Injuries to the hip and groin are common among athletes who participate in sports involving pivoting, cutting, and twisting. Many acute injuries involve a strain of structures around the hip and will resolve over time with proper rehabilitation; however, some injuries will require further treatment. A common cause of hip and groin pain is a hip labral tear. If you are experiencing any symptoms of a hip labral tear, we welcome you to reach out to AICA to ensure that you receive any additional care that you may need as well as an effective treatment plan for your hip injury.
What Is a Hip Labral Tear?
A labral tear of the hip is an injury to the labrum, a ring of cartilage on the socket part of your hip joint. The hip joint is composed of the ball, which is the top of the femur, and the socket, which is part of the pelvis. Your labrum helps keep the bones of the hip joint aligned as you move and helps to keep the joint fluid inside the joint.
The severity of labral tears can vary. Hip labrums can have small tears or fray at the edges, typically as a result of gradual wear in the labrum. In other instances, a section of the labrum can separate from the socket bone, typically as a result of trauma.
Depending on which part of the joint is impacted, doctors sometimes describe a labral tear as either anterior or posterior. An anterior tear is when the tear occurs on the front of the hip joint, and a posterior tear is when the tear occurs on the back of the hip joint. An anterior hip labral tear is the most common type of hip labral tear; however, a tear can occur anywhere along the labrum.
Causes of a Hip Labral Tear
A variety of things can cause hip labral tears, including repetitive hip motions and hip overuse, regular wear and tear of the hip, structural ailments, injury, and degenerative health conditions. Structural ailments and conditions that cause abnormal hip movement can also cause labral hip tears. In patients with femoroacetabular impingement (FAI), the femoral head does not properly fit into the socket. This improper fit can lead to movement limitations and long-lasting groin pain. FAI is the most common cause of labral tears. Without treatment, FAI can also lead to osteoarthritis in some patients.
Degenerative health conditions, such as osteoarthritis, can also lead to a hip labral tear. Osteoarthritis is a chronic wearing down of the cartilage between the joints. As this cartilage erodes over time, it becomes increasingly prone to tearing. Higher weight and older age can increase the risk of developing osteoarthritis.
Deformities of the hip joint can also cause hip labral tears. These deformities include hip dysplasia and abnormal bone shape that leads to hip impingement, which can lead to increased stress on the hip labrum.
Hip trauma can also lead to a hip labral tear. People who play sports with repetitive and high-impact movements, including football, soccer, hockey, and golf, are at higher risk for this kind of trauma.
The causes of labral hip tears may also vary depending on where on the hip labrum the tear occurs. Anterior hip labral tears, located on the front of the hip joint, are often caused by repetitive hip movements that are common in sports such as football, hockey, golf, and ballet. Posterior hip labral tears, located on the back of the hip joint, are commonly caused by a traumatic injury such as a fall or high-impact sports injury.
Preventing a Hip Labral Tear
If you engage in physical activities that put a lot of strain on your hips, it’s important to condition the surrounding muscles with strength and flexibility exercises to prevent a hip labral tear. Since hip labral tears are often associated with sports, one of the best ways to prevent them is proper stretching and warming up prior to participating in athletic activity.
Some of the exercises that you can incorporate into your routine to prevent hip labral tears include side-leg raises, donkey kicks, squats, and yoga exercises that stretch and gently condition the lower body. It’s also important to avoid placing your full body weight on your hip when your legs are positioned at extremes of the normal range of motion. Many athletes also train with a professional to ensure proper form when performing their sport.
Symptoms of a Hip Labral Tear
Symptoms of a labral hip tear include hip pain or stiffness, pain in the groin or buttocks area, feeling unsteady on your feet, and a clicking or locking sensation in the hip joint when you move. The pain in the hip or groin area is often made worse by long periods of standing, sitting, walking, or athletic activity. If you have a hip labral tear, the pain or discomfort in your hip may also worsen when you bend, rotate, or move the hip or exercise.
Although hip pain isn’t normally life-threatening, it can significantly impact how you live your life. It is recommended that you see a specialist if these symptoms worsen or do not improve within six weeks. It is also possible to have no symptoms at all with a labral hip tear.
Diagnosis of a Hip Labral Tear
To diagnose a hip labral tear, your healthcare provider will perform a physical exam that will likely include moving your leg and hip joint to check for pain and to evaluate the hip’s range of motion. They may also watch you walk and ask a series of questions regarding the history of your pain and discomfort in your hip.
Oftentimes a hip labral tear will occur with other injuries, so your healthcare provider may use various imaging scans such as X-rays to check for any additional structural problems or arthritis, and a magnetic resonance arthrography (MRA) to get more detailed images of your hip’s soft tissue. MRA uses MRI technology in combination with a contrast material that is injected into the hip to more easily see a hip labral tear. Your healthcare provider may also use an anesthesia injection in the hip joint space to relieve pain. If this injection relieves your pain, it’s possible that there is a problem inside the hip joint.
