Acetabular labral (hip) tears

  • If you or your teen has an acetabular labral tear, you may have many concerns and questions. It may comfort you to know that caregivers at Boston Children's Hospital offer a wealth of experience treating labral tears. We’re here to answer your questions and to support you and your family every step of the way.

    About acetabular labral tears

    Acetabular labral tears (also called labral tears) can occur with wear and tear on the hip or as the result of an injury.

    A labral tear usually causes sharp pain in the front of the hip, sometimes shooting down the thigh. A catching or giving sensation in the hip may occur. Some patients do not experience any pain.

    What is the labrum?

    The labrum lines the rim of the hip socket (acetabulum). It acts as a cushion that:

    • provides hip joint stability
    • offers extra support to the hip
    • reduces friction in the hip joint
    • distributes force evenly across the articular surface (cartilage)

    Does Boston Children’s Child and Young Adult Hip Preservation Program treat teens and adults?

    Our hip team treats patients of all ages. Many teens and young adults with hip problems may need diagnostic and surgical techniques that differ from what is indicated for older adults. Our surgeons are recognized across the globe as pioneers in hip arthroscopy for teens and young adults, and our clinicians and researchers are dedicated to finding better ways to care for adolescents and young adults with hip problems.  

    Boston Children’s Child and Young Adult Hip Preservation Program delivers 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 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. 

    Boston Children’s is known throughout the world for our expertise and excellence in orthopedic care.  We’re happy to share that U.S. News & World Report has recognized the great work we do for and with our families and named Boston Children’s the #1 children’s hospital in orthopedics.

    Acetabular labral tears: Reviewed by Yi-Meng Yen, MD, PhD
    © Boston Children's Hospital, 2014

  • Right now, you may have many 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. Our hip experts can answer other questions you may have when you meet with us.

    Background: the normal hip joint

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

    The surfaces of the femoral head and acetabulum, which face each other, are lined with a layer of cartilage and lubricated by a thin fluid film.

    What is an acetabular labral tear?

    An acetabular labral tear is a tear in the seal that normally cushions the joint and provides joint stability and support. What causes an acetabular labral tear?

    An acetabular labral tear is often a wear-and-tear injury caused by sports and activities that involve hip rotation. Labral tears are often associated with underlying structural problems of the hip. They also can occur with repetitive hip over-rotation and hyper-flexion in normal hips.

    What are the signs and symptoms of a labral tear?

    Signs and symptoms 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 patient may not feel any pain.

    Who is at risk for an acetabular labral tear?

    An acetabular labral tear affects 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 and sprinters

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

    • Legg-Calvé-Perthes disease
    • slipped capital femoral epiphysis (SCFE)
    • developmental dysplasia of the hip (DDH)

    Patients with hip impingement (femoral acetabular impingement or FAI) may have acetabular labral tears.

    How does Boston Children’s Child and Young Adult Hip Preservation Program diagnose labral tears?

    Our hip specialists meet with you and review your medical and physical history (including family history of hip problems). The next step is a thorough physical exam. Your doctor will check range of motion in your hip to look for a loss of internal rotation of the hip, which often signals a problem within the joint.

    She may order imaging exams to confirm the diagnosis and location of labral tear. Most imaging exams, including MRI, can be performed on the same day you see your doctor. Boston Children’s hip team is a pioneer in the use of advanced MRI technology to guide more precise diagnosis and treatment. Our hip specialists make sure to find the cause of the acetabular labral tear, including an underlying hip condition.

    How does Boston Children’s care for patients with labral tears?

    Boston Children’s hip specialists are global leaders in hip care and offer unique expertise caring for teens and young adults with hip conditions. Although we’re recognized for our expertise in treating patients with complex labral tears, we offer the same level of care and attention to every patient.

    Some labral tears are treated non-surgically with pain medication and physical therapy. Other tears may require minimally invasive (arthroscopic) surgery.

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

    Boston Children’s pioneering research helps answer the most pressing questions in pediatric orthopedics and provides patients with the most innovative care available.

    Our orthopedic research team includes:

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

    Current studies include:

    • ongoing studies to follow patients who have had various treatments for slipped capital femoral epiphysis (SCFE) and hip dysplasia
    • a study investigating the effectiveness new surgical treatments for femoral acetabular impingement (FAI)
    • a study of the long-term outcomes after Bernese periacetabular osteotomy (Bernese PAO) for hip dysplasia
    • a study of delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) to assess early arthritis in dysplastic hips: Read more.
    • A study of perfusion MRI as a predictor for reduced blood flow and cell death after treatment for hip dislocation. Read more.

    Boston Children’s Child and Young Adult Hip Perseveration Program is a founding member of the ANCHOR (Academic Network of Conservational Hip Outcomes Research). ANCHOR was founded in 2006 to study surgical outcomes in teens and young adults with hip dysplasia. The goal is improved patient care, including quality of life, overall health, and high levels of activity.

    How does Boston Children’s support my family?

    Boston Children’s supports families in many ways.

    Teen Advisory Committee

    To help teenagers take a more proactive role in their care and to have their needs recognized, Boston Children’s developed the Teen Advisory Committee. The group—made up of current 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.

    Center for Families

    You may find a hospital visit stressful. We offer services 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

    Other resources

    The hip care team at Boston Children’s can connect you with resources to help you and your family cope with a labral tear, including:

    • patient education: From doctor's appointments to treatment to follow-up, our nurses and physical therapists will walk you through your child's diagnosis, surgery and recovery. After you return home, we'll help you coordinate care and support.
    • parent-to-parent: Do you 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.
  • The first step to treating a labral tear is a timely, complete and accurate diagnosis. Our goal is to diagnose and treat your child’s labral tear early in order to minimize her risk of developing arthritis (joint inflammation, resulting in pain, swelling, stiffness and limited movement) of her hip joint.

