Hip Labral Tears

For 1 in 5 people this hip pathology will be the cause of their groin problems. Hip labral tears are now a common finding in the modern athlete and a challenging problem in sports medicine. It’s only in the last 10 years with the advent of flexible portals and arthroscopy equipment has Sports Physicians been able to diagnose and treat hip labrum problems in athletes.

The labrum of the hip is a ring of cartilage equivalent to the meniscus in the knee that has two main functions. It acts to deepen the “socket” in the ball-and-socket joint of the hip joint and provide stability. The labrum also acts to decrease the friction with the joint and spread out the load. Only the outer third of the labrum is thought to have a blood supply affecting healing of the labrum during injury.

HOW DO INJURIES OCCUR? The five most common causes of hip Labral tears are trauma, hip dysplasia, degeneration, capsular laxity and femero-acetabular impingement. In athletes the main cause is trauma and is usually caused by twisting or pivoting whilst weight bearing.

Symptoms of a torn labrum include pain that can radiate into the groin, down the front of the thigh, buttock, greater trochanter and medial knee. Patients may also feel catching, clicking, locking, giving way or a stiffening of their hip leading to a decrease in the range of motion.

Plain x-rays, bone scans, CT scans and MRI as a group have proven poor in detecting hip Labral tears. MRI with dye is proving more effective than MRI alone and is now the investigation of choice in sports medicine. This however can miss up to 50% of all hip labral tears. Hip arthroscopy and a good examination are needed to identify the problem.

Treatment involves either conservative or surgical treatment. A period of rest and a gradual return to weight bearing exercise may suffice for small tears to the labrum. Surgery to the hip with arthroscopy is now becoming quite common and increasingly slick in its approach. The surgery is usually done as a day only procedure. A patient will have a general anaesthetic and the procedure will take 30-40 minutes to complete. The torn labrum can be debrided using a shaver and in some cases the surgeon may elect to repair the loose cartilage with an anchor.

Post operatively, there is usually 4-5 days of relative rest before a gradual return to weight bearing is allowed. Swimming and cycling are encouraged for the first 2 weeks to give the hip joint a chance to mobilize without compression of the joint. Hip arthroscopic surgery is reported to improve symptoms by 60-90%.