Treatment of a Hip Labral Tear
Nonsurgical Treatment of a Hip Labral Tear
Your specialist will walk you through the variety of options available to treat your hip labral tear. A hip labral tear will not heal without surgical treatment, but rest and other measures can help manage the symptoms of a tear for years, or sometimes indefinitely, if your hip labral tear is minor and not cot limiting your mobility or causing much pain. Nonsurgical treatments include anti-inflammatory medications, medication injection with medications such as steroids, and physical therapy that focuses on stretching and strengthening the hip muscles. During hip labrum physical therapy, a specialist guides patients through various exercises and proper execution so that patients can also perform these exercises at home. Each physical therapy program is personalized to best fit the needs of the patient.
A specialist may also suggest lifestyle adjustments to minimize discomfort or pain resulting from a hip labral tear. Sometimes weight loss is recommended to reduce the amount of weight and stress on the hip joint during activity. Other patients may need to change their activity and fitness routines to reduce the frequency or intensity of activities that can cause hip labral tear symptom flare-ups.
Surgical Treatment of a Hip Labral Tear
If your hip labral tear is severe or if symptoms persist, your specialist may recommend surgery. The majority of surgeries for hip labral tears are done arthroscopically. Arthroscopic surgery is a minimally invasive surgery in which the doctor makes small incisions and uses miniature instruments during the procedure. Arthroscopic procedures offer patients much faster recovery times and less post-surgery pain and swelling compared to open surgeries. Depending on the cause of the tear, the doctor may use methods including refixation, debridement, and/or reconstruction.
During an arthroscopic hip labrum procedure, small incisions are made around the hip joint. A small camera is then inserted by the surgeon into one of the incisions to give visual access to the joint. A series of instruments are used to remove any frayed or damaged parts of the labrum and to shave or remove any excess bone growths or loose fragments.
If the hip labral tear is a result of osteoarthritis, the treatment will focus on restoring function to the joint. If the osteoarthritis is severe, a specialist may recommend a partial or total joint replacement.
Surgical Reconstruction Treatment of a Hip Labral Tear
If a hip labral tear cannot be corrected with traditional repair or debridement, a doctor may recommend a reconstruction. The key difference between a hip labrum that can be repaired and one that requires reconstruction is the amount of undamaged tissue remaining. If there is too little labral tissue, the labrum cannot make a sufficient seal between the ball and socket in the hip. If there is too much labral tissue, the tissue can get in the way and prevent the necessary compression to provide a tight seal between the ball and socket in the hip. The ideal amount of tissue is determined on a case-by-case basis. A labral reconstruction is a relatively new procedure and is not considered a standard treatment.
During a hip labral reconstruction, a graft is used to reconstruct the torn and damaged part of the hip labrum. Graft options are selected after a review of a patient’s hip anatomy and medical history. Doctors may use an allograft or an autograft. An allograft is a soft tissue that is generally from a donor’s iliotibial band. Normally the donor is a relatively young, healthy person. An autograft is a tissue from another part of the patient’s own body. The autograft is typically taken from a hamstring tendon or the iliotibial band.
Your healthcare provider will decide whether to reconstruct the entire hip labrum or just the damaged portion, depending on how much healthy tissue is left. Some providers find it better to preserve as much of the native tissue as possible and to replace only the damaged portion of the hip labrum, creating junction points between the native hip labrum and the graft. Other providers may find that the junction points could potentially have a negative effect on the suction seal with the hip’s femoral head and will reconstruct the entire hip labrum to ensure a tighter seal.
Recovery for a Hip Labral Tear
If surgery is required for your hip labral tear, recovery times may vary depending on your procedure. Patients who have had a hip arthroscopy may begin walking unaided within two to three weeks. Patients who have had an open surgery typically take about six weeks to begin walking unaided. Typically your specialist will refer you to a physical therapist to begin exercising your hip to restore the range of motion and strengthen the joint in the hip.
In most cases, full recovery typically occurs within six months, and patients are normally able to return to physical activity and athletic pursuits. If a hip labral reconstruction fails to properly heal, an additional procedure or a full hip replacement may be necessary. Your provider will work with you to determine the best recovery plan for your hip labral tear.
Get Treated Today
Visit AICA Orthopedics to learn more about how our team of doctors can help you receive a proper diagnosis and provide you with an effective treatment plan for your hip labral tear. Our specialists will talk you through all of your options for your injury, and our orthopedic doctors will help you determine what treatment will work best for you. We also have physical therapists who work alongside our orthopedic surgeons and other specialists to ensure that you receive quality, comprehensive care as you recover. Call or visit us online to get started at an AICA Orthopedics location near you.