고관절 질환 - Labral Tears of the Hip

 labral tear of the hip 

Acetabular labrumtears (labral tears) can cause pain, stiffness, and other disabling symptoms of the hip joint. The pain can occur if the labrum is torn, frayed, or damaged. 

Active adults between the ages of 20 and 40 are affected most often, requiring some type of treatment in order to stay active and functional. New information from ongoing studies is changing the way this condition is treated from a surgical approach to a more conservative (nonoperative) path. 

Anatomy

What parts of the hip are involved?

The acetabular labrum is a fibrous rim of cartilage around the hip socket that is important in normal function of the hip. It helps keep the head of the femur (thigh bone) inside the acetabulum (hip socket). It provides stability to the joint.

Our understanding of the acetabular labrum has expanded just in the last 10 years. The availability of high-power photography and improved lab techniques have made it possible to take a closer look at the structure of this area of the hip. 

Causes

How does this condition develop?

It was once believed that a single injury was the main reason labral tears occurred (running, twisting, slipping). But with improved radiographic imaging and anatomy studies, it’s clear now that abnormal shape and structure of the acetabulum, labrum, and/or femoral head can also lead to the problem.

Injury is still a major cause for labral tears. Anatomical changes that contribute to labral tears combined with repetitive small injuries lead to a gradual onset of the problem. Athletic activities that require repetitive pivoting motions or repeated hip flexion cause these type of small injuries.

What are these “anatomical changes”? The most common one called femoral acetabular impingement (FAI) is a major cause of hip labral tears. With FAI, there is decreased joint clearance between the junction of the femoral head and neck with the acetabular rim

simptoms

What does a labral tear feel like?

Pain in the front of the hip (most often in the groin area) accompanied by clicking, locking, or catching of the hip are the main symptoms reported with hip acetabular labral tears. Joint stiffness and a feeling of instability where the hip and leg seem to give away are also common. The pain may radiate (travel) to the buttocks, along the side of the hip, or even down to the knee.

Symptoms get worse with long periods of standing, sitting, or walking. Pivoting on the involved leg is avoided for the same reason (causes pain). Some patients walk with a limp or have a positive Trendelenburg sign(hip drops down on the right side when standing on the left leg and vice versa).

The pain can be constant and severe enough to limit all recreational activities and sports participation.

Treatment

What treatment options are available?

In the past, when arthroscopic surgery was the only way to confirm the presence of a labral tear, the surgeon would just go ahead and remove the torn edges or pieces during the arthroscopic examination procedure. However, studies over the years have called this approach into question. With removal of the labrum, changes in the way the hip functioned, increased friction of the joint, and increased load on the joint led to degenerative changes and osteoarthritis.

Surgeons stopped cutting out the torn labrum and started repairing it instead. Physical therapists started doing studies that showed strengthening muscles and resolving issues of muscle imbalances could reduce the need for surgery with the traditional risks (e.g., bleeding, infection, poor wound healing, negative reactions to anesthesia).

More efforts are being made now to manage labral tears with conservative (nonoperative) care. This is a possibility most often when there are no symptoms of labral pathology. Patients with confirmed labral tears but who have normal hip anatomy or only mild changes in the shape and structure of the hip may also benefit from conservative care.

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