TORN ACETABULAR LABRUM

 The Injury

The Acetabular labrum is a fibrocartilage ring, located in the socket (acetabulum) of the hip joint.

• Similar to the menisci (cartilages) in the knee and the Glenoid labrum of the shoulder, the acetabular labrum increases the congruency of the hip joint, acting as a 'spacer' and shock absorber during weight bearing.
• Just like the fibrocartilage structures of the shoulder and knee, the acetabular labrum can become torn if there is a twisting movement while the hip joint is bearing weight. 

By visualizing the hip joint using an arthroscopy, orthopedic surgeons have been able to document hip injuries in much more detail. Research has noted the incidence of a torn Acetabular labrum is much higher than previously thought. 

 Signs and Symptoms

• A history of twisting on a load bearing hip during sport is common.
• The onset of pain is immediate and is usually located at the front of the hip joint.
• As with all hip problems, the pain may become diffuse and difficult to pinpoint.
• It is not possible to see swelling, although the inflamed joint may become larger in volume because of an 'effusion' due to trauma.
• If the front of the hip joint is affected there may be a pinching sensation when the person flexes the hip by bringing the knee up to the chest.
• The pain may be reproduced in sport during activities that require weight bearing and twisting.
• It may be possible to see the injury using a CT or MRI arthrogram. These scans are done after a contrast medium has been injected into the joint to highlight the damaged labrum. The injury is not always visible on a straightforward MRI or CT scan.

• Help is now at hand with more and more surgeons learning the arthroscopic technique for the hip, a procedure that can be performed on an outpatient basis. Although a general anesthetic is used, a stay in hospital is not usually necessary. A tear in the labrum can be seen and trimmed using the arthroscopy, with the whole procedure taking less than an hour.
• Following surgery, the patient will be taught how to use crutches by a physical therapist and will remain on these for four or five days. This is purely precautionary because of the load bearing nature of the hip joint.
• Once the 'portals' where the arthroscopy were inserted have healed, the patient can begin mobilizing the hip joint to regain full range of movement. Exercises in a hydrotherapy pool are particularly effective because they allow mobilization without compression through the joint.
• Progressive muscle strengthening is then undertaken and, once the operated side has normal range of motion and strength, functional exercises can be started.
• A return to sports is usually possible between two and three months after the operation.