Hip Labral Repair

Why this approach — at MOS

The decision between labral repair and labral reconstruction is one of the most consequential judgments in hip arthroscopy. The goal is always to preserve the native labrum — patient's own tissue has no risk of graft failure or immune response, heals to bone predictably when the rim is properly prepared, and restores native anatomy.

Dr. Christoforetti's approach to labral repair emphasizes three things: tissue assessment, rim preparation, and repair configuration. Tissue quality is evaluated both on pre-operative MRI and directly under arthroscopic magnification during surgery. A labrum that appears thin or calcified on MRI may still be reparable when viewed arthroscopically; conversely, a labrum that appears intact on MRI may be found to be severely degenerated intraoperatively. The intraoperative assessment drives the decision.

Rim preparation is performed meticulously to create a vascular bed for healing. Anchor placement and suture configuration are planned to capture adequate labral tissue volume and restore the normal triangular cross-sectional shape of the labrum — not just close the tear at the surface.

FAI correction is almost always performed at the same setting. Repairing a labrum without correcting the mechanical impingement that tore it exposes the repair to the same damaging forces from the first day of weight-bearing. Long-term evidence consistently shows superior outcomes when both the labrum and the underlying bony pathology are addressed together.

Patients served across Montgomery County benefit from the same detailed pre-operative planning process: imaging review, diagnostic injection when appropriate, and a thorough discussion of what the surgery will and will not accomplish before a plan is finalized.

Who is a candidate?

Indications

• Acetabular labral tear confirmed on MRI arthrogram with symptoms that match the imaging findings
• Labral tissue that is of sufficient quality (not severely degenerated, calcified, or atrophic) to hold suture anchors and heal
• Deep groin pain, mechanical clicking, or hip instability symptoms — particularly with hip flexion, pivoting, or prolonged sitting
• Positive impingement test (FADIR) and/or positive flexion-abduction-external rotation (FABER) test
• Failure of 3–6 months of non-operative management
• Adequate joint space indicating the hip can benefit from joint preservation surgery

Contraindications

• Labral tissue that is too thin, calcified, or degenerated to hold sutures — these cases require reconstruction with a graft instead
• Advanced hip osteoarthritis (Tönnis grade 3) — labral repair does not adequately treat end-stage arthritis
• Significant dysplasia (lateral center-edge angle < 20°) — dysplastic hips may require periacetabular osteotomy (PAO)
• Active hip joint infection
• Medical conditions that prevent safe general anesthesia

Conservative Treatment First

Before surgical repair is recommended, patients undergo a structured non-operative program. Physical therapy targets hip flexor flexibility, external rotator and abductor strengthening, and core stability. Movement pattern correction reduces the impingement load on the labrum during daily activities. NSAIDs reduce inflammation. An intra-articular cortisone injection confirms the diagnosis — pain relief following injection supports the labrum as the pain generator — and may temporarily reduce inflammation.

Most patients with labral tears do not require immediate surgery. Those with mild or intermittent symptoms, no associated bony impingement, or higher Tönnis grades are managed conservatively for longer periods. Surgery is considered when pain is functionally limiting, imaging shows a reparable structural tear, and conservative measures have provided only temporary or incomplete relief.

The procedure

What Is Hip Labral Repair?

Hip labral repair is an arthroscopic procedure in which a surgeon uses small suture anchors to reattach a torn acetabular labrum back to the rim of the hip socket. It is the preferred treatment for labral tears when the native labral tissue is of adequate quality — preserving the original labrum rather than replacing it with a graft.

The acetabular labrum is a ring of tough fibrocartilage that lines the rim of the hip socket (acetabulum). It plays several important roles: it deepens the socket to improve joint stability, creates a fluid seal that lubricates the articular surfaces, distributes load across the hip, and acts as a suction cup that resists distraction forces. When the labrum tears — most commonly at the anterosuperior rim where impingement forces are greatest — the joint loses this seal. Pain, clicking, and mechanical symptoms follow, and the joint is exposed to greater cartilage wear.

Labral tears occur most often in the setting of femoroacetabular impingement (FAI), where abnormal bone morphology on the femoral head or acetabular rim repeatedly pinches the labrum. They also occur after hip dislocations, in athletes with repetitive hip flexion loads, and occasionally without a clear precipitating event.

Hip labral repair is distinct from hip labral reconstruction. Repair means the surgeon reattaches the patient's own (native) labral tissue using suture anchors — the preferred approach when the labrum has not been destroyed and retains adequate tissue quality. Reconstruction means the labrum is too damaged to repair and must be recreated using a tissue graft. At MOS, the goal is always to preserve and repair the native labrum when tissue quality allows.

What Happens During Hip Labral Repair?

Setup and Anesthesia Hip labral repair is performed at our ambulatory surgery center under general anesthesia with a nerve block for post-operative pain control. The patient is positioned on a hip arthroscopy traction table. Controlled traction opens the hip joint by 8–10 millimeters to allow the arthroscope and instruments to enter safely. Fluoroscopy guides portal placement.

Diagnostic Inspection Two to three small portals are created around the hip. The surgeon performs a systematic arthroscopic inspection of the entire central compartment: the labrum, articular cartilage, ligamentum teres, and synovium. The tear is assessed — its location, extent, and tissue quality are evaluated to confirm reparability.

Rim Preparation The acetabular rim at the tear site is prepared to create a bleeding bony surface that will promote healing of the reattached labrum. The rim is carefully debrided of scar tissue and fibrous material using a shaver and burr, creating a fresh surface without damaging the surrounding labrum. This preparation step is critical — the labrum will not heal to bone without an adequately prepared surface.

Anchor Placement and Suture Passing Small suture anchors — typically 2–4 anchors, 2.4–3.5 mm in diameter — are placed in the acetabular rim at the base of the tear. Each anchor is pre-loaded with strong, non-absorbable sutures. A specialized curved suture passer is then used to thread the suture through the body of the labrum, capturing the labral tissue in a configuration that will reapproximate it to the bone. The sutures are tied, pulling the labrum back flush against the acetabular rim in its anatomic position.

Assessment and Capsular Repair After the repair is complete, the surgeon assesses labral tension and seating, confirming the tear is fully covered and the labrum creates an adequate seal against the femoral head. If FAI is present, the peripheral compartment is entered after traction is released and osteoplasty is performed. The capsule is repaired at the conclusion of the procedure.

Closure and Recovery Portal sites are closed. Patients go to recovery for 1–2 hours and are discharged home the same day. Crutches are provided.

Recovery timeline

Frequently Asked Questions