Acetabular labral (hip) tears

  • "Think of the labrum as a little cushion that sits at the edge of the hip socket. It can tear for many different reasons. For some children the hip socket is shallow, so the labrum bears too much of the mechanical load, and that can make a tear. Occasionally, you can tear it in an injury, although it's usually more of a wear-and-tear issue than the result of trauma."

    Young-Jo Kim, MD, PhD, orthopedic surgeon, Boston Children's Hospital

    If your child or teen has an acetabular labral tear, you’ll have many concerns and questions about her health, treatment, recovery, outlook and other issues. It may comfort you to know that Boston Children's Hospital is a world leader in pediatric orthopedics and we have a wealth of experience helping children with this condition. We specialize in innovative, family-centered care that supports your child and family every step of the way.

    About acetabular labral tears

    The labrum is a gristle-like, fibrous lining around the rim of the hip socket (acetabulum) whose cushioning characteristics:

    • provide hip joint stability
    • can offer extra structural support
    • reduce friction in the joint
    • distribute force evenly across the articular surface (cartilage)

    A tear of the labrum usually causes sharp pain in the front of the hip, sometimes shooting down the thigh.

    • A catching or giving way sensation in the hip may also occur.
    • In some cases, patients may not feel any pain.
    • Over time, an untreated acetabular labral tear can increase stress on the hip joint, causing deterioration and permanent damage to the joint. Acetabular labral tears may lead to osteoarthritis when your child is older, or be linked to arthritis in a way that’s still being studied.
    • Girls (especially dancers) and boys can both sustain acetabular labral tears.
      • Children whose sports or dancing involves frequent rotation of the hip, such as golf, soccer, hockey and ballet, can have an increased risk for acetabular labral tears.
      • About 22% of athletes who report groin pain have an acetabular labral tear.

    Also at risk for acetabular labral tears are children with pre-existing hip problems, such as:

    How Boston Children's Hospital approaches acetabular labral tearsand other developmental hip conditions

    At Boston Children's, acetabular labral tears may be treated non-surgically with pain medication and physical therapy. Severe cases may require arthroscopic surgery, but doctors at Children's will always identify the cause of the acetabular labral tear first, including an underlying hip condition.

    Whatever treatment your child requires, you can have peace of mind knowing that, as national and international orthopedics referral centers, Boston Children’s Child and Adult Hip Preservation Program, and Orthopedic Center have vast experience treating children who have treated every kind of hip condition, some of which few other pediatric hospitals have ever encountered. As a result, we can provide expert diagnosis, treatment and care for every level of complexity and severity of acetabular labral tear—and any possible underlying hip condition that may have caused it.

    Unique expertise in treating adolescents with hip problems. Many adolescents and young adults with hip problems need diagnostic and surgical techniques that differ significantly from what’s indicated for younger children. Boston Children’s Child and Adult Hip Preservation Program is the only such program of its kind. We offer our extensive experience and advanced techniques, with clinicians and researchers who are dedicated to finding better ways to care for adolescents and young adults with hip problems.

    One of the first programs. Our Orthopedic Center is one of the world’s first comprehensive pediatric orthopedic programs, and today is the largest pediatric orthopedic surgery center in the United States, performing more than 5,000 procedures each year. Our program, consistently ranked among the top pediatric hospitals in the nation under preeminent care center for children and young adults with developmental, congenital, post-traumatic and neuromuscular problems of the musculoskeletal system.

    Leaders in Bernese periacetabular osteotomy (Bernese PAO). At Boston Children’s, we’ve performed more than 1,400 Bernese periacetabular osteotomies since 1991 to correct hip dysplasia (a major cause of acetabular labral tears) in teens and adults. Our large volume makes us the most experienced center in the United States for this procedure—and the second-most experienced in the world. The Bernese PAO—the most powerful procedure for repositioning the hip socket—is Children’s standard treatment for a hip socket that’s too shallow in a patient whose socket has finished growing (typically from age 13 or 14 through adult).

    Acetabular labral tears: Reviewed by Young-Jo Kim, MD, PhD

    © Boston Children's Hospital, 2011

    The World's Most Extensive Pediatric Hospital Research Enterprise

    At Boston Children’s, we’re known for our innovative treatments and a research-driven approach. We’re home to the world’s most extensive pediatric hospital research enterprise, and we partner with elite health care and biotech organizations around the globe. But as specialists in family-centered care, our physicians never forget that your child is precious, and not just a patient.

