Knees and Hips
Labral Tears FAQ
Where is the labrum and what is it?
There are two types of cartilage in the hip. One is the surface cartilage, and the other is the labral cartilage. The labral cartilage actually runs along the rim of the socket. The labrum has been known for quite some time as a piece of anatomy, but also is a source of pain when torn. Access to the hip space is somewhat difficult because it is surrounded by a variety of muscles, tendons and ligaments; therefore it’s deep inside the body compared with other cartilage tears such as a meniscus in the knee.
What are some of the symptoms of a labral tear?
Many of our patients have had symptoms for years and oftentimes have had other diagnoses for their pain. The labrum is a deep cartilage structure, so being located around the hip joint, a labral tear can be confused with many other potential sources of pain. Common symptoms include back problems, disc problems, occasionally intra-pelvic problems – ovarian type pain symptoms. Sometimes, something as simple as a misdiagnosed leg length discrepancy can be confused with a labral tear.
Why does the cartilage tear?
There are a couple of theories as to why the labrum tears. Typically speaking, these tears are a few millimeters in length, but they may be a few centimeters. One of those theories has to do with the idea that the cartilage is taking more pressure than normal, and that has to do with the way that the socket is shaped. Other theories purport that labrum is pinched inside the joint, so it’s getting caught in between the ball and the socket as the hip joint moves. A third theory is that the cartilage is actually sheared off, causing a friction force on the inside and that the labrum fails. A fourth theory has to do with as we age, our tissues become more susceptible to injury and therefore it tears based on an age-related mechanism.
What surgical procedures(s) are used to fix the tear?
The surgery itself is an outpatient procedure and is typically done through two incisions about the size of a dime. Labral tear surgery may take on average, between two to four hours, depending on the amount of work that needs to be done. The primary goal of the surgery is to safely enter the hip joint, identify what is the suspected problem, which often involves the labral cartilage tearing, and then to repair the anatomy. At the same time, in addition to restoring the anatomy, surgeons try to remove any bad mechanics of the hip. If there is too much abnormal rubbing inside the joint, the surgeon will, through the same incisions, change the shape of the bone slightly to allow a patient’s hip to have a more natural motion.
Is surgery the best option or the only option?
Patients have a choice because this is not a life threatening condition, but it may affect their lifestyle. Often, by the time patients are presented, they are looking for a more definitive solution. Many patients have tried non-operative treatments. At Wake Forest Baptist, we do present the non-operative options, which include activity modification, and occasionally, anti-inflammatories or pain management. Injections may also be beneficial. Oftentimes, rehabilitation is another possibility and is not eliminated as a treatment option. Surgery is reserved for patients that have pain refractory to non-operative treatment.
How long is the recovery time?
Recovery time is approximately three to four months, and it ultimately is determined by how much work needs to be done and how much healing needs to occur before the patient can be allowed to return to activities. The ultimate goal of the procedure is to diagnose the problem, effectively treat it and then actually allow people to return to the activities that they enjoy.
What are the potential benefits to patients?
The procedure can be a life changing procedure for the better, as far as improving quality of life. The goal of a hip arthroscopy may be to delay or prevent a total hip replacement. The procedure is also minimally invasive, providing patient benefits of less scarring, less pain and shorter recovery periods than comparable open surgery.