Hip Labral Tears

Over the past several years hip arthroscopy has become increasingly more popular. With the advent of better diagnostic tools such as magnetic resonance imaging, intraarticular hip pathology has been diagnosed in a more predictable fashion. Technical advances in appropriate portal placement, needle positioning, distraction techniques, patient set up, arthroscopic instruments and surgical techniques have all improved the accessibility of the hip joint. These improvements in technology have led to a more detailed understanding of specific intraarticular soft tissue lesions, notably hip labral tears. The diagnosis of a hip labral tear remains largely clinical and is analogous to those patients who present with meniscal pathology. These patients often present with mechanical symptoms (catching and painful clicking) as well as restricted range of motion. Sometimes their presentation is more subtle, with symptoms of dull, activity-induced, positional pain that fails to improve with rest. Classic symptoms of hip clicking may be misdiagnosed as a hip labral tear when the etiology is in fact from a different source (snapping iliotibial tendon or a hypermobile psoas tendon). The work-up for hip labral tears begins with a full history and physical examination and proper diagnostic imaging, including both radiographs and MR imaging (either gadolinium-enhanced or noncontrast methods).

The cause of hip labral tears are usually from femoral-acetabular impingement, capsular laxity, dysplasia, and trauma. Non-operative management is the cornerstone of treatment including pharmacology, injections, and physical therapy. There are very few alternative open procedures such as open surgical dislocations. Hip arthroscopy, on the other hand, is reserved for patients who have recalcitrant symptoms resistant to non-operative treatment, and clearly identifiable pathology based upon their clinical exam and radiographic studies.

Arthroscopic management consists of debridement and repair. The goal of arthroscopic debridement of a torn hip labrum is to relieve pain by eliminating the unstable flap tear that causes the observed hip discomfort. The surgical technique of a hip labral tear repair depends on the nature of the labral injury (Figure 1, 2, 3). There are at least two distinct types of acetabular labrum tears. Type I consist of a detachment of the labrum at the zone of transition to the articular hyaline cartilage and require reattachment to the acetabular rim, usally with anchor. On the other hand, Type II tears are intrasubstance splits with one or more cleavage planes can be repaired with a suture lasso technique and a bioabsorbable suture.