Labral Tears

Labral tears are the most common problem encountered in the hip and can often be detected with a good quality MRI. However, labral tears rarely occur alone. Often, there may be accompanying damage to the articular cartilage, which can represent the beginning of arthritis. MRIs are less reliable at determining the extent of this injury to the articular cartilage. At arthroscopy, the labrum can be repaired and the articular damage smoothed but there may still be some damage that cannot be fully reversed.

The labrum is a hardy structure and tearing rarely occurs unless there is some underlying problem that makes it more vulnerable to injury. Femoroacetabular impingement (FAI) is the most commonly recognized cause. Bony overgrowth around the acetabulum (pincer impingement) or an overgrown bump on the femoral head (cam impingement) can tear the labrum as well as injure the articular cartilage. Under these circumstances, it is important to correct the impingement by reshaping the bone, in addition to repairing the labrum. This gives a better chance for the repair to heal and also slows any eventual deterioration of the joint that may occur.

Labral tears also tend to occur in association with dysplasia of the acetabulum, where the socket is shallow. The labrum can be treated with arthroscopic surgery but careful evaluation of the severity of the dysplasia is important. When dysplasia is extreme, some patients may better benefit from an open operation to deepen the socket.

The labrum has good healing capacity and most can be repaired. However, sometimes it can be better managed simply by removing the torn portion that is causing pain. Numerous factors go into making the best choice for each individual patient.