Ross Hauser, MD, Danielle Matias, PA-C, Demi Foster, APRN

A hip MRI shows a torn labrum. You have pain getting out of a car, rotating your leg, or returning to exercise. The next question is whether the tear requires surgery—and whether it explains all your symptoms.

At Caring Medical, our perspective emphasizes the stability of the hip as a whole. A labral finding deserves attention, but so do the supporting capsule, ligaments, tendons, and the way the hip moves. Understanding these relationships helps explain why a treatment directed at one structure may leave other symptoms unresolved.

What is the hip labrum?

The acetabular labrum is a ring of cartilage around the hip socket. It helps maintain the joint’s fluid seal and contributes to stability. The ball and socket, capsule, ligaments, and surrounding muscles also help control movement. A labral tear can be painful, but its significance depends on the condition of the rest of the joint. A 2025 expert consensus identified trauma, repetitive loading, hip dysplasia, and impingement-related bone shapes among relevant factors. (1)

Hip dysplasia means that the socket provides insufficient coverage of the ball. Femoroacetabular impingement involves abnormal contact between the femur and socket during movement. These are different structural problems, even when both are associated with labral injury. Our discussion of femoroacetabular impingement explores that related topic.

Symptoms: groin pain, catching, and painful rotation

A symptomatic tear may be associated with pain in the front of the hip or groin, particularly during deep bending or rotation. Patients may describe a sharp catch when turning or pain when getting into a vehicle. The 2025 consensus identified the combination of anterior groin pain, pain in deep flexion, and catching with rotation as suggestive features. Symptoms should still be correlated with examination and imaging. (1)

Clicking alone is less specific. A tendon moving over another structure can also produce snapping. Our article on snapping hip syndrome discusses these other sources of hip noise. A painful catch is therefore a symptom to explain, rather than confirmation that a particular MRI finding requires repair.

Does an MRI tear automatically require treatment?

No. In a blinded study of 45 volunteers without hip symptoms, MRI showed labral tears in 69% of hips. This small study does not tell us how common tears are in every age group, but it demonstrates that a visible tear can exist without pain. (2)

The distinction matters for treatment expectations. If several structures contribute to pain, improving one does not necessarily resolve all symptoms. Conversely, improved comfort and function do not by themselves establish that the labrum has returned to its original structure.

Nonsurgical treatment can improve symptoms

Conventional nonsurgical approaches include modifying aggravating activities, progressive rehabilitation, and selected medications or injections. Rehabilitation generally addresses strength, movement control, and tolerance for activity. It does not require every patient to follow the same exercise program.

In a 2024 randomized trial of 97 adults aged 40 or older with symptomatic tears and limited radiographic arthritis, surgery plus rehabilitation produced better outcomes overall than physical therapy alone. Nevertheless, some patients avoided surgery, and a trial of physical therapy did not worsen outcomes among those who later underwent arthroscopy. The results support meaningful consideration of nonsurgical care while recognizing that it is insufficient for some patients. (3)

What can an injection tell us about the pain?

An injection containing local anesthetic inside the hip may help clarify whether pain originates within the joint. The 2025 consensus supported a diagnostic injection when the pain source is uncertain. Relief does not distinguish perfectly among all structures inside the joint, prove that the labrum is the sole source, or guarantee a good surgical outcome. (1)

It is also useful to distinguish the intended purposes of injections. An anesthetic temporarily reduces sensation. A corticosteroid is intended to reduce inflammation and symptoms. Dextrose prolotherapy and PRP have different proposed biological actions. One injection’s effect should not be used as evidence that another repairs a tear.

Caring Medical’s published hip labrum prolotherapy research

Our published retrospective case series evaluated 19 patients with acetabular labral tears treated with intra-articular hypertonic dextrose. Questionnaires were collected between one and 60 months afterward, averaging 12 months. All participants reported improvements in pain and function; complete relief was reported for 54% of recorded symptoms. No adverse events were reported in this small series. (4)

That final percentage refers to symptoms, not the percentage of patients whose tears healed. The study had no randomized comparison group and relied on retrospective patient reports. It did not establish structural labral repair, superiority to physical therapy or surgery, or prevention of hip replacement.

We regard these findings as preliminary clinical evidence warranting further investigation. They support discussion of prolotherapy as a potential nonsurgical approach; they do not justify a promise that injections will close a tear. The biological rationale for dextrose includes stimulation of tissue responses, but the mechanism and extent of healing in a human hip labrum remain uncertain. (4)

Our broader chronic hip pain research

An earlier retrospective study included 61 patients representing 94 painful hips, with symptoms averaging 63 months. At an average of 19 months after the last treatment, reported pain scores had decreased from 7.0 to 2.4; 89% of hips were reported to have more than 50% pain relief. (5)

This was a broader chronic hip pain population, not a trial confined to MRI-confirmed labral tears. The study relied on recalled before-and-after symptoms and had no untreated comparison group. Its findings should not be presented as a labral healing rate or evidence that prolotherapy prevents replacement. It remains relevant as preliminary research into pain and function in a different population. (5)

What does PRP research show?

