The acetabular labrum is a fibrocartilaginous ring that lines the rim of the acetabulum, the cup-shaped socket of the hipjoint located in the pelvis, where it encircles the head of the femur to form a stable ball-and-socket articulation.[1] This structure deepens the acetabular cavity by up to 21% and expands the articular surface area by approximately 28%, thereby enhancing joint congruence and load distribution during hip motion.[2] Composed primarily of type I and II collagen fibers, the labrum merges seamlessly with the adjacent hyaline articular cartilage and transverse acetabular ligament, forming a contiguous seal around the joint.[3]Structurally, the acetabular labrum exhibits a zonal organization with three layers of collagen: an outer layer of randomly oriented fibers for tensile strength, a thicker middle layer of intersecting bundles particularly prominent in the superior region, and an inner circumferential layer that integrates with the joint capsule.[3] Its vascular supply derives from a periacetabular ring formed by branches of the superior and inferior gluteal arteries as well as the medial and lateral circumflex femoral arteries, though the central free margin remains relatively avascular, making it susceptible to degenerative changes.[3] Innervation includes free nerve endings and mechanoreceptors such as Pacinian corpuscles, which provide proprioceptive feedback and contribute to pain signaling in cases of injury.[3]The labrum's key functions encompass stabilizing the hip by resisting subluxation of the femoral head, creating a fluidseal that maintains pressurized synovial lubrication to protect articular cartilage from shear forces, and distributing compressive loads to minimize stress concentrations within the joint.[4] By generating a suction effect and increasing contact area, it reduces peak pressures on the chondral surfaces by up to 92% during dynamic activities, thereby supporting joint durability and preventing early osteoarthritis.[5] Clinically, labral integrity is vital, as tears—often resulting from femoroacetabular impingement, trauma, or dysplasia—can disrupt these mechanisms, leading to pain, microinstability, and accelerated cartilage degeneration, with surgical repair or reconstruction aimed at restoring native function.[6]
Anatomy
Gross anatomy
The acetabular labrum is a C-shaped fibrocartilaginous ring that encircles the periphery of the acetabulum, attaching firmly to the bony rim via a 1-2 mm transitional zone of hyaline cartilage, except at the anteroinferior acetabular notch where its free ends blend to form the transverse acetabular ligament.[5] This structure deepens the acetabular cavity and enhances containment of the femoral head, with its free margin typically oriented toward the joint space. The labrum measures 2-3 mm in average thickness and exhibits morphological variations, including triangular, round, irregular, or flattened shapes, the latter becoming more common with age.[5]In cross-section, the labrum is generally triangular anteriorly, with its base attached to the acetabular rim and apex facing the articular space, while it adopts a more square configuration posteriorly, featuring a rounded distal surface that contributes to load distribution.[7] Thickness and width vary regionally: it is wider and thinner anteriorly, becoming thicker and more robust posteriorly and superiorly, which influences its mechanical properties and susceptibility to injury.[5] Using a clock-face orientation (with 12 o'clock positioned superiorly and 6 o'clock inferiorly relative to the acetabulum), the labrum spans the anterior zone (1-3 o'clock), superior zone (12 o'clock), posterior zone (9-11 o'clock), and inferior zone (6 o'clock), with the superior and posterior regions demonstrating greater thickness and relative stability compared to the anterior and inferior areas.[8]The labrum relates intimately to surrounding structures, sealing the joint cavity against the femoral head to maintain synovial fluid pressurization, while its peripheral attachment to the acetabular rim and hip capsule provides additional reinforcement.[5] Inferiorly, it integrates seamlessly with the transverse acetabular ligament, bridging the notch to complete the circumferential ring. Quantitatively, the labrum augments acetabular depth by approximately 21% and increases the articulating surface area by 28%, thereby distributing joint loads more evenly and enhancing overall hip stability.[5]
Microscopic anatomy
The acetabular labrum is a fibrocartilaginous structure primarily composed of type I and type II collagen fibers, with type I collagen predominant in the outer layers to provide tensile strength and type II collagen more prevalent in the inner regions, conferring properties similar to hyaline cartilage.[9][10] The extracellular matrix is predominantly acellular, containing embedded chondrocytes that maintain the tissue's integrity, and proteoglycans that contribute to its biomechanical resilience.[9] Unlike the knee meniscus, the labrum lacks a highly organized lamellar architecture, instead featuring a more irregular arrangement of collagen fibrils oriented circumferentially and radially.Histologically, the labrum displays distinct zonal variations that reflect differences in cellular composition and vascularity. The outer third, adjacent to the joint capsule, consists of dense connective tissue rich in fibroblasts and is vascularized, facilitating nutrient exchange.[10][11] This transitions to a middle avascular zone, followed by an inner avascular region dominated by chondrocytes within a fibrocartilaginous matrix, which bears the majority of articular loads.[10] These zones exhibit varying degrees of cellularity, with the inner zone showing relative hypocellularity compared to the outer.[10]The labrum's thickness varies regionally from 2 mm anteriorly to up to 6 mm posteriorly and superiorly, with studies reporting averages around 4-5 mm, and it decreases with advancing age due to reduced chondrocyte density.[12][9] Its attachment to the acetabular bone occurs through a 1-2 mm fibrocartilaginous transition zone, featuring calcified cartilage and a tidemark that resembles a fibrocartilaginous enthesis, ensuring stable integration with the underlying bone.
