Labral Tears

The etiology for labral tears can be from traumatic and degenerative causes, structural abnormalities from femoroacetabular impingement (cam and pincer

Fig. 2. Limited blood supply to the labrum at the labrocapsular junction. Arthroscopic view of a hyperemic labrum.
Fig. 3. Arthroscopic view showing degenerative changes within the labrum.

type lesions) [9], developmental abnormalities from dysplasia, old slip epiphysis and Perthes disease [9], and hip instability [10].

Traumatic tears in athletes can occur from an isolated event, or more commonly from repetitive trauma [2]. Traumatic hip dislocations are also susceptible to labral tears. Acetabular fractures that occurred from football injuries have also been associated with labral tears [2,11]. Acetabular labral tearing from repetitive trauma during sport-specific activity has been demonstrated [11,12]. Hip injuries in golfers from repetitive golf swing show anterior labral tears with delamination of the adjacent cartilage [12].

Degenerative labral tears (Fig. 3) in the athletic population can be the result of wear-and-tear injuries, and may be associated with degenerative changes of the hip joint. These types of tears can cause mechanical symptoms during athletic participation.

Labral tears can also be caused by structural abnormalities of the hip joint, leading to abnormal loading of and irritation to the labrum and adjacent

Fig. 4. Three-dimensional CT scan image of the femoral head and neck junction. The arrow points to the bump deformity.
Fig. 5. 27-year-old female marathon runner with displaced anterior labral tear. Assessing head-neck junction in peripheral compartment.

cartilage. Sport activity and injury can enhance this irritation and lead to eventual tearing of the acetabular labrum and thinning of the adjacent cartilage [9]. The concept of femoroacetabular impingement has been developed to describe this phenomenon [13]. Cam-type impingement occurs from loss of femoral neck offset (Fig. 4), leading to abnormal contact during flexion and internal rotation. Pincer-type impingement is the result of a retroverted ace-tabulum creating an anterior wall overhang [13]. Both types of impingement can occur in combination [13]. The labrum is encountered first during contact with both types of impingement (Fig. 5). Continued insult to the labrum, initially in the anterolateral zone, can lead to bruising (Fig. 6) and give the labrum a short, round appearance [9]. Eventually tearing can occur with detachment from the acetabular rim and direct chondral injury. Repetitive activity, as seen in golfers [12] and martial arts practitioners, can lead to bruising and tearing of the labrum. Articular lesions on the posteromedial load zone of the acetabulum

Fig. 6. 19-year-old male hockey player with femoroacetabular impingement, with arthroscopic view showing bruised anterior labrum.

Fig. 7. Hypertrophied anterior labrum in a patient with mild hip dysplasia.

result from anterior impingement and leverage of the head posteromedial into the acetabulum [9]. This process may lead to arthrosis of the hip joint.

Developmental abnormalities such as developmental dysplasia, Perthes, and old slipped capital femoral epiphysis (SCFE) can lead to abnormal contact of the labrum [9]. Mild hip dysplasia has been identified in athletes who have lab-ral tears [2,11]. A hypertrophied labrum (Fig. 7) may also be seen during arthroscopic evaluation of the dysplastic hip.

Hip instability in athletes has been attributed to capsular laxity from either acquired or traumatic etiology. Capsular elongation, particularly at the level of iliofemoral ligament (capsular ligament), can create increased stress and pathology to the labrum [10]. Labral tears can also cause capsular redundancy and affect hip stability.

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