Displaced acetabular labral tear

Case contributed by Dr Henry Knipe

Presentation

Fell from a bike onto the right side. Increasing severe right pain.

Patient Data

Age: 50 years
Gender: Male

Mild acetabular rim edema.  Mild cam morphology with a small synovial herniation pit. Large partially circumferential anterosuperior to posteroinferiorly labral tear with a large displaced fragment posterosuperiorly with adjacent soft tissue edema. No paralabral cyst. Hip cartilage is preserved. Small hip joint effusion. 

Extensive tenoperiosteal edema of gluteus minimus. Gluteus minimus tendon demonstrates a partial interstitial tear of the distal free tendon. Partial tear/strain of the anterior gluteus medius tendon insertional fibers. Muscle belly edema of tensor fascia lata with peripheral fiber disruption. Large proximal lateral thigh myofascial edema/fluid collection. Effusion of the trochanteric bursa.

Tendinosis and chronic partial tears of the hamstring origin complexes bilaterally. 

Case Discussion

Isolated traumatic labral tears (without cartilage or bone injury) are uncommon. They are most common posteriorly, as in this case. These often occur in cases of subluxation/dislocation, although features of instability is not apparent on this MRI and the mechanism is uncertain.  

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