The hip labrum is a ring of cartilage that lines the acetabulum, providing stability, shock absorption, and a suction seal to the hip joint. Tears of the labrum can cause pain, mechanical symptoms (such as clicking or catching), and progressive joint degeneration. Labral tears occur on a spectrum, with underlying causes ranging from impingement to instability, and the best surgical approach depends on addressing the root cause of the injury.

Etiology: Impingement vs. Instability

Impingement-Related Labral Tears

Structural abnormalities such as CAM deformities, subspine impingement, and pincer deformities lead to abnormal contact between the femoral head and acetabulum, resulting in labral damage over time.
Hip arthroscopy is highly effective in treating these conditions by reshaping the bone to eliminate impingement while repairing the torn labrum.
Femoral and acetabular retroversion can contribute to impingement, but these cases are more complex. Hip arthroscopy may help, though it is less predictable in cases where retroversion is severe.

Instability-Related Labral Tears

Some patients develop labral tears due to microinstability, where the hip joint lacks adequate bony support, leading to excessive stress on the labrum.
Causes of instability include acetabular undercoverage (hip dysplasia) and significant femoral version abnormalities (excessive anteversion).
Unlike impingement-related tears, hip arthroscopy alone may not adequately address instability. In cases where bony deficiencies are significant, additional procedures such as periacetabular osteotomy (PAO) or femoral derotational osteotomy (FDO) may be necessary to restore joint stability.

The Procedure

Hip labrum repair is performed arthroscopically using small incisions. The surgeon reattaches the torn labrum to the acetabular rim using suture anchors. If necessary, bony abnormalities contributing to impingement may be corrected at the same time through osteoplasty.

Patient Selection Considerations

Older patients or those with significant hip arthritis have unpredictable outcomes following hip arthroscopy. In these cases, labral repair may not provide durable pain relief, and alternative treatments, including hip replacement, may be considered.
Patients with underlying bony instability should be carefully evaluated, as hip arthroscopy alone may not be sufficient to address their symptoms.

Recovery Process

Initial Phase (0-6 Weeks): Patients typically use crutches and follow a gradual weight-bearing protocol to protect the repair.
Intermediate Phase (6-12 Weeks): Strengthening and mobility exercises focus on restoring stability and biomechanics.
Advanced Phase (3-6 Months): Return to sport and high-impact activities is gradual, with a focus on neuromuscular control.

Risks and Considerations

Potential risks include persistent pain, recurrent instability, incomplete healing, and the need for future procedures if underlying bony issues are not fully addressed.
A comprehensive evaluation, including imaging and functional assessment, is crucial to selecting the right procedure for each patient.

Conclusion

Hip labrum repair is an effective procedure for addressing labral tears caused by femoroacetabular impingement, though outcomes are less predictable in cases of instability or advanced arthritis. If you are experiencing hip pain and mechanical symptoms, contact our office for a thorough evaluation and a personalized treatment plan.

Hip Labrum Repair

Procedures