    Orthopedic Center
    Boston Children's Hospital

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  • Right now, you probably have lots of questions: How serious is an acetabular labral tear? What’s the best treatment? What do we do next? We’ve provided some answers to your questions on this site, and our experts at Boston Children's Hospital can explain your child’s condition fully when you meet with us.

    Background: the normal hip joint

    The hip joint is one of the body's most reliable structures, providing people with movement and support without pain or problems in most people for a lifetime. The hip’s simple ball-and-socket anatomy—with the ball-shaped femoral head rotating inside a cup-shaped socket called the acetabulum—usually works well with amazingly little friction, and little or no wear. with amazingly little friction, and little or no wear.

    The well-fitting surfaces of the femoral head and acetabulum, which face each other, are lined with a layer of cartilage, lubricated by a thin film of fluid. Friction inside a normal hip is less than one-tenth that of ice gliding on ice.

    What is an acetabular labral tear?

    An acetabular labral tear is a tear in the hip joint’s fibrous seal, which normally cushions the joint and provides joint stability and support.

    What causes an acetabular labral tear?

    An acetabular labral tear is often a gradually developing wear-and-tear injury caused by sports and activities that involve hip rotation, such as hockey, golf, soccer and ballet. It’s rarely the result of direct trauma to the joint. Acetabular labral tears are also associated with underlying problems of the hip, such as Legg-Calvé-Perthes disease, slipped capital femoral epiphysis or developmental dysplasia of the hip. These tears are also usually a feature in hip impingement (femoral acetabular impingement).

    What are the signs and symptoms of an acetabular labral tear?

    Some signs and symptoms can include:

    • a sharp pain in the front of the hip, sometimes shooting down the thigh
    • a locking, catching, clicking or giving-way sensation in the hip
    • pain when rotating the leg
    • pain in the back of the thigh or buttock
    • stiffness or limited range of motion in the hip joint

    In some cases, a child may not feel any pain.

    How common are acetabular labral tears?

    An acetabular labral tear is essentially a gradually developing wear-and-tear condition, possibly affecting an up to 22 percent of athletes who report groin pain. It’s more common among athletes whose sports and activities involve rotating and twisting leg motions, such as:

    • golfers
    • soccer players
    • hockey players
    • ballet dancers
    • football players (especially kickers)
    • runners
    • sprinters

    How serious is an acetabular labral tear?

    Over time, an untreated acetabular labral tear can increase stress on the hip joint, causing deterioration and permanent damage to the joint.

    Acetabular labral tears can be associated with serious underlying problems of the hip, such as Legg-Calvé-Perthes disease, slipped capital femoral epiphysis or developmental dysplasia of the hip, or as a feature in hip impingement (femoral acetabular impingement). For example, hip impingement can cause significant pain, loss of hip motion and early arthritis, and is treated surgically.

    Who’s at risk for developing an acetabular labral tear?

    • Girls (especially dancers) and boys can both sustain acetabular labral tears.
      • Children whose sports or dancing involves frequent rotation of the hip, such as golf, soccer, hockey and ballet, can have an increased risk for acetabular labral tears.
      • About 22 percent of athletes who report groin pain have an acetabular labral tear.
    • Also at risk for acetabular labral tears are children with pre-existing hip problems, such as:
    • Children with hip impingement (femoral acetabular impingement) usually have acetabular labral tears.

    How do you diagnose an acetabular labral tear?
    To diagnose an acetabular labral tear, your child’s doctor will take a complete medical and family history (including any hip problems in the family). Your doctor will then conduct a physical exam, and may order imaging tests such as:

    • MRI (magnetic resonance imaging): produces detailed images of organs and structures within the body; shows the amount of damage to the labrum and any other parts of the hip, such as cartilage and/or ligaments
    • x-ray: to rule out a fracture or other damage to the bone

    How does Boston Children’s treat an acetabular labral tear?


    Specific treatment for an acetabular labral tear is determined by your child’s doctor based on:

    • his age, overall health and medical history
    • the type, extent and severity of the tear

    Treatment may include conservative approaches such as:

    • rest
    • activity restrictions
    • anti-inflammatory and pain medications
    • exercises and physical therapy

    The labrum can be a difficult area to heal on its own, because there’s blood supply to only a part of the area. So if the labrum doesn’t heal with above treatments, doctors may perform minimally-invasive arthroscopic surgery. The surgical approach and techniques that your child’s surgeon uses depend on the type of tear, the cause of the condition and the degree of damage that’s occurred.

