Labral tears are one of the most common hip injuries in young athletes and can be a result of acute injury to the hip, an underlying anatomical issue that damages the labrum or in some cases, both. Treatment of labral tears ranges from rest and physical therapy to arthroscopy to open surgery. So how do you know what course of treatment is right for each patient?
Young-Jo Kim, MD, PhD, a pediatric and young adult orthopedic hip specialist at Boston Children’s Orthopedic and Sports Medicine Center, discusses the causes of labral tears and his philosophy for treatment of this injury in young athletes.
When you see a patient who has labral tear, how does that appointment usually go?
If I see a new patient, I usually start out with their history and a physical. I’ll ask them, “How did this injury happen? Where is the pain located? What kinds of things make it hurt more?” If it’s an athletic injury, sometimes the pain could have happened pretty suddenly, but more often it’s a gradual onset pain.
Certain sports and activities may predispose people to getting labral tears. It’s more common among athletes who do a lot of rotating and twisting leg motions, such as golf, soccer, ice hockey, ballet and football. It’s an injury we see a lot with hockey players, particularly goalies.
Often patients will be referred to me from another physician or another orthopedic surgeon that may have already worked with them and diagnosed them with a labral tear.
What is the difference between a labral tear in a younger person vs. an adult?
When people are older, they can get labral tears just from the wear and tear of aging. But if you are talking about a teenager or 20-year-old, often it’s due to activity. In many cases, it’s also due to certain hip shape problems, such as hip dysplasia or impingement. The majority of the patients I see have some sort of underlying anatomical issue. The current thinking is that there’s some susceptibility to labral tears from underlying hip structure issues. Combined with the demands that an individual may put on their hip, this can cause injury to the labrum.
When you see patients who have these hip anatomy problems, along with a labral tear, do you usually suggest surgical treatment?
If they have hip dysplasia and a labral tear for example, which is a common combination, we talk about most likely needing to fix the dysplasia surgically. For a person with hip dysplasia, their hip socket is too shallow and the labrum is not well supported, so if you just fix the labral tear, it can often re-tear. It’s the same situation if a patient has a significant cam deformity within the hip socket, where the femoral head is abnormally shaped, and it’s aggravating the labrum. If we were to do surgical treatment, we would try to fix the underlying cause as well as the labral tear.
Do most of your patients end up being surgical cases?
No, not always. We also do a lot of nonsurgical management — especially with patients who have a small labral tear and not a lot of hip shape problems. We work closely with the sports medicine primary care physicians here at Boston Children’s to help patients get the best access to therapy, and sometimes injections as well.
Sometimes they not only have a labral tear, but they also have a lot of tendonitis around the hip. In that case, we would do therapy and injections to try to calm that down. What’s nice about working with Drs. Pierre d’Hemecourt, Andrea Stracciolini and Sarah Jackson in our Sports Medicine Division, is that they know a lot about how to treat people with therapy. They’re also the ones who do the ultrasound exam and injections — we have complementary skills.
Before you suggest a surgical course of treatment for patients with underlying anatomical hip problems, do you seek out non-surgical options?
There’s a spectrum; if there’s severe dysplasia or impingement, we’ll still offer non-surgical treatment, but often it does not work.
If an athlete comes in with a labral tear and does have mild hip dysplasia, we will definitely try non-surgical treatment first. If the symptoms improve, then I will let them return to sports, but advise them on the possibility that the labrum can re-tear and become symptomatic. If they re-tear their labrum they should definitely come back for further treatment, which will likely be surgical.
If a physician sees a patient with hip pain they suspect has a labral tear, are there any abnormalities they could see in clinic that may require a referral to a hip specialist?
Sometimes an athlete presenting with hip pain could also have locking and catching in the hip joint that is somewhat uncommon — like a bucket handle labral tear. Something like that should be referred to a specialist right away.
For most patients, the standard teaching is that they should try to rest and do physical therapy first. But if it doesn’t get better or the patient re-tears, they can refer to a hip specialist, who may be able to present surgical options that will improve the patient’s quality of life.
Learn more about the Child & Young Adult Hip Preservation Program at Boston Children’s Hospital