Hip Labral Tear: Difference between revisions
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The acetabular labrum seals the central hip joint from the periphery, keeps the synovial fluid within the central compartment, and creates a negative pressure within the joint. The negative pressure helps to resist subluxation of the femoral head and increases stability. Any disruption of the labrum can negatively affect articular cartilage health and joint stability. | The acetabular labrum seals the central hip joint from the periphery, keeps the synovial fluid within the central compartment, and creates a negative pressure within the joint. The negative pressure helps to resist subluxation of the femoral head and increases stability. Any disruption of the labrum can negatively affect articular cartilage health and joint stability.<ref name="uptodate">Johnson, R. Approach to hip and groin pain in the athlete and active adult. In: UpToDate, Post, TW (Ed), UpToDate, Waltham, MA, 2020.</ref> | ||
There are two general mechanisms of injury to the acetabular labrum. | There are two general mechanisms of injury to the acetabular labrum.<ref name=uptodate/> | ||
#A single event of significant trauma. This normally involves forced resistance of hip flexion while kicking or running (for example in Rugby). | #A single event of significant trauma. This normally involves forced resistance of hip flexion while kicking or running (for example in Rugby). | ||
#Repetititve injury and microtrauma in an osteoarthritic, dysplastic hip or in a hip with [[Femoroacetabular Impingement|FAI]]. | #Repetititve injury and microtrauma in an osteoarthritic, dysplastic hip or in a hip with [[Femoroacetabular Impingement|FAI]]. | ||
Pathology normally occurs in the weightbearing anterosuperior aspect of the labrum.<ref name="uptodate"/> This is thought to be due to the decreased thickness anteriorly, the rate of anterior impingement in FAI, and based on functional activities such as with repetitive twisting and pivoting.<ref name="brukner">Brukner. Clinical Sports Medicine. 4th Edition. McGraw-Hill. 2012</ref> | |||
==Epidemiology== | ==Epidemiology== | ||
Labral tears are present in 22% of athletes with groin pain and 55% of those with mechanical symptoms. | Labral tears are present in 22% of athletes with groin pain and 55% of those with mechanical symptoms.<ref name="brukner"> | ||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 18:01, 14 July 2020
The acetabular labrum seals the central hip joint from the periphery, keeps the synovial fluid within the central compartment, and creates a negative pressure within the joint. The negative pressure helps to resist subluxation of the femoral head and increases stability. Any disruption of the labrum can negatively affect articular cartilage health and joint stability.[1]
There are two general mechanisms of injury to the acetabular labrum.[1]
- A single event of significant trauma. This normally involves forced resistance of hip flexion while kicking or running (for example in Rugby).
- Repetititve injury and microtrauma in an osteoarthritic, dysplastic hip or in a hip with FAI.
Pathology normally occurs in the weightbearing anterosuperior aspect of the labrum.[1] This is thought to be due to the decreased thickness anteriorly, the rate of anterior impingement in FAI, and based on functional activities such as with repetitive twisting and pivoting.[2]
Epidemiology
Labral tears are present in 22% of athletes with groin pain and 55% of those with mechanical symptoms.Cite error: Closing </ref> missing for <ref> tag Physical therapy is the mainstay of conservative management. Strengthening of the pelvic girdle can aid in stabilising the hip joint, correct abnormal pelvic tilt, and rectify abnormal load on the labrum.
Arthroscopic surgery can be considered upon failure of conservative management. Where possible the labrum should be restored rather than excised in order to restore normal hip joint function.
