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Looking Back to Find Hip Labral Tears

This is a retrospective study of 66 patients who were diagnosed by arthroscopy with a hip labral tear. Retrospective means the researchers looked back after the diagnosis was made to see if there was any way to tell what the problem was. For example, did all the patients have a limp? Did they all have hip and/or groin pain? Was there any one clinical test that was positive for every patient to point to a labral tear?

The labrum is a rim of cartilage around the edge of the acetabulum (hip socket). It helps keep the joint stable and in place. Recent studies have shown that many degenerative conditions affecting the hip cause this kind of tear. Young and middle-aged adults are affected most often.

Diagnosis of labral tears can be difficult. The wrong diagnosis is often made, and time is wasted on the wrong treatment. Sometimes surgery is done on the wrong body part. The results of this study may help change that. The authors report 95 per cent of the patients had a positive impingement sign. Almost as many had moderate to severe groin pain.

A positive impingement sign occurs when the patient has groin pain when his or her hip is bent to 90 degrees. The upper leg moved in and across the body applying pressure or compression through the joint. Many patients reported night pain and walked with a limp. Hip or groin pain was worse with activity, especially when pivoting over the foot.

X-rays should be taken but may not show the problem. The only way to know for sure is arthroscopy to look inside the joint. The authors suggest a trial of conservative treatment for no more than two months. At that point, if symptoms are the same or worse, then an injection of a numbing agent into the hip or more advanced imaging studies may be helpful.

Once the diagnosis is confirmed, the authors suggest surgery as the only successful way to deal with painful labral tears. Several operations used to repair a hip labral tear are discussed. Each one is based on the type and location of the tissue damage.

References: R. Stephen J. Burnett, MD, FRCS(C), et al. Clinical Presentation of Patients with Tears of the Acetabular Labrum. In The Journal of Bone and Joint Surgery. July 2006. Vol. 88-A. No. 7. Pp. 1448-1457.

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