Hip - Labral Tear
Description
The labrum is a soft cartilage structure surrounding the socket of the “ball and socket” joint. It acts as a cushion between the two bones. The labrum can be torn from its attachment anywhere on the socket.
What are the causes?
Labral tears occur with acute dislocations, twisting injuries or chronic, repetitive stresses to the joint. The labrum can also become degenerative and tear or calcify with anatomic anomalies and extra bone formation (see Pincer Lesion in Femoral Acetabular Impingement).
What are the symptoms?
Labral tears cause deep groin pain. Depending on the size of the tear, clicking or popping may be felt with certain hip motions. Pain can occur with going up and down stairs, squatting, sitting cross-leg, or prolonged sitting. Labral tears that displace into the joint can cause a locking sensation.
How is it diagnosed?
Your surgeon will perform a thorough history and physical exam with X-rays. The hip will be moved through a range of motion and stressed in certain ways to elicit pain or popping. X-rays may or may not show evidence of FAI (particularly Pincer lesions). MRI (with contrast dye) is helpful for evaluating the labrum. Your surgeon may also suggest minimally-invasive hip arthroscopy to evaluate the structures of the joint if the diagnosis is unclear based on physical exam and MRI.
Non-operative
Labral tears are sometimes misdiagnosed as tendon or muscle strains. Even if accurately diagnosed, your surgeon may prescribe anti-inflammatory medication, physical therapy and activity modification to decrease pain and inflammation. If the symptoms resolve, no further treatment is necessary. Your surgeon may also offer an injection, which both confirms the diagnosis and decreases pain.
Platelet Rich Plasma (PRP) Injections is another non operative option. Blood is taken from your arm and is spun down to get the healthiest healing factors - platelets and serum. Once injected, the platelets degranulate and release activate growth factors and cytokines to promote healing. One injection may be all you need, however, there are times where multiple injections may provide additional benefit. Not covered by insurance.
Mesenchymal Stem Cell Injections is another non operative option. Bone marrow is aspirated from the back of your pelvis and centrifuged in a special kit to concentrate the stem cells, which are then reinjected into the hip. The goals are to change the living microenvironment of the tendon, up regulating collagen formation, and promote tendon cell healing and reorganization. Not covered by insurance.
Operative
Operative treatment of labral tears consists of minimally-invasive hip arthroscopy. Your surgeon has multiple options to repair the torn tissue, remove it or reconstruct the damaged tissue if the torn tissue is not amenable to repair. Repairing the tissue is completed with a series of sutures and anchors. If the tissue is reconstructed, a graft (from a donor) will be used in place of the damaged tissue and repaired to the bone with sutures and anchors. Postoperative medication and physical therapy are at your surgeon’s discretion.
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