What you're feeling¶
A torn labrum usually causes pain deep in the groin or the front of your hip. The pain can move around and change in intensity. It often flares with certain movements or activities, then settles when you rest. Walking on flat ground may barely bother you, while twisting, pivoting or getting out of a low chair can bring the pain on.
Many people also notice mechanical symptoms. These are sounds or sensations from the joint itself: clicking, catching or locking, or a feeling that the hip might give way. Some people find the hip stiff, with less range of movement than usual. The pain can wake you at night or be there first thing when you get out of bed.
Day to day, the things that become hard are the ones that load a twisted or bent hip. Getting in and out of the car, squatting to pick something up, or turning to reach behind you can all aggravate it. Sitting for long periods, then standing up, is another common trigger.
One thing worth knowing: these symptoms are not specific to a labral tear. Groin pain like this can come from several different hip problems, and even a careful examination cannot always pin down the cause on its own. That is why your surgeon will want scans before talking about any treatment.
A labral tear also rarely happens in isolation. Most hips with a torn labrum have some underlying change in the shape of the joint, and many also have early wear in the smooth cartilage lining the socket, often in the same spot as the tear itself. Your surgeon will look for these on your imaging, because treating the tear alone without addressing the shape of the bone around it tends not to last.
If any of this sounds familiar, bring a note of when the pain strikes and what you were doing at the time. That pattern is genuinely useful at your appointment.
What's actually happening¶
Inside your hip, where the ball of the thigh bone meets the socket, there is a ring of tough, rubbery tissue called the labrum. Think of it as a gasket that sits around the rim of the socket. It does three jobs at once: it deepens the socket so the ball is held more securely, it acts as a shock absorber, and it forms a tight seal that keeps fluid inside the joint. That seal matters. It helps the joint glide smoothly and protects the smooth cartilage on the bone surfaces from taking too much pressure.
A labral tear is a split or fraying in that ring. When the gasket is torn, the seal is lost. The ball can shift slightly within the socket, and the load that used to be spread evenly across the cartilage gets concentrated in one spot. That is why a torn labrum can ache deep in the groin, click or catch, and why the pain tends to flare with twisting or bending movements.
Tears come in different patterns. Some are a small flap of tissue catching in the joint. Some are fraying, where the edge of the labrum wears rough. Some run lengthways along the rim. A few are unstable, where a strip of the labrum flips in and out of the joint. The pattern matters because it affects what can be done about it.
Most labral tears do not happen on their own. In most hips there is some change in the shape of the bones around the joint, and that shape difference puts extra pressure on the labrum every time the hip moves. Over time, that repeated rubbing is what wears through it. The tear is often the first part of the hip to give way, and once it does, the cartilage underneath starts to take more of the strain.
What we can do about it¶
The first step is usually not surgery. Rest, changing the activities that flare your hip, and physiotherapy come first. Physiotherapy aims to settle the pain and improve how the hip moves and works. Give it a fair run: people with a painful labral tear can keep improving for at least a year of non-surgical care, even if some discomfort stays.
Anti-inflammatory medicine can help with the pain while you work on the other measures. We do not use injections for this problem, so we will not offer you cortisone or similar joint injections here.
If a year of good non-surgical care has not settled things, we then talk about keyhole surgery on the hip. The surgeon looks inside the joint with a small camera and repairs the torn labrum, keeping as much of your own tissue as possible. Because most torn labrums sit in a hip whose bones are shaped in a way that rubs the labrum, that shape is corrected at the same time. Fixing the tear without fixing the shape tends not to last, and leaves the tear likely to come back.
Whether surgery suits you depends on several things we will talk through together: the quality of the remaining labral tissue, the size of the tear, the state of the cartilage lining the socket, and whether there is any arthritis already. Your age is not a barrier on its own. What matters more is the health of the joint surface.
This is a shared decision. We will explain what we found on your scans, what surgery would involve for your hip, and what non-surgical care can still offer, and you decide with us which path to take.
What to expect¶
Left alone, a torn labrum rarely settles for good. The pain tends to come and go, flaring with twisting or bending and easing with rest, much as you have already noticed. Without treatment, the rubbing that wore through the labrum in the first place usually keeps going, so the symptoms tend to persist rather than fade. There is also a risk of new damage: if the shape of the bone around the joint is not addressed, a tear can form again even after surgery that repaired the first one.
With well-matched treatment, the outlook is steadier. Non-surgical care can keep improving your hip for at least a year, though some discomfort may stay. When surgery is the right fit, most people report meaningful improvement in pain and day-to-day function, and those gains hold up over the years. Results have been followed for five years and beyond, and for some people past ten years, with the improvement lasting. Surgery that treats both the tear and the underlying shape of the bone also lowers the chance of arthritis developing in the joint later, compared with exercise programs alone.
