Update on Evidence-Based Diagnosis and Treatment of Acetabular Labral Tears
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SPORTS MEDICINE REHABILITATION (B LIEM AND BJ KRABAK, SECTION EDITORS)
Update on Evidence-Based Diagnosis and Treatment of Acetabular Labral Tears Steven A. Makovitch 1
&
Catherine A. Mills 1 & Christine Eng 1
Accepted: 22 September 2020 / Published online: 13 November 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review This paper aims to assess the pathophysiology, diagnosis, and latest evidence-based treatment of acetabular labral tears. Recent Findings The acetabular labrum contributes to the stability of the hip. Labral tears may lead to significant pain and disability, although many are asymptomatic. Imaging and intra-articular injections are often required in addition to standard history and physical examination for accurate diagnosis. Most patients will benefit from initial conservative treatment, but those requiring surgical intervention may have better outcomes with labral repair over debridement. If the labral tear is irreparable, reconstruction is favored. There is still conflicting evidence regarding the efficacy of surgical versus non-surgical treatment likely due to heterogeneity of pathology, patient activity, and lack of long-term follow up. Summary The approach to management of acetabular labral tears starts with confirming the labrum as the primary pain generator. Most patients benefit from initial conservative treatment. Ultimately, the decision for surgical treatment is dependent on correct patient selection. Those patients who are youger, with bony morphologic changes, a higher activity level, an isolated labral tear without significant cartilage degeneration, and good response to intra-articular diagnostic injection will likely have better outcomes with surgical treatment. Keywords Hip pain . Hip labrum . Acetabular labral tear . Arthroscopic Labral repair
Introduction The acetabular labrum contributes to the stability of the hip joint by increasing the articular surface of the joint and the depth of the acetabulum and creating a suctionseal effect on the femoral head [1–4]. While acetabular labral tears are prevalent in both symptomatic and asymptomatic individuals, the prevelence is slightly higher in symptomatic individuals (62% compared with 54%) and may be correlated with age and degenerative changes [5–7•]. In the younger population, labral tears are highly
This article belongs to the Topical Collection on Sports Medicine Rehabilitation * Steven A. Makovitch [email protected] 1
Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, 300 1st Avenue, Charlestown, Boston, MA 02129, USA
prevalent in athletes and are often associated with bony abnormalities of the acetabulum or femoral head [3, 4, 8]. It is proposed that when the labrum is torn, the stability it offers to the hip joint is lost, resulting in a heavier burden on the surrounding muscles, tendons, and ligaments [8–10]. This may result in pain not only to the hip joint but also to key surrounding structures. As such
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