What is a labral tear?
The acetabular labrum is a fibrous tissue attached to the rim of the acetabulum (socket) in so deepening it. The labrum has a number of functions to keep the joint healthy. These functions include forming a seal around the femoral head to help with lubrication of joint, proprioception and stability of the joint. Traumatic or spontaneous tears of the labrum are uncommon. The majority of tears of the labrum are a consequence of impingement caused by overgrowth of the acetabular rim (hip socket) called a PINCER lesion. Or the presence of extra bone at the head neck junction of the femur called a CAM lesion, the majority of situations there is a combination of both causing FAI (femoro acetabular impingement).
What are the symptoms?
Patients usually present with a deep-seated groin pain and mechanical symptoms with clicking, catching, locking and giving way of the hip.
Discomfort and restriction of hip movements are often present before the onset of acute symptoms of a labral tear.
What investigations are needed?
How can it be managed?
Initially conservative measure are utilised to help with the pain and disability which include:
• Activity level and lifestyle can be modified
• An individualised physical therapy rehabilitation programme and regular non-impact exercise.
• Simple painkillers, anti–inflammatory medication and supplements can be of help.
• Hip joint injection with a steroid and local anaesthetic and or Hyaluronic acid (viscosupplements) an artificial synovial fluid. These injections are carried out under X ray control. These may help, as well as confirming the pain is coming from the hip joint.
• The majority of these labral tears with mechanical symptoms that do not respond to conservative management will require surgery.
What does the surgery involve?
It is keyhole surgery of the hip joint and is carried out under general anaesthetic; you will be asleep (Hip Arthroscopy). The labrum is assessed at the time of surgery along with all the other pathology and suitability for repair/ reattachment is undertaken. After the removal the pincer lesion (rim) the labrum is reattached using bone anchors to reconstitute the seal around the femoral head.
What are the risks?
The labrum may not heal, tear again giving rise to ongoing symptoms.
Click on for details of risks of Hip Arthroscopy and risks.
What are outcomes?
In general good outcomes are achieved with this operation, recovery is relatively slow over months and is dependent on the underlying pathology/condition being found and treated along with the surgery that is performed.
With labral repair/reattachment there will be restriction on range of movement for a minimum of six weeks, your physiotherapist will give you exercises to do and monitor your progress.
If there is damage to the articular cartilage (wear and tear / arthritis) the outcome is less predictable and more likely to give ongoing issues.
Acetabular Labrum - Most common site for tears of the labrum to occur, is in the antero-superior portion
(region marked by red line).
Arthroscopy view - showing the tear in the anterior labrum of the right hip.
AC 34 year’s old patient presented to Mr Aslam Mohammed with a 12 month history of groin pain, made worse by activity, a feeling of catching and giving way of the hip joint associated with a clicking.
History, Examination and Investigations confirmed a PINICER lesion with a labral tear was the cause of the symptoms. It was agreed that hip arthroscopy was the way forward. At arthroscopy the findings were confirmed and the PINCER was removed and the labrum repaired.
AC made a good recovery and at six weeks following her surgery her symptoms had completely resolved and she was returning to full activity.
1. - Repaired labrum with two anchors..
2. - Hip joint showing a good seal is formed by the repaired labrum around the femoral head (black line).
London, Manchester and Lancashire
North West Hip & Knee Clinic
• Keyhole (minimally invasive)
• Hip and Knee Surgery
• Hip and Knee Joint Replacement
• Hip and Knee Sports Injury
• Hip Arthroscopy, FAI and Labral Surgery
• Knee Arthroscopy - Meniscus surgery
• Knee Arthroscopy and ACL / PCL
• Ligament Reconstruction
• Biologics – PRP, Stem Cell
• Cartilage Regeneration