    Will my child be OK?

    Minimally-invasive hip arthroscopy is very successful in relieving children’s symptoms and improving their hip function as long as there aren’t any underlying anatomic problems around the hip, or as long as any problems that did exist have been corrected.

    If there is an underlying hip condition associated with your child’s acetabular labral tear, the long-term result of surgery depends on the amount of damage present at the time of surgery. For example, in a condition such as hip impingement (with its attendant acetabular labral tear), a perfect outcome is possible with early joint-preserving treatments before the cartilage is damaged. But even surgery may not be able to fully repair the impingement if the cartilage has already been severely damaged.

    What new research is Boston Children’s doing regarding developmental hip conditions?

    Developmental hip conditions such as acetabular labral tears, hip impingement, slipped capital femoral epiphysis, hip dysplasia and Legg-Calve-Perthes disease can lead to premature arthritis in young adults, with resulting pain and disability. Boston Children’s many research studies focus on understanding the mechanical forces (pathomechanics) that adversely change the hip’s structure and function. With better understanding, we can improve existing therapies and develop new therapies for these conditions.

    The clinical and basic science researchers at Boston Children’s Orthopedic Center are recognized throughout the world for their achievements in the field. Our breakthroughs mean that we can provide your child with the most innovative care available.

    Unique Expertise in Problems with Adolescent Hip

    Many teens and young adults with hip problems need diagnostic and surgical techniques that are significantly different from what’s indicated for younger children. Boston Children’s Child and Adult Hip Preservation Program, is the only program of its kind in the world. We offer the extensive experience and advanced techniques of clinicians and researchers dedicated to finding better ways to care for adolescents and young adults with hip problems.

    Our Complete Orthopedic Team

    Boston Children’s is the primary pediatric teaching hospital of Harvard Medical School, where our physicians hold faculty appointments. We’re the largest pediatric orthopedic center in the nation, with 13 specialty clinics; an onsite brace shop; a plaster room; and a clinical team of orthopedic surgeons, orthopedic residents and fellows, certified physician assistants, nurse practitioners, registered nurses, physical/occupational therapists, brace technicians and cast technicians.

    Boston Children's Teen Advisory Committee

    To help teenagers take a more proactive role in their treatment and to have their needs recognized, Boston Children’s developed the Teen Advisory Committee. The group—made up of current Children’s patients, ages 14 to 21—serves as a team of peers who can listen to other patients’ needs and ensure that their voices are heard. 

  • How does a doctor know my child has an acetabular labral tear?

    Acetabular labral tears may be accompanied by other injuries and can require

    • X-rays - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film
    • Magnetic Resonance Imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body.

    At Boston Children's Hospital, we know that the first step to treating your child’s acetabular labral tear is to form a timely, complete and accurate diagnosis. Our goal is to diagnose and treat her condition early in order to minimize her risk of developing arthritis (joint inflammation, resulting in pain, swelling, stiffness and limited movement) of her hip joint.

    Physical exam tests

    To diagnose an acetabular labral tear, your child’s doctor will take a complete medical and family history (including any hip problems in the family). The doctor will conduct a physical exam, which may include:

    • an impingement test
      • flexion (bending)
      • adduction (movement inwards towards the body)
      • internal (for anterior tear) and/or external (for posterior tear) rotations of the hip joint)

    If your child feels pain from these motions, a positive test has occurred and a tear is present.

    • the McCarthy test
      • flexion (bending in both hips)
      • extension (straightening the affected hip)

    If your child feels a catch during these motions, a positive test has occurred and a labral tear is present.

    Imaging tests

    To confirm a diagnosis, the doctor may order testing that can include:

    • MRI (magnetic resonance imaging): produces detailed images of organs and structures within the body; shows the amount of damage to the labrum and other parts of the hip, such as cartilage and/or ligaments
    • X-ray: a radiographic picture of the inside your child's body to rule out a fracture or other damage to her bone, rather than to diagnose her acetabular labral tear
    • the oldest and most frequently used form of medical imaging
    • uses small doses of ionizing radiation to produce diagnostic pictures of the human body
    • arthroscopy (now rarely used for diagnostics at Boston Children’s): diagnostic examination of the hip using an arthroscope—a thin, flexible fiberoptic scope introduced into the hip joint to assess the extent of damage to the labrum.

