Labral tear of the hip

What is a Labral tear of the hip?

The hip socket (acetabulum) is ringed by a strong fibrocartilage gasket called the labrum. The labrum can be damaged by a twisting injury or heavy fall while playing sport. Often, labral tears are the result of repetitive overstressing of the labrum, usually by putting the hip into extreme positions during sport. An underlying abnormality in the bone shape is a major predisposing factor in many patients with labral tears. This is called femoroacetabular impingement, or FAI.

Labral Anatomy

The hip is a ball-and-socket joint. The socket is formed by the acetabulum, which is part of the pelvis. The ball is the femoral head, which is the upper end of the femur (thighbone). Articular cartilage lines the joint. It is a smooth, low friction material that covers the surface of the ball and socket, enabling the bones to glide easily across each other. In a healthy hip, the femoral head fits perfectly into the acetabulum.

Normal labrum from inside the socket.
The labrum (blue arrow) blends smoothly with the cartilage of the socket (asterisk), increasing the area for force transfer and protecting the cartilage.

Normal labrum (blue arrow) creating a “gasket seal” around the head of the femur (asterisk) in the socket, keeping fluid lubricating the joint and protecting the cartilage from wear.

What does the labrum do?

The labrum is vital for the long-term health of the hip. It has a number of important functions.

  • Providing a suction seal to improve hip stability.
  • Keeping lubricating fluid inside the joint.
  • Nerve endings in the labrum are important for joint position sense and help tell your brain what the hip is doing.
  • Increasing the area of contact across the hip and decreasing the pressure on the cartilage

What are the symptoms of a torn labrum?

Symptomatic labral tearing usually causes pain in the groin area. Often a sharp stabbing pain can occur with turning, twisting, and squatting, or specific sporting activities. Catching, clicking or popping can occur with labral tears, but also occurs with other hip problems, so is not absolute proof of a labral tear.

Many people with labral tears diagnosed on MRI scans have no symptoms and the labral tear is an incidental finding. This is probably because the torn portion of labrum is not getting caught between joint surfaces, or causing irritation of the joint. Not all labral tears need surgical treatment.

Torn labrum, with associated damage to the articular cartilage in the socket.

How is a labral tear diagnosed?

A diagnosis of a labral tear is suggested by the pattern of hip pain and limitations. Importantly, some abnormalities can cause labral tears, specifically femoroacetabular impingement (FAI) and must be ruled out during your assessment. Other problems can mimic labral tearing, including hernia, groin muscle injuries and back problems. An examination will help to exclude these diagnoses.

X-rays: of your hip will be performed to assess the shape and orientation of the bones (FAI).

MRI scan: will show up labral tears (arrow) and also indicate areas of cartilage damage.

Local anaesthetic: This is usually injected into the hip at the same time as the MRI scan. This is important to figure out if your pain is truly coming from within the hip joint itself.

CT scan: If we are planning surgery, and you have FAI associated with your labral tear, we will usually perform a 3D CT scan to accurately map the shape and size of the bony abnormalities we need to remove during surgery.

How is a labral tear treated?

When hip symptoms first occur, it is helpful to try and identify an activity or something you may have done that could have caused the pain. Sometimes, you can just back off on your activities, let your hip rest, and see if the pain will settle down. Over-the-counter anti-inflammatory medicines (ibuprofen, naproxen) may help.

The initial treatment of labral tears is non-surgical. This is a combination of:

  • Activity modification to avoid painful movements and activities.
  • Anti-inflammatory medications.
  • Physiotherapy to improve the range of motion in your hip and strengthen the muscles that support the joint. This can relieve some stress on the injured labrum or cartilage.
  • Steroid injection: If the hip is particularly irritable and inflamed, a steroid injection may be used to help settle the inflammation.

Surgical treatment

Surgical treatment is indicated if:

  1. You have tried non-operative treatment and it hasn’t improved your symptoms enough.
  2. Scans show that there is associated impingement (FAI) that is already causing damage to the joint surfaces.