Acetabular labral tear
The diagnosis of labral tears is increasing since the increasing use of hip arthroscopy. Indeed, labral tears are found in up to 55% of arthroscopies for intractable hip pain.
- Incidence: 50.00 cases per 100,000 person-years
- Peak incidence: 40-50 years
- Sex ratio: more common in females 1:1
|Osteoarthritis of the hip||10.00|
|Greater trochanteric pain syndrome||6.00|
|Acetabular labral tear||1|
|Avascular necrosis of the hip||0.05|
- Pain is felt in the groin/hip region and is likely to gradually worsen with time. 90% of patients report the pain to be specifically in the anterior hip or groin region.
- Pain may be exacerbated with prolonged walking, sitting or activity.
- Mechanical symptoms
- Clicking, locking, catching and giving way of the hip are commonly reported symptoms in labral tears.
- Labral tears may also cause a reduced range of movement of the hip joint.
The two main diagnostic investigations for acetabular labral tears are:
- An MRI scan combined with injecting contrast direct into the hip joint.
- The best non-operative imaging modality for investigating suspected acetabular labral tears.
- If the diagnosis remains unclear following MRI, diagnostic analgesic injections may be trialled. If the discomfort and pain respond to the injections, the labrum is the likely source of pain.
- Diagnostic laparoscopy
- The gold standard definitive investigation.
- Physiotherapy can provide good long term outcomes for treatment of labral tears.
- Initially, limited activity is advised to minimise pain and discomfort, including the activities that bring on hip pain.
- Treatment focuses on strengthening the buttocks, thigh, and back, while also improving hip stability.
- A gradual return to full activities is advocated post physiotherapy.
- Medical management
- Physiotherapy my be supplemented with medical therapies, namely NSAIDs, to reduce pain and discomfort.
- Intra-articular steroid and local anaesthetic injections may also be utilised.
- Surgical management
- Surgical management is considered in patients with signs/symptoms of a labral tear for over 4-weeks in conjunction with indicative findings of a labral tear by way of MRI or MRA, or in cases where a labral tear is seen on diagnostic arthroscopy.
- Hip arthroscopy is the surgical management of choice for acetabular labral tears.
- The labral tears are undergo either debridement or repair, depending on the pattern and severity of the tear.
- In addition to elevating symptoms, a key aim of the procedure is to improve the hip joint integrity, reducing the risk future joint degeneration associated with labral tears.