Vascular supply and innervation
The acetabular labrum derives its blood supply from branches of the superior and inferior gluteal arteries as well as the medial and lateral circumflex femoral arteries, which contribute to a periacetabular periosteal vascular ring that encircles the acetabulum.[3] These vessels form radial branches that traverse the osseolabral junction and penetrate the labrum primarily from the capsular side, supplying nutrients to the peripheral region.[13] However, vascular penetration is limited to the outer third of the labrum, approximately 1-2 mm deep, resulting in avascularity of the central two-thirds.[5] Histologic studies using techniques such as silicone injection and microscopic examination have confirmed this zonal pattern, showing no significant vascular contribution from the synovial lining, hip capsule interior, or osseous acetabular rim.The restricted vascularity of the inner labral zones underlies its poor intrinsic healing capacity, particularly for tears extending beyond the peripheral vascularized area, as confirmed by cadaveric dissections demonstrating intact peripheral supply even in the presence of tears but absent deeper perfusion.[14] This avascular architecture implies that reparative processes in the central labrum rely heavily on external factors like synovial diffusion or surgical augmentation, limiting spontaneous recovery in degenerative or traumatic injuries confined to avascular regions.[13]Innervation of the acetabular labrum arises primarily from branches of the obturator nerve and the nerve to the quadratus femoris, providing sensory feedback to the hip joint.[15] The labrum contains a rich network of free nerve endings (FNEs) responsible for nociception and mechanoreceptors, including Ruffini and Pacini corpuscles, which facilitate proprioception; these structures are densely distributed in the antero-superior (12-3 o'clock) and postero-superior (9-12 o'clock) zones, with predominance on the superficial and chondral surfaces.[15] In contrast, the inferior and posterior zones exhibit fewer receptors, potentially correlating with variable pain patterns.[15] This innervation profile supports pain referral to the groin from anterior labral involvement via obturator branches, or to the buttock from posterior aspects.[5]Age-related changes in the labrum include progressive degenerative alterations that elevate susceptibility to tears and impair regenerative potential.[11]
Function
Biomechanical roles
The acetabular labrum deepens the acetabulum by approximately 21%, increasing the effective coverage of the femoral head and enhancing joint stability against dislocation. This structural contribution resists both lateral and vertical motion of the femoral head, providing a mechanical barrier that promotes containment within the socket.[5]By increasing the acetabular surface area by 28%, the labrum facilitates more even distribution of compressive loads across the joint, bearing 1-2% of the total load in normal hips and up to 4-11% in dysplastic hips. This load-sharing mechanism reduces peakcontact pressures on the articular cartilage, with studies showing that labral absence can elevate contact stresses by up to 92%. Finite element models further indicate that the labrum expands the joint contact area and mitigates peak pressure concentrations during weight-bearing activities.[5][16]The labrum forms a fluidseal that generates negative intra-articular pressure, creating a vacuum effect that resists shear forces and anterior translation of the femoral head, particularly in positions of flexion and internal rotation. This seal supports interstitial fluid pressurization, which contributes to load support during dynamic motions such as gait. Disruption of the labrum impairs this seal, with a labral tear reducing fluid pressurization capabilities and intra-articular pressure to approximately 75% of intact levels.[17][18][19]
Physiological contributions
The acetabular labrum contributes to joint health by retaining synovial fluid within the hip joint, thereby enhancing lubrication and minimizing friction during movement. This sealing function maintains a pressurized fluidenvironment that reduces the friction coefficient between articular surfaces to levels as low as 0.002–0.02, approaching near-zero under dynamic conditions.[16][20] By preventing fluid exudation from the joint space, the labrum sustains this low-friction state, which is essential for smooth articulation and long-term cartilage preservation.[21]In addition to lubrication, the labrum serves as a shock absorber, dissipating impact forces transmitted through the hip and promoting even pressure distribution across the articular cartilage. This role helps mitigate chondral damage by buffering loads and reducing peak stresses on the cartilage matrix during weight-bearing activities.