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Acetabular labral tears

Acetabular labral tears as the name implies are tears involving the acetabular labrum of the hip.  

With the increasing use of hip arthroscopy in orthopaedic surgery since the nineteen-seventies, pathologies of the acetabular labrum as a possible cause of chronic hip and groin pain have become more familiar to a wider medical audience.

Epidemiology

Acetabular labral tears are not infrequent. They are found in 55% of arthroscopies for intractable hip pain1.

Clinical presentation

  • pain on weight-bearing, flexion and internal rotation.
  • microinstability, painful audible clicking, transient locking, giving way of the hip.
  • mismatch between clinical symptoms and radiographic findings.
  • delayed diagnosis.
  • long-standing labral tears contribute to premature osteoarthritis1&2.

Aetiology

Major trauma (e.g. hip dislocation) may cause a labral tear.
However, there is no history of previous trauma in most cases.
Structural osseous abnormalities are often found3&4.

Radiographic features

Frequent associations
Plain film - CT
  • normal appearance in most cases
  • structural skeletal abnormalities
  • osteoarthritis (advanced cases)
MRI
  • may show perilabral cysts or advanced cartilage lesions.
  • labrum integrity can be assessed only in the presence of joint effusions.
  • intrasubstance high T1 or PD signal is not considered as pathologic.
  • high T2 signal may be interpreted as mucoid or cystic degeneration.
Direct MR arthrography
  • most accurate imaging study (91vs 36% on native MRI).
  • minimally invasive compared with arthroscopy.
  • highly diluted intra-articular Gd-injection (0.0025 mmol/ml) with joint distension (10-20 ml) allows optimal assessment of the labrum on fatsat T1 sequences.
Normal findings
  • triangular cross-section
  • rounded/flattened labral cross-section
  • perilabral cleft
  • insertional cleft on transverse ligament
  • communicating iliopsoas bursa (15%)
Controversial findings
  • absent antero-superior labrum
  • sublabral sulcus
Pathologic findings
  • Labral tears (marked by intrasubstance contrast entry)
    • longitudinal
    • bucket handle
    • flap
    • radial
    • cleavage
    • labral detachment
  • cartilage delamination
  • loose bodies1

Treatment and prognosis

Acetabular labral tears are the main indication for hip arthroscopy.
Partial labrectomy and labral repair are the current surgical options.
Preliminary scientific data suggest that labral repairs can heal and patients can expect both symptomatic and functional improvement. However, valid prospective studies are needed to determine the long-term outcome of labral repair 5-6.

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