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Hip Labral Tear

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Topic updated on 09/12/13 7:56pm
Introduction
  • Traumatic tear of the acetabular labrum that may lead to
    • pain
    • intra-articular snapping hip
  • Epidemiology
    • incidence
      • highest incidence in patients with acetabular dysplasia
    • demographics
      • seen in all age groups
      • patients commonly active females
    • location
      • anterosuperior labrum most common location
  • Pathophysiology
    • etiology
      • femoroacetabular impingement
      • hip dysplasia
        • floppy labrum more susceptible to tearing
      • trauma
        • hip dislocations/subluxations are a common cause
      • capsular laxity
        • increased translational forces across labrum due to joint hypermobility
      • joint degeneration
        • causes acetabular edge loading
Anatomy
  • Structure
    • horse-shoe shaped structure continuous with transverse acetabular ligament
    • 2 parts
      • articular
        • fibrocartilage
      • capsular
        • dense connective tissue
  • Vascularity
    • capsule and synovium at acetabular margin
  • Innervation
    • branch of nerve to the quadratus femoris
    • obturator nerve
Presentation
  • Symptoms
    • mechanical hip pain and snapping
    • may have vague groin pain
    • may be associated with a sensation of locking
  • Physical exam
    • provocative tests
      • anterior labral tear
        • pain if hip is brought from a fully flexed, externally rotated, and abducted position to a position of extension, internal rotation, and adduction
      • posterior labral tear
        • pain if hip is brought from a flexed, adducted, and internally rotated position to one of abduction, external rotation, and extension.
Imaging
  • Radiographs
    • useful to exclude other types of hip pathology
    • may show
      • hip dysplasia
      • arthritis
      • acetabular cysts
  • MRI arthrogram
    • imaging study of choice
      • 92% sensitive for detecting labral tears
      • may be combined with intra-articular injections of lidocaine and steroid for diagnostic and therapeutic purposes
Treatment
  • Nonoperative
    • rest, NSAIDS, physical therapy, steroid injections
      • indications
        • initial treatment of choice for all patients with labral tears
      • outcomes
        • no long-term follow-up data on conservative management
  • Operative
    • arthroscopic labral debridement
      • indications
        • symptoms that have failed to improve with nonoperative modalities
        • labral tear not amenable to repair
      • technique
        • remove any unstable portions of the labrum and associated synovitis
        • underlying hip pathology (e.g. FAI) should also be addressed at time of surgery
        • post-operative care
          • limited weight-bearing x4 weeks
          • flexion and abduction are limited for 4 to 6 weeks
      • outcomes
        • 70-85% experience short-term relief of symptoms following arthroscopic debridement
        • long-term follow-up data not available
    • arthroscopic labral repair
      • indications
        • symptoms that have failed to improve with nonoperative modalities
        • full-thickness tears at the labral-chondral junction
      • outcomes
        • unknown at this time

 

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Arthroscopic surgery of a hip labral repair with a knotless anchor performed by...
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