Labral re-tears

Symptoms attributed to a “labral re-tear” may reflect persistent preoperative pain, incomplete healing, residual impingement, a new injury, capsulolabral adhesions, instability, progressive cartilage disease, or a true recurrent tear. Imaging cannot reliably distinguish all of these states. 1-4

Postoperative imaging

Postoperative MRA can be useful in selected cases, but false-positive and false-negative findings are common. In a revision cohort, Aprato et al. reported 53% sensitivity and 50% specificity for recurrent labral lesions after prior labral treatment. Postoperative MR arthrographic abnormalities have also been reported in both symptomatic and asymptomatic patients. A reported tear should therefore be correlated with the examination, mechanics, and original procedure before revision is considered. 1,2

Clinical assessment

• Is the current pain the same as the pre-operative pain, and was there a period of meaningful improvement?
• Was the original pain generator and bony morphology adequately addressed? Residual FAI is common in revision series. 3,4
• Is there clinical or imaging evidence of instability, capsular deficiency, dysplasia, version abnormality, adhesions, iliopsoas pathology, or advancing chondral disease?
• Does the patient have reproducible mechanical symptoms and a concordant examination?
• Would a targeted injection change the localization or treatment decision?

Treatment is cause-specific

When revision is appropriate, the operative plan should correct the mechanism rather than merely revise the labrum. Options may include treatment of residual osseous impingement, lysis of adhesions, capsular management, and labral repair when tissue is repairable. Reconstruction or augmentation can be considered when native tissue is irreparable, deficient, or unsuitable for a durable repair. The preferred graft and technique are surgeon- and pathology-specific; the key decision is whether the labrum can be preserved and made functional within a stable, correctly contoured hip. 3-5

A postoperative labral abnormality is most clinically relevant when it is concordant with the current pain pattern, examination, mechanics, and a correctable reason for failure.