Acetabular Labral Tears- General Surgery

The hip joint has a ball-and-socket shape. The femoral head, which is at the top of the femur (thigh bone), serves as the ball, and the socket is known as the acetabulum.

The femoral head can move easily within the socket thanks to the labrum or the ring of cartilage. It allows your hip to move freely and painlessly. In addition to protecting the hip joint, the labrum functions as a gasket or rubber seal to keep the ball at the top of the thigh bone firmly inside the hip socket.

An acetabular or hip labral tear involves an injury to the cartilage and connective tissue that lines the outside rim of the hip joint socket. Athletes participating in soccer, ice hockey, golf, and football, and ballet dancers are more likely to have hip labral tears. Hip structural issues or degeneration can also potentially cause a hip labral tear.

Symptoms include hip pain or stiffness. Hip labral tears can be treated non-operatively or surgically in more severe cases.

Types Of Acetabular Labral Tear

The labrum can tear anywhere along the rim. According to the part of the joint injured, doctors may refer to labral tears as anterior or posterior:

1. Anterior hip labral tears:

Most common hip labral tears occur anteriorly. These tears occur at the front of the hip joint.

2. Posterior hip labral tears:

These injuries affect the back of the hip joint.

Symptoms Of A Labral Tear

Regardless of the type of tear, hip labral tears exhibit similar symptoms. However, depending on whether the hip labrum rupture is in the front or the rear, the symptoms may differ.

If you have a torn hip labrum, bending, moving, rotating your hip, exercising, or participating in sports may worsen your hip pain or discomfort. Unfortunately, hip labral tears often go unnoticed for years because they do not present any symptoms.

Symptoms of a hip labral tear include:

• Hip, groin, or buttock pain (especially when running, walking, and occasionally while you are sleeping)
• Feeling shaky while standing
• Limitations in hip range of motion or stiffness
• A clicking or locking sensation in your hip joint when you move

Causes Of An Acetabular Tear

There may be several causes of hip labral tears, taking into account the location of the tear. Usually, repetitive movements seen in sports like golf, football, and hockey or a dance form such as ballet lead to anterior hip labral injuries. Traumatic injuries, such as those sustained in falls, accidents, or high-impact sports, frequently result in posterior hip labral tears.

Acetabular labral tears can result from a variety of factors, such as the following:

Structural problems:

Hip labral tears can result from structural conditions that produce abnormal hip motion. For instance, femoral acetabular impingement (FAI) is a condition where the femoral head does not adequately fit into the socket.

Movement restrictions and chronic groin pain might result from this poor fit. This is the most frequent reason for labral tears and can affect people of any age. In addition, some patients may develop osteoarthritis if they do not receive treatment.

Trauma

Hip labral tears can result from trauma to the hip. This can happen to those who play sports such as ice hockey, football, soccer, and golf, which involve repetitive, high-impact movements.

Degenerative joint disease

Osteoarthritis is a chronic (prolonged) wearing down of the joint cartilage. Over time, the cartilage gradually deteriorates and becomes more prone to tearing. A person's chance of having osteoarthritis can rise with advanced age and excessive weight. Osteoarthritis patients frequently experience pain and stiffness in many joints (the hip and knee, for example).

Repetitive movement

Long-distance running and the abrupt twisting or pivoting motions frequent in sports such as softball or golf can cause joint wear and strain that ultimately results in a hip labral rupture.

Diagnosis Of An Acetabular Labral Tear

The doctor will perform a physical examination to identify a hip labral tear. For example, the doctor would ask you to move your leg or walk around as they examine you. The doctor can diagnose an acetabular labral tear based on how well you can move and any pain you experience.

Imaging studies are also utilized in diagnosing a hip labral tear. The doctor may request the following imaging exams:

X-rays

X-rays can show doctors issues with the hip bones, such as osteoarthritis or femoral acetabular impingement, which may cause a labral tear and hip discomfort.

MRI

A magnetic resonance imaging or MRI exam provides more specific information on soft tissues. For example, it can locate and assess the severity of a labral tear.

Magnetic resonance arthrography

Detailed pictures of the soft tissues in your hip can be obtained using magnetic resonance arthrography (MRA). MRA combines MRI technology with a contrast agent injected into the hip joint area, making it easier to observe a labral tear.

Treatment

The severity of your symptoms will determine the course of treatment. Conservative advice, such as rest and limited activity, can help some people recover in a few weeks, but for others, arthroscopic surgery is required to repair the torn labrum.

Medications

Ibuprofen (Advil, Motrin IB, among others) and naproxen sodium (Aleve) are nonsteroidal anti-inflammatory drugs (NSAIDs) that help reduce inflammation and relieve pain. In addition, an injection of corticosteroids into the joint can also momentarily minimize pain.

Therapy

Your hip's range of motion can be enhanced with the help of physical therapy exercises that also strengthen and stabilize your hips and core. In addition, you can learn from therapists how to prevent actions that strain your hip joint.

Surgical procedures

Your doctor might advise surgery if other conservative treatments are not effective. Hip labral tear surgery is typically performed arthroscopically. This minimally invasive surgery entails several small incisions on the hip to enable the following procedures using tiny instruments:

• Repair or refixation (putting the tissue that was torn back together)
• Reconstruction (using healthy tissue from elsewhere on your body or from a donor to reconfigure the wounded tissue)
• Debridement (a small piece of labral tissue is removed)

If femoral acetabular impingement (FAI) is present, it is removed as well. This will help prevent the labrum from rupturing again.

This arthroscopic procedure is frequently performed on an outpatient basis, allowing the patient to return home the same day.

References:

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697339/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365273/

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