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Health condition

Labral hip tear, FAI, dysplasia and the stepped plan that actually works.

A tear of the acetabular labrum rarely happens in isolation. Understand the shape of your hip and the ladder of care - and the surgery question answers itself.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against BOA, BHS and peer-reviewed hip preservation literature you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK hip preservation practice including MRI arthrogram protocols, arthroscopic repair and PAO for dysplasia.

Key facts

The labral hip tear at a glance.

The essentials, in plain English - what tears, why it tears, and how it is treated in the UK today. Also known as a hip labral tear or labral tear in the hip.

  • What it is

    A tear of the acetabular labrum, the fibrocartilaginous ring around the hip socket that seals the joint and dampens load.

  • Common drivers

    Femoroacetabular impingement (FAI), hip dysplasia, single traumatic events and generalised hypermobility.

  • Typical age

    Most symptomatic tears present between 20 and 45, often in active adults or people with subtle bony hip shape variation.

  • Gold standard test

    MRI arthrogram (MRA) - contrast injected into the joint lifts a torn labral edge into clear view.

  • First-line care

    Load management, targeted physiotherapy and a diagnostic-therapeutic intra-articular injection where indicated.

  • Surgery

    Hip arthroscopy for repair or reconstruction of the labrum, with reshaping of the bony impingement lesion where present.

Why this guide matters

Understand the shape, not just the tear.

A tear on a scan is only half the story. The bony shape of the hip - impingement or dysplasia - decides which operation, if any, is right. The three points below shape the rest of this page.

  • The bone drives the tear

    Most symptomatic tears sit on a background of cam or pincer impingement - see /conditions/hip-impingement/ - or dysplasia. Treat the shape, not just the labrum.

  • MRI arthrogram is the standard

    Standard MRI misses subtle tears. Direct arthrography with intra-articular contrast is far more sensitive and remains the UK reference test.

  • Rehab earns the operation

    A structured 3 to 6-month physiotherapy programme is not a delaying tactic - it prepares the hip and identifies who really needs surgery.

How the diagnosis is made

From first groin twinge to a clear plan.

The steps a UK GP, sports physician or hip preservation surgeon will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Focused history

    Groin pain with pivoting, deep flexion or prolonged sitting. Catching, clicking or a giving-way sensation are common.

  2. 02

    Assessing

    Clinical examination

    FADIR and FABER tests, range of movement, gait, single-leg squat and a screen for lumbar or sacroiliac referral.

  3. 03

    Assessing

    Assess for hypermobility

    Beighton scoring in younger women with anterior groin pain - see our guide to hypermobility for context.

  4. 04

    Confirming

    Plain radiographs

    AP pelvis and lateral views to look for FAI cam or pincer morphology, dysplasia (LCEA), joint space and early arthritis.

  5. 05

    Confirming

    MRI arthrogram

    The gold standard - direct MR arthrography shows labral tears, cartilage delamination and paralabral cysts.

  6. 06

    Planning

    Intra-articular injection

    A guided anaesthetic and steroid injection is diagnostic and therapeutic - relief supports an intra-articular pain source.

  7. 07

    Planning

    Hip preservation MDT

    Complex cases (young adults, dysplasia, borderline morphology) benefit from a specialist hip preservation opinion before surgery.

Typical timeline: first consultation to imaging and a rehab plan in a few weeks.

Symptoms

What a labral hip tear actually feels like.

Deep groin pain, sitting intolerance and mechanical symptoms - alongside the features that suggest the tear is more than incidental.

  • Deep anterior groin pain

    A classic C-sign, where the patient cups the hip with thumb and forefinger over the greater trochanter and groin.

  • Pain with pivoting and twisting

    Cutting, changing direction and getting in and out of a car reliably reproduce symptoms.

  • Sitting intolerance

    Deep hip flexion in low car seats or cinema seats provokes pain - a hallmark of anterior impingement and tear.

  • Mechanical catching or clicking

    A palpable click, catch or snap on rotation suggests an unstable labral flap.

  • Weakness and giving way

    Perceived instability, buckling on stairs and loss of confidence with sport are common.

  • Night and rest pain

    Aching pain at rest, side-lying discomfort and difficulty finding a comfortable sleep position.

  • Reduced sporting tolerance

    Runners, footballers, dancers and yoga practitioners often notice loss of end-range hip movement.

  • Red flag - true locking

    A hip that truly locks needs urgent imaging - loose bodies, large flap tears or chondral injury may be present.

Treatment

How a labral hip tear is treated in the UK.

Physiotherapy, load management and injections first - hip arthroscopy for repair or reconstruction where indicated, and a PAO for dysplasia.

  • Activity modification

    Short-term load management - cut deep flexion, prolonged sitting and end-range rotation while the joint calms down.

  • Structured physiotherapy

    Targeted work on gluteal strength, deep hip stabilisers, core control and movement retraining over 3 to 6 months.

  • Analgesia

    Short-course NSAIDs or paracetamol used sensibly to allow rehabilitation - not a long-term strategy.

  • Guided intra-articular injection

    Image-guided anaesthetic and steroid injection - diagnostic value plus a rehabilitation window of pain relief.

  • Hip arthroscopy - labral repair

    Keyhole surgery to refixate a torn but healthy labrum with suture anchors while addressing any bony impingement.

  • Labral reconstruction

    For deficient or irreparable labrum - a graft rebuilds the seal, restoring hip suction and joint mechanics.

  • Periacetabular osteotomy (PAO)

    For symptomatic hip dysplasia - reorientates the acetabulum to protect the labrum and cartilage long-term.

