Acetabular labral tears

Right now, you probably have lots of questions: How serious is an acetabular labral tear? What’s the best treatment? What do we do next? We’ve provided some answers to your questions on this site, and our experts at Children’s Hospital Boston can explain your child’s condition fully when you meet with us.

Background: the normal hip joint

The hip joint is one of the body's most reliable structures, providing people with movement and support without pain or problems in most people for a lifetime. The hip’s simple ball-and-socket anatomy—with the ball-shaped femoral head rotating inside a cup-shaped socket called the acetabulum—usually works well with amazingly little friction, and little or no wear. with amazingly little friction, and little or no wear.

The well-fitting surfaces of the femoral head and acetabulum, which face each other, are lined with a layer of cartilage, lubricated by a thin film of fluid. Friction inside a normal hip is less than one-tenth that of ice gliding on ice.

What is an acetabular labral tear?

An acetabular labral tear is a tear in the hip joint’s fibrous seal, which normally cushions the joint and provides joint stability and support.

What causes an acetabular labral tear?

An acetabular labral tear is often a gradually developing wear-and-tear injury caused by sports and activities that involve hip rotation, such as hockey, golf, soccer and ballet. It’s rarely the result of direct trauma to the joint. Acetabular labral tears are also associated with underlying problems of the hip, such as Legg-Calvé-Perthes disease, slipped capital femoral epiphysis or developmental dysplasia of the hip. These tears are also usually a feature in hip impingement (femoral acetabular impingement).

What are the signs and symptoms of an acetabular labral tear?

Some signs and symptoms can include:

• a sharp pain in the front of the hip, sometimes shooting down the thigh
• a locking, catching, clicking or giving-way sensation in the hip
• pain when rotating the leg
• pain in the back of the thigh or buttock
• stiffness or limited range of motion in the hip joint

In some cases, a child may not feel any pain.

How common are acetabular labral tears?

An acetabular labral tear is essentially a gradually developing wear-and-tear condition, possibly affecting an up to 22 percent of athletes who report groin pain. It’s more common among athletes whose sports and activities involve rotating and twisting leg motions, such as:

• golfers
• soccer players
• hockey players
• ballet dancers
• football players (especially kickers)
• runners
• sprinters

How serious is an acetabular labral tear?

Over time, an untreated acetabular labral tear can increase stress on the hip joint, causing deterioration and permanent damage to the joint.

Acetabular labral tears can be associated with serious underlying problems of the hip, such as Legg-Calvé-Perthes disease, slipped capital femoral epiphysis or developmental dysplasia of the hip, or as a feature in hip impingement (femoral acetabular impingement). For example, hip impingement can cause significant pain, loss of hip motion and early arthritis, and is treated surgically.

Who’s at risk for developing an acetabular labral tear?

• Girls (especially dancers) and boys can both sustain acetabular labral tears.
  • Children whose sports or dancing involves frequent rotation of the hip, such as golf, soccer, hockey and ballet, can have an increased risk for acetabular labral tears.
  • About 22 percent of athletes who report groin pain have an acetabular labral tear.
• Also at risk for acetabular labral tears are children with pre-existing hip problems, such as:
  • Legg-Calvé-Perthes disease
  • slipped capital femoral epiphysis
  • developmental dysplasia of the hip
• Children with hip impingement (femoral acetabular impingement) usually have acetabular labral tears.

How do you diagnose an acetabular labral tear?
To diagnose an acetabular labral tear, your child’s doctor will take a complete medical and family history (including any hip problems in the family). Your doctor will then conduct a physical exam, and may order imaging tests such as:

• MRI (magnetic resonance imaging): produces detailed images of organs and structures within the body; shows the amount of damage to the labrum and any other parts of the hip, such as cartilage and/or ligaments

• x-ray: to rule out a fracture or other damage to the bone

For details, see Tests.

How does Children’s treat an acetabular labral tear?
Specific treatment for an acetabular labral tear is determined by your child’s doctor based on:

• his age, overall health and medical history
• the type, extent and severity of the tear

Treatment may include conservative approaches such as:

• rest
• activity restrictions
• anti-inflammatory and pain medications
• exercises and physical therapy

The labrum can be a difficult area to heal on its own, because there’s blood supply to only a part of the area. So if the labrum doesn’t heal with above treatments, doctors may perform minimally-invasive arthroscopic surgery. The surgical approach and techniques that your child’s surgeon uses depend on the type of tear, the cause of the condition and the degree of damage that’s occurred.

For details on treatments, see Treatment & Care.

Will my child be OK?

Minimally-invasive hip arthroscopy is very successful in relieving children’s symptoms and improving their hip function as long as there aren’t any underlying anatomic problems around the hip, or as long as any problems that did exist have been corrected.

If there is an underlying hip condition associated with your child’s acetabular labral tear, the long-term result of surgery depends on the amount of damage present at the time of surgery. For example, in a condition such as hip impingement (with its attendant acetabular labral tear), a perfect outcome is possible with early joint-preserving treatments before the cartilage is damaged. But even surgery may not be able to fully repair the impingement if the cartilage has already been severely damaged.

What new research is Children’s doing regarding developmental hip conditions?

Developmental hip conditions such as acetabular labral tears, hip impingement, slipped capital femoral epiphysis, hip dysplasia and Legg-Calve-Perthes disease can lead to premature arthritis in young adults, with resulting pain and disability. Children’s many research studies focus on understanding the mechanical forces (pathomechanics) that adversely change the hip’s structure and function. With better understanding, we can improve existing therapies and develop new therapies for these conditions.

The clinical and basic science researchers at Children’s Orthopedic Center are recognized throughout the world for their achievements in the field. Our breakthroughs mean that we can provide your child with the most innovative care available.

For more on Children’s extensive orthopedic research, see Research & Innovation.