[5] The labrum's contribution to fluid dynamics further supports cartilage integrity by slowing consolidation and maintaining hydrostatic pressure within the joint.[22]The labrum also facilitates proprioception through its dense population of mechanoreceptors, which provide sensory feedback for neuromuscular control and balance during hip motion.[23] This sensory input, linked to the labrum's innervation patterns, enhances joint stability and coordination. Furthermore, by sealing the joint cavity, the labrum enables efficient diffusion of nutrients from synovial fluid to the avascular articular cartilage, supporting chondrocyte metabolism and overall joint nutrition.[5]With advancing age, the labrum exhibits physiological decline, including thinning and degenerative changes that become prominent after the fifth decade of life.[24] Such alterations impair the labrum's protective functions, significantly elevating the risk of osteoarthritis through accelerated cartilage wear and altered joint mechanics.[25]
Pathology
Injuries and tears
Acetabular labral injuries typically arise from acute traumatic events or repetitive microtrauma, leading to tears that disrupt the labrum's integrity. Acute tears often result from high-impact incidents such as hip dislocations, posterior dislocations during falls, or direct blows in contact sports like football.[5] Repetitive microtrauma, common in activities involving pivoting or extreme hip flexion, such as soccer, hockey, or ballet, causes cumulative stress at the labrochondral junction, particularly in athletes performing end-range motions.[5] Labral tears are frequently associated with femoroacetabular impingement (FAI), with over 90% of FAI cases involving labral pathology.[26]Labral tears vary in morphology and location, with common patterns including superior rim detachments from traction forces, anterior radial flap tears due to impingement, and longitudinal bucket-handle tears resembling meniscal injuries.[5] A seminal arthroscopic classification by Lage et al. (1996) categorizes tears into four types based on appearance and stability: radial flap (a tear with a flap-like extension), radial fibrillated (frayed edges without a distinct flap), longitudinal peripheral (parallel to the labral base), and abnormally mobile (detached and unstable).[27] These types reflect underlying etiologies, with traumatic tears more likely to present as detachments or flaps, while microtraumatic ones often show fibrillated or longitudinal patterns.[27]Epidemiologically, acetabular labral tears are prevalent even in asymptomatic populations, with MRI studies reporting rates of 24-69% in adults without hippain, increasing with age and activity level.[28][29] In symptomatic individuals, particularly young athletes aged 15-30 years, tears occur in 22-55% of cases presenting with hip or groin complaints, often linked to sports participation.[5] Anterior tears predominate in Western populations, correlating with groinpain from flexion-adduction activities, whereas posterior tears are more frequent in Asian cohorts, associated with buttock discomfort from squatting postures.[5] Symptoms typically include mechanical sensations of catching, clicking, or locking during hip motion, alongside sharp pain provoked by rotation or weight-bearing.[5]Risk factors for labral tears include structural abnormalities like acetabular dysplasia, which alters load distribution and increases tear risk in up to 72% of affected hips, and capsular hyperlaxity from connective tissue disorders, predisposing to instability during dynamic activities.[5] Females face a higher incidence, attributed to greater prevalence of dysplasia and ligamentous laxity.[30] Healing is compromised by the labrum's avascular zones, particularly in inner thirds, often resulting in poor spontaneous healing without surgical intervention.[5]
Degenerative and associated conditions
Degenerative fraying of the acetabular labrum involves intrasubstance degeneration without detachment from the acetabular rim, representing a common age-related change in the hip joint. This process typically manifests as fibrillation, mucoid degeneration, or cystic changes within the labral tissue, progressing gradually over time due to cumulative mechanicalstress and reduced tissueresilience. Studies indicate that such degenerative alterations become increasingly prevalent with advancing age, affecting a majority of individuals over 60 years old.[31]The acetabular labrum is closely associated with femoroacetabular impingement (FAI), where structural abnormalities in the femur or acetabulum lead to abnormal contact and chronic labral wear. In cam-type FAI, an aspherical femoral head-neck junction generates shear forces that damage the labral chondrolabral junction, often resulting in intrasubstance degeneration or delamination. Conversely, pincer-type FAI involves overcoverage of the acetabulum, causing global abutment and compression of the labrum against the femoral head, which can lead to sealed tears or crushing injuries, particularly at the posteroinferior acetabulum in a contre-coup manner. Approximately 94% of patients with FAI exhibit labral pathology, highlighting the strong mechanistic link between impingement and degenerative labral changes.