Marbrum injury is the most common cause of hip pain in young adults and athletes, but it can affect teenagers and older people. It is the most common indication for hip arthroscopy.
Anatomy and function
The bone structure of the hip is composed of the acetabulum and femoral head, known as the socket ball joint. The ball representing the femoral head and the socket the ice cream-shaped acetabulum.
The hip (or lip) of the hip surrounds the edge of the acetabulum and increases the coverage of the femoral head, as if it were the extension of a roof. It helps stabilize the hip and causes joint fluid to distribute better, reducing pressure on the articular cartilage. The harab has microscopic sensory organs that tell the brain where the hip is. It is also innervated by pain fibers and causes pain when injured.
Harm injuries can occur in sports or as a consequence of diseases that affect the hip structure. However, in most patients both are associated as causes of injury.
Sports activities can damage the harem by repetitive motions, with minor injuries adding to each movement. Eventually a single movement that required extreme hip rotation can traumatize the labrom. Direct trauma such as falls on the hip can also lead to labral injury.
Diseases of the hip structure can impact the femur and acetabulum during hip flexion, “crushing” or “stretching” the labile and articular cartilage. In addition, bone deficiency in the acetabulum and laxity of the ligaments may cause the femoral head to be partially dislocated and the labyrinth to be injured. This dislocation is usually subtle and damages the labyrinth through repeated episodes, known as hip instability.
As already mentioned, labral injuries are usually the result of the association between structural changes of the hip and sports activities or extreme hip movements.
Pain with sports or walking is the main symptom. Sitting pain may also occur. Crackling and distortion are also common complaints, and are caused by abnormal movement of the injured part of the harab within the joint.
Athletes with injury to the labral usually experience poor performance or end up practicing with pain. Some slow down, switch sports, or drop out. When associated with trauma, symptoms may subside after the first few weeks. Sedentary patients eventually have minimal symptoms, as they do not place their hips in uncomfortable positions or physical activities that irritate the injuredlabyrinth.
The finding of labral lesion on magnetic resonance imaging is common in patients without hip pain. Thus, not every labral lesion found on imaging exams causes symptoms. Similarly, finding labral lesions on imaging exams does not guarantee that this is the cause of the pain. Like all orthopedic pathology, proper interview and physical examination are the key to correct diagnosis. Imaging exams are complementary.
For proper treatment of labral injuries, other diseases that cause hip pain need to be ruled out. It should be understood that the hip is not only formed by bones but also by ligaments, muscles, tendons, vessels and nerves. Being that these different structures can be the cause of the pain, alone or associated.
The treatment aims at pain resolution and return to sports activities. Bone structure changes need to be seen before treating the labral lesion itself. Impact between femur and acetabulum or instability needs to be identified and treated. In these cases, treating only the labral lesion without considering structural changes is unlikely to yield good results in the medium and long term.
Treatment without surgery is initially indicated. This should be based on the identification of structural changes, so that certain positions that irritate the labyrinth through the impact between the femur and acetabulum or the displacement of the femoral head are avoided. Pain medications and anti-inflammatory drugs, physical therapy and readjustment of activities may be used. Stem cell and PRP therapies are promising, but have not yet defined indications and proven success in quality studies.
Patients with symptoms not resolved by conservative treatment are candidates for surgical treatment. The age, condition of the articular cartilage and the patient’s activities need to be taken into consideration when choosing the surgical procedure. This can be performed open (traditional surgery) or arthroscopically. Most labral lesions and structural changes can be treated by arthroscopy.
Since the structural changes associated with labral injury have been identified, the prognosis is good, with about 90% showing significant improvement in symptoms and may return to sports activities.