A hip labral tear, or acetabular labrum tear, occurs when the fibrous ring of cartilage (labrum) around the hip socket (acetabulum) becomes torn, damaged, or frayed which can adversely affect hip joint functionality. Hip labral tears typically affect active adults ages 20-40 and can cause pain and other disabling symptoms that usually require some type of rehabilitative treatment. Hip pain can be caused by many other orthopedic disorders that the specialists at the Orthopedic and Sports Medicine Institute of Fort Worth can evalute and treat.
Patient’s Guide to Hip Labral Tear
Anatomy of the Acetabular Labrum
The acetabular labrum keeps the thigh bone (femur) inside the hip socket and provides joint stability. The connective tissue around the hip socket is comprised of one side which is connected to the head of the femur and another side that connects with the joint capsule which is made up of ligaments that hold the hip in place and allow a range of motion.
Because the two zones of the labrum differ in quality of blood supply, the avascular, or poorly supplied, an intraarticular zone which lies next to the joint is less likely to heal quickly from a tear or injury than the extra-articular side located next to the joint capsule. When the labrum is damaged, the seal that ensures proper fluid pressure within the joint and nutrition to the joint cartilage is no longer intact.
A damaged labrum can result in:
- Early degenerative arthritis
- Change in the hip center of rotation
- Increased impact and wear-and-tear on the hip joint
- Increased risk for multiple labrum tears and other injuries to the hip joint
Causes of Hip Labral Tears
Hip labral tears can be the result of a single injury, abnormal anatomical structures, or a combination of anatomical changes and repetitive small injuries. The most common cause of a hip labral tear is femoral acetabular impingement (FAI) which occurs when the labrum becomes pinched between the acetabular rim and the neck of the femur, causing the edges of the labrum to fray or tear. In some cases, the labrum can become completely separated from the acetabulum (avulsion).
Other causes of hip labral tears include:
- Muscle weakness around the hip in conjunction with changes in routine hip movements
- Trauma, injury, or dislocation of the hip joint
- Loose ligaments within the hip joint (capsular laxity)
- Arthritic/degenerative changes due to aging
- Hip dysplasia
- Repetitive motion or hip flexion (often associated with specific sporting activities)
- Previous hip disease
Symptoms of Hip Labral Tear
Hip labral tears may present no symptoms or may cause various activity-limiting symptoms including:
- Pain in the frontal hip area, particularly near the groin
- Clicking or catching sensation in the hip
- Hip joint stiffness
- Limited range of motion in the hip
- Instability of the hip (feeling that the hip may give away)
- Pain which radiates down the side of the hip as far as the knee or toward the buttocks
Symptoms of a hip labral tear often flare up with extended periods of sitting, standing or walking. Patients may walk with a limp, avoid pivoting on the affected leg or exhibit a hip drop on the torn side. Pain can become serious enough to limit participation in sports and recreational activities.
Diagnosing and Treating Hip Labral Tear
Hip labral tear symptoms often develop gradually over time and rarely occur in isolation. Especially when a traumatic injury is involved, hip labral tears typically present in conjunction with other hip structure injuries. Diagnosing a hip labral tear will begin with a physical examination which includes a hip flexion test to determine if impingement is a factor.
Your doctor will evaluate the range of motion through:
- Bending at the hip
- Hip internal rotation
- Adduction (bringing the thigh across the body)
Because many factors can contribute to hip pain, additional tests are usually necessary to diagnose a hip labral tear, including:
- X-rays: To reveal change in hip structure or position
- Lidocaine injection: To determine if pain originates from within or outside of the hip joint
- MRI (magnetic resonance imaging): To provide a more detailed picture of soft tissues surrounding the hip
- MRA (magnetic resonance arthrography): To show highly clarified images of damage or irregularities in the hip joint
If a hip labral tear is diagnosed, treatment choices include both surgical and non-surgical options, depending on the severity of symptoms.
Conservative non-surgical treatments for hip labral tear can include:
- Physical therapy: At OSMI, an individualized rehabilitation plan will be customized for you based on your symptoms and a detailed analysis of your range of motion, gait, posture, strength, and alignment.
- Activity modification: Avoidance of activities which place pressure on the hip joint may be recommended during your rehabilitation period.
- Medication: Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen sodium can reduce inflammation and relieve pain.
- SERF (stability through external rotation of the femur) strap: A specialized strap which is applied from the thigh to the lower leg can improve leg movement and hip control.
- Cortisone injection: Injecting the intra-articular zone of the hip with a powerful anti-inflammatory medicine often relieves pain successfully for weeks or months.
Surgical Treatment for Hip Labral Tear
For cases in which conservative non-surgical treatments are not successful, a minimally invasive arthroscopic procedure can be performed by your orthopedic surgeon. During an arthroscopy for a hip labral tear, a small fiber-optic tube (arthroscope) equipped with a tiny camera is used to see inside the hip joint. Small surgical instruments are utilized to repair the torn labrum through several small incisions. A picture of the hip joint is displayed on a TV monitor and your surgeon can clearly visualize the entire operation as it is performed.
During arthroscopic surgery for a hip labral tear, your surgeon may:
- Trim frayed or torn labral tissue
- Reattach the torn labrum (labral refixation)
- Remove torn labral tissue (debridement)
Arthroscopic hip surgery is typically performed as an outpatient procedure and involves less pain and faster recovery than open surgery. In some cases, such as bone abnormalities and femoroacetabular impingement, open surgery may be necessary due to the complexity of the procedures involved.
Postoperative Care for Labral Hip Tear
After surgery to repair a hip labral tear, a rehabilitation plan will be implemented as an important part of your successful recovery. Physical therapy will involve a progression of exercises to strengthen the hip muscles and restore range of motion and functionality.
Other goals of rehabilitation include:
- Improved posture
- Restored neuromuscular control
- Pain reduction
- Muscle lengthening
Full recovery from hip labral tear surgery usually takes approximately 4-6 months. Closely adhering to the recommended physical therapy plan will assist with a faster, more effective recovery after which normal activities can resume.
If you are experiencing symptoms of a hip labral tear, please contact our office for an evaluation by one of our orthopedic surgeons. Let the team at The Orthopedics & Sports Medicine Institute evaluate, diagnose, and recommend the least invasive, most effective road to your recovery.