[32][26]Hip dysplasia further contributes to labral degeneration through altered joint mechanics, where a shallow acetabulum increases shear and translational forces on the labrum, accelerating wear and hypertrophy as the labrum compensates for instability. This predisposition often results in anterosuperior labral damage and is a major pathomechanism for early degeneration in dysplastic hips. Recent systematic reviews report labral tear prevalence of approximately 79% in dysplastic hips.[26] Labral degeneration and tears frequently precede osteoarthritis (OA), with evidence suggesting they initiate chondral damage in a substantial majority of cases, potentially up to 70%, by disrupting jointstability and load distribution. The prevalence of labral degeneration is markedly higher in OA-affected hips (approximately 69-83%) compared to asymptomatic controls (around 24-39%), underscoring its role in OA progression.[33][34][28][35]Extrinsic factors such as capsular laxity and iliopsoas impingement also promote labral degeneration by exacerbating joint instability or creating focal pressure points. Capsular laxity, often seen in hypermobile hips, allows excessive femoral head translation, leading to labral attenuation and tearing, particularly in the presence of subtle dysplasia or connective tissue disorders. Iliopsoas impingement occurs when the taut iliopsoas tendon abuts the anterior labrum, typically at the 3 o'clock position, causing isolated anterior tears and progressive degeneration through repetitive compression. If untreated, these degenerative processes can extend to adjacent chondral surfaces, resulting in defects and further joint deterioration.[36][37][38][39]
Diagnosis
Clinical evaluation
Clinical evaluation of acetabular labrum pathology begins with a detailed patient history, which often reveals insidious onset of anterior groinpain in over 90% of cases, typically exacerbated by prolonged sitting, twisting, pivoting, or weight-bearing activities. Mechanical symptoms, such as clicking, catching, locking, or giving way, are frequently reported and may occur in up to 50% of patients, reflecting irritation or instability within the hip joint. Night pain is common in approximately 71% of individuals, and functional limitations like limping (89%) or difficulty with stair climbing (67%) further characterize the presentation. These symptoms arise due to the labrum's role in joint stability and load distribution, with pain patterns influenced by its sensory innervation from branches of the obturator, sciatic, and femoral nerves.Physical examination focuses on provocative maneuvers to elicit pain or mechanical signs indicative of labral involvement. The flexion-adduction-internal rotation (FADIR) test, also known as the anterior impingement test, is performed by flexing the hip to 90 degrees, adducting, and internally rotating the leg; it reproduces groin pain in about 90% of patients with labral pathology and demonstrates high sensitivity (99%) but low specificity (8%) for detecting tears. The FABER (flexion-abduction-external rotation) test assesses posterior labral or sacroiliac involvement by positioning the ankle on the contralateral knee and applying downward pressure on the knee while stabilizing the pelvis; a positive response includes ipsilateral buttock or groin pain. The McCarthy test, involving hip hyperextension from a flexed position, provokes a clicking or catching sensation in cases of anterior labral tears. The load-and-go test evaluates dynamic instability by having the patient perform a single-leg hop or pivot; apprehension or pain suggests labral deficiency contributing to instability. Combining these tests with historical features improves overall diagnostic accuracy to around 90%.Differential diagnosis must consider overlapping conditions, as labral pathology often coexists with or mimics other hip disorders. Femoroacetabular impingement (FAI) frequently accompanies labral tears and presents similarly with groin pain during rotation, while synovitis from inflammatory arthritis may cause diffuse joint effusion and stiffness without mechanical symptoms. Referred pain from lumbar spine pathology, such as disc herniation or facet joint dysfunction, can radiate to the groin but typically lacks mechanical clicking and is provoked by spinal maneuvers rather than hip-specific tests. Athletic pubalgia, osteoarthritis, and extra-articular issues like iliopsoastendinopathy should also be ruled out through targeted history and exam elements to isolate intra-articular labral contributions.
