| Labral Tears |
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Labral tears are the most common problem treated with arthroscopic surgery. Xrays are usually normal, since they only show the bone and not the cartilage and other soft tissue structures around the hip. MRI (magnetic resonance imaging) is a more sophisticated non-radiation imaging technique for showing the various soft tissues. This may sometimes include a technique where dye is injected inside the joint to enhance the images. Even these sophisticated studies will miss problems in the joint about one third of the time. In general, they are best at showing injury to the labrum, but still poor at showing other problems, especially damage to the articular cartilage. Labral tears may occur from an acute injury such as twisting, but often occur as a consequence of repetitive activities and can happen simply as a result of degeneration or deterioration of the cartilage. In general, a healthy labrum is pretty resilient to injury. Thus, any time a torn labrum is encountered, it should be suspected that there may have been some underlying predisposition to this injury. Only a few specific causes have been identified. Sometimes the way the hip joint is shaped may make this cartilage easier to tear. Among competitive athletes, it can occur as a consequence of breakdown as the body is pushed beyond its physiologic limits. Degeneration of the labrum is also recognized as an inevitable consequence of the aging process. Arthroscopic treatment of a simple labral tear can be very successful. However, labral tears are often not so simple. Studies have shown that the majority of labral tears will have some associated damage to the articular cartilage. While MRIs are better at showing labral tearing, they usually will not show the associated injury to the articular cartilage. This is best defined and addressed during arthroscopy. However, the arthroscopic treatment of articular damage is generally less successful. Thus, when treating labral tears, it is often the uncertain, but expected, extent of associated articular damage that may be the limiting factor on the success of the procedure. Neglecting a labral tear with worsening symptoms can result in more secondary damage. This is not urgent but, in general, it is preferable to recommend arthroscopic treatment of these injuries rather than letting them go indefinitely as the symptoms are getting worse. However, there have also been reports where MRIs have shown evidence of injury to the labrum among asymptomatic volunteers and some patients with injury have come to be pain free over time. Thus, a trial of conservative management be appropriate as long as the symptoms are not worsening and the joint is given a chance to rest. |
