Labral tears of the hip
A labral tear is an injury to the ring of soft tissue around the hip socket. It often accompanies other hip injuries and conditions.
If you have torn your hip labrum you are likely to experince sharp or catching groin pain especially on twisting and bending movements. Over time this may become more of a dull ache.
You are likely to benefit form physiotherapy if you have not had any but if non-operative measures have failed, hip arthroscopy surgery can repair the torn labrum.
The labrum is a ring of cartilage along the edge of the acetabulum (hip socket), which creates a suction seal around the head (ball) of the femur. This adds to joint stability and function. It can be torn suddenly (acute injury) or slowly damaged over time (chronic).
Many patients with labral tears will have no symptoms at all. Studies have shown that labral tears can be found in 30-40% of young patients with pain-free hips, and the percentage increases with age.
When pain is present, it can vary from a deep ache to a sharp catching feeling. It will often worsen with activities involving bending the hip for long periods (such as sitting). There may also be sharp pain in the groin or front of the hip when squatting or bending down to put on pants, shoes and socks.
Other patients with labral overload pain or tears from dysplasia (shallow hip sockets) are more likely to experience deep pain on the outer side of their hip with prolonged standing or walking.
Your surgeon will ask you about the exact nature of your pain and examine your hip. They will assess the hip for stiffness, strength, and gently identify movements that reproduce your pain.
A labral tear is best diagnosed with an MRI scan of the hip. The MRI will also assess the hip’s other bony and soft tissue structures, looking for other causes of pain.
Determining the origin of pain around the hip joint can be quite complex. Most tears occur in the front (anterior) portion of the labrum, but pain can arise from inside the joint capsule (labrum, cartilage, bone), outside the joint capsule (tendons, bursitis) or referred pain from the back, knee or abdomen. A local anaesthetic injection into the joint or other areas under imaging guidance may be used to help pinpoint the origin of the pain.
Specialised pelvis and hip x-rays views are another important part of your workup for a labral tear, as these may indicate underlying structural abnormalities which caused it.
The pain from a labral tear will often get better on its own with time, so your surgeon will usually recommend nonsurgical treatment at first. This may include specific physiotherapy, resting from provocative activities, and anti-inflammatory medications such as ibuprofen, diclofenac or meloxicam for 1 to 2 weeks. **Please check with your doctor or specialist that these medicines are safe for you first.
A CT-guided injection of local anaesthetic and corticosteroid can help settle inflammation within the hip.
If the pain is severe or prolonged enough to warrant surgery, your surgeon will discuss which option is most suitable for you. This depends on many factors, including:
- Your age
- Your functional goals (including job and hobbies)
- The shape of your hip’s ball and socket
- Other abnormalities in the hip joint (such as arthritis).
In broad terms, the options include hip preservation surgery or hip replacement surgery. Procedures that may be offered under the hip preservation umbrella include:
- Hip arthroscopy (keyhole surgery)
- Periacetabular osteotomy (reorientation of the hip socket)
- Surgical hip dislocation