    Our Orthopedic Clinical Effectiveness Research Center (CERC)

    Boston Children’s Orthopedic Clinical Effectiveness Research Center (CERC) was established by the Orthopedic Center to improve the quality of life for children with musculoskeletal disorders. This collaborative clinical research program is unique in the nation and is playing an instrumental role in establishing, for the first time, evidence-based standards of care for pediatric orthopedic patients throughout the world. 

    If You Come From Far Away, We Can Help

    As an international pediatric orthopedics center, Children’s cares for young patients from all over the world. Our International Center assists families residing outside the United States: facilitating the medical review of patient records; coordinating appointment scheduling; and helping families with customs and immigration, transportation, hotel and housing accommodations. 

  • Boston Children's Hospital's hip sub-specialists provide comprehensive treatment—including evaluation, diagnosis, consultation and follow-up care to children, teens and young adults. How we'll treat your child's acetabular labral tear is determined by your child's doctor based on:

    • his age, overall health and medical history
    • the type, extent and severity of the tear

    Conservative treatment


    Treatment may include conservative approaches such as:
    • rest
    • activity restrictions
    • anti-inflammatory and pain medications
    • exercises and physical therapy (to strengthen the muscles around the hip joint and avoid stress)

    Arthroscopic surgery

    The labrum can be a difficult area to heal on its own, because there's blood supply to only a part of the area. So if the labrum doesn't heal with conservative treatments, doctors may perform minimally invasive arthroscopic surgery: Through a small incision, a thin, flexible fiberoptic scope “sees” the joint, and the surgeon uses instruments for repair.

    The arthroscopic procedure that your child's surgeon uses to trim/remove (debride) or repair the damaged tissue depends on:

    • the type of tear
      • type 1: the labrum detaches at in the area where it transitions to the articular cartilage; surgery is to reattach to the acetabular rim, usually with an anchor
      • type 2: an intra-substance split with one or more cleavage planes
    • the cause of the condition
    • the degree of damage

    After surgery

    After surgery, your child will need to limit her weight-bearing with crutches, probably for four to six weeks. Physical therapy will help her restore her muscle strength and range of motion. She'll probably be able to resume full activities, including sports, two to six months after surgery.

    Long-term outlook

    Hip arthroscopy is very successful in relieving symptoms and improving hip function as long as there aren't any underlying anatomic problems around the hip, or as long as any problems that did exist have been corrected.

    If there is an underlying hip condition associated with your child's acetabular labral tear, the long-term result of surgery depends on the amount of damage present at the time of surgery. For example, in a condition such as hip impingement (with its attendant acetabular labral tear), a perfect outcome is possible with early joint-preserving treatments before the cartilage is damaged. But even surgery may not be able to fully repair the impingement if the cartilage has already been severely damaged.

    Coping and support

    We at Boston Children's understand that a hospital visit can be difficult. So, we offer many amenities to make your child's—and your own—hospital experience as pleasant as possible. Visit the Center for Families for all you need to know about:

    • getting to Boston Children's
    • accommodations
    • navigating the hospital experience
    • resources that are available for your family

    In particular, we understand that you may have a lot of questions when your child is diagnosed with an acetabular labral tear. Will my child need surgery? How long will her recovery take? Will it affect her long term? What should we do at home? Children's can help you connect with extensive resources to help you and your family through this stressful time, including:

    • patient education: From doctor's appointments to treatment to follow-up, our nurses and physical therapists will be on hand to walk you through your child's diagnosis, surgery and recovery. And once your child is home, we'll help you coordinate and continue the care and support she received at Children's.
    • parent-to-parent: Want to talk with someone whose child has been treated for an acetabular labral tear? Our Orthopedic Center can often put you in touch with other families who've been through the same experience that you and your child are facing.
    • faith-based support: If you're in need of spiritual support, we'll connect you with the Boston Children's chaplaincy. Our program includes nearly a dozen clergy—representing Protestant, Jewish, Muslim, Catholic and other faith traditions—who will listen to you, pray with you and help you observe your own faith practices during your hospital experience.
    • social work: Our social workers and mental health clinicians have helped many other families in your situation. We can offer counseling and assistance with issues such as coping with your child's diagnosis, stresses relating to coping with illness and dealing with financial issues.
  • For more than a century, orthopedic surgeons and investigators at Boston Children's Hospital have played a vital role in advancing the field of musculoskeletal research. We’ve developed breakthrough treatments and major advances for conditions such as developmental hip problems, scoliosis, polio, tuberculosis and traumas to the hand and upper extremities.

