A hip labral tear is a tear in the rubbery tissue (labrum) that normally cushions and supports the edge of the hip joint. Also known as an acetabular labral tear, this common hip injury can occur in children as young as 8, adults in their 70s, and everyone in between. In teens and young adults, hip labral tears are often the result of athletic activity. Structural issues, such as hip dysplasia or hip impingement, can also cause a tear in the labrum.
Hip labral tear treatments range from rest and physical therapy to surgery. If you have hip pain, it’s important to see a doctor as soon as possible in order to limit any future damage to your hip.
The labrum is a ring of rubbery tissue that lines the rim of the hip socket (acetabulum). The labrum cushions and supports the hip joint while also stabilizing the joint. When you walk, run, jump, or twist, the labrum absorbs friction and distributes force evenly across the hip.
There are two types of hip labral tear: one occurs at the front of the hip and another at the back of the hip. The two types are usually caused by different motions.
Hip impingement and dysplasia forced the track star to give up running. Her surgeon printed a 3D model of her hip joints to better understand and correct the irregularities causing her pain.
Hip labral tear symptoms may include:
A hip labral tear is a wear-and-tear injury. Athletes whose sports and activities involve repetitive rotating and twisting leg motions are particularly prone to this injury. Such sports include golf, soccer, ice hockey, ballet, gymnastics, and football.
Labral tears can also be caused by structural problems of the hip, including hip dysplasia and hip impingement. In both conditions the hip bone does not fit well in the hip socket, and can damage the labrum over time. In a small number of cases, labral tears can be caused by a trauma, like a car accident, fall, or a serious collision in sports.
Your doctor will start by asking about your symptoms and what triggers them. They may ask if you or any of your close family members (parents, siblings) have had problems with your hip such as hip dysplasia or impingement.
During a physical exam, your doctor will look for signs of a hip labral tear or other hip disorder. They may move your leg around to test the range of motion in your hip joint, as well its stability.
Your doctor may also do FABER (flexion, abduction, external rotation) and FADIR (flexion, adduction, internal rotation) tests. You will lay on your back on an exam table and bend the knee of your affected leg so that it is at a right angle to your other leg. The doctor will then press gently on your bent knee back and forth and ask if this causes pain.
Dr. Young-Jo Kim, director of the Child and Young Adult Hip Preservation Program, discusses the causes of hip labral tears and his treatment philosophy.
Hip labral tears occur on a spectrum, from mild to severe. If you have a mild hip tear, your doctor may recommend non-surgical treatment. However, a severe tear or one caused by a structural hip issue will likely require surgery.
Some labral tears are treated with pain medication and physical therapy. Sometimes a hip injection may be needed. The doctor injects the hip with numbing medication and may use a steroid to reduce the pain and inflammation in the hip joint.
Non-surgical treatments for hip labral tears include:
If the labrum does not heal on its own, you may need arthroscopic surgery to repair the torn tissue. During this minimally invasive surgery, the surgeon makes two or three keyhole incisions and inserts a thin scope to see the joint. Then, the doctor repairs or removes damaged tissue.
If you have hip dysplasia and a labral tear, you may need open hip surgery to correct the underlying problem. With hip dysplasia, the hip socket is too shallow and the labrum is not well supported. If your doctor only fixed the labral tear without treating the dysplasia, your labrum would probably tear again. A surgery called periacetabular osteotomy (PAO) corrects hip dysplasia by changing the angle of the hip socket. This allows the hip bone to move more freely inside the socket and reduces friction between the bones that stress the labrum. The surgeon may repair the torn labrum at the same time.
You will need to use crutches for the first two to three weeks after arthroscopic surgery. You will also need physical therapy to help restore muscle strength and range of motion after the surgery. Most patients can return to sports four to six months after surgery.
Recovery from PAO surgery is different for each patient. You will regain strength in your hip gradually, and should be able to start outpatient physical therapy around one month after the PAO. Most patients use crutches for two months post-surgery. After the hip has healed, most patients are able to return to their highest previous level of activity.
Your long-term outlook depends on the severity of your labrum tear. For many patients, minimally-invasive hip arthroscopy successfully relieves symptoms and improves hip function. If you have hip dysplasia or another underlying hip condition, your doctor will talk with you about the long-term results of surgery and any additional treatments you may need in the future.
The Child and Young Adult Hip Preservation Program at Boston Children’s Hospital has a long tradition of excellence in treating children and adults with hip labral tears and other hip disorders. We approach each patient’s condition and injury as unique and base our clinical decisions on each patient’s situation. Whenever possible, we take a non-surgical approach to our patients’ hip conditions. When a patient does need surgery for a serious hip labral tear, our surgeons are recognized across the globe for excellence in hip arthroscopy and other surgical repairs.
As the first program in the country to focus specifically on hip disorders in children and young adults, we are experts in diagnosing and treating hip pain so our patients can return to the activities they enjoy.