Recently, more and more athletes are being diagnosed with labral tears or impingement of the hip. This is especially common in athletes who perform repeated hip flexion such as runners, hockey players, soccer players, and football players. It is hard to remember players being diagnosed as having labral tears of the hip 10 years ago, as these were often misdiagnosed as common groin pulls. The use of MRI has greatly improved our ability to diagnose labral injuries.
The hip is a ball and socket joint with the femur, or thigh bone (ball) inserting into the acetabulum, or pelvic bone (socket). Both the ball and socket are covered with smooth articular cartilage. The labrum is an additional, specialized piece of cartilage that runs along the rim of the socket to provide a suction seal and stability to the hip joint. The labrum can be torn with a sudden, specific injury or with repetitive motions that cause ‘wear and tear.’
Labral tears are difficult to diagnose, partially because of the many muscles and other structures that are near the hip joint. It is very common for the diagnosis to be missed for many months after the initial injury. Patients have pain deep in the groin, usually on one side. There will often be a feeling of 'clicking,' 'locking,' or instability of the hip. There may be a feeling of stiffness as well. Physical exam of the hip will often lead the physician specialist to suspect a labral tear, especially if the athlete has pain with rotation of the hip in certain directions. Radiographs and an MRI of the hip help confirm the diagnosis.
Many labral tears may become asymptomatic, and these do not need specific treatment. However, for athletes with persistent pain from labral tears, there are many treatment options. Physical therapy is used to improve hip range of motion and strengthen the muscles around the hip joint. Pain medications such as anti-inflammatories (ibuprofen, advil, motrin, aleve) can be used to decrease inflammation around the labrum and provide pain relief.
For those with continued pain from a labral tear, surgery is often indicated. Arthroscopic surgery can be performed through small incisions (1/2 cm) around the hip with specialized instruments to either debride (clean) or remove the injured labrum, or repair it to the socket.
After the surgery, the patient will be on crutches for two to six weeks; this is determined on a case by case basis. Physical therapy is used to improve the hip range of motion and muscle strength around the hip. Once a patient is free of symptoms and has regained their strength, they can return to play, which is usually between two and six months, depending on the extent of the injury.