    Our pioneering research helps answer the most pressing questions in pediatric orthopedics today—to provide children with the most innovative care available.

    In Boston Children’s Orthopedic Center and Child and Adult Hip Preservation Program, we take great pride in our basic science and clinical research leaders, who are recognized throughout the world for their achievements. Our orthopedic research team includes:

    • full-time basic scientists
    • 28 clinical investigators
    • a team of research coordinators and statisticians

    Studies of developmental hip conditions

    Developmental hip conditions such as acetabular labral tear, hip impingement, slipped capital femoral epiphysis, hip dysplasia and Legg-Calve-Perthes disease can lead to premature arthritis in young adults with resulting pain and disability. Our research focuses on understanding the pathomechanics (mechanical forces that adversely change the body's structure and function) of these conditions. With better understanding, we can improve existing therapies and develop new therapies for these complex conditions.

    Current and recent studies include the following:

    • We’re conducting a large number of ongoing studies to follow patients who’ve had various treatments for SCFE and hip dysplasia. Our studies use outcomes measures, custom questionnaires and special methods for measuring results—both prospectively (before treatment) and retrospectively.

    For example, a very common hip condition called femoral acetabular impingement (FAI) is a research topic that Children’s is working on extensively. FAI is a frequent cause of osteoarthritis of the hip. FAI is a jamming that occurs in some hips, resulting in damage to the cartilage. The most common cause of FAI is a “bump” on the neck of the femur that remains as a result of SCFE. The impingement can be small (causing minor damage) or larger (resulting in arthritis). In a long-term study, our researchers are investigating the effectiveness of removing the bump at the time of surgery.

    • We’re studying long-term outcomes after Bernese periacetabular osteotomy (Bernese PAO) for hip dysplasia: Since 1991, Boston Children's has performed more than 1,400 Bernese periacetabular osteotomies to correct hip dysplasia in teens and adults, whose hip sockets have finished growing. This large volume makes Children’s the most experienced center in the United States for this procedure—and the second-most experienced in the world.

      PAO is our standard treatment for a hip socket that’s too shallow in a patient whose socket has finished growing—typically teens ages 13 or 14 through adults—and whose hip is still viable enough to be repaired rather than replaced. The procedure rotates the hip socket into a more stable position and is the most complex and powerful procedure for positioning the hip socket.

      We’re constantly obtaining and analyzing radiographic and clinical long-term follow-up data on sub-groups of our PAO patient population as it ages, to determine the effectiveness of the procedure for halting or preventing the development of osteoarthritis of the hip.
    • We’re studying the use of delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) to assess early osteoarthritis in dysplastic hips: In early osteoarthritis, the charge of the extracellular matrix is degraded and lost. The delayed gadolinium-enhanced MRI of cartilage technique is designed to indirectly measure the early loss of charge density in cartilage. Read more.
    • We’re studying perfusion MRI as a predictor for developing avascular necrosis after closed reduction of dislocated hips: Our retrospective analysis is looking at predictive values of contrast-enhanced MRI after closed reduction for avascular necrosis (cellular death due to interrupted blood supply) in people with developmental dysplasia of the hip. Read more.
    • Children’s is a founding member of the Academic Network of Conservational Hip Outcomes Research (ANCHOR), a collaboration of researchers dedicated to following patients with developmental hip disease. The group now comprises 10 centers in the United States and one in Europe, and enrolls more than 500 patients each year in various studies.

    Orthopedic basic science laboratories

    Working in Boston Children’s labs are some of the leading musculoskeletal researchers in the nation. Our labs include:

    Children Speak About What it's Like to be a Medical Research Subject

    View a video of a day in the life of Boston Children’s Clinical and Translational Study Unit, through the eyes of children who are “giving back” to science.

    Boston Children's Hip Program's Unique Insight and Expertise

    Boston Children’s Child and Adult Hip Preservation Program enjoys a special degree of effectiveness—not just because of our long tradition of excellence in pediatric hip care, but also because we follow our patients through adulthood. This gives us a unique perspective, insight and expertise—we can track how the hip works in each age group, how the problems evolve, and how the hip’s function changes over time in adult patients who’ve had treatment in childhood. 

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