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What is the Labral Structure of the Hip Joint?
The labral structure in the hip joint is a cartilage-like structure found on the edge of the hip socket (acetabulum). The labrum is located where the joint cartilage ends and is structurally different from the joint cartilage.
The labrum deepens the joint by lying on the bony edge of the acetabulum and, together with the hip socket, forms a bed for the head of the femur (femoral head), serving multiple functions such as helping to keep the hip joint in place (stability). The labral structure in the hip joint is functionally similar to the meniscal tissue in the knee joint and the labral tissue in the shoulder joint.
How Do Hip Labral Tears Occur?
Hip labral tears most often occur after recurring minor traumas or high-energy traumas such as traffic accidents. In some patients, there is no history of trauma or sports activity. In these cases, the tear is due to wear and tear (degenerative tear). These patients may also have hip joint impingement (femoroacetabular impingement) or hip joint arthritis.
Who is Most Prone to Hip Labral Tears?
Athletes who play sports that require sudden stops and turns, such as soccer, basketball, and skiing.
Athletes who need a high range of motion in their hip joint, such as those involved in karate, taekwondo, and yoga.
It can also occur after high-energy trauma like traffic accidents, or as a result of injuring the hip joint due to tripping on a rug at home.
What are the Symptoms of a Hip Labral Tear?
Groin pain that usually worsens with prolonged standing, sitting, or walking.
A feeling of locking or clicking in your hip joint.
Limited motion in the hip joint.
How is a Hip Labral Tear Diagnosed?
A detailed medical history and physical examination can raise suspicion of a labral tear, which is then diagnosed using an MRI imaging method specifically targeting the labral structure. In some patients, the underlying cause of unexplained groin pain is a labral tear. These patients' standard hip MRIs may be normal. The labral tear is diagnosed with an MRI specifically targeting the labral structure. The patient's pain relief after a local anesthetic is applied to the hip joint under ultrasound guidance is also investigated. If the pain subsides, intra-articular problems such as labral tears are focused on.
What is the Treatment for a Hip Labral Tear?
The treatment of a hip labral tear depends on the severity of the symptoms. Some patients benefit from non-surgical solutions, while others benefit from labral repair with hip arthroscopy.
Non-surgical Treatment for Hip Labral Tear
Physical therapy is started with the aim of regulating activities, strengthening core, and hip region muscles.
Injection Treatment for Hip Labral Tear
The goal is to repair the tear by injecting platelet-rich plasma, stem cells obtained from adipose tissue or bone marrow, both into the tear and inside the hip joint under ultrasound guidance.
How is Hip Labral Tear Surgery Performed?
Hip labral tear surgery is performed using a minimally invasive technique called hip arthroscopy. To perform this procedure, appropriate instruments and a traction table are required to stretch and open the leg during surgery, as the natural state of the hip joint is narrow. A camera is inserted into the joint to check for any intra-articular problems. Some tears can be seen from inside the joint. Additionally, it is determined whether there is impingement (cam-type impingement) in the neck part of the femur bone.
Once the tear is detected, the bone structure behind the tear is checked to see if it causes an extra protrusion (pincer-type femoroacetabular impingement). The tear is then sutured to the bone using special stitching instruments. Bone protrusions causing impingement are filed down at the same time. In some patients, the labrum may be too worn to hold stitches. In such cases, the worn labrum is cleaned, and a new labral tissue is formed using a tendon just above the labrum or a band (iliotibial band) taken from the outer part of the leg (reconstruction surgery).
Postoperative Process for Hip Labral Tear Surgery
If stitches have been placed in the labrum, the patient is instructed to use crutches for approximately 4-6 weeks after surgery to avoid putting weight on the area. The sutured labral tissue integrates with the bone and heals naturally during this time frame.
