Labrum Flashcards
Labrum ring is completed by ___
Transverse Lig
Anterior half collagen
Thin
Parallel fibers
Posterior half collagen
Thick
Perpendicular fibers
Vascularization
outer 3rd
Functions of labrum
Increase joint depth
Stabilize
Increase congruency
Protect articular cartiliage
How are labral tears classified?
Directional: A vs P
Physical Location: at articular cartilage vs within substance
Labral tear at articular cartilage
Labrum detaches from articular surface.
Advanced tear = cartilage detaches from bone.
Labral tear within substance
Perpendicular thru the plane of the labrum
Risk factors for labrum tear
FAI
Trauma
Hypermobility/laxity
DDH
Degeneration
What types of trauma increase risk of labrum tear?
Femoral head dislocation or subluxation
Hypermobility & capsular laxity can result from what?
Underlying disorders, hormone influences.
Abnormal loading in ER - kicking/twisting sports.
What is FAI?
Compression of anterior-superior labrum.
Compressed btwn acetabulum & anterior femoral neck.
Causes of FAI
Congenital
Acquired from sport
CAM FAI
Most common type of FAI.
Bony overgrowth of femoral neck.
Direct impingement of femoral head on labrum = shear force btwn labrum & articular cartilage.
Pincer FAI
Overhang of anterior-superior rim of acetabulum
Isolated traumatic MOI
HyperABD
Twisting
Falling
MVA
Dislocation
Repetitive microtrauma MOI
Sports involving ER and hyperext (hockey, soccer, ballet, golf)
Symptoms
C Sign
Clicking, catching, instability.
Pain: groin & anterior hip. Constant dull w/ episodes of sharp.
Aggs: sitting, STS, descending stairs.
Night pain: lying on affected side, or innominate rotation.
Functional limitations
Antalgic gait
Stairs
Sitting or walking for extended time
Pivoting/rotation activities
Impact (running, jumping)
Gait
Prolonged foot flattening
Decreased knee flex at heel strike
Hip hyperext & ER
Posture
Swayback or Lower Crossed
ROM
Limited ER/IR, flexion, add/ABD.
Pain at end-range FADIR.
Pain moving from flex to ext.
MMT
Weak flexion & adduction
Pt education: avoid what activities?
Crossing legs
Pelvic rotation during STS
Hyperextension during gait or exercise
High impact exercise
Optimize biomechanical alignment by controlling…
Force from glutes (ext).
Force from iliopsoas (flex).
Other PT treatment options
PNF
Aquatics (once wounds healed if post-op)
Indications for surgery
FAI
Conservative tx not improving s/s
Contraindications for surgery
Significant OA
Uncorrected DDH
Asymptomatic
Potential complications during surgery
Traction-related injury
Portal placement
Chondral/labral damage
Instability
Inadequate correction of FAI
Potential complications post-op
Excess fluid
Femoral neck fx
AVN
HO
Surgical procedure options
Debridement
Repair
Reconstruction
Debridement
Arthroscopic
Part of labrum removed.
Good for immediate relief but worst long-term outcomes.
Increased risk of OA (like meniscectomy).
Repair
Arthroscopic
Performed if labral tissue is adequate.
Better outcomes, prevents degeneration & maintains stability.
Looped Repair (for small) or Labral Base Re-Fixation (for large).
Reconstruction
Open or Arthroscopic
Performed if repair too difficult or previous debridement cannot be repaired.
Graft from ITB, Ligamentum Teres Capitis, Gracilis.
Reconstruction: allograft vs autograft, which has better outcomes?
Allograft - less prone to fraying/swelling.
Reconstruction: open vs arthroscopic, which has better outcomes?
Arthro - less scar, less risk of infect, less post-op pain.