Imaging techniques
Magnetic resonance imaging (MRI) serves as a primary non-invasive tool for evaluating the acetabular labrum, offering good soft tissue contrast to identify tears and associated pathology. Conventional MRI demonstrates moderate sensitivity for detecting labral tears, typically ranging from 70% to 90% in optimized protocols, though lower values (around 30%) have been reported in earlier studies with standard field strengths. T2-weighted sequences are particularly useful, revealing high signal intensity within the labrum indicative of tears or fluid extension. Higher-field-strength 3T MRI enhances resolution and diagnostic accuracy, with pooled sensitivity reaching 87% (95% CI 0.82–0.91) and specificity of 77% (95% CI 0.64–0.87), making it a preferred non-contrast option for initial assessment.[40][41]MR arthrography (MRA), involving intra-articular contrast injection, is considered the gold standard imaging modality for acetabular labral tears due to its superior visualization of intra-articular structures. It achieves high sensitivity of 90–97% and accuracy of 88–94%, outperforming conventional MRI by better delineating detachments and subtle tears through joint distension. Optimal protocols use T1-weighted fat-suppressed sequences post-contrast, with 3T MRA yielding sensitivity up to 97.3% and specificity of 91.6% for labral lesions. Despite its invasiveness, MRA remains highly reliable for preoperative planning when clinical suspicion is high.[42][43][44]Computed tomography (CT) arthrography provides detailed assessment of both labral pathology and associated bony abnormalities, such as those in femoroacetabular impingement (FAI). It offers sensitivity of approximately 85% for labral tears and excels in evaluating acetabular morphology, with accuracy of 89.8% overall. However, its use is limited by ionizing radiation exposure, reserving it for cases where MRI is contraindicated or when precise osseous detail is needed alongside soft tissueevaluation.[44][42]Ultrasound is a noninvasive, cost-effective option but has limited utility for direct visualization of the deep acetabular labrum due to acoustic shadowing from overlying bone and soft tissues. It is operator-dependent and less accurate for comprehensive labral assessment, with sensitivity as low as 44% for tears in accessible regions. Dynamic ultrasound proves valuable for evaluating extra-articular issues, such as snapping iliopsoas tendon over the iliopectineal eminence, by capturing real-time motion and guiding interventions.[45]Plain radiography (X-ray) does not directly visualize the acetabular labrum but is essential for excluding bony abnormalities that may contribute to labral pathology, such as acetabular dysplasia or FAI features on anteroposterior views. It serves as an initial screening tool to assess joint alignment and osteoarthritis. Hip arthroscopy remains the definitive diagnostic method for confirming labral tears and guiding treatment.[46][46]
Management
Conservative approaches
Conservative management of acetabular labral pathology prioritizes non-invasive strategies to alleviate symptoms, promote healing, and restore function as the initial approach for most patients. Initial treatment often involves a period of relative rest and activity modification lasting 4-6 weeks to minimize stress on the hip joint.[47] Patients are advised to avoid provocative positions such as deep hip flexion greater than 90 degrees or combined flexion with internal rotation, which can exacerbate labral irritation and associated pain.[47] This approach reduces inflammation and allows for symptomatic relief without invasive intervention.[48]Pharmacotherapy plays a key role in controlling pain and inflammation during the early phases of conservative care. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen at doses of 400-600 mg three times daily, are commonly prescribed to target inflammatory processes in the hip joint.[49] For more persistent symptoms, intra-articular corticosteroid injections provide short-term relief, typically lasting 1-3 months, by directly reducing joint inflammation.[50] These interventions are most effective when combined with other conservative measures and are guided by fluoroscopy to ensure accurate delivery.[25]Physical therapy forms the cornerstone of rehabilitation, typically spanning 10-12 weeks and tailored to address neuromuscular deficits and improve hip stability. Programs emphasize core stability exercises, such as supine bridging and transverse abdominis activation, alongside gluteal strengthening through maneuvers like clamshells and side-lying hip abduction.[51]Hip range of motion is gradually restored via stretching and mobilizations, progressing from basic phases focused on pain reduction to advanced functional training.