A few things shape how well you personally do. The state of the smooth cartilage lining the socket matters: damage there is linked with less improvement two years after surgery. The shape of your pelvis plays a part too, as some pelvic shapes are linked with less improvement than others. Your age, on its own, does not rule out a good result.
It is honest to say that not everyone is happy with the outcome. Some people who have keyhole surgery for this problem still feel dissatisfied afterwards. And if the tear is severe and cannot be repaired, rebuilding the labrum rather than trimming it away gives better results, with far fewer people needing another operation.
None of this is a promise about your hip. It is a realistic picture of what tends to happen, which we will tailor to your scans and your examination when we talk it through together.
When to see someone¶
See your GP if you have had groin or hip pain for more than a few weeks, especially if it flares with twisting, bending or sitting, and rest is not settling it. Ask for a specialist review if the hip is also clicking, catching, locking or feels like it might give way, or if the pain is disturbing your sleep or getting in the way of your work. If your hip has already been scanned and a tear was seen but you have no pain, you do not need to rush: many tears on scans never cause trouble. But if that hip starts to ache, do not wait it out, because a tear that is causing symptoms is worth assessing before it wears the joint surface.
Evidence & references
This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.
Anatomy & Pathophysiology¶
Bony Anatomy & Vascular Supply¶
- The acetabular labrum is a fibrocartilaginous structure that surrounds the periphery of the acetabulum and inserts on the transverse acetabular ligament [1].
- The acetabular labrum is a triangular fibrocartilaginous ring attached firmly to the acetabular rim, encompassing nearly the entire acetabulum except for the most inferior aspect bridged by the transverse acetabular ligament [2].
- Blood supply to the acetabulum is primarily through the obturator artery, superior gluteal artery, and inferior gluteal artery [1].
- The periphery of the labrum is more vascularized than the articular region [1].
Biomechanical Function¶
- The labrum functions to increase the stability of the hip joint and to seal the hip and prevent escape of fluid [1].
- The labrum deepens the acetabulum, increases coverage of the femoral head, and plays a role in shock absorption, joint lubrication, and pressure distribution [2].
- The most critical role of the labrum may be the creation of a negative pressure seal with the femoral head, which aids in joint stability [2].
- Removal of the labrum leads to a shift in the femoral contact point toward the acetabular rim [2].
- Removal of the labrum leads to a decrease in intra-articular fluid pressurization [2].
- Removal of the labrum leads to a loss of lateral restraint to femoral head motion [2].
- Removal of the labrum increases contact stresses between the articular cartilage of the femoral head and the acetabulum by 92% [2].
Pathophysiology of Labral Tears¶
- In the presence of a labral tear, the sealing function is lost, which may lead to increased contact pressure thought to have a role in the development of degenerative disease [1].
- In a study of 436 patients, 73% of those with labral tears or fraying had articular damage [1].
- In a study of 436 patients, most articular damage was located in the same zone as the labral damage [1].
- The severity of chondral damage was greater in patients with labral tears than in patients who had an intact labrum [1].
- The majority of labral tears have been suggested to be related to abnormal joint morphology and function [1].
- Labral-chondral separation is more commonly seen with cam type impingement than with femoroacetabular impingement [1].
- Intrasubstance tears are more typical of pincer impingement [1].
- The labrum is injured most often in femoroacetabular impingement (FAI) and acetabular dysplasia [2].
- Hip trauma leading to a labral tear generally involves a high-energy contact mechanism resulting in a frank dislocation or subluxation [2].
- Traumatic hip instability is frequently associated with chondral lesions to the femoral head and acetabulum analogous to those seen in a shoulder dislocation [2].
- Sports requiring great deal of hip torsion can lead to capsule attenuation and laxity secondary to repetitive microtrauma [2].
- Attenuation of the capsule leads to microinstability of the joint, in which the femoral head subluxates anteriorly and rides on the anterior superior labrum [2].
- Microinstability can occur in patients with collagen disorders such as Ehlers-Danlos syndrome, Marfan syndrome, and Down syndrome [2].
- Degenerative labral tears are analogous to degenerative meniscus tears in the knee and are frequently associated with diffuse articular changes in an arthritic joint [2].
- Degenerative labral tears are thought to be extremely common in the aging hip and likely occur early in the arthritic process [2].
- Iliopsoas impingement on the anterior hip joint has been suggested as an additional mechanism for labral tears [2].
- An atypical labral tear pattern occurs on the anterior acetabulum directly beneath where the iliopsoas tendon crosses the hip joint, unlike the common location in FAI and dysplasia which is more superior on the anterior acetabulum [2].
- In the pediatric literature, labral tears are described in association with avulsions of the rectus femoris [2].
