What it is.
The labrum is a rim of fibrocartilage around the edge of the hip socket. It deepens the socket, helps seal the joint so the fluid inside distributes load evenly, and contributes to stability. A tear is a split in that rim.
The important context is how common labral tears are in people with no symptoms at all. Imaging studies of asymptomatic volunteers have found labral tears in a substantial proportion, and the proportion rises with age. Finding a labral tear on an MRI therefore does not establish that it is causing your pain.
Why the tear usually is not the whole story.
Most labral tears are not isolated injuries. They occur because of the shape of the joint. Extra bone on the femoral neck or socket rim (impingement) repeatedly pinches the labrum. A shallow socket (dysplasia) overloads it. In both cases the tear is a symptom of the underlying mechanics.
That matters for treatment. Repairing a tear without addressing the shape that caused it tends to disappoint. It is also why the pattern of the tear on MRI is less useful than the shape of the bone on a plain radiograph.
Symptoms.
Typically groin pain, worse with deep flexion and rotation: getting in and out of a car, sitting for long periods, putting on shoes. Some people describe clicking, catching or a sense of the hip giving way. Pain is often intermittent at first and provoked by specific positions rather than by walking.
How it is diagnosed.
Examination looks for pain on flexion, adduction and internal rotation. A weight-bearing radiograph comes first, to assess the shape of the joint and to look for arthritis. MRI, or MR arthrogram, shows the labrum itself.
A diagnostic injection of local anaesthetic into the joint is often the most useful test. If the pain settles substantially while the anaesthetic is working, the pain is coming from inside the joint. If it does not, the labral tear on the scan is unlikely to be the source.
Treatment.
First line is non-operative: activity modification to avoid the provoking positions, physiotherapy directed at the deep hip stabilisers and the gluteal muscles, and sometimes an intra-articular injection. Many people settle with this.
Where symptoms persist in a young hip with good cartilage and a correctable bony abnormality, arthroscopic surgery to repair the labrum and reshape the bone is an option, performed by a surgeon who specialises in hip preservation.
Where arthritis is already established, arthroscopy is not appropriate. There is evidence that arthroscopy in an arthritic hip is associated with earlier progression to joint replacement rather than delaying it. In that situation hip replacement is the operation that helps.
Where this practice fits.
Professor Rodda's practice is focused on hip and knee replacement. He does not perform joint-preserving surgery such as arthroscopy or osteotomy. If your condition is at a stage where preservation surgery is the right option, you will be told that and referred to a colleague who does it, within Sunshine Coast Orthopaedic Group or elsewhere. Where the joint has reached the point that replacement is the reasonable option, that is the work done here.
Common questions.
Does a labral tear always need surgery?
No. Many labral tears are asymptomatic and many symptomatic ones settle with activity modification and physiotherapy. Surgery is considered when symptoms persist, the cartilage is still good, and there is a correctable bony cause.
Can a labral tear heal on its own?
The tear itself does not usually heal, because the inner portion of the labrum has a poor blood supply. Symptoms can settle even though the tear remains, which is why treatment targets symptoms and mechanics rather than the appearance on a scan.
My MRI shows a labral tear. Is that why my hip hurts?
Not necessarily. Labral tears are found in a large proportion of people with no hip symptoms at all, and the rate rises with age. A diagnostic injection is the most reliable way to establish whether your pain is actually coming from inside the joint.
Will a labral tear lead to arthritis?
The tear itself is less important than the mechanics that caused it. Impingement and dysplasia are both associated with earlier osteoarthritis, and a labral tear is often the first sign that one of them is present.
Does Professor Rodda perform hip arthroscopy?
No. This practice is focused on hip and knee replacement. If arthroscopic labral surgery is the right option for you, you will be referred to a surgeon who specialises in hip preservation.
References.
- Register T, Wuerz TH, Kim YJ, Millis MB. Prevalence of abnormal hip findings in asymptomatic participants: a prospective, blinded study. Am J Sports Med. 2012;40(12):2720-2724.
- Griffin DR, Dickenson EJ, O'Donnell J, et al. The Warwick Agreement on femoroacetabular impingement syndrome. Br J Sports Med. 2016;50(19):1169-1176.
This page provides general information about a medical condition and a surgical procedure. It is not individual medical advice and does not replace consultation with a qualified practitioner. Outcomes vary between individuals and all surgery carries risk. A referral is needed for a consultation with Professor Daevyd Rodda; without one, you can start with the practice nurse practitioner, who can provide it.