acetabular labrum tears

Groin pain is a major source of problems in athletes, with numerous potential causes, including adductor strains, hernias, referred back pain, inflammation of the pubic bone – and acetabular labrum tears.

The latter injury, first reported in 1957, has become recognised as a cause of groin pain only during the last decade, but is now thought to be the underlying problem in more than 20% of athletes presenting with groin pain, according to a new British review.

The bad news is that this delay in recognition has led to inappropriate and ineffective treatment for many groin pain sufferers. The good news is that advances in diagnosis and treatment now hold out the hope of good recovery for most of them.

The labrum is a fibrocartilaginous rim which encompasses the circumference of the acetabulum – the socket on each side of the hip bone, into which the femur fits. The labrum, which effectively deepens the socket, is thought to enhance the stability of the hip joint and help distribute applied force more evenly across the surface of the cartilage.

Acetabular labrum tear is a common finding in the aging adult hip and is also associated with traumatic injury, usually caused by the hip joint being stressed in rotation. The pain is mainly felt in the groin (but can be in the trochanteric or buttock region) and is commonly sharp, with a clicking and catching sensation. Activities that involve force adduction of the hip joint in association with rotation in either direction tend to aggravate the pain.

There are a number of clinical tests, but generally speaking the groin pain caused by acetabular labrum tears is associated with combined movements of flexion and rotation.

As these tears have become recognised as a cause of hip and groin pain there has been growing interest in the search for a suitable diagnostic tool. And hip arthroscopy – surgical examination of the cavity of a joint – has emerged as a promising tool for both diagnosis and treatment, particularly since the introduction of microsurgical techniques.

Several studies on arthroscopic ‘debridement’ – cleaning of the wound by removal of foreign material and dead tissue – have shown promising results, with success rates as high as 90%, particularly in younger patients and those without complications, such as arthritis.

The authors of the current study have called for further studies with long-term follow-up and, particularly, for a randomised controlled trial comparing conservative management (bed rest and crutches) with arthroscopic debridement.

But in the meantime they urge greater awareness by sports clinicians of the signs and symptoms of acetabular labrum tears and, particularly, ‘a high clinical suspicion of acetabular labrum tears in athletes with mechanical symptoms and also in those who have not responded to treatment designed for the more familiar causes of joint pain’.

British Journal of Sports Medicine, 2003;37:207- 211