Hip Labral Tears
What is a labral tear of the hip?
The labrum is a fibrocartilage rim that surrounds the hip joint and gives it stability. This type of cartilage seals the joint, deepens the socket and protects the joint by decreasing the forces transmitted to the joint. A tear to the labrum can cause pain in the front of the hip, in the groin or side of the hip. The pain usually worsens with walking, pivoting or impact activities such as running. The pain also occurs at night and can be associated with clicking, catching or locking.
Labral tears occur in association with a traumatic event such as a motor vehicle accident, a fall or a collision with another player. However, it is also damaged through overuse injuries due to repetitive tortional forces across the hip joint and labrum. Athletes that repetitively perform rotational motion at the hip such as soccer, hockey, golf and dance are at increased risk for injury. Underlying structural abnormalities of the hip increase the risk of an individual to have a labral tear. These abnormalities include femoroacetabular impingement (FAI) and dysplasia of the hip.
How do you diagnose a labral tear of the hip?
Labral tears frequently go undiagnosed due to the overlap of symptoms with hip flexor tendonitis, hip bursitis and other soft tissue injuries to the hip. A specialist in sports medicine or young adult hip disorders relies on the history of the injury and a thorough physical examination to delineate the etiology of the problem. Imaging can be useful if the diagnosis is still in question. X-rays help qualify any associated bony abnormality of the hip such as FAI or dysplasia. If necessary a dye enhanced Magnetic Resonance Image (MRI) will be ordered. Gadolinium (dye) is injected into the joint prior to the MRI to better evaluate the details of the labrum. Specialist can also use diagnostic injections of lidocaine (numbing medicine) when appropriate. This can occur when the clinical picture points towards a labral tear but the MRI is negative. Unfortunately, 15-20% of labral tears are not seen with a gadolinium enhanced MRI. In these cases, the doctors must rely on their clinical judgment.
Do I have to have surgery for a labral tear of the hip?
Fortunately not all labral tears require surgery. A combination of relative rest (avoiding activities that cause pain), anti-inflammatory medicines and a focused course of physical therapy are the first choice for the treatment of a labral tear. Many times the pain, mechanical symptoms (popping, clicking, locking) and decreased mobility improve with these measures and the athlete is able to return to sport. The physical therapy protocol is very specific to the individual and addresses the biomechanical faults that placed the hip at risk for a labral tear in the first place. It is very important for the athlete to address these issues to avoid re-injury.
If these measures do not succeed, then surgery is considered. Depending on the type of labral tear and associated bony abnormalities, the labrum can be debrided (shaved down to healthy tissue) or repaired. Post-operative rehabilitation is essential to the success of the procedure. A graduated return to activity occurs first with a focus on normal day to day activities and then progresses to higher impact activities such as running. Pivoting and twisting must be avoided for a longer period of time. Return to sports is dependent on the specific demands of the sport. Athletes that perform repetitive pivoting and rotation of the hip will require 6 months to a year and occasionally longer to return to full participation.
Regardless of if surgery is required or not, it is important to restore pain-free functioning of the hip to guard against re-injury and early wearing down of the joint (arthritis).