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Acetabular Labral Tears

The hip is one of the largest joints in the human body and is a ball-and-socket joint. The ball is the femoral head, which is the upper end of the femur (thighbone). The socket is formed by the acetabulum, which is part of the large pelvis bone. The bone surfaces of the ball and socket are covered with articular cartilage, a smooth, white connective tissue that enables the bones of a joint to easily glide over one another with very little friction allowing easy movement. Large ligaments (tough bands of tissues) connect the ball and the socket in order to stabilize the joint by preventing excessive movement.

Overview

The acetabular labrum is a ring consisting of fibrous cartilage and dense connective tissues surround the femoral head. The acetabular labrum acts like a gasket or seal to help hold the femoral ball at the top of the thighbone securely with the acetabulum socket. The exact function of the labrum is a topic for discussion, however, it is thought to aid in the stability of the hip as well as decrease the stress placed on the hip joint as well as the acetabular cartilage. The labrum is susceptible to damage, tearing, or injury as a result of a traumatic event. Athletes participating in sports such as soccer, football, golf, or ice hockey or individuals with abnormal structure of the hips are at a higher risk of developing a hip labral tear.

Symptoms

Individuals who have experienced a labral tear may have the following symptoms:

  • Pain in the front of the hip after prolonged sitting or walking
  • Pain in the buttock and the side of the thigh
  • Locking, clicking, or catching sensation in the hip joint
  • Restricted or limited range of motion associated with hip stiffness

If symptoms worsen or do not improve within four to six weeks of initial pain and more-conservative treatment such as medication, rest, and physical therapy. It is highly recommended to visit a physician to rule out any other causes and avoid further damage.

Diagnosis

Making the diagnosis of a labral tear requires a thorough history, physical examination, as well as imaging studies. After gathering information about the individual's general health and the extent of his or her hip pain and how it affects their ability to perform day-to-day activities, the physician may examine the hip to assess the motion to check for pain and range of motion. Very rarely, do labral tears occur in isolation; therefore, the physician may order X-rays to check for fractures and structural abnormalities in the hip joint or an MRI scan to determine the condition of the tissues and bones of the hip. A colored, fluid dye may be injected into the joint space prior to your MRI scan to better define a labral tear, should one exist. After a thorough analysis, the physician will recommend the appropriate course of treatment.

Treatment

Treatment will heavily depend on the severity of the individual's conditions. Often, symptoms subside with more-conservative non-operative treatments. However, if that fails, the physician may recommend an arthroscopic hip surgery to remove or repair the torn portions of the labrum.

Rest - It is advised to decrease or completely stop the activity that makes the pain worse. A great way to stay active while allowing the symptoms to subside is to switch to low-impact, cross-training activities such as biking or swimming.

Medication - Over-the-counter medication such as ibuprofen and naproxen usually help reduce pain and swelling. If these are deemed insufficient by your physician, they might prescribe stronger medication to relive pain and reduce inflammation.

Physical Therapy - Physical Therapists will often prescribe specific strengthening and stretching exercises that promote healing and strengthening of the hip joints.

Surgery - If symptoms persist for more than eight to eight weeks of non-operative treatment, an arthroscopic surgery may be deemed necessary. During the procedure, an arthroscope, which is a small, flexible tube with a camera attached, is inserted into the hip joint. Two or three small incisions, called portals, are made to allow the scope and other surgical instruments to enter through a narrow space between the femoral head (ball) and the acetabulum (socket). Once inside, the physicians will examine the labrum and either repair or trim portions of the torn labrum. The physician will also examine the articular cartilage and other soft tissues that surround the hip ball-and-socket joint to identify any inflammation, loose bodies, bone spurs, etc. and make any necessary repairs removing loose fragments of cartilage or lining or removing painful bone spurs. Once all the repairs are made, the incisions are closed with sutures, steri-strips, or small bandages and the procedure will be completed.

Recovery

Recovery with more-conservative treatment will vary based on the extent of the damage and the severity of the individual's symptoms. Hip arthroscopy often results in a quick recovery process as symptoms often improve immediately following the procedure. Swelling generally subsides within a week and the sutures will either dissolve or be removed in seven to ten days. The time of recovery will depend on the severity of the labral tear. Regardless, a physical therapist will provide instructions on the specific exercises to strengthen the leg and restore hip movement to allow for walking and other activities post operatively. Each patient is unique, so the recovery period will vary depending on the level of activity the individual hopes to return to; this should be discussed with the physician as well as the physical therapist.

 

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