Labral tear is extremely common in elderly people, less common in young adults. It is usually associated with developmental hip dysplasia (DDH) and trauma.
Cam type: The problem is on the femoral neck. Deformity of the femoral neck – Ganz bump. May be anterior or lateral. This results in enlarged head-neck junction, which leads to decrease head-neck offset, and impingement on the acetabular rim in flexion and internal rotation of the hip joint.
Pincer type: The problem is on the acetabular side. Results from over coverage by the anterior aspect of the acetabulum this is mostly due to acetabular retroversion.
Look at the AP X-Ray – the lines of the posterior and anterior acetabular walls should not cross. If they do, the cup is retroverted (“cross-over” sign).
Combined type: This is the commonest type of all.
Tear is located at the the cartilage-labrum junction (not the labrum-capsule junction)
Look for secondary changes: Femoral neck osteophytes, cysts, and adjacent acetabular rim oedema on MRI scan.
Groin pain, related to movement, worse on flexion, initially only with movement, but may progress to become continuous. Associated click. Provocation test is usually positive, best tested by flexion adduction and internal rotation (FADIR) of the hip joint.
Snapping hip, internal or external, osteonecrosis of the femoral head, pigmented villonodular synovitis (PVNS), synovial chondromatosis and acute haemorrhage of ligamentum teres.
Non-surgical includes activity modification, nonsteroidal anti inflamatories (NSAIDs), Corticosteroid injections. Poor efficacy (< 20% success).
Surgical treatment includes arthroscopic debridement this technique has good results with success rate between 85-90%. Open debridement. Ganz’s safe dislocation of the hip ( not commonly used due to the high risk of damaging the blood supply to the femoral head).
In general terms the aim is to remove of any Ganz bump, ring osteophytes of the acetabulum and labral debridement.