Update on contribution of hip labral tears to hip pain: A narrative review

Hip labral tears are found in 22-55% of individuals with hip pain, but labral tears without cysts are usu-ally not responsible for hip pain, which originates mostly from other structures than the torn labrum, like osteochondral, but also tendinous injuries (rectus femoris, gluteus minimus, iliopsoas) or capsulo-ligamentous tears (iliofemoral ligaments, ligament teres). Those lesions are mainly the consequences of underlying unrecognized functional acetabular dysplasia, and/or femoroacetabular impingements. Although the early repair of labral tears in young sportsmen induces a marked and lasting relief, and might delay the onset of osteoarthritis, the microinstability fostered by labral damages seems less important than underlying dysplasias/impingements. This narrative review details recent findings on: (i) the vari-ous mechanisms of pain associated with labral tears; (ii) few evidence for hip microinstability induced by isolated labral tears; (iii) how to best detect labral tears, both clinically (including through IROP test) and on imaging (MRI, MRA, computed tomography arthrography, ultrasound). Some authors suggested to use pull-out tests during surgery, but pulling of hips do not seem to increase much diagnostic perfor-mances of ultrasounds. Ultrasound-guided intra-articular and peri-articular injections may tell how often hip pain is exclusively induced by peri-capsular injuries secondary to the acetabular dysplasia/femoro-acetabular impingements already responsible for labral tears. Further works could tell whether labral repair, tendinous debridement, plication of capsule, and/or focal denervation, may induce lasting reliefs of pain induced by the chronic contraction of surrounding muscles (rectus femoris, gluteus minimus, psoas), whose deep aponeuroses mix with the superficial fibres of the thick hip capsule.(c) 2022 Socie acute accent te acute accent franc , aise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.

Automated summary

Hip labral tears are common in individuals with hip pain, but tears without cysts usually do not cause pain. The pain is mainly caused by injuries to other structures such as osteochondral, tendons, and capsulo-ligamentous tears. These injuries are mainly associated with underlying unrecognized acetabular dysplasia and femoroacetabular impingements.