral tears is complex and challenging, especially when weight-bearing joints such as the hip are involved 1. Nonsurgical methods of alleviating pain are temporizing measures; they do not solve the underlying problem.
Conservative Management
Conservative measures include rest, activity modification, and anti-inflammatory medications like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks. Physical therapy focusing on core strengthening, hip stabilization, and range of motion exercises is crucial and should be continued for 6-12 weeks. For persistent pain, corticosteroid injections into the hip joint may provide temporary relief.
Diagnostic Imaging
Diagnostic imaging modalities such as radiographs, CT, MRI, ultrasound (US), and nuclear medicine testing (bone scan and PET) can be used to evaluate hip pain 1. MRI and CT can be performed with contrast, either injected intravenously or intra-articularly, to evaluate soft tissues and aid or enhance the imaging contrast between vascular and nonvascular tissues.
Surgical Options
Surgery is considered when conservative treatment fails after 3-6 months, with arthroscopic labral repair being the most common procedure 1. Recovery from surgery requires 4-6 months of rehabilitation. These tears often result from repetitive motions in sports, structural abnormalities like femoroacetabular impingement, or degenerative changes. Early diagnosis and treatment are important as untreated tears can lead to hip osteoarthritis. Patients should avoid activities that cause pain during recovery and gradually return to sports only when strength and range of motion are restored.
Key Considerations
- Hip labral tears are often associated with other intra-articular pathologies, such as chondral injuries and femoroacetabular impingement 1.
- Patients with chondral injuries of the hip typically have a history of hip catching or locking and present with pain in the groin area that occasionally radiates to the buttock or thigh 1.
- Physical examination should be thorough, focusing on intra-articular and extra-articular causes of pain 1.
- Injections of anesthetic, with or without corticosteroids, are often used as a diagnostic test to distinguish the source of pain 1.
From the Research
Causes and Symptoms of Hip Labral Tears
- Hip labral tears can be caused by trauma, femoroacetabular impingement (FAI), capsular laxity/hip hypermobility, dysplasia, and degeneration 2, 3
- Symptoms of hip labral tears include anterior hip or groin pain, and less commonly buttock pain, as well as mechanical symptoms such as clicking, locking, and giving way 2, 3
- The most consistent physical examination finding is a positive anterior hip impingement test 2, 3
Diagnosis of Hip Labral Tears
- Evaluation of hip labral tears 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
- Magnetic resonance imaging (MRI) and computed tomography scans are unreliable for diagnosis 2
Treatment of Hip Labral Tears
- Treatment of hip 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 management of labral tears has been shown to be effective in improving patient satisfaction and functional outcomes 4
- A randomized controlled trial found that 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
Outcomes of Treatment
- Patient satisfaction rates after arthroscopic labral debridement have been reported to be approximately 67% at 3.5 years follow-up 4
- Complete resolution of mechanical symptoms has been reported in nearly 50% of patients with this complaint after arthroscopic labral debridement 4
- The long-term outcomes of various treatments for hip labral tears remain unknown, and further research is needed to investigate the efficacy of conservative approaches to care 6, 3