A hip (acetabular) labral tear is damage to cartilage and tissue in the hip socket.
The labrum is a band of tough cartilage and connective tissue that lines the rim of the hip socket, or acetabulum. It cushions the joint of the hip bone, preventing the bones from directly rubbing against each other. The labrum also helps keep the leg bone in place and increases stability of the joint.
What Causes a Labral Tear?
The labrum can tear for many reasons. Some people get a torn labrum from falls or car accidents. Sports that require regular rotation of the hip -- like golf, soccer, hockey, and ballet -- increase the risk. So do running and sprinting.
But almost 75% cases of torn acetabular labrum have no known direct cause. Instead, these tears may develop gradually. Labral tears in the hip have been linked to osteoarthritis. But it's not clear if they contribute to its development or are a symptom of it.
Labral tears of the hip are more common in women. They also occur more often in people who have abnormalities of the hip structure, like hip dysplasia and other conditions.
In recent years, experts have found that acetabular labral tears are much more common than once thought. Studies show that up to 22% of athletes who complain of groin pain have a labral tear in the hip.
What Are the Symptoms of an Acetabular Labrum Tear?
An acetabular labrum tear can cause a wide variety of symptoms. Some people don't have any discomfort. Others have sharp pain around the groin, which may extend into the upper leg or buttocks. Pain can come on suddenly or develop gradually. Rotating your leg may be particularly painful.
Acetabular labral tears often cause a feeling of the leg "catching" or "clicking" in the hip socket as you move it. It may also feel like the leg is locking up.
Over time, the increased stress on the joint could lead to further deterioration and permanent damage.
How Is an Acetabular Labral Tear Diagnosed?
Acetabular labral tears can be hard to diagnose. Studies show that, on average, people with labral tears of the hip go more than 2 years before getting a correct diagnosis.
Your doctor will give you a thorough evaluation, examining the hip, and getting you to flex and rotate your leg. You may need an MRI or other imaging tests to look for the tear. However, even with these tests, diagnosis is often difficult.
A more invasive way of diagnosing an acetabular labral tear is an arthroscopy, in which small incisions are made and a tool with a tiny camera is slipped into the hip to look at the labrum.
How Is an Acetabular Labral Tear Treated?
If you've been diagnosed with an acetabular labral tear, your doctor will probably start with conservative treatment. They may recommend using painkillers and resting the hip. However, it’s unclear how well this approach works in the long run. Most of the labrum gets little to no blood flow, making natural healing difficult or even impossible.
Physical therapy may help an acetabular labral tear. You can learn to avoid putting too much pressure on the joint while building muscle strength to support the joint.
If conservative measures don’t work, your doctor may recommend arthroscopic surgery. This is a minimally invasive approach. The doctor will guide several small tools, including a camera, to the site through two or three incisions. Usually, the torn tissue is removed, but in some cases the tear is repaired. It's still not clear, though, whether this type of treatment can help prevent hip arthritis. Plus there is some evidence that the effectiveness of such treatment is only minimal in patients over 45. So caution is urged when considering it.
As with any surgery, there are risks, including nerve damage. This side effect is usually temporary.
Surgery usually provides short-term improvement. But experts aren’t sure how long the effects last. Surgery is less likely to be successful in people who already have other problems in the hip like arthritis or hip dysplasia. Following surgery, you will need physical therapy to rebuild strength and flexibility.
Since the success of arthroscopy and surgery for an acetabular labral tear is by no means certain, talk over the pros and cons with your doctor. You may also want to get a second opinion.