What you should know about hip labral tears in young athletes

Dr. Young-Jo Kim hip labral tears Q&A lead image

Labral tears are a common injury in the hip, particularly with young athletes who may have underlying hip anatomy issues, such as hip dysplasia or impingement. Treatment for labral tears can range from rest and physical therapy to open surgery, with time away from sports spanning from days to weeks, or even months.

It’s important that any individual experiencing hip pain see a physician as soon as possible in order to limit pain and damage to the hip. Dr. Young-Jo Kim, a pediatric and young adult orthopedic hip specialist at Boston Children’s Hospital Orthopedic and Sports Medicine Center, discusses the causes of labral tears and his philosophy for treatment of this injury in young athletes.

hip labrum image
The labrum in the hip is a rim of soft tissue that surrounds the hip socket and protects the surface of the joint.

When you see a patient who has labral tear, how does that appointment usually go?

If I see a new patient, I usually start out with their history and a physical. I’ll ask them, “How did this injury happen? Where is the pain located? What kinds of things make it hurt more?” If it’s an athletic injury, sometimes the pain could have happened pretty suddenly, but more often it’s a gradual onset pain.

Certain sports and activities may predispose people to getting labral tears. It’s more common among athletes who do a lot of rotating and twisting leg motions, such as golf, soccer, ice hockey, ballet and football. It’s an injury we see a lot with hockey players, particularly goalies.

With certain sports, there tends to be a higher risk of labral tears. What sports would you say you see the most?

I see labral tears most often in hockey players and dancers. These types of activities seem to be the ones that put a unique stress on the hip, and labral tears are unfortunately quite common.

What is the difference between a labral tear in a younger person versus an adult?

When people are older, they can get labral tears just from the wear and tear of aging. But if you are talking about a teenager or 20-year-old — often it’s due to activity. In many cases, it’s also due to certain hip shape problems, such as hip dysplasia or impingement. The majority of the patients I see have some sort of underlying anatomical issue.

Hip dysplasia is a result of one or more areas of the hip joint not developing properly. It occurs when the ball at the top of the thigh bone (femur) that fits into the hip socket (acetabulum) is loose within the socket.
Hip impingement occurs when the femur has abnormal contact with the acetabulum, which can be a result of a deformity of the top of the femur (femoral head) and/or a deformity of the acetabulum.

Would you say that’s the main driver behind them having a labral tear or pain in the hip?

That’s the current thinking — that there’s some susceptibility to labral tears from underlying hip structure issues. Combined with the demands that an individual may put on their hip, this can cause injury to the labrum.

When you see patients who have these hip anatomy problems along with a labral tear, do you usually suggest surgical treatment?

If they have hip dysplasia and a labral tear for example, which is a common combination, we talk about most likely needing to fix the dysplasia surgically. For a person with hip dysplasia, their hip socket is too shallow and the labrum is not well supported, so if you just fix the labral tear, it can often re-tear. If we were to do surgical treatment, we would try to fix the underlying cause as well as the labral tear.

hip labrum and hip dysplasia image
Improper coverage of the femoral head caused by hip dysplasia can put additional stress on the labrum and lead to a labral tear.

We also do a lot of nonsurgical management — especially with patients who have a small labral tear and not a lot of hip shape problems. We work closely with the sports medicine primary care physicians here at Boston Children’s to help patients get the best access to therapy, and sometimes injections as well.

Sometimes they not only have a labral tear, but they also have a lot of tendonitis around the hip. In that case, we would do therapy and injections to try to calm that down. What’s nice about working with Drs. Pierre d’Hemecourt, Andrea Stracciolini and Sarah Jackson in our Sports Medicine Division, is that they know a lot about how to treat patients therapeutically. They’re also the ones who do the ultrasound exam and injections — we have complementary skills. 

Before you suggest a surgical course of treatment for patients with underlying anatomical hip problems, do you seek out nonsurgical options?

There’s a spectrum; if there’s severe dysplasia or impingement, we’ll still offer nonsurgical treatment, but often it does not work.

If an athlete comes in with a labral tear and does have mild hip dysplasia, we will try nonsurgical treatment first. If the symptoms improve, then I will let them return to sports, but advise them on the possibility that the labrum can re-tear and become symptomatic. If they re-tear their labrum they should come back for further treatment, which will likely be surgical.

In general, I like to think of each patient’s condition and injury as unique. There isn’t going to be one best answer for every patient. Our shared decision-making is based on each patient’s situation and what’s best for that individual.

Learn more about Boston Children’s Child & Young Adult Hip Preservation Program.