Acetabular Labral Tear

Definition/diagnostic criteria An acetabular labral tear is a tear in the ring of cartilage (labrum) that surrounds the socket of the hip joint. The labrum increases the stability of the joint and acts as a shock absorber. Diagnostic criteria for an acetabular labral tear typically involve clinical evaluation and imaging, with magnetic resonance imaging (MRI) being the most definitive diagnostic tool, often enhanced by the use of intra-articular contrast (MR arthrography).

Epidemiology This condition is relatively common among athletes, particularly those participating in sports requiring repetitive hip flexion or pivoting movements. However, it can also occur in the general population, often due to structural abnormalities of the hip, trauma or degenerative changes. The exact prevalence in the UK is not well defined but is believed to be higher in females and in the 20-40 age group.

Diagnosis
Clinical features Patients with an acetabular labral tear often present with groin pain, which may radiate to the front of the thigh. The pain is typically exacerbated by prolonged sitting, walking, or activities involving hip rotation. A clicking or catching sensation in the hip may also be reported. Physical examination may reveal a reduced range of motion in the hip, particularly during internal rotation, and pain upon performing the impingement test (flexion, adduction, and internal rotation of the hip).

Investigations: Initial investigations usually start with plain radiographs to assess for any bony abnormalities. However, the mainstay of diagnosis is an MRI scan, preferably with intra-articular contrast (MR arthrography), which can reveal labral tears and associated chondral lesions. Ultrasound may also be used but is less sensitive than MRI.

Treatment Treatment options vary based on the severity of the tear and the patient’s symptoms. Initial management usually involves conservative measures such as activity modification, physiotherapy, and pain management with non-steroidal anti-inflammatory drugs (NSAIDs. Intra-articular steroid injections may also be considered for pain relief. If conservative measures fail, arthroscopic surgery to repair or debride the torn labrum may be considered. This approach is often reserved for patients with persistent symptoms and significant functional impairment.

Prognosis The prognosis for an acetabular labral tear varies. Many patients respond well to conservative management, with improvements in symptoms and function. However, some may have persistent symptoms that require surgical intervention. Post-surgical outcomes are generally positive, with most patients experiencing a reduction in pain and improvement in joint function. Long-term prognosis is dependent on several factors, including the extent of the tear, associated hip abnormalities, and the patient’s age and activity level.