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Orthopaedic Surgery Patient Education: Hip - Tears
Tears
a. Labral Tears
What is a Labral Tear?
The cartilage that surrounds the hip socket and makes it deeper is referred to as the labrum. A labral tear is an injury to this cartilage.
What causes a Labral Tear?
Labral tears can occur as a result of natural degeneration that occurs with increasing age, or as a result of an injury. Falls, twisting or hyperextension injuries to the leg, or sports collisions are common causes. Femoral Acetabular Impingement is early arthritis in the hip that results from the formation of bone spurs on the ball and socket. These spurs pinch the labrum and are common causes of tears.
What are the symptoms?
Patients will complain of pain in the groin. The pain is usually felt to be deep, and the patient will put their entire hand over the lateral aspect of the hip to describe the location of the pain. A 'click', 'pop' or 'snap' may be felt. Pain can occur with going up and down stairs, squatting, Sitting Indian style, crossing legs, or prolonged sitting. Labral tears that displace into the joint can cause a locking sensation.
How is a Labral Tear diagnosed?
On physical exam, patients will have pain with motions that stress the labrum. Your surgeon will bring your knee to your chest and turn the leg inward, pinching the labrum between the femur and the hip socket. X-rays are usually unremarkable, but may show Femoral Acetabular Impingement (FAI), a common cause of labral tears. An MRI will show a tear of the labrum. Your surgeon may obtain an MRI with dye placed in the hip to more accurately evaluate the labrum. If the dye is seen to have entered inside, or completely surround the labrum, it is torn or detached. Even with MRI, labral tears can be difficult to detect. In this instance, your surgeon may suggest a hip arthroscopy to evaluate the labrum.
How is it treated?
Non-operative
Non-operative treatment begins with physical therapy, anti-inflammatory medication, and avoiding painful activities. Your surgeon may suggest a cortisone shot given under x-ray directly into the hip joint. This shot combines a local anesthetic, such as lidocaine, with the cortisone. If the patient's pain resolves when the joint is filled with anesthetic, then the surgeon knows the problem is inside the joint. If pain is unchanged despite the anesthetic in the hip, the surgeon will look for another cause.
Operative
Operative treatment consists of a hip arthroscopy and labral repair or debridement. Debridement removes torn or injured tissue, leaving only healthy tissue behind. A debridement is performed when the labrum is heavily damaged, and cannot be repaired. In a labral repair, your surgeon will sew detached cartilage back to the hip socket using plastic devices containing suture called anchors.
b. Ligamentum Teres Rupture
What is a Ligamentum Teres Rupture?
The ligamentum teres is the ligament that holds the ball of the hip into the socket. It runs from the center of the acetabulum (socket) to the center of the femoral head (ball). It contains an artery that supplies some blood to the femoral head.
What causes a Ligamentum Teres Rupture?
Falls, twisting or hyperextension injuries to the leg, or sports collisions are common causes of ligamentum teres ruptures.
What are the symptoms?
When the ligamentum teres ruptures, it folds over into the joint, and takes up space. It may bleed and become swollen or calcified following an injury. This takes up even more space in an already tight hip socket. Patients will complain of groin pain, 'catching', 'locking' or 'popping'. The hip may feel like it gets stuck in one position.
How is it diagnosed?
MRI will confirm the tear.
How is it treated?
Non-operative
Patients who have few or no symptoms from their tear should be observed.
Operative
Symptomatic tears should be removed with hip arthroscopy.
c. Abductor Tears (Gluteus Medius and Minimus)
What is an Abductor Tear?
An abductor tear of the hip is a tear of the gluteus medius or minimus, two of the muscles responsible for moving the leg away from the body. They attach on the greater trochanter, a bump on the outside of the hip. The tendons are located just below the trochanteric bursa. Inflammation of, or injury to, the abductor tendons will often cause trochanteric bursitis.
What causes an Abductor Tear?
Tears can occur as a result of an injury, or from age-related degeneration in the tendon.
What are the symptoms?
Patients will complain of pain and tenderness in the lateral aspect of the upper thigh. They may walk with a limp, or have trouble keeping their pelvis level while standing on one leg.
How is an Abductor Tear diagnosed?
Your surgeon will perform a physical exam and examine your gait. X-rays are unremarkable. MRI will confirm the tear.
How is it treated?
Non-operative
Partial tears, or those with few symptoms, can be managed non-operatively with physical therapy to strengthen the abductors and muscles that perform similar functions.
Operative
Repair of the torn gluteus medius tendon can be accomplished with arthroscopic surgery. The surgeon removes the trochanteric bursa to expose the tear, then sutures the tendon to the bone using small plastic or metal devices containing suture.
Orthopaedic Treatment Options: Hip - Tears
Acetabular Labral Repair
The labrum is the cartilage that surrounds the hip socket. It may tear as a result of athletic injuries, falls, motor vehicle accidents, or arthritis. Patients with symptomatic tears should consider an arthroscopic repair.
The surgeon begins by placing the affected leg in traction to create room between the ball and socket of the hip joint. A needle is placed inside the joint under X-ray guidance, and a guide wire is passed through the needle. The needle is removed and a metal dilator is passed over the guide wire to create a track into the hip. A small camera is then placed over the guide wire into the hip joint. The process is repeated to create a second access portal for the surgeon to perform the repair. A needle is placed anterior to the first in the hip joint, and a guide wire passed over the needle. Two dilators are used to allow for the passage of larger instruments. A tissue cutting instrument, or shaver, is passed into the joint over the guide wire. The shaver is used to create room in the lining of the joint for the easy passage of other instruments. A blade is then inserted through a cannula and is used to free the remaining labrum from the hip socket. Once the labrum is completely detached, the underlying bone is smoothed to allow for easy reattachment. A suture is then placed around the labrum, and brought out the cannula. A punch hole is created just above the rim of the socket, and the suture is secured in the hole using a Pushlock anchor. For larger tears, the surgeon will use multiple anchors.
