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Labral Tear

The hip joint is a so called ball joint which is guided by the acetabulum, this allows a full movement at all three levels. Disorders in the hip joint area can be a result of femural head or acetabulum misalignments and will become noticeable through load-independent pain.

Besides hip joint abrasion (arthrosis) other deteriorations and diseases of the periaticular area must be kept in mind. After thorough examination a labrum injurie is a common diagnosis.
The labrum encloses the hip joint and protects the edge of cartilage. Besides the enlargement of the articular surface the labrum stops the synovia from leaving the joint line. This enables you a low-frictioning movement and counteracts premature deterioration.

In case of repeated labrum damage due to misalignments, a loss of continuity in the labrum can result (Figure 1 and 2). Similar to a torn meniscus inside the knee joint. Due to neural supply labrum damages distinguish themselves during irritatiangly load or certain movement. Most of the labrum damages are located in the anterior acetabuluar area (62-92%), as a result the pain can already appear during seating position inside the groin.


Figure 1 (left): Degenerative labrum damage at the anterior acetabulum
Figure 2 (right): From the acetabulum loosened labrum

If pain appears, there often is a mechanical problem , in addition to the initial labrum damage this can lead to an detachment and exporsure of the cartilage (Figure 3).
At the same time, due to increased pressure and shearing forces, premature deterioration and hip joint arthrosis occur.


Figure 3: From the acetabulum detached cartilage, due a labrum damage with Cam-Impingement

Besides the clinical examination the MRI is used by suspicion about labral tear. Prior the MRI, a contrast medium is asministered into the hip joint (MR-Arthrography). This technique leads to a more precise diagnosis then the normal MRI (Figure 4).


Figure 4: MR-Arthrography: Labreal tear inside the hip joint

In case of labral tear there is only a small chance of success for conservative treatment, surgical treatment should therfore be prefered. If there is no huge hip joint misalingment the treatment normally takes place in the course of an arthoscopy. Depending on the defect, a smoothing too a removal of degenerative labral pieces or a reconstruction of the torn part due a suture will be carried out.

The follow-up treatment depends on the extent of the damage and the surgical treatment. In most of the cases a full load combined with physiotherapeutic treatment is directly possible.
Furthermore studies have shown that this kind of tretament reduces the pain in most of the cases. Bryd et al. showed that there is a number of very good to exellent results (87%).

As a consequence the arthroscopic treatment of labral tear is the method of choice which will help you to get better in a short of time.

Arthroscopic suture of labral tear inside the hip joint
(Source: courtesy of Fa. Arthrex Inc.)