    How will my child’s doctor diagnose a labral tear?

    Your doctor will ask for 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 toward the body)
      • internal (for anterior tear) and/or external (for posterior tear) rotations of the hip joint)
    • the McCarthy test
      • flexion (bending in both hips)
      • extension (straightening the affected hip)

    Your doctor may order imaging tests:

    • MRI (magnetic resonance imaging): produces detailed images of organs and structures; 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 and characterize the bony anatomy
  • If you or a family member is diagnosed with a labral tear, you may wonder how it should be treated. It may reassure you to know that the Orthopedic Center at Boston Children's Hospital is the best in the nation according to U.S. News & World Report. You will receive excellent treatment and support from our team of expert hip sub-specialists.

    Treatment for acetabular labral tear is based on:

    • a patient’s 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)

    Surgical treatment

    The labrum may not heal on its own, because there’s limited blood supply to the area. If the labrum doesn’t heal with conservative treatment, doctors may perform arthroscopic surgery.

    During this minimally invasive surgery, the surgeon makes two or three keyhole incisions. She inserts a thin scope to see the joint. Then she repairs or removes damaged tissue.

    How long does it take to recover from arthroscopic surgery?

    Your care team will help you stand and walk with crutches after surgery. For the first two to three weeks, crutches are used to support your weight (partial weight-bearing). Physical therapy to help restore muscle strength and range of motion begins after surgery. Most patients can return to sports four to six months after surgery.

    What is the long-term outlook for patients with labral tears?

    For many patients, minimally-invasive hip arthroscopy is very successful in relieving symptoms and improving hip function

    If you have an underlying hip condition, your doctor will discuss long-term results of surgery and possible additional treatment in the future.

  • 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 Young 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 Young 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. 

  • kristina_s_1The buddy system is great. It helps keep buddies safe, secure and confident. When you’re a college athlete facing two major surgeries (called periacetabular osteotomy or PAO) to correct hip dysplasia in one year, a buddy can be a lifeline.

    Until she was 18, Kristina Simonson had been one of those lucky athletes who escaped injury season after season. The Babson College student started playing soccer at 5 and entered college as a two-sport athlete—soccer and lacrosse.

    She began experiencing hip pain her freshman year in college. Her trainer suspected it might be a torn labrum, or a rip in the seal that normally cushions the hip joint. He was right … but only partially.

    krsitina_s_3Enter the hip experts

    Kristina was referred to Young-Jo Kim, MD, director of the Child and Young Adult Hip Preservation Program at Boston Children’s Hospital. Because Babson College has a partnership with Boston Children’s, Kristina knew that the hip program and sports medicine team treat young adults. “Boston Children’s has a great reputation, and I wanted to go there for my care.”

    An MRI showed that Kristina had torn the labrum in both hips. But this was only part of the problem. Kristina also had hip dysplasia in both hips. Hip dysplasia occurs when the hip socket is too shallow to make a good fit for the head of the femur (or thigh bone).

    Kim cautioned her that if he repaired the labrum without fixing the dysplasia, the labrum would likely tear again. She needed PAO. During the operation, the surgeon rotates the socket into proper position and inserts metal screws to hold it in place.

    “We needed to fix the root cause,” Kim says. Kristina steeled herself for the long haul. She needed PAOs in both hips, but because the surgery involves cutting the pelvis bone, and it takes time for the bones to heal, the surgeries had to be spaced out by one year.

    Kristina and Kim agreed that she would give up lacrosse and scheduled the first surgery for November 2013—after soccer season. She worked with a physical therapist through the summer to build as much strength as possible for the soccer season.

    And as surgery day neared, Boston Children’s hip experts helped her prepare. They provided a patient guide about PAO to help her understand what to expect.

    While surgical expertise certainly can help allay pre-operative fears, nothing is quite like connecting with someone who’s successfully recovered.

    Enter the buddy

    Erin Dawicki, a physician assistant in the Orthopedic Center, connected Kristina with Ally Markowitz—a hip buddy. “PAO is a tough surgery and recovery,” says Ally, a student at University of St. Joseph in West Hartford, Conn. Kim had completed Ally’s PAO in May 2013. “Erin told me I had handled my PAO really well and asked if I would be willing to talk to Kristina because we had similar lifestyles,” recalls Ally.

    “I was very nervous before my surgery. I was able to email Ally and ask questions. It helped alleviate my anxiety because she had been through the PAO and was able to return to an active lifestyle. I realized I would be OK,” says Kristina.

    Ally’s perspective helped get Kristina through a process that started with the surgery and a five-day hospital stay. But Kristina wasn’t the only one who gained from the buddy system. “It’s wonderful to be able to help make this surgery a little easier for someone else,” says Ally.

    kristina_s_2Post-PAO: Back in the game

    The soccer player returned to campus a little more than one week after surgery and used a wheelchair to get around for the first month.

    By two months post-surgery, she had graduated from a wheelchair to crutches and an elliptical trainer and stationary bike. In April, she started soccer-specific drills to help prepare her for the 2014 season.

    The plan paid off. “I was able to play at my pre-surgical level without limitations,” says Kristina.

    And as the 2014 soccer season comes to a close, Kristina is ready for the next challenge—her second PAO. “I know what to expect and what a difference the surgery makes. Surgery is scary, but it’s great to think about a future of playing without pain.”

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