Hip Labral Tears

Patient information — Dr Christopher Spelman, Orthopaedic Surgeon

Overview

The labrum is a ring of strong, flexible cartilage around the rim of the hip socket (acetabulum). It deepens the socket, and – importantly – it creates a suction seal that holds a thin layer of fluid within the joint, distributing load and helping to stabilise the hip. A labral tear damages this seal and is a common source of groin pain in younger, active adults, often with clicking, catching or a sense that the hip is locking.

Why the cause matters more than the tear

A labral tear is usually not a random event but the consequence of an underlying difference in the shape or stability of the hip. Identifying and treating that cause is the single most important part of getting treatment right. The main causes are:

●      Femoroacetabular impingement (FAI) – extra bone on the ball or socket pinches and shears the labrum. This is the most common cause.

●      Hip dysplasia – a shallow socket overloads the labrum, which enlarges and tears as it tries to compensate. Operating inside a dysplastic hip without correcting the socket can make it more unstable.

●      Microinstability and capsular laxity – subtle looseness of the joint, sometimes in people who are naturally flexible.

●      Trauma and, in older patients, degeneration as part of early arthritis.

Symptoms and diagnosis

Groin pain, worse with prolonged sitting, getting out of a car, squatting and pivoting, is typical, sometimes with clicking or catching. On examination, bringing the hip into flexion, adduction and internal rotation often reproduces the pain (the impingement test). Imaging combines plain X-rays (to show the bony shape and check for dysplasia) with MRI – usually with contrast injected into the joint (MR arthrogram), which best shows the labrum. A diagnostic injection of local anaesthetic into the joint can confirm that the pain is coming from inside the hip.

Treatment

Many patients improve with physiotherapy focused on hip and core strength, movement control and activity modification, and this is usually tried first for a symptomatic labral tear without a major bony abnormality. Where symptoms persist, hip arthroscopy (keyhole surgery) is used to treat both the labrum and its underlying cause. The options for the labrum itself are:

●      Repair – reattaching the torn labrum to the rim with small anchors, preserving its sealing function. This is preferred wherever the labral tissue is of good quality, and is combined with reshaping the bone in FAI.

●      Debridement (trimming) – removing a small, irreparable or frayed portion when repair is not possible.

●      Reconstruction – rebuilding the labrum with a tendon graft when it is deficient, calcified or has failed a previous repair.

Critically, the underlying cause is addressed at the same time – reshaping the bone in FAI, managing the capsule in instability, and, where dysplasia is the main problem, reorientating the socket with a periacetabular osteotomy rather than operating inside the joint.

What the evidence shows

A systematic review comparing labral repair with debridement found that repair generally produces better patient-reported outcomes, with some evidence it may slow the progression of arthritis; there was no difference in the rate of eventual hip replacement. Labral reconstruction is a valuable option for irreparable or revision cases. The consistent theme is that preserving the labrum and correcting the underlying hip shape gives the best result.

Complications

Labral surgery is performed arthroscopically and carries the risks of hip arthroscopy: temporary numbness from the traction used during surgery, a small risk of nerve irritation, infection, blood clots, extra bone formation, and – where cartilage wear is already established – incomplete relief of symptoms, progression to arthritis, and the possibility of further surgery. Removing too much bone or labrum, or not addressing instability, can leave the hip worse, which is why accurate assessment is essential.

Summary

A hip labral tear is usually a sign of an underlying problem with the shape or stability of the hip. Good treatment identifies and corrects that cause – impingement, dysplasia or instability – and preserves the labrum by repairing it where possible, reconstructing it when necessary. Dr Spelman assesses both the labrum and the overall hip mechanics to recommend the right treatment. See also the pages on hip impingement (FAI) and periacetabular osteotomy.