Why Do We Focus on the Acetabular Labral Tear? You Can't See the Forest for the Trees.

Abstract

The advent of higher-quality imaging has brought increased attention to the understanding and implications of commonly observed hip morphology and pathology. Many patients and even physicians like to focus on the presence of an acetabular labral tear when one is present on magnetic resonance imaging (MRI), despite the limitations of MRI in identifying labral tears. Furthermore, recent studies have demonstrated normal variations of the acetabular labrum, as well as a high prevalence of labral tears in both symptomatic and asymptomatic individuals. For patients electing surgical treatment of a labral tear, addressing the underlying pathology is imperative. Ignoring the primary pathology (e.g. femoroacetabular impingement [FAI] or hip dysplasia) risks the formation of a new labral tear following initial surgical management. This comprehensive approach ensures that the primary cause of the labral tear is treated, thereby reducing the likelihood of recurrence and improving patient outcomes. Although the labrum is highly innervated, making labral tears a direct cause of hip pain in affected patients, we should not be setting our focus on the labral tear itself. Focusing solely on the labral pathology may set up our patients for failure by overlooking the underlying anatomical issues that precipitate these tears. Addressing the root cause, such as correcting FAI and/or hip dysplasia, is crucial for effective treatment. By correcting these anatomical factors, we can prevent future labral damage and provide more comprehensive and lasting relief for the patient. Ignoring the primary anatomical issues risks recurrent tears and ongoing pain, highlighting the need for a holistic approach to treatment.