0:02

So we have just finished, in a prior event.

0:04

Yet, talking about the different types of

0:05

tears that can truncate the tip of the labrum,

0:08

analogous to the radial tear of the knee.

0:12

Tears that are elongated, somewhat

0:15

longitudinal along the long axis of the

0:17

labrum, not infrequently dissecting into

0:19

the hyaline space with a hyaline line.

0:22

Uh, an oft-symptomatic tear, tears

0:24

that we see on a more chronic basis,

0:27

that may propagate progressively

0:29

in a straight vertical orientation.

0:31

And now let's add a little bit to

0:33

that vertical orientation concept.

0:36

These vertically oriented tears may sometimes

0:38

burst out and create a paralabral cyst.

0:43

That paralabral cyst may sit underneath the

0:45

capsule, but sometimes the capsule itself

0:49

on a chronic basis or from a remote injury

0:52

may actually tear.

0:54

The tear may be small, and the synovial

0:57

fluid may slowly transgress the capsule

1:01

and create an extracapsular para-meniscal

1:06

pseudocyst or paralabral cyst of meniscal origin.

1:10

So these cysts may be intracapsular, or

1:13

as we see here in pink, extracapsular.

1:17

The intracapsular ones are a little more

1:19

common when you're assessing the labrum.

1:23

It is so critical

1:25

to evaluate the kind of hyaline destruction and

1:30

attenuation that is present and its severity.

1:33

Because the decision to fix the

1:35

labrum is going to be highly dependent

1:39

upon the status of the joint.

1:42

If the joint is, uh, to the point where there is

1:46

moderate to end-stage chondromalacia, nobody's

1:49

going to go in arthroscopically and fix this.

1:51

They're going to do a total hip.

1:52

So you want to look at what type of

1:54

ulcers you have, how many, how broad,

1:58

and how much cartilage loss you have.

2:00

And especially, do you have

2:01

penetration of the subchondral plate?

2:05

And if you do, where is it?

2:06

Now frequently, these areas

2:08

of penetration associated with

2:09

labral tears are right next door.

2:12

They're either under this line, or directly

2:14

adjacent to the labrum, along the tip.

2:18

And that may not be enough to stop labral

2:21

surgery, but it's uncommon to have this as

2:23

just an isolated phenomenon and nothing else.

2:26

But this is still an important observation,

2:28

because it markedly contributes to

2:31

the patient's clinical pain syndrome.

2:35

Another key issue in assessing the

2:37

amount of hyaline loss is the thickness.

2:40

Especially in younger individuals.

2:42

Now, a younger individual should have

2:45

hyaline thickness of the acetabulum combined

2:49

with hyaline thickness of the femoral head

2:51

cartilage, which I haven't shown here.

2:54

And I'm just adding it in green.

2:55

So that these two add up to three millimeters.

3:00

All the way around the hip.

3:02

Now, in some areas, the femoral

3:03

cartilage will be thicker.

3:04

In some areas, the acetabular

3:06

cartilage will be thicker.

3:08

But they will still add up to

3:10

approximately 3 millimeters.

3:13

The other aspect of labral evaluation

3:16

is the assessment of the capsule.

3:19

The capsule is composed in part

3:21

of the iliofemoral ligament.

3:23

Let's take a little light blue approach here.

3:25

There's the iliofemoral ligament.

3:27

And as it courses over the acetabular labral

3:30

complex, there is a little sulcus here.

3:33

And that sulcus gets a little deeper with age.

3:36

As long as it's not more than 2 millimeters

3:38

in a young person, or 3 to 4 millimeters

3:40

in an older person, and there's no

3:42

associated inflammation with it, no cysts,

3:45

no maceration, no edema, I let it slide.

3:49

But if there is either a traumatic injury or

3:51

an elderly individual with an unstable labrum,

3:54

this may progressively detach and separate.

3:58

You're going to see inflammation and fluid track

4:01

for a variable distance on high in here, more

4:04

than three or four millimeters, and you'll see

4:06

the capsule itself, in other words, this tissue

4:08

right here, will swell, you may see tears, you

4:12

may see areas of disruption, you may see damage.

4:15

Paralabral cyst formation underneath

4:17

or over top of the capsule.

4:21

That concludes our discussion of the

4:23

labrum magnified using our diagram.

4:26

If you're following along with us, you may want

4:29

to look at some of the magnified MR images that

4:31

we share with you in our labral assessment.

4:34

Thanks.