Comprehensive Morphologic Evaluation of the Hip in Patients with Symptomatic Labral Tear

Abstract

A torn acetabular labrum is a well-documented source of hip pain, but the mechanism of injury is debated because the relationship between the bone morphology and labral tears is poorly understood. We compared hips with and without labral abnormalities to determine the relative incidence of morphologic abnormalities. The study group consisted of patients with a labral tear confirmed by arthroscopy or arthrotomy at the time of open débridement or periacetabular osteotomy. We compared the affected hip with the contralateral, unaffected hip to ascertain signs of hip dysplasia and impingement. We observed differences in the center edge angle, acetabular depth to width index, acetabular index of elevation, femoral head extrusion, lateral and superior subluxation, Sharp's angle, peak to edge distance, and acetabular retroversion. Similar differences occurred in the subgroup analyses. Symptomatic labral tears correlated with abnormal hip morphology as reflected by radiographic measurements of dysplasia and impingement. This relationship occurred in patients with hip dysplasia and patients without obvious femoral head uncovering. Our findings suggest abnormal hip morphology may be a risk factor for labral tears.

CT Reveals a High Incidence of Osseous Abnormalities in Hips with Labral Tears

“…Although multiple etiologies of labral tears have been proposed, there is a growing consensus that labral tears rarely occur in the absence of bony abnormalities [9,11,16,32]. Plain radiographs and MRI often are used in the initial evaluation of patients with labral tears, however CT may be helpful in evaluating the subtle osseous abnormalities that underlie these tears and provide additional information regarding femoral version.…”

“…Third, we decided to use values that exceeded the proposed normal limits to classify a measurement as abnormal. Although this may have underestimated the number of structural abnormalities reported, the values were chosen based on previous studies of morphologic features of the hip [2,5,11,13,16,19,21,22,26,28,[32][33][34]. Furthermore, the CT measurements of the lateral and anterior CEAs have not been validated.…”

Anatomic Labral Repair in the Hip Using a Knotless Tensionable Suture Anchor

“…Subsequently, these findings were confirmed [5][6][7] ; several further studies on the causes, diagnosis, and implications of labral tears have been published [8][9][10][11][12][13][14] ; and several techniques for treatment have been described. [15][16][17][18][19][20][21][22][23][24][25] In 2005, Kelly et al 15 created a classification system based on the causes of labral tears: (1) trauma, (2) femoroacetabular impingement, (3) capsular laxity and/or hip hypermobility, (4) dysplasia, and (5) degeneration.…”

Detection of Acetabular and Proximal Femoral Radiographic Abnormalities Showed by Hip Digital Tomosynthesis in Special Functional Position Compared with Conventional Radiography

“…The acquired osseous abnormalities are closely related with an abnormal contact during hip joint motion between the skeletal prominences of the acetabulum and the proximal femur (16)(17)(18). The recurrent impingement can lead to microtrauma of abnormal developmental osseous convexities, acetabular labral tear and cartilage damage, that progresses and results in degenerative disease of the hip joint if the underlying cause of impingement is not eliminated (19,20). In the ini- tial phase of this entity, patients do not have obvious radiographic signs, such as joint space narrowing, osteophyte formation, subchondral sclerosis, or cyst formation (16,17,20).…”

“…The recurrent impingement can lead to microtrauma of abnormal developmental osseous convexities, acetabular labral tear and cartilage damage, that progresses and results in degenerative disease of the hip joint if the underlying cause of impingement is not eliminated (19,20). In the ini- tial phase of this entity, patients do not have obvious radiographic signs, such as joint space narrowing, osteophyte formation, subchondral sclerosis, or cyst formation (16,17,20). Therefore observing the early stage of radiographic features is helpful for the correct diagnosis and evaluation before potential surgical treatment.…”