What is the Labrum?
The hip is a ball-and-socket joint. The bones are lined with articular cartilage which provides near frictionless movement and shock absorption.
The hip joint is held together and stabilized by the joint capsule, a thick fibrous structure that provides stability and limits movement of the joint. The hip capsule is attached to the pelvis by the acetabular labrum, strong fibro-cartilagenous bridging tissue.
What is a Labral Tear?
The acetabular labrum can tear from injury , wear and tear, or due to dysplasia and other anatomical abnormalities.
Femoro-acetabular Impingement (FAI)
Femoroacetabular Impingement (FAI) is a condition resulting from abnormal pressure and friction between the ball and socket of the hip joint.
When an abnormally shaped ball (cam lesion) or socket (pincer lesion) come into contact with other structures, the resulting impingement can result in damage to the cartilage and the acetabular labrum.
Causes of Femoro-acetabular Impingement
There are three common causes for Femoroacetabular Impingement.
Genetic – an abnormally shaped ball and socket can develop as patients grow. Recent research suggests a genetic link. This abnormal bony morphology is the most common cause for FAI.
FAI develops only when the ball and socket impinges, causing damage to the joint
Degenerative – FAI and labral tears may also develop in normally shaped hips if the hip joint impinges due to excessive or repetitive movement.
Traumatic – FAI can also occur with trauma, eg. falls and also with certain sports and professions: football, ballet dancing, martial arts, gymnastics, weight lifting etc.
Symptoms of a torn acetabular labrum
Labral tears may be pain and symptom free
Labral tears may cause the following symptoms:
- Groin pain
- Thigh pain radiating pain from the hip
- Clunking, clicking and locking in the hip
- Difficulty walking
- Loss of movement in the hip
The pain is often made worse with activity, including sports, and in positions where the ball and socket impinge such as: sitting in low chairs, getting up from chairs, climbing stairs, driving, and putting on shoes and socks.
Diagnosis of Femoro-acetabular Impingement
FAI in the hip can be diagnosed and assessed clinically and with imaging tests.
- Medical history
- Physical examination
- X-rays may show FAI cam lesions on the femur or pincer type lesions on the acetabulum.
- MRI can create detailed images of both hard and soft tissues within your hip., including the articular cartilage
MRI scans can produce cross-sectional images of internal structures and are very accurate in the assessment and diagnosis of cartilage, ligament, labral and FAI lesions in the hip.
Treatment for a Labral Tear?
Unfortunately, labral tears do not heal without surgery.
Not everyone requires surgery and treatment is tailored to the patient’s individual needs. Patients with mild symptoms can usually be treated conservatively with activity modification.
Short Term Treatment
Non-surgical treatments can include:
- Medications – analgesics and anti-inflammatories can help relieve symptoms.
- Avoidance of the ‘impingement position’.
- Injections into the hip joint can give temporary relief of symptoms and may be useful as a diagnostic test in difficult cases.
Unfortunately none of these modalities treat the underlying cause, nor do they repair or stabilise the torn labrum.
Arthroscopic Treatment for Labral Tears
Labral tears and the underlying FAI can often be successfully treated with hip arthroscopy (keyhole surgery) including:
- FAI bump or cam type lesion: The abnormal bone is removed and reshaped to prevent further impingement and to protect the hip from further damage. This can also improve a patient’s range of motion.
- Abnormal socket (pincer lesion) – The abnormal bone is removed to prevent further impingement and to protect the hip from further damage.
- Labral tears – These can be repaired and stabilised. Specialised anchors are used to re-attach the torn labrum.
- Articular cartilage damage – Unstable cartilage flaps can be debrided and stabilized, but not repaired
- Ligamentum teres tears – These can be trimmed, tightened and reconstructed
Untreated Labral Tears
Labral tears are not life threatening but can adversely impact a patient’s quality of life and function. It can affect anyone: elite athletes and the active individual, manual labourers and office workers.
The labrum is an important structure of the hip and untreated damage can lead to
- Short Term Impact – ongoing pain and disability.
- Long Term Impact – damage becomes permanent and may ultimately result in the hip joint wearing out leading to premature osteoarthritis of the hip.
Risks of hip arthroscopy for treatment of FAI and labral tears
While complications due to surgery are uncommon they can occur, the following are some:
- Numbness or tingling in the groin
- Some discomfort in the leg, thigh and buttock region
- Joint stiffness
- Local nerve or blood vessel damage
- Reflex sympathetic dystrophy
Other general medical and surgical risks can include:
- Risk of infection
- Bleeding and clots in the leg (DVT) or lung post-operatively
- Allergies and anaesthetic complications
If there are any postoperative concerns or pain please do not hesitate in contacting your treating surgeon
Preparing for Labral Repair Surgery
If I think that surgery is required, I will refer you to a trusted colleague who performs a lot of hip arthroscopies.
Participating and completing a tailored exercise program before surgery(pre-hab) with a trained physiotherapist will help you to achieve the best result after surgery.
You will also need to:
- Discuss any medications being taken with your doctor or physician to see which ones should be stopped before surgery
- Not eat or drink anything, including water, for 6 hours before surgery
- Stop taking aspirin, warfarin, anti-inflammatory medications or drugs that increase the risk of bleeding one week before surgery.
- Stop or cut down smoking to reduce your surgery risks and improve your recovery
Report any infections to your surgeon prior to surgery as the procedure cannot be performed until all infections have cleared up.
After Your Operation:
Some patients need one night in hospital, although it is possible to leave hospital the day of surgery. The incision wounds take 7-10 days to heal.
Most patients improve dramatically in the first 6 weeks. Occasionally, there are periods where the hip may become sore and then settle again. This is part of the normal healing process.
It takes three months for your hip to fully recover from hip arthroscopy. Continued improvements may be gained up to 1 year post-surgery.
If any postoperative problems arise with your hip, such as redness, increasing pain or fevers, do not hesitate to contact your surgeon. If unavailable, seek advice from the hospital or your general practitioner.
Pain Management after Labral Tear Surgery
A patient’s experience of pain will vary depending on the procedure performed and the amount of pre-existing damage in the hip.
After your operation you will have pain medication and antibiotics.
Most patients are pleasantly surprised at how little pain they have after the procedure. Local anaesthetic is injected before and after the procedure to minimise any pain you may feel.
Walking – full weight-bearing and walking is allowed immediately. Initially, this will be aided by crutches. Most people will walk independently by 10-14 days post-operatively.
Driving – do not drive for 48 hours after an anaesthetic. After 48 hours, your ability to drive will depend on the side you had your operation, left or right, and the type of vehicle you drive, manual or automatic.
If you had a left hip procedure and drive an automatic, you can drive whenever you feel comfortable. Otherwise, it is reasonable to drive when you are confident with walking and can fully weight-bear on your affected side. You must not drive if you are taking strong analgesics, e.g. Endone, codeine etc.
Return To Work After Labral Tear Surgery
Return to work will vary depending on the procedure performed and type of work you are engaged in. Most people can return to office work within 2 weeks. Labour intensive work may require you to take 6-8 weeks before returning to full duties.
During this period patients are not fit to perform work duties that involve:
- Prolonged standing,
- Heavy lifting,
- Bending or
- Excessive stair climbing
Return To Sport
It is best to delay leisure activities or sports for at least 6-8 weeks to allow the labrum time to heal and repair.
Low impact activities, such as cycling and swimming, can be commenced from week 4.
Post Operative Rehab
Participating and completing a tailored exercise program after surgery (rehab) with a trained physiotherapist will achieve the best result for you after surgery.
The rehab program will be tailored specifically for you and will depend on the type and extent of the surgery you have had.