Anatomy of the Hip
The hip is a ball-and-socket joint formed by the acetabulum (the socket) and the upper end of the femur, called the femoral head (the ball). Covering the surfaces of both the acetabulum and the femoral head is articular cartilage, which is a slippery tissue that allows the bones to smoothly glide past one another. The labrum is a strong cartilage around the acetabulum that forms a tight seal around the socket to provide stability to the joint.
Causes of Hip Labral Tears
A hip labral tear may be caused by:
- Injury or dislocation of the hip, such as from contact in a sport or during an automobile accident
- Structural abnormalities of the hip, such as femoroacetabular impingement
- Certain repetitive motions, such as the twisting motion in a golf swing. Athletes who participate in ice hockey, soccer, football, golf, and ballet are at higher risk of developing a tear.
Symptoms of a hip labral tear include:
- Pain in the hip or groin
- Stiffness and limited range of motion in the hip joint
- A clicking or catching sensation in the hip joint
Your doctor will perform a physical exam of the hip, looking for tenderness and evaluating range of motion. Rarely does a labral tear occur in isolation, so there will likely be other parts of the hip injured. Imaging tests, x-rays and MRIs, will help identify structural abnormalities of the bones, fractures, or damage to other soft tissues.
Treatment Options for Hip Labral Tears
Treatment options will depend on factors such as the severity of the tear, the presence of and severity of other conditions or injuries such as femoroacetabular impingement, and the severity of symptoms.
A combination of medication and therapy is usually the first line of treatment. Nonsteroidal anti-inflammatories to reduce pain and inflammation along with exercises that increase range of motion and strength can alleviate symptoms in some people.
Corticosteroid injections into the joint may be another non-surgical option.
Arthroscopic surgery can be performed to either repair or trim out the piece of torn labrum. If femoroacetabular impingement exists as well, then this must also be addressed in conjunction with a labral repair. Occasionally for a large tear or defect, a labral reconstruction may be performed to replace an irreparably damaged section of labrum with a tissue graft.
As with all surgeries, there is a risk of infection, damage to surrounding nerves, and blood clots. Hip arthroscopy carries a small risk of traction injury to nerves around the hip, and also heterotopic ossification, where the healing soft tissues become calcified and turn to bone causing stiffness of the hip.
A labral debridement usually has only a short period of weight-bearing restriction, and physical therapy will begin right away. A labral repair procedure involves a lengthier period of weight bearing restriction, up to 6 weeks, but therapy is usually prescribed during this time to maintain motion and strength of the hip. It may take up to 6 months to return to high-level sporting activities after a labral repair.
- Do I have to have surgery for a hip labral tear?
No, non-surgical management can sometimes be successful in managing a labral tear. This usually involves activity modification to avoid the activities that cause pain, so athletes generally fail at non-surgical management if they continue their sport.
- Can I play sports again after treatment for a labral tear?
Yes, but it could take several months to return depending on the size of the tear and extent of the repair. Co-existing conditions such as femoroacetabular impingement that require treatement as well may slow down the return to sports.
If you have more questions, please call my office at 502-394-6341.