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ACE TA BUL A R L A BR A L TE A R S of t he hip a re a n under- recog nized problem in the or thopedic communit y. Labra l tea rs of ten present a s va g ue, deep pa in in t he g roin t hat appear without antecedent injur y. The diff iculty in recogniz- ing a nd treating acetabu la r labra l tea rs comes f rom t he underly ing issue that caused the tea r. Over 90% of labra l tea rs a re caused by Femoroacetabula r Impingement (FA I). FA I is a condition where the acetabulum and proxima l femur have for med abnor ma l ly a nd cause contact bet ween t he femur a nd acetabu lum. The v ictim of t his contact is t he acetabula r labr um, a specia lized piece of ca r tilage, which provides a suction sea l to the ba ll a nd socket joint a nd ca n be torn over time by this abnorma l contact. These tea rs a re insidious in nature. Of ten patients will repor t vag ue lower quadra nt, groin, a nd hip pa in that wa xes and wanes. Labra l tears of ten cause severe acute pain, which w i l l t hen m it i gat e w it h rest a nd a ct iv it y mod i f icat ion . Imag ing of the hip, via radiog raphs, of ten revea ls no over t chondra l loss or na rrowing of the joint space. Seconda rily, low Tesla , low resolution, non-contra st M R Is revea l no releva nt patholog y, which ma kes the diag nosis even more vexing a nd dif f icu lt for the clinicia n. A r throg ra m MR Is, with specif ic acetabula r labra l protocol ima g ing, provide the best insight in diagnosing a nd subsequently treating the underlying patholog y. The underlying treatment is then tailored to the patholog y. Sma l l tea rs ca n be rea sonably treated w ith rest , activ it y modif ication, NSA IDs, a nd physiot herapy. Reca lcitra nt tea rs, la rger tea rs, or tea rs which involve the underly ing ar ticular car tilage can be addressed surgica lly. Data derived from a nima l studies demonstrate progressive bone-on-bone arthritis in animals with surgically induced labral tears. The ultimate goal with an arthroscopic intervention is to provide the patient with an excellent short term outcome, as well as obviating the need for a Total Hip Arthroplasty in the future. The arthroscopic approach provides several advantages. Visualization, and subsequently, the reliability of the repair can be better assessed and performed arthroscopically. Arthroscopy allows for a more precise correction of the underlying FAI as well as a more accurate repair. It provides an avenue for less morbidity, less pain, less blood loss, and an easier recovery with an overall better outcome than open surgical dislocation, which can be rife with complications. In more complicated ca ses w ith more complex tea rs, a number of strategies ca n be utilized. Labra l reconstruction, usi n g aut og ra f t i l iot ibia l ba nd , or a l log ra f t usi n g sem i tendinosis or gracilis, can provide the patient with an avenue to reconstruct norma l labra l dyna mics in the severely da m- aged hip. Microfracture can be used to augment labra l repairs w it h i nt r a-a r t ic u l a r chond r a l d a m a ge. M icrof r a c t u re stimulates bone ma rrow mesenchema l stem cells to g row f ibrocartilage or can be augmented with platelet rich plasma, hya luronic acid or bone ma rrow derived stem cells to g row a more hya line-like a r ticula r ca r tilage, thus covering chon- dra l defects with a more reliable chondra l surface. A r throscopic hip surger y is t y pica lly done in a sa me day surger y scena rio; however, there a re circumsta nces that would have a patient stay for a 23-hour obser vation such as pain, nausea, etc. The literature has shown excellent outcomes with low patient morbidit y for labra l tea r with underlying FA I treated a r throscopica lly. U lti mately, we have a potentia l solution for a li felong hip problem with low morbidit y a nd low complication rate. A lt hou g h a cet abu la r labra l t ea rs a re a f r ust rat i n g a nd of ten diff icult diag nosis, patients a re ver y content to have a solution to their chronic hip a nd g roin pa in. Dia g nosis a nd treatment requires, from the clinicia n, a knowledge of the underly ing patholog y a s well a s a tea m approach with our physiotherapy colleag ues to deliver the best of ca re for these diff icult problems. Dr. Jovan Laskovski is a board-certified orthopedic surgeon fellowship trained in Sports Medicine and Arthroscopy with a particular focu s on hip arthroscopy. He is a member of Crystal Clinic and practices at Crystal Clinic Orthopaedic Center at 1622 E . Turkeyfoot Road in Akron , OH. ■ TREATMENT BY JOVAN LASKOVSKI, MD for Hip Labral Tears 1 6 1 6❱❱❱❱❱ S P E C I A L S E C T I O N : O R T H O P E D I C S