  • Hip replacement

    For established osteoarthritis with a torn labrum - arthroscopy alone will not help once cartilage is gone.

What this guide is based on

The sources behind every claim on this page.

UK national guidance, specialist society standards and the landmark hip preservation trials, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or hip preservation surgeon knows your imaging and history and can tell you which parts apply to you. If in doubt, get seen.

  • British Hip Society (BHS). Position statements on hip arthroscopy and hip preservation.

  • British Orthopaedic Association (BOA). Standards for trauma and orthopaedic care.

  • Warwick Agreement on femoroacetabular impingement syndrome (2016).

  • NICE. Arthroscopic femoro-acetabular surgery for hip impingement syndrome (IPG408).

  • Griffin DR et al. UK FASHIoN trial - hip arthroscopy versus best conservative care.

Red flags

When hip pain needs urgent attention.

Most labral pain is manageable with a stepped plan. These are the situations that are not - and where a specialist opinion is needed.

  • True mechanical locking

    A hip that will not move through its normal range needs prompt imaging - a large unstable flap or loose body may be present.

  • Sudden severe atraumatic pain

    Sudden onset without an injury, with fever or systemic upset, needs urgent assessment to exclude septic arthritis.

  • Post-traumatic acute pain

    After a dislocation, fall or road traffic collision - assume a labral or chondral injury until proven otherwise.

  • Progressive weakness or numbness

    Neurological features suggest lumbar or pelvic pathology rather than isolated labral disease.

  • Rapid loss of joint space on X-ray

    Established osteoarthritis changes the operation - hip preservation is unlikely to help once cartilage is thin.

  • Untreated hip dysplasia

    Arthroscopy on a dysplastic hip without a PAO worsens outcomes - see /conditions/hip-dysplasia/ before booking surgery.

  • Unexplained weight loss

    Constitutional symptoms with hip pain need imaging to exclude infection or malignancy.

  • Bilateral simultaneous symptoms

    Widespread joint pain and stiffness may point to inflammatory arthritis, not a mechanical labral tear.

  • Persistent night pain

    Unrelenting rest pain unresponsive to a diagnostic injection deserves broader imaging review.

Living with it

A treatable condition, with a clear ladder.

Four things that make the biggest difference day to day - manage load intelligently, build the right muscles, give physiotherapy a fair run, and don’t leave a mechanical hip in pain indefinitely.

A quiet reminder

Consistency beats intensity, every time.

Steady daily gluteal work for months does more than a heroic gym week that leaves the joint angrier than it started.

  1. 01 Load

    Manage the load, not just the pain

    Short breaks from deep flexion, sensible squat depth and a smart return-to-running plan matter more than any single exercise.

  2. 02 Strength

    Glutes and deep stabilisers

    Gluteus medius and maximus strength, plus deep hip external rotator work, reliably calm an irritable labrum.

  3. 03 Timing

    Give rehab 12 weeks

    Physiotherapy needs a fair run before surgery is considered - three months of structured work is a reasonable benchmark.

  4. 04 Escalate

    Ask about the operation earlier

    Younger patients with FAI and a clear tear often do best with earlier arthroscopy - the FASHIoN trial supports it.

Frequently asked

Everything we get asked about labral hip tears.

Quick answers on MRI arthrogram, physiotherapy, hip arthroscopy, PAO and when replacement is the right call.

  • What is a labral hip tear?

    It is a tear of the acetabular labrum, the fibrocartilaginous rim around the hip socket. The labrum seals the joint, spreads load and steadies the femoral head. When it tears - usually from femoroacetabular impingement, dysplasia, trauma or hypermobility - the seal is lost and pain, catching and instability follow. Also written as a hip labral tear or labral tear in the hip.

  • How is a labral hip tear diagnosed?

    The diagnosis is clinical first - groin pain reproduced by FADIR testing in a patient with impingement or dysplasia features. MRI arthrogram is the gold-standard imaging test because injected contrast lifts the torn edge into view. A guided intra-articular anaesthetic injection is a useful confirmatory test - clear relief suggests an intra-articular pain source.

  • Can a torn hip labrum heal on its own?

    The labrum has a limited blood supply and does not reliably heal on its own. What often does settle, however, is the pain - if the underlying cause is respected. Structured physiotherapy, load management and, where appropriate, a guided injection can control symptoms for months to years without surgery. The tear is usually still there on imaging.

  • Do I need hip arthroscopy?

    Not immediately. The Warwick Agreement and the UK FASHIoN trial support a stepped plan - three to six months of good physiotherapy first. If mechanical symptoms persist and imaging confirms a tear with FAI, hip arthroscopy for labral repair and bony reshaping produces reliable improvements in symptomatic FAI. See our guide to /treatments/hip-arthroscopy/.

  • What if I also have hip dysplasia?

    This is where hip preservation gets specialist. Arthroscopy alone on a dysplastic hip destabilises the joint and worsens outcomes. If the acetabulum is undercovered, the operation of choice is a periacetabular osteotomy (PAO) to reorientate the socket - sometimes combined with a scope. Read /conditions/hip-dysplasia/ and /treatments/periacetabular-osteotomy/.

  • When is hip replacement the right answer?

    Once osteoarthritis has taken hold - joint space narrowing, cartilage loss and bone-on-bone rubbing - hip preservation surgery has little to offer. In that situation, /treatments/hip-replacement-surgery/ is a more predictable, longer-lasting solution than arthroscopy on a worn joint. See /conditions/hip-osteoarthritis/ for the wider picture.

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