Background: The clinical presentation of a labral tear of the
acetabulum may be variable, and the diagnosis is often delayed. We sought to
define the clinical characteristics associated with symptomatic acetabular
labral tears by reviewing a group of patients who had an arthroscopically
Methods: We retrospectively reviewed the records for sixty-six
consecutive patients (sixty-six hips) who had a documented labral tear that
had been confirmed with hip arthroscopy. We had prospectively recorded
demographic factors, symptoms, physical examination findings, previous
treatments, functional limitations, the manner of onset, the duration of
symptoms until the diagnosis of the labral tear, other diagnoses offered by
health-care providers, and other surgical procedures that these patients had
undergone. Radiographic abnormalities and magnetic resonance arthrography
findings were also recorded.
Results: The study group included forty-seven female patients (71%)
and nineteen male patients (29%) with a mean age of thirty-eight years. The
initial presentation was insidious in forty patients, was associated with a
low-energy acute injury in twenty, and was associated with major trauma in
six. Moderate to severe pain was reported by fifty-seven patients (86%), with
groin pain predominating (sixty-one patients; 92%). Sixty patients (91%) had
activity-related pain (p < 0.0001), and forty-seven patients (71%) had
night pain (p = 0.0006). On examination, twenty-six patients (39%) had a limp,
twenty-five (38%) had a positive Trendelenburg sign, and sixty-three (95%) had
a positive impingement sign. The mean time from the onset of symptoms to the
diagnosis of a labral tear was twenty-one months. A mean of 3.3 health-care
providers had been seen by the patients prior to the definitive diagnosis.
Surgery on another anatomic site had been recommended for eleven patients
(17%), and four had undergone an unsuccessful operative procedure prior to the
diagnosis of the labral tear. At an average of 16.4 months after hip
arthroscopy, fifty-nine patients (89%) reported clinical improvement in
comparison with the preoperative status.
Conclusions: The clinical presentation of a patient who has a labral
tear may vary, and the correct diagnosis may not be considered initially. In
young, active patients with a predominant complaint of groin pain with or
without a history of trauma, the diagnosis of a labral tear should be
suspected and investigated as radiographs and the history may be nonspecific
for this diagnosis.
Level of Evidence: Diagnostic Level IV. See Instructions
to Authors for a complete description of levels of evidence.