Hip Labral Tear - Anca & Bacia

Labrum lesion

Morphological, functional, post-traumatic and degenerative alterations

Key concepts

The acetabular labrum is a fibrocartilaginous structure that surrounds the hip joint almost in its entirety. Its functions are to increase stability, to promote proprioception (to signal to the brain its location in space without having to look at it) and seal the joint by creating negative pressure internally.

The labrum (hip meniscus) is a highly innervated and poorly vascularized structure, which can lead to pain if there is any injury to its structure, and it is very difficult to heal per se. Normally the injury occurs due to a chronic cumulative impact and in hips with certain morphological characteristics which predispose to femoral-acetabular conflict.

What causes it?

Impact and rotation sports are associated with an increased possibility of acetabular labrum injury. This injury is common in martial arts practitioners, yoga, footballers, hockey players and dancers.

How does it manifest?

The complaints are varied and can start during sports practice or not. Pain is the cardinal symptom and is generally in the anterior (inguinal) or lateral (gluteal) part of the hip. It can course with rebound, click or block of the joint. In more symptomatic cases, it may also lead to walking claudication.

Diagnosis is made on the basis of a specific clinical examination and with the use of auxiliary diagnostic tests. The morphological study is done through simple X-rays in specific positions. The articular study is done using magnetic resonance to assess the labrum, cartilage tissue and other articular and peri-articular structures. Computed tomography may be used for a more detailed study of the bone morphology of the hip and pelvis.

How is it treated?

The initial phase of treatment consists of reducing sports activity and using analgesics and anti-inflammatories. Physiotherapy should be started in this phase and its main objectives are to strengthen periarticular muscles and improve proprioception. Physical activity should be reduced and movements which cause pain should be avoided, as well as hyper amplitude of joint movement (hyper flexion and abduction).

When conservative treatment fails, there may be room for a surgical procedure, through arthroscopy. This technique consists of introducing a small camera into the hip joint through 3 small incisions of 1 cm each, followed by malleable instruments that allow the treatment of the labrum by suturing or reinserting it. During arthroscopy, the joint is thoroughly examined for other lesions that may be associated with the labral lesion, such as cartilage defects, femoral head ligament (round ligament) or loose bodies inside the joint. It is also performed the correction of the anatomic bone defect (osteoplasty) between the femoral neck/head transition and the acetabular cavity to treat the femoral-acetabular conflict as the cause of the labrum lesion.