A hip labral tear is a structural injury of the acetabular labrum, the fibrocartilaginous rim that seals the femoral head inside the hip socket and provides roughly 22% of the joint's articular surface area. MRI studies of asymptomatic adults show labral abnormalities in 38-69% of hips by age 40, but tears become symptomatic when paired with bony impingement, dysplasia, or athletic loading.
A hip labral tear (ICD-10: S73.191A acute; M24.85 chronic) is a partial or complete disruption of the acetabular labrum, a triangular ring of dense fibrocartilage attached to the bony rim of the acetabulum. The labrum extends socket depth, maintains negative intra-articular pressure (the suction-seal effect), distributes synovial fluid for cartilage nutrition, and resists femoral head subluxation. Tears are classified by location (anterosuperior most common at 80-95%, then posterior), morphology (fraying, radial flap, longitudinal peripheral, unstable bucket-handle), and etiology (femoroacetabular impingement, dysplasia, trauma, capsular laxity, degeneration). The anterosuperior labrum is the workhorse region during hip flexion and internal rotation; cam-type femoroacetabular impingement progressively shears this segment with each pivot.
The key symptoms of Labral Tear (Hip) are: Deep, anterior groin pain that the patient often localizes by cupping the hip with the thumb anteriorly and the fingers over the greater trochanter — the classic C-sign — and which worsens with prolonged sitting, driving, or pivoting., Mechanical clicking, catching, locking, or a sensation of the hip giving way during rotation, climbing stairs, or rising from a low chair, present in 50-70% of patients with confirmed tears., Sharp pain reproduced by hip flexion to 90 degrees combined with adduction and internal rotation — the anterior impingement (FADIR) maneuver., Lateral hip and buttock pain referred along the trochanter and into the proximal posterior thigh, often misattributed to trochanteric bursitis., Stiffness and pain after long periods of inactivity, with patients reporting they have to walk off the hip for the first 5-10 minutes in the morning., Limited squat depth, inability to sit cross-legged comfortably, and pain getting in and out of a car — daily activities that load the hip in flexion and rotation., Symptoms aggravated by impact loading (running, jumping, cutting sports) and partially relieved by rest; persistence of mild groin ache between training sessions..
Diagnosis combines history, provocative physical examination, plain radiographs to assess bony morphology, and MRI arthrography for direct visualization of the labrum. History elicits the C-sign, mechanical symptoms, sport or work demands, and prior trauma. Examination focuses on hip range of motion (loss of internal rotation at 90 degrees flexion is the single most sensitive finding for FAI-associated tears) and provocative tests — the FADIR (Flexion-Adduction-Internal-Rotation) maneuver has sensitivity above 85% but specificity below 50%, while the FABER (Flexion-Abduction-External-Rotation) and posterior impingement tests help localize. Plain anteroposterior pelvis and Dunn lateral radiographs assess cam morphology (alpha angle >55 degrees), pincer morphology (cross-over sign, lateral center-edge angle >40), and dysplasia (LCEA <25). MR arthrography with intra-articular gadolinium is the imaging gold standard with sensitivity 80-90% and specificity 50-90% for labral tears, far higher than non-arthrographic MRI. A diagnostic intra-articular anesthetic injection (lidocaine ± steroid) is decisive when imaging is equivocal: pain relief above 50% confirms intra-articular origin. Direct arthroscopic visualization remains the definitive reference standard but is not used for diagnosis alone. Differential diagnosis must exclude lumbar radiculopathy, athletic pubalgia (sports hernia), iliopsoas tendinopathy, adductor strain, trochanteric bursitis, and stress fracture of the femoral neck.
Outlook depends on age, joint space at presentation, the underlying morphology, and tissue quality at surgery. Athletes under 40 with preserved joint space, FAI-driven tears, and salvageable labral tissue achieve return-to-sport in 75-85% at two years after labral repair, with mean iHOT-33 improvements of 25-35 points. Ten-year survivorship free of conversion to total hip arthroplasty after primary arthroscopic labral repair and FAI correction is 75-85% in modern series. Patients with Tönnis grade 2 or worse at the time of arthroscopy, age above 50, or BMI above 30 have substantially lower outcomes and higher conversion rates to arthroplasty. Dysplastic hips treated with isolated arthroscopy without periacetabular osteotomy have early failure rates approaching 30-50%, while combined or staged PAO with labral repair produces durable outcomes. Most patients diagnosed early and managed appropriately maintain active recreational sport, though high-level professional careers in cutting sports are at risk when cam morphology is severe.
Hip labral tears benefit from evaluation by a sports medicine or hip-preservation orthopedic surgeon experienced in hip arthroscopy, FAI assessment, and periacetabular osteotomy. Specialist referral is required when symptoms persist beyond 8-12 weeks of structured physical therapy, when imaging shows correctable bony morphology, or when mechanical symptoms (locking, true giving way) are present.
Find specialists →After arthroscopic labral repair: crutches and partial weight-bearing 2-4 weeks; return to desk work in 7-14 days; pain-free walking by 6-8 weeks; stationary cycling at 4 weeks; running progression at 12-16 weeks; agility and cutting at 16-20 weeks; full return to sport by 4-6 months for non-cutting sports and 6-9 months for high-cutting sports. Conservative management improves over 8-12 weeks with structured therapy.
Cardiovascular fitness is maintained with low-impact options: stationary cycling with the seat slightly raised, elliptical, deep-water running, and swimming with a pull buoy (avoid breaststroke kick). Resistance training focuses on glute medius, glute maximus, deep external rotators, core, and quadriceps; avoid deep hip flexion exercises (deep squats, leg presses below 90, hip flexor loading) during acute flares. Sport-specific return follows a graded program over 4-6 months postoperatively for repair patients.
Choose a fellowship-trained hip-preservation or sports-medicine orthopedic surgeon performing at least 50 hip arthroscopies annually. Ask about labral repair versus debridement rate (modern centers repair more than 85%), capsular closure technique, and indications for PAO over arthroscopy. Centers with a hip-preservation program offering both arthroscopy and open hip surgery provide the broadest options.
Medically reviewed by AIHealz Medical Editorial Board · May 13, 2026
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