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, establishes a suction seal, and helps stabilize the hip joint by keeping the head of the femur (thigh bone) properly aligned in the socket.

(A) The acetabular labrum is the cartilage gasket at the rim of the socket.

(B) A healthy, intact labrum is visualized as a solid black triangle on MRI.

(C) During arthroscopic surgery, the labrum is a seen as continuation of the articular (joint) cartilage at the rim of the socket

Hip arthroscopy is a minimally invasive surgical procedure used by sports medicine specialists 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 (labral repair), or reconstructed from cadaver tissue (labral reconstruction) (Figure 1).

Labral Debridement

Debridement and removal of a damaged labrum along with removal of bone spurs from the rim of the acetabulum using a bur in a procedure (acetabuloplasty). This treatment helps alleviate chronic hip pain by eliminating friction and preventing further wear on the protective soft tissue of the joint.

Labral Repair

After acetabuloplasty, a damaged labrum can often be repaired or re-fixated to the acetabular rim using suture anchors. This formal labrum repair secures the torn labrum back to its anatomical position to preserve the joint's natural function.

Labral Reconstruction

An irreparable labrum has been debrided and removed (as in 1A) and reconstructed with fascia lata allograft fashioned into a cylindrical graft. By using this advanced graft technique during hip arthroscopy, your orthopedic surgeon can successfully re-establish the critical internal framework necessary to stabilize the joint and alleviate chronic hip pain.

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

Arthroscopy to repair a labrum tear is typically performed when:

Nonsurgical treatments such as physical therapy, anti-inflammatory medications, or injections fail to relieve hip pain.
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

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.
A diagnostic hip arthroscopy is performed first, allowing the orthopedic surgeon to inspect the hip joint and assess the location and extent of the labral tear.
Repair:
- Sutures are used to reattach the torn labrum to the rim of the acetabulum.
- To prevent future labral damage, it is critical that structural abnormalities like FAI be corrected during any labral repair surgery.

Labral tear

Torn labrum elevated off acetabular rim

Removal of bone from acetabular rim

Completion of acetabuloplasty

All-suture anchors (no screws)

Labral repair with 3 all-suture anchors

Suction seal is restored when traction is released

Flexing hip to confirm reshaped femoral neck does not impact repaired labrum

Post-Operative Recovery

Outpatient surgery: most patients go home the same day as surgery.
Initial Phase: Crutches are typically used for 2-4 weeks to protect the repair.
Rehabilitation: A physical therapist will begin working with you 2-3 days after surgery, focusing on restoring range of motion, strength, and hip joint stability. Daily range of motion exercises such as stationary biking and stretching are essential to prevent scar tissue formation. Full post-operative recovery can take 4-6 months depending on the severity of the labral tear and the individual's healing process. Regular follow up appointments are scheduled to monitor healing and progress throughout recovery.

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 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 continue experiencing hip pain. Treating impingement and instability alongside a hip labral tear may also help prevent further cartilage damage and slow the progression of osteoarthritis.