Hip Labral Tear Recovery Without Surgery

The hip joint is a ball-socket joint with the acetabulum being the shallow socket. The labrum is a ring of fibrocartilage and connective tissue attached to the acetabulum. The labrum provides support to the hip, deepens the shallow joint and increases the surface area of the acetabulum by 28% (1). Tears in the hip labrum can occur as a result of direct trauma and activities that require external rotation such as soccer, hockey, and golf. Unfortunately, up to 74% of all hip labrum tears are not associated with any known specific cause or event (2). Labral tears are reported more in females than males (3). The significance of a hip labrum tear has recently been questioned. Why? Research has shown that hip labrum tears are present in patients without hip pain (4) In one study, 69% of patients without hip pain had labral tears (5).

The hip labrum can only heal itself in the very young (6). As discussed above, labral tears are oftentimes present in patients without hip pain. The mere presence of a labral tear on MRI does not necessitate treatment. If you have a labral tear on MRI but have no pain or restriction in range of motion, no treatment is necessary. If pain and restriction in range of motion exist an evaluation is appropriate. The stability of the hip joint, the presence or absence of lumbar disc disease, lumbar nerve irritation, gluteal tendon inflammation, iliotibial band dysfunction, and SI joint instability are all important sources of hip pain and warrant examination. An Interventional orthopedic physician will provide a thorough evaluation and discussion of nonsurgical options. To learn more about interventional Orthopedics click on the video below.

No! In one of the largest high-level studies to date comparing hip arthroscopy to physical therapy, there was no difference between the outcomes of the two groups (7). In another study where many research investigations were summarized, while patients reported earlier pain improvements with surgery, there were indications that the patients who had surgery did worse on residual hip pain and function in the long run (8). First-line therapy should be activity modification and physical therapy. PT goals should include pain reduction, trunk stabilization, muscular strengthening and improved range of motion. A recent study demonstrated that physical therapy was effective in reducing pain and improving function in patients with labral tears (9).

Hip labral surgery involves the insertion of a small camera and instruments into the small, tight hip joint. To accomplish this the patient is placed on a traction table with the affected leg pulled partially out of the socket. Not surprisingly the most common complication of hip labrum surgery is nerve damage with an incidence of 16.5 % (10).

Activity will be dependent upon multiple issues which include range of motion, presence or absence of pain, hip osteoarthritis, hip bone spurs, lumbar disc injuries, and irritated spinal nerves. Evaluation by a physician trained in Interventional Orthopedics is best and will provide guidance on the level of activity and nonsurgical treatment options.

Cortisone is a steroid that is a very powerful anti-inflammatory medication. While a cortisone shot may reduce inflammation it is very toxic to cartilage (11). In addition, a 2014 study demonstrated that cortisone injected into patients with hip pain and who had labral tears was of limited benefit (12).

The hip labrum is a ring of fibrocartilage and connective tissue that is attached to the hip socket. It provides important support to the hip and is susceptible to injury. Hip labrum tears can present in patients who have no hip pain. Labral tears that are symptomatic should be evaluated by a skilled Interventional Orthopedic physician who will evaluate other possible sources of hip pain which include tendon, ligament, disc, and SI joint dysfunction. Cortisone is a steroid that is a powerful anti-inflammatory agent but is toxic to cartilage and provides little benefit to patients with labral tears. Hip labral tear recovery without surgery is possible. PRP and bone marrow-derived stem cells are an effective alternative to steroids and surgery.

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