Hoa Ngan Doan; Hung Nguyen Phu; Mathieu Boudier-Revéret; Min Cheol Chang

doi:10.12701/jyms.2025.42.48

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Hip labral tear with acetabular cartilage delamination: Hoa Ngan Doan¹, Hung Nguyen Phu², Mathieu Boudier-Revéret³, Min Cheol Chang¹; Journal of Yeungnam Medical Science 2025;42:48.
DOI: https://doi.org/10.12701/jyms.2025.42.48
Published online: August 25, 2025

¹Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea

²Department of Radiology, Saint Paul Hospital, Ha Noi, Vietnam

³Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada

Corresponding author: Min Cheol Chang, MD Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea Tel: +82-53-620-4682 • E-mail: wheel633@gmail.com

• Received: August 11, 2025 • Revised: August 19, 2025 • Accepted: August 23, 2025

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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A 55-year-old woman with no remarkable medical history presented with pain in the left anterior hip that had worsened over 2 months. Her pain intensity was rated 7 out of 10 on the numeric rating scale (NRS) and was exacerbated by sit-to-stand transitions, directional changes during walking, prolonged sitting, and hip flexion. The patient reported a locking sensation upon hip flexion.

On examination, left hip flexion was restricted to approximately 90° because of pain. The FADDIR (flexion, adduction, and internal rotation) test reproduced her anterior hip pain. Despite showing positive results, the FABER (flexion, abduction, external rotation) test elicited less pain than the FADDIR test. The findings of motor and sensory examinations were normal. Pelvic radiography and computed tomography revealed no bone abnormalities in the left hip. Magnetic resonance imaging (MRI) revealed an anterosuperior labral tear and anterosuperior acetabular cartilage delamination in the left hip (Fig. 1). These findings, along with the patient’s symptoms and physical examination results, were deemed to have contributed to her left hip pain.

The patient was managed conservatively with rest and activity modification (avoiding high-impact activities), oral ibuprofen (400 mg, three times daily), and physical therapy, focusing on core stabilization and progressive strengthening of the left gluteus maximus, gluteus medius, deep hip external rotators, and iliopsoas. At the 1-month follow-up, her pain had decreased to an NRS score of 3.

Hip labral tears occur in approximately 22% to 55% of patients with hip or groin pain [1]. Labral tears most commonly occur in the anterosuperior quadrant of the acetabulum and frequently cause anterior hip pain. Mechanical symptoms such as clicking, locking, or buckling are also frequently reported. Physical examination tests, including the FADDIR and FABER tests, often yield positive results in patients with labral tears [1]. Sensitivity and specificity ranges have been reported at 43% to 59% and 56% to 100% for the FADDIR test, and 41% to 68% and 68% to 100% for the FABER test, respectively [2]. Additionally, acetabular delamination commonly occurs in the anterosuperior acetabular cartilage near the labral junction, often causing anterior hip pain. Intermittent clicking, buckling, or locking can also result from hip cartilage delamination. FADDIR and FABER test results may also be positive [3], indicating intra-articular hip pathology [4]. The positive results of both tests on the left hip were consistent with the MRI findings, which revealed an anterosuperior labral tear and anterosuperior acetabular cartilage delamination in the left hip.

The clinical presentations of hip labral tears and acetabular cartilage delamination are similar, making it difficult to distinguish between these conditions without MRI. Most patients with acetabular cartilage delamination present with coexisting hip labral tears. In a cohort study of 613 patients who underwent hip arthroplasty, acetabular cartilage delamination was observed in 36.9% of the patients. Among those with acetabular cartilage delamination, 94.3% had a concomitant labral tear [5].

In patients with anterior hip pain exacerbated by hip flexion and with positive FADDIR and FABER test results, the possibility of a hip labral tear or acetabular cartilage delamination should be considered.

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Ethics statement

This study was approved by the Institutional Review Board (IRB) of the Yeungnam University Hospital (IRB No: 2025-08-013). The Informed consent was received for publication of this report.

Conflicts of interest

Min Cheol Chang has been a Deputy Editor of Journal of Yeungnam Medical Science since 2025. He was not involved in the review process of this manuscript. There are no other conflicts of interest to declare.

Funding

None.

Fig. 1.

(A) Axial and (B, C) sagittal proton density-weighted fat-saturated magnetic resonance images of the left hip. A hyperintense, fluid-filled cleft is present in the anterosuperior labrum (blue arrows), consistent with an anterosuperior labral tear. The hypointense line within the adjacent anterosuperior acetabular cartilage (red arrows) indicates anterosuperior acetabular cartilage delamination. The hyperintense area in the acetabulum (white arrows) represents a subchondral cyst.

References

1. Groh MM, Herrera J. A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med 2009;2:105–17.Article PubMed PMC PDF
2. Dhillon J, Hernandez EJ, Keeter C, Kraeutler MJ. Sensitivity and specificity for physical examination tests in diagnosing prearthritic intra-articular hip pathology are highly variable: a systematic review. Arthrosc Sports Med Rehabil 2025;7:101117.Article PubMed PMC
3. Li Z, Yu J, An P, Zhang W, Tian K. Current understanding of articular cartilage lesions in femoroacetabular impingement syndrome. J Orthop Surg Res 2024;19:886.Article PubMed PMC
4. Chamberlain R. Hip pain in adults: evaluation and differential diagnosis. Am Fam Physician 2021;103:81–9.PubMed
5. Jannelli E, Parafioriti A, Acerbi A, Ivone A, Fioruzzi A, Fontana A, et al. Acetabular delamination: epidemiology, histological features, and treatment. Cartilage 2019;10:314–20.Article PubMed PMC PDF

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Figure

Hip labral tear with acetabular cartilage delamination

Fig. 1. (A) Axial and (B, C) sagittal proton density-weighted fat-saturated magnetic resonance images of the left hip. A hyperintense, fluid-filled cleft is present in the anterosuperior labrum (blue arrows), consistent with an anterosuperior labral tear. The hypointense line within the adjacent anterosuperior acetabular cartilage (red arrows) indicates anterosuperior acetabular cartilage delamination. The hyperintense area in the acetabulum (white arrows) represents a subchondral cyst.

Fig. 1.

Hip labral tear with acetabular cartilage delamination