Labral Repair

A hip labral tear is an injury to the labrum, the fibrous ring of cartilage that surrounds the rim of the hip joint socket (acetabulum). The labrum acts as a cushion and helps stabilize the hip joint by keeping the head of the femur (thigh bone) properly aligned in the socket.

Hip arthroscopy is a minimally invasive surgical procedure used to address painful hip pathology that results from hip instability or femoroacetabular impingement (FAI). Damage to the acetabular labrum and articular cartilage from hip microinstability or FAI often results in painful pathology including arthritis.  The labrum plays a key role in establishing a suction seal, which helps stabilize the joint, preserve joint function, and delay the need for a hip replacement.

Depending on the extent of degeneration and tearing, the damaged segment of the labrum can be debrided (removed), repaired or reconstructed from cadaver tissue (Figure 1).

A hip labral repair is a surgical procedure to treat damage to the labrum, a ring of cartilage that surrounds the hip joint socket (acetabulum). The labrum plays a critical role in stabilizing the joint, cushioning the hip, and maintaining smooth motion. Damage to the labrum, often referred to as a labral tear, can result from trauma, overuse, or structural issues like instability or femoroacetabular impingement (FAI).

Arthroscopy to repair a labrum tear is typically performed when:

• Non-surgical treatments (physical therapy, medications, or injections) fail to relieve symptoms.
• There is significant pain, stiffness, or instability in the hip.
• The tear is large or associated with structural issues, such as bone spurs or FAI.

The Procedure

1. Labral repair surgery is done arthroscopically.  It is considered minimally invasive as it typically requires only 2 small (1/3-inch) incisions and a camera to guide instruments.
2. A diagnostic arthroscopy is performed, in which the surgeon inspects the joint to assess the location and extent of the damage.
3. Repair:
   • Sutures are used to reattach the torn labrum to the rim of acetabulum.
   • To prevent future labral damage, it is critical that structural abnormalities like FAI be corrected during any labral repair surgery. 

Post-Operative Recovery

• Outpatient surgery: most patients go home same day as surgery. 
• Initial Phase: Crutches a typically used for 2-4 weeks to protect the repair.
• Rehabilitation: Physical therapy begins 2-3 days after surgery focuses on restoring range of motion, strength, and stability. Daily range of motion (e.g., stationary biking and stretching) are essential to prevent the formation of scar tissue. Full recovery can take 3-6 months, depending on the severity of the tear and the individual’s healing process.

Risks

Like any surgery, hip labral repair carries risks, including:

• Infection (very low …  *Dr. Pappas has zero surgical hip infections over 15 years*)
• Blood clots (DVT)
• Nerve damage
• Persistent pain, stiffness, or scar tissue
• Re-tear of the labrum

Restoring the Suction Seal

By reattaching the labrum to its proper position, labral repair surgery can restore the suction seal, which improves joint stability and decreases the stress on the joint cartilage.  Restoring the suction seal is an important goal of hip arthroscopy, as it is essential for joint health, mobility, and long-term function

Mechanical issues and joint deformity, such as instability and femoroacetabular impingement, must be addressed appropriately.  Otherwise, the successful outcome of labral repair surgery may be compromised, and the patient may remain symptomatic. Addressing instability and FAI may also prevent further cartilage damage and the progression of arthritis.