Before you have a surgery for a Torn Hip Labrum
In this article Danielle R. Steilen-Matias, MMS, PA-C discusses various methods of acetabulum hip labrum repair including regenerative and biomaterials such as Platelet Rich Plasma Therapy and stem cell therapy.
In a recent study doctors expressed concern that there does not appear to be treatment options for patients showing labrum hip tear symptoms: painful, torn, irreparable, or completely ossified (calcified) acetabular labrum short of reconstruction with grafts.
It had been suggested that regeneration of the acetabular labrum was possible after excision or removal of the diseased labral tissue but studies are inconclusive and one study says it does not happen. (cited also below)1 It may not happen because diseased tissue is a building block of repair.
In other research doctors suggested that radial and circumferential labral tears significantly decrease hip stability and significantly alter strain patterns in the anterior and anterior–superior acetabular labrum.2
The hip labrum is a cartilage ring that holds the thigh bone to the hip socket at the acetabulum. The place where the head of the thigh bone (or femur) meets the pelvis at the hip socket.
Damage to the labrum causes pain and joint instability and overgrow bone in attempt to stabilize the area. In femoral acetabular impingement, it is believed that pain is due to the bones of the hip joint coming too close together during movement and pinching various tissues such as the labrum and cartilage.
The labrum has a poor blood supply, which makes a tear or injury difficult to treat with conservative approaches, such as pain medicine or rest. These particular recommendations have very little long term appeal, especially for an active person who does not want to take medication long term. Physical therapy may also be recommended for rehabilitation. In patients with pain from femoral acetabular impingement (FAI) and labral tear, intra-articular cortisone injection has limited clinical benefit.3
Labral hip tears are grouped into four classifications
- anterior superior labrum hip tear
- posterior superior labrum hip tear
- superior labrum hip tear
- posterior labrum hip tear
While physical therapy can help the surrounding muscles, it does not promote repair to the the labrum or prevent further instability of the hip joint. Consequently, labral tear cases are quickly referred to surgeons for potential surgery to try and repair or remove the damaged tissue. The surgical prognosis is often guarded as to whether the athlete would be able to return fully to his or her sport, especially if labral tissue is removed.
- New research says that patients, forty-five years of age or older, who had arthroscopic labral surgery had a relatively high re-operation rate and minimal overall improvement with small clinical benefit.4
- Resection (removal) of a nonreparable acetabular labrum does not stimulate regrowth of tissue…patients who underwent this procedure had neither results in regrowth nor the restoration of consistently high hip function.1
In new research doctors acknowledge that cartilage injuries can be managed a number of different ways, including with debridement, microfracture or drilling, cartilage transplants, and higher level restorative techniques. These cartilage restoration techniques have evolved rapidly as well, and may include the use of scaffolds, allograft cartilage cells, and other stem-cell-related procedures for hip labral tears.5
Problems with surgery for hip labrum tear
The studies mentioned above point out the problem with completely removing the labrum but also point to problems with tears: Doctors recognize that without the labrum, the articular cartilage must withstand significantly increased pressure, and a compromise of this system could lead to early joint deterioration. Research noted that a tear in the labrum would also likely destabilize the hip joint. This explains why there is an association between acetabular labral tears and early onset osteoarthritis.”6
anterior superior labral tear hip surgery
Platelet Rich Plasma Therapy treatment for hip labrum tear
Platelets play a central role in blood clotting and wound healing. Tissue repair begins with clot formation and platelet degranulation, which release the growth factors necessary for wound repair. Platelet-derived growth factors are biologically active substances that enhance tissue repair mechanisms.
After platelets are activated at a wound site, proteins are released that directly and indirectly influence virtually all aspects of the wound healing cascade. Studies have shown a direct correlation between the platelet concentration and the level of secretory proteins, as well as the amount of proliferation involved in the wound healing.7-11
In our own research, Prolotherapy for hip labral tears was curative in 54% of the patients (no pain at all after Prolotherapy) and overall relieved 80-85% of their pain, which in our experience will end up much better than surgical procedures, because the hip is now stable.
References for this article
1 Miozzari HH, Celia M, Clark JM, Werlen S, Naal FD, Nötzli HP. No Regeneration of the Human Acetabular Labrum After Excision to Bone. Clin Orthop Relat Res. 2015 Apr;473(4):1349-57. doi: 10.1007/s11999-014-4021-z.
2. Smith MV, Panchal HB, Ruberte Thiele RA, Sekiya JK. Effect of acetabular labrum tears on hip stability and labral strain in a joint compression model. Am J Sports Med. 2011 Jul;39 Suppl:103S-10S. doi: 10.11
3 Krych AJ, Griffith TB, Hudgens JL, et al. Limited therapeutic benefits of intra-articular cortisone injection for patients with femoro-acetabular impingement and labral tear. Knee Surg Sports Traumatol Arthrosc. 2014 Apr;22(4):750-5. doi: 10.1007/s00167-014-2862-3. Epub 2014 Feb 1.
4 Wilkin G, March G, Beaulé PE. Arthroscopic Acetabular Labral Debridement in Patients Forty-five Years of Age or Older Has Minimal Benefit for Pain and Function. J Bone Joint Surg Am. 2014 Jan 15;96(2):113-8. doi: 10.2106/JBJS.L.01710.
5. Salata MJ, Vasileff WK. Management of Labral and Chondral Disease in Hip Preservation Surgery. Sports Med Arthrosc. 2015 Dec;23(4):200-4. doi: 10.1097/JSA.0000000000000093.
6. Groh MM, Herrara J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med. 2009 June; 2(2): 105–117.
7. Pietrzak WS, Eppley BL. Platelet rich plasma: biology and new technology. Journal of Craniofacial Surgery. 2005; 16:1043-1054
8. Crane D, Everts P. Platelet Rich Plasma Matrix Grafts. Practical Pain Management. 2008; Jan/Feb: 12-26.
9. Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Current Reviews in Musculoskeletal Medicine. 2008; 3:165-174.
10. Rabago D, Best TM, Zgierska A, et al. A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet rich plasma. British Journal of Sports Medicine. 2009; 43:
11. Sanchez A, Nurden AT, Zalduendo MM, et al. Platelet-released growth factors enhance the secretion of hyaluronic acid and induce hepatocyte growth factor production by synovial fibroblasts from arthritic patients. Rheumatology. 2007;46:1769-1772.
This article was updated 4/11/16