- It is theorized that a traction injury of sufficient energy can tear the labrum in the location near the reflected head of the rectus femoris, which is near the anterior labrum and inferior to the anterior superior iliac spine [2].
Tear Morphology & Classification¶
- Seldes et al. described two types of labral injuries: a separation of the labrum from its articular attachment and tears in various planes within the substance of the labrum [1].
- A morphologic classification based on arthroscopic findings includes radial flap tears, radial fibrillated tears, longitudinal peripheral tears, and unstable tears [1].
- Stable tear patterns include radial, fibrillated, and longitudinal peripheral tear patterns [2].
- Radial flap tears occur with an intra-articular free-edge disruption [2].
- Radial fibrillated tears are degenerative tears with fibrillated free margins [2].
- Longitudinal peripheral tears are stable labral separations from the acetabular margin [2].
- Unstable tears include the bucket-handle tear [2].
- Type 1 histological tears occurred at the junction between the fibrocartilaginous labrum and the articular hyaline cartilage [2].
- Type 2 histological tears occurred in various planes within the substance of the labrum [2].
- Anterior labral tears have been prevalent in most studies because of their association with FAI [2].
- Acetabular labral tears are the most common pathologic finding at the time of hip arthroscopy [2].
- Acetabular labral tears typically occur anteriorly and/or anterolaterally [2].
Clinical Presentation¶
- Patients with labral tears typically present with pain, usually in the groin [1].
- Patients with labral tears typically present with mechanical symptoms [1].
- Byrd described the C-sign, where patients cup their hand forming a C over the greater trochanter when asked to localize pain [1].
- Pain associated with labral tears may be minimal during level walking [1].
- Evaluation for suspected labral tears should include radiographs of the pelvis and hip [1].
- Evaluation for suspected labral tears should include advanced imaging when indicated [1].
- CT scan offers greater detail in assessing bony architecture [1].
- MRI and MRI-arthrogram are useful for identifying labral tears [1].
Investigations¶
Clinical Presentation and Examination¶
- Patients with acetabular labral tears typically present with pain, usually in the groin, and mechanical symptoms [1].
- The "C-sign" is described as a patient cupping their hand to form a C over the greater trochanter when asked to localize pain [1].
- Pain may be minimal during level walking in patients with labral tears [1].
- Patients may report mechanical symptoms such as clicking and catching [2].
- Pain with prolonged sitting is a common symptom of labral tears [2].
- Physical examination findings for anterior labral tears include pain in the provocative position of flexion, adduction, and internal rotation [2].
- Physical examination findings for lateral labral tears include pain in flexion, abduction, and external rotation [2].
- The FADIR test (flexion, adduction, internal rotation) is used to detect anterior labral tears [2].
- The dynamic internal rotation impingement test is used to detect anterior labral tears [2].
Imaging¶
- Imaging for the diagnosis of a labral tear includes plain radiographs and magnetic resonance arthrography [2].
- A positive response to an intra-articular joint injection that brings complete pain relief is the most valuable diagnostic sign for confirming the joint as the source of pain [2].
Treatment¶
Non-Operative¶
- Initial treatment for acetabular labral tears is typically nonoperative [1].
- Nonoperative management includes rest, anti-inflammatory agents, and physical therapy [1].
Operative¶
- Unresolved pain after nonoperative treatment is treated with labral debridement or repair [1].
- In a 10-year follow-up study of patients with labral lesions treated with debridement, hips without signs of arthritis showed a significant increase in Harris Hip Scores that remained significant throughout the period [1].
- In the same 10-year follow-up study, seven of eight patients with associated arthritis required total hip arthroplasty [1].
- In patients with femoral acetabular impingement, improvement in Harris Hip scores was greater in the labral refixation group compared to the labral debridement group [1].
- Two main suture configurations are used for labral repair: circumferential repair and labral base repair [1].
- The decision between circumferential and labral base repair is based on the quality of the remaining labral tissue [1].
- A labral base repair is typically used in patients with robust labral tissue [1].
- A circumferential repair is chosen when the labrum is significantly frayed to avoid the suture lacerating the remaining labrum [1].
- It is essential to maintain labral contact with the femoral head to reestablish the suction seal during repair [1].
- Anchors placed too far from the acetabular rim or overtightened sutures may evert the labral edge [1].
- A retrospective study by Jackson et al. showed no difference in outcomes between suture patterns [1].
References¶
[1] Campbell S Operative Orthopaedics 4 Volume Set. ANTERIOR CRUCIATE AND ANTROLATERAL LIGAMENT RECONSTRUCTION (BOX 51.8) > ARTHROSCOPIC MANAGEMENT OF LABRAL TEARS.
[2] Orthopaedic Knowledge Update Sports Medicine 6. Athletic Hip Injuries > Acetabular Labral Tears.