Is hip labral tear recovery without surgery possible? If you’ve been told your hip pain is caused by a hip labral tear, you probably have many questions, and you should. What is a hip labrum? What happens if a labral tear goes untreated? Do you need surgery for a torn hip labrum? Will cortisone shot help with a torn hip labrum? Let’s dig in.
What Is a Hip Labrum?
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).
What Happens If a Labral Tear Goes Untreated?
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.
Do You Need Surgery For a Torn Hip Labrum?
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).
Can you Function With a Torn Labrum?
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.
Will a Cortisone Shot Help a Torn Hip Labrum?
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).
Hip Labral Tear Recovery without Surgery
The Centeno-Schultz Clinic has extensive experience in the treatment of hip labral tears. Evaluations are performed by board-certified, fellowship-trained physicians. Platelet-rich plasma (PRP) injections have been effective in the treatment of labral tears with a reduction of pain and improved function at 8 weeks (13). Bone marrow-derived stem cells injected into labral tears have also resulted in a reduction in pain (14). At the Centeno-Schultz Clinic, both PRP and bone marrow-derived stem cells are treatment options for labral tears. Intermittent x-ray and ultrasounds are utilized to accurately place the cells or platelets into the labral tear. Blind injections used by many pain and regenerative care clinics can not get the cells or PRP into the torn tissue. This is a complex procedure that your chiropractor, family medicine, and orthopedic surgeon can not perform. To better understand the complexity of hip labral tears please click on the video below.
https://www.youtube.com/watch?v=Gdrwf2-Tw8I
In Conclusion
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.
Santori N, Villar RN. Acetabular labral tears: result of arthroscopic partial limbectomy. Arthroscopy. 2000;16(1):11-5.DOI: 10.1016/s0749-8063(00)90121-x
Dorrell JH, Catterall A. The torn acetabular labrum. J Bone Joint Surg Br. 1986;68(3):400-3.
Kumar D, Wyatt CR, Lee S, et al. Association of cartilage defects, and other MRI findings with pain and function in individuals with mild-moderate radiographic hip osteoarthritis and controls. Osteoarthritis Cartilage. 2013;21(11):1685–1692. doi:10.1016/j.joca.2013.08.009
Register B, Pennock AT, Ho CP, Strickland CD, Lawand A, Philippon MJ. Prevalence of abnormal hip findings in asymptomatic participants: a prospective, blinded study. Am J Sports Med. 2012 Dec;40(12):2720-4. doi: 10.1177/0363546512462124.
Clement RC, Carpenter DP, Cuomo AV. Spontaneous Healing of a Bucket-Handle Posterior Labral Detachment After Hip Dislocation in a Five-Year-Old Child: A Case Report. JBJS Case Connect. 2018 Apr-Jun;8(2):e28. doi: 10.2106/JBJS.CC.17.00133.
Mansell NS, Rhon DI, Meyer J, Slevin JM, Marchant BG. Arthroscopic Surgery or Physical Therapy for Patients With Femoroacetabular Impingement Syndrome: A Randomized Controlled Trial With 2-Year Follow-up. Am J Sports Med. 2018 May;46(6):1306-1314. doi: 10.1177/0363546517751912.
Kierkegaard S, Langeskov-Christensen M, Lund B, Naal FD, Mechlenburg I, Dalgas U, Casartelli NC. Pain, activities of daily living and sport function at different time points after hip arthroscopy in patients with femoroacetabular impingement: a systematic review with meta-analysis. Br J Sports Med. 2017 Apr;51(7):572-579. doi: 10.1136/bjsports-2016-096618.
Yazbek PM, Ovanessian V, Martin RL, et al. Nonsurgical treatment of acetabular labrum tears: a case series. J Orthop Sports Phys Ther. 2011;41(5):346-DOI: 10.2519/jospt.2011.322553.
Larson CM, Clohisy JC, Beaulé PE, et al. Intraoperative and Early Postoperative Complications After Hip Arthroscopic Surgery: A Prospective Multicenter Trial Utilizing a Validated Grading Scheme. Am J Sports Med. 2016;44(9):2292-8.DOI: 10.1177/0363546516650885
McAlindon TE, LaValley MP, Harvey WF, et al. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2017;317(19):1967–1975. doi:10.1001/jama.2017.5283
Krych AJ, Griffith TB, Hudgens JL, Kuzma SA, Sierra RJ, Levy BA. Limited therapeutic benefits of intra-articular cortisone injection for patients with femoro-acetabular impingement and labral tear. Knee Surg Sports Traumatol Arthrosc. 2014 Apr;22(4):750-5. doi: 10.1007/s00167-014-2862-3.
De Luigi AJ, Blatz D, Karam C, Gustin Z, Gordon A. Use of Platelet Rich Plasma for the Treatment of Acetabular Labral Tear of the Hip: A Pilot Study. Am J Phys Med Rehabil. [published online: May 30, 2019]. 10.1097/PHM.0000000000001237
