Acetabular and Labral Pathology

Joseph C. McCarthy, Philip Noble, Michael Schuck, Frank V. Aluisio, John Wright, and Jo-ann Lee

The diagnosis of acetabular labral tear as a cause for hip pain has received little attention in the orthopedic literature, until recently. Many reasons contributed to making this diagnosis difficult. Radiographs readily visualize the bony architecture of the hip and pelvis, but not the chondral surfaces. Bone scans can demonstrate areas of increased uptake, but not the relatively avascular labrum. Tomography again witnesses only the bony anatomy of the femoral head and acetabulum. Computerized tomography, especially with thin sections and multiplanar reconstruction, allows excellent resolution for ossified loose bodies, degenerative joint disease, and bony displacement, but not chondral pathology. Magnetic resonance imaging facilitates visualization of osteonecrosis, muscular anatomy, and joint effusions, but is not reliable for diagnosing labral injury.1

Clinically the etiology of hip pain can be equally perplexing. Pain felt in the hip area can be referred from the spine, the sacroiliac joint, the retroperitoneum, and the pelvic structures, as well as the pervasive muscular envelope surrounding the joint. In addition, localized entities may produce pain in the same inguinal area as hip abnormalities do. These entities include inguinal or femoral hernias, psoas bursitis, enlarged inguinal lymph nodes, femoral pseudoaneurysms, and tendon avulsions.

Moreover, hip conditions that are self-limited may be difficult to distinguish from chondral injury. These self-limited causes of inguinal hip pain include transient synovitis, which is often viral or associated with hepatitis or collagen disease. Posttraumatic hematoma may involve the joint or surrounding soft tissues. Joint pain following reduction of a dislocation may or may not be associated with a labral injury.

Prior to the advent of hip arthroscopy, surgeons were reluctant to perform an open arthrotomy of the joint for diagnostic reasons because of the many associated potential risks. These risks included osteonecrosis, heterotopic bone formation, infection, neurovascular injury, thromboembolic disease, and muscle weakness. For this reason patients with hip pain were often treated medically with rest, anti-inflammatories, and physical therapy for protracted periods of time. While these treatment techniques may be successful for muscle strains, they will not resolve an acetabular labral tear.1-3

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