Hip Labral Tears
If you’ve ever had hip pain, you know that it can make playing sports or walking or even just getting up from a chair difficult. Although there are several potential causes for hip pain, one common one is a torn labrum.
The labrum is a ring of tough tissue that wraps around the rim of one of the bones in the hip joint, acting both as a cushion and a stabilizer. When the labrum tears, it can cause pain and hip instability. A torn labrum also increases the risk of developing osteoarthritis of the hip, a painful and potentially debilitating condition.
Fortunately, treatments are available for hip labral tears, including nonsurgical and surgical options. With appropriate treatment, people with torn labrums can successfully return to their everyday activities.
“Treatment of labral tears can range from conservative treatment such as physical therapy or injections to surgical intervention,” says Yale Medicine orthopaedic surgeon Andrew Jimenez, MD. “Surgery for treatment of labral tears can be done arthroscopically and on an outpatient basis. If the labrum is badly injured and cannot be repaired, a new labrum can be rebuilt, which is called a labral reconstruction.”
What is the labrum?
The hip labrum is essential to a well-functioning, healthy hip.
First, some background. The hip is a ball and socket joint. The “ball” is the head of the femur (the thigh bone), which has a rounded, spherical shape. The concave, cup-shaped acetabulum (part of the pelvis) is the “socket.” The rounded head of the femur fits inside the cup-shaped acetabulum. When you move your hip, the head of your femur rotates within the acetabulum.
The hip labrum (also known as the acetabular labrum) is a ring of tough fibrocartilage that covers the rim of the acetabulum. It serves as a gasket between the acetabulum and head of the femur, creating a vacuum seal and providing stability between the bones. It also keeps fluid within the joint, helping it stay lubricated, so the bones slide smoothly over one another. The labrum also plays an important role as a shock absorber, distributing loads placed on the hip joint.
What is a hip labral tear?
A hip labral tear occurs when the labrum of the hip tears or detaches from the rim of the acetabulum. Tears can affect any part of the labrum and can occur in people of any age. They are more common in females than in males.
A torn labrum can cause hip instability and can also reduce the labrum’s capacity to absorb shocks and keep fluid within the joint. These problems can increase the stress on the cartilage that lines the head of the femur and acetabulum, raising the risk for developing osteoarthritis in the affected hip.
What causes a hip labral tear?
Labral tears may be caused by the following:
- Abnormally shaped bones in the hip joint. In people with certain hip disorders, the bones in the hip joint are not shaped properly, which can increase stress on the labrum and lead to tears. For instance, in femoroacetabular impingement (FAI), also known as hip impingement, excess bone growth occurs on the head of the femur, the rim of the acetabulum, or both. When the hip flexes, rather than gliding smoothly over, the bones collide against each other, pinching and compressing the labrum, which over time, can result in tears. FAI is the most common cause of labral tears. Another hip disorder, called hip dysplasia, is also associated with labral tears. In people with this condition, the acetabulum does not fully cover the head of the femur, resulting in joint instability, thereby increasing the risk for hip dislocations. Hip dislocations can cause the labrum to tear.
- Pivoting and twisting injuries. Pivoting or twisting can cause labral tears. It’s important to note that these tears are not usually caused by a single event. Instead, tears develop slowly, due to repetitive pivoting or twisting over time, such as in certain sports. Labral tears are more common in people who play such sports as soccer, basketball, and ballet, among many others.
- Traumatic injuries. Tackles or collisions in high-impact sports, falls, or traffic accidents can result in a labral tear. These injuries often involve dislocation of the hip joint.
- Degeneration of hip joint. The hip can degenerate over time, as people age, due to wear and tear on the joint. It’s worth noting that degenerative tears of the labrum are often not well-treated with arthroscopic surgery.
What are the symptoms of labral tears?
Symptoms of a torn hip labrum may include:
- Pain in the front of the hip and/or groin. Sitting, walking, or standing for long periods may worsen the pain. Twisting movements may also cause pain.
