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

From the Guidelines

Hip labral tears should be managed with a multidisciplinary approach, starting with conservative management including rest, activity modification, and over-the-counter pain relievers, and progressing to arthroscopic surgery if necessary, to prevent further joint damage and development of osteoarthritis. 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. The initial treatment for mild to moderate hip labral tears typically involves conservative management, including:

• Rest and activity modification to reduce stress on the hip joint
• Over-the-counter pain relievers such as ibuprofen (400-800mg three times daily with food) or naproxen (220-500mg twice daily) to manage pain and inflammation
• Physical therapy focusing on core strengthening, hip stabilization, and range-of-motion exercises for 6-12 weeks to improve hip function and reduce pain
• Applying ice for 15-20 minutes several times daily to reduce inflammation If conservative treatment fails after 6-12 weeks, consider corticosteroid injections for temporary relief 1. For severe tears causing significant pain or functional limitations, arthroscopic surgery may be necessary to repair or remove the damaged labrum 1. Recovery from surgery typically takes 4-6 months with rehabilitation, and early diagnosis and appropriate treatment are important to prevent further joint damage and development of osteoarthritis 1. Some key points to consider in the management of hip labral tears include:
• The use of imaging modalities such as MRI and CT to evaluate the extent of the tear and associated intra-articular pathologies
• The importance of a thorough physical examination to identify underlying structural abnormalities or other causes of hip pain
• The potential benefits and risks of arthroscopic surgery, including the risk of complications and the need for post-operative rehabilitation.

From the Research

Definition and Function of Hip Labrum

• The hip labrum is a ring of tissue on the periphery of the acetabulum that provides a seal for the hip joint and increases the surface area to spread load distribution during weight-bearing 2.
• The hip labrum has many functions, including shock absorption, joint lubrication, pressure distribution, and aiding in stability, with damage to the labrum associated with osteoarthritis 3.

Causes and Symptoms of Hip Labral Tears

• The etiology of labral tears includes trauma, femoroacetabular impingement (FAI), capsular laxity/hip hypermobility, dysplasia, and degeneration 3, 4.
• Labral tears present with anterior hip or groin pain, and less commonly buttock pain, with mechanical symptoms including clicking, locking, and giving way 3, 4.
• The most consistent physical examination finding is a positive anterior hip impingement test 3, 4.

Diagnosis of Hip Labral Tears

• Evaluation usually begins with plain radiographs to assess for dysplasia, degeneration, and other causes of pain 3, 5.
• Magnetic resonance arthrography (MRA) is the diagnostic test of choice, with arthroscopy being the gold standard 3, 4.
• A diagnostic injection should be performed if there is uncertainty that the pain is intra-articular in origin 5.

Treatment of Hip Labral Tears

• Treatment begins conservatively with relative rest and non-steroid anti-inflammatory agents, with physical therapy (PT) being controversial 3, 4.
• Surgical treatment is necessary when conservative management fails, which entails arthroscopic debridement of labral tears and surgical repair of associated structural problems 2, 3, 4.
• Hip arthroscopy with postoperative physical therapy led to better outcomes than physical therapy alone in patients ≥40 years of age with limited osteoarthritis 6.

Management and Rehabilitation

• A minimum of 6 months should elapse after surgical treatment before reinvestigation for persistent symptoms 5.
• The timing of return to play (RTP) after surgery, prognostic factors affecting surgical success, and the timing to begin sport-specific training after nonoperative management are important considerations in the management of labral tears 5.