Labral Tears and Chondral Lesions in the Hip
What is the Hip?
The hip is a term frequently used to describe a large area of the body including the pelvis. The hip joint is the ball and socket joint where the top of the femur (bone in the thigh) that is shaped like a ball, the femoral head, fits into the “socket” or acetabulum of the pelvis. This joint is surrounded by a joint capsule, muscles, and ligaments increasing stability and facilitating its function.
What are Labral Tears?
The rim of the socket of the hip joint is lined by a ring of cartilage called the labrum. The labrum provides cushioning at the rim of the joint, additional support, and facilitates adequate nutrition of the hip cartilage. It assists in normal motion of the hip. When damaged, the hip can catch, lock, and cause pain.
What are Chondral Lesions in the Hip?
In your joints, the ends of your bones are covered with articular cartilage, which is a tissue that reduces friction to allow for smooth joint mobility. This tissue also acts as a shock absorber by protecting the joint during impact activities such as running and jumping. A chondral defect of the hip occurs when the articular cartilage becomes damaged.
A labral tear or chondral lesion in the hip can occur from an injury, repetitive motion, soft tissue instability in connective tissue diseases (for example Ehlers Danlos Syndrom) or normal wear and tear. It is frequently associated with abnormality of the ball and socket joint called femoroacetabular impingement (FAI). In general there are two types, one called cam impingement, and one called pincer impingement. Often, although they can occur in varying degrees at the same time, they are then called mixed impingement.
In cam impingement an abnormally shaped ball, the head of the thigh bone (femur), articulates against a normal socket (acetabulum). This “bump” impinges against the labrum and can lead to tears and joint cartilage damage over time.
In pincer impingement the socket is too deep or abnormally rotated. This results in the neck of the thigh bone impinging on the labrum and acetabular rim, often leading to labral tears and joint cartilage damage.
Diagnosis and Examination
Initially, a medical history and physical examination by a musculoskeletal expert should be completed. Diagnostic imaging like x-rays or MRI may be ordered.
To control pain, over the counter medications could be taken. Anti-inflammatory medications may be recommended. Injections may also be prescribed to relieve pain, but can also provide diagnostic information to differentiate from hip pain that might actually be caused by the spine or surrounding soft tissues. Conservative treatment options, such as physical therapy, are typically recommended.
If non-operative treatment is unsuccessful, surgery may be recommended to minimize symptoms. The exact surgical technique can vary based on the size and severity of the defect, but would typically encompass hip arthroscopy with labral repair (or debridement or reconstruction if not repairable), trimming the bony rim if it is too deep or rotated, shaving down the head and neck of the thigh bone to make it round again, and typically a repair of the joint capsule.