[51] Structured protocols can lead to improvements in pain and function for many patients with labral tears.[52]Intra-articular injections, including fluoroscopy-guided corticosteroids or platelet-rich plasma (PRP), serve as adjuncts for pain management when oral medications are insufficient. Corticosteroid injections offer reliable short-term symptom reduction, while PRP aims to enhance tissue repair through growth factors, though evidence for its efficacy remains mixed.[53] These procedures support symptom management and can facilitate physical therapy participation.[52]Overall outcomes for conservative approaches vary by patient demographics and tear severity, with about 50% of non-athletes achieving symptom resolution without progression to surgery.[54] Failure rates, leading to surgical referral in 30-40% of cases, are higher in athletes or those with structural abnormalities, underscoring the need for individualized assessment.[55] A 2025 consensus statement recommends trialing conservative management in nearly all patients, emphasizing a multidisciplinary approach involving physicians, physical therapists, and patient education.[56]
Surgical interventions
Surgical interventions for acetabular labral tears primarily involve hip arthroscopy, a minimally invasive procedure performed in either the supine or lateral decubitus position to access the joint through small portals, such as anterolateral and mid-anterior.[57][58] This approach allows visualization and treatment of labral pathology alongside associated conditions like femoroacetabular impingement (FAI), with the acetabular rim often trimmed (3-5 mm) to facilitate repair in cases of pincer-type FAI.[59] For frayed or unstable labral tissue, debridement is indicated when the tear is not amenable to repair, involving selective resection of damaged segments using a shaver, radiofrequency device, or forceps while preserving as much healthy labrum as possible to maintain joint stability.[57][59]Labral repair is preferred for full-thickness detachments at the labral-chondral junction, particularly in acute tears identified via preoperative imaging, employing 2-4 suture anchors (e.g., 2.2-mm knotless anchors) placed 2-3 mm below the cartilage edge to refixate the labrum and restore its suction-seal function.[57][59][58] Sutures are passed through the labrum in a looped or piercing manner to balance inversion and eversion, with labral advancement commonly used for pincer FAI by mobilizing the labrum over the trimmed rim.[58] For irreparable segments, segmental excision removes isolated damaged areas, though this is less favored due to potential long-term joint degeneration.[59] In cases of absent or severely deficient labrum, reconstruction employs autografts like the iliotibial band or allografts such as tensor fascia lata, fixed with multiple anchors to recreate labral anatomy, often in revision settings or global pathology.[60]Open surgical approaches are reserved for complex cases, such as developmental dysplasia of the hip, where periacetabular osteotomy (PAO) reorients the acetabulum and is combined with labral repair via arthroscopy or mini-open techniques to address both bony deformity and soft-tissue damage.[61] This combined procedure improves acetabular coverage and labral integrity, though it is less common than arthroscopy due to higher morbidity.[61]Postoperative rehabilitation follows a phased protocol to protect the repair and restore function. Phase 1 (0-4 weeks) emphasizes protected weight-bearing with crutches, limited hip flexion to 90-120 degrees, and gentle passive range-of-motion exercises to minimize inflammation.[57][62] Phase 2 (4-8 weeks) advances to full weight-bearing, progressive strengthening of hip stabilizers (e.g., gluteals), and improved flexion/abduction while avoiding high-impact activities.[62] Subsequent phases (8-16 weeks) focus on neuromuscular control and sport-specific training, with return to athletics typically at 4-6 months, contingent on achieving symmetric strength and pain-free motion.[62][58]Clinical outcomes for arthroscopic labral repair demonstrate high patient satisfaction rates of 85-90% at 2-5 years follow-up, with significant improvements in modified Harris Hip Scores (mean 94 points postoperatively) and 86-90% of athletes returning to prior activity levels.[63][58] Re-tear rates range from 10-20%, lower in acute injuries (success ~90%) compared to degenerative tears (~70-80%), underscoring the importance of timelyintervention.[60] Labral reconstruction yields comparable or superior durability, with failure rates under 10% in mid-term studies and sustained functional gains.[60]Debridement provides 70-85% short-term relief but inferior long-term results to repair.[57] A 2025 consensus statement supports arthroscopic approaches as preferred, with strong agreement on labral repair for most cases.[56]