- Pain may also occur in the buttock, thigh, or knee
- Clicking or locking sensation in hip
- Feeling that hip joint is “giving way”
How are hip labral tears diagnosed?
To diagnose a hip labral tear your doctor will review your medical history, conduct a physical exam, and order one or more imaging tests.
As a first step toward making a diagnosis, your doctor will ask about your symptoms including when they began and which activities aggravate them.
During the physical exam, your doctor will closely examine your affected hip. He or she will feel your hip for signs of tenderness and pain, as well as flex and rotate your hip to evaluate its range of motion and stability. The doctor will ask whether pain occurs in certain positions. You may be asked to stand and walk so your doctor can observe how you move.
Additional imaging tests will be necessary to confirm a diagnosis. These tests may include X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and magnetic resonance arthrography (MRA). Sometimes, an injection may be needed to confirm the diagnosis either as part of the MRA of as a separate procedure.
How are hip labral tears treated?
Treatment for hip labral tears falls into two broad categories: nonsurgical and surgical.
Nonsurgical treatment. In most cases, the initial treatment for labral tears is nonsurgical. These treatments, which are usually used in combination with one another, may include:
- Activity modification. If you stop doing the things that make your hip hurt, symptoms may improve. Without additional treatment, however, the pain may return when you resume these activities.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). Drugs like ibuprofen and naproxen help reduce inflammation and pain.
- Physical therapy. Following an individually tailored exercise and stretching program helps strengthen muscles in the core, pelvis, and around the hip. Physical therapy, which may last three months or longer, improves hip stability, gait, and range of motion with the aim of helping you return to your previous activities without pain or other symptoms.
- Steroid injections. Corticosteroid injections in the hip are used to reduce inflammation and pain.
- Biologic injections. Injections of platelet rich plasma or PRP may be considered. These are cells from the patient’s own blood that can be injected into the hip, with the goal of helping to incite a healing response.
Surgical treatment. If nonsurgical treatments don’t solve the problem, surgery may be recommended. Arthroscopy, a minimally invasive surgical procedure in which a surgeon inserts a thin tube with a camera at the end of it through a small incision, is the most commonly used surgical procedure. In some cases, open surgery is necessary, which requires a larger incision and typically involves a longer recovery period.
In general, three surgical techniques are used to treat hip labral tears:
- Repair of the labrum. To repair a torn labrum, the surgeon inserts plastic anchors into the acetabulum bone, then sutures the torn labrum to the anchors and reattaches it to the underlying bone.
- Reconstruction of the labrum. In this procedure, the labrum can be rebuilt if it cannot be repaired. The labrum can be reconstructed using tissue taken from elsewhere in your body (this is known as an autograft) or from a donor (known as an allograft). Labral reconstruction is needed when the labrum cannot be repaired or for patients with recurring problems after undergoing a previous debridement procedure.
In addition to treating the torn labrum, the surgeon may also need to address the underlying cause of the tear. For instance, If the torn labrum was caused by FAI, the surgeon may treat both the torn labrum and FAI during a single procedure.
After surgery, patients will need to follow a rehabilitative physical therapy program to rebuild strength, stability, and flexibility of the hip joint.
What is the outlook for people with hip labral tears?
Outcomes for people with hip labral tears vary based on several factors, including age and general health, the presence of articular cartilage damage or osteoarthritis, as well as whether the underlying cause of the tear can be successfully treated. In general, though, people who receive appropriate treatment and follow a rehabilitation program are able to resume normal activities.
Studies have shown that both nonsurgical and surgical treatments can improve symptoms and help people return to previous activity levels.
What is unique about Yale Medicine's approach to hip labral tears?
“The providers in the Yale hip preservation program are experts in arthroscopic treatment of labrum tears,” says Dr. Jimenez. “They are on the cutting edge of treatment utilizing the most advanced techniques in labral preservation and treatment. They are also often use biologic injections such as PRP or stem cells to help augment their labral repairs and offer the best outcomes for their patients.”