Platelet-rich plasma is made from a patient’s blood and contains concentrated platelets. A prospective pilot study evaluated eight patients with labral tears after unsuccessful conservative care. Pain and function improved during short follow-up after ultrasound-guided PRP injection. However, an uncontrolled eight-person study cannot establish lasting effectiveness or tissue regeneration. (6)

The 2025 consensus did not reach agreement on the role of orthobiologic injections for nonsurgical labral tear management. This is an important evidence boundary: biological plausibility and early clinical results are different from demonstrated effectiveness in large comparative trials. (1)

Why we emphasize joint stability

Our clinical framework considers whether painful soft tissues and abnormal movement may contribute to persistent symptoms. It is a framework for understanding a problem, rather than proof that every labral tear results from ligament laxity. Current hip instability literature supports considering symptoms, examination findings, and relevant risk factors together. It does not validate prolotherapy as a proven treatment for all forms of instability. (7)

Our hip instability and microinstability article examines this mechanical perspective in greater detail. For patients, the useful distinction is between reducing symptoms, improving movement, and demonstrating structural healing. Those outcomes may overlap, but they should not be treated as interchangeable.

Can symptoms improve even if the tear remains visible?

Pain, everyday function, and tissue structure are separate outcomes. A patient may tolerate sitting, walking, or exercise better without a study demonstrating that the labrum has regenerated. Conversely, a technically repaired labrum does not guarantee that every source of pain has been addressed.

The available injection studies mainly measured symptoms and function. Their results should be described using those outcomes. Claims that PRP fills a tear, that prolotherapy restores the labral seal, or that injections prevent future arthritis require direct supporting evidence.

For the surgical comparison and long-term questions, see our updated discussion of hip arthroscopy outcomes. Detailed imaging questions are addressed in our hip MRI companion article.

When the diagnosis needs reconsideration

Persistent pain may have another or an additional source. Pain around the hip can also involve tendons, the lower back, or other structures. Sudden severe pain after injury, inability to bear weight, or fever with a painful hip warrants prompt medical assessment rather than assuming that an existing labral tear explains the change.

Nonsurgical treatment can be reasonable for selected patients. The decision depends on the clinical importance of the tear, the joint’s condition, and the patient’s symptoms and functional limitations. Our published prolotherapy results remain relevant, provided their limitations are stated as clearly as their encouraging findings.

Our research expanded discussion

Prolotherapy for Hip Labrum Tears

In our own research, Prolotherapy for hip labral tears was curative in 54% of the patients (no pain at all after Prolotherapy) and overall relieved 80-85% of their pain, which in our experience will end up much better than surgical procedures, because the hip is now stable.

Prolotherapy is an injection technique utilizing simple sugar or dextrose.

Regenerative Injection Therapy (Prolotherapy) for Hip Labrum Lesions: Rationale and Retrospective Study

Ross Hauser MD of Caring Medical and Amos Z. Orlofsky, Ph.D. of Albert Einstein College of Medicine published the above study in The Open Rehabilitation Journal research describing the effectiveness of Prolotherapy for a hip labral tear and groin pain. The study concluded Prolotherapy for acetabular labral tear appears to be a safe and potentially effective treatment.

Here are learning points from that research:

• The results of the study were encouraging, as all 19 patients reported pain reduction, and all reported improvement in at least one of two functional categories.
• All patients expressed a positive view of their treatment on a (self-reported) questionnaire. Improvements appeared to
  be stable during at least the first two years post-treatment, as judged by the lack of time dependence for pain reduction.
• (Prolotherapy)  was well tolerated and no adverse events were observed.
• The study results are notable for the high frequency of posttreatment reports of complete symptomatic relief, rather than
  partial relief
• Hypertonic dextrose potentially has multiple effects that may enhance labral healing, including the induction of growth factor production and proliferative responses as well as the possible elicitation of inflammatory changes that may promote healing responses.
• The nature of healing responses in the labrum is still poorly understood, but earlier studies suggest that considerable
  spontaneous healing occurs and that therapies that focus on amplifying and optimizing this spontaneous process may have merit.
• Given the poor efficacy of the current conservative treatment of labral tear, and the risks, failure rate, and expense associated with arthroscopy, regenerative therapy may be viewed as a potential adjunct to conservative management. (17)

A Retrospective Study on Hackett-Hemwall Dextrose Prolotherapy for Chronic Hip Pain at an Outpatient Charity Clinic in Rural Illinois

In this research published in the Journal of Prolotherapy, (18) Prolotherapy was found to provide connective tissue growth responses and provide clinical benefits with low risks in musculoskeletal conditions. Further, Prolotherapy can be a cost-effective alternative to surgery for patients with hip pain and labral tear.

We examined Sixty-one patients, representing 94 hips, who had been in pain for an average of 63 months We treated these patients quarterly with dextrose Prolotherapy.

This included a subset of 20 patients who were told by their medical doctor(s) that there were no other treatment options for their pain and a subset of eight patients who were told by their doctor(s) that surgery was their only option.

The patients have been contacted an average of 19 months following their last Prolotherapy session and asked questions regarding their levels of pain, physical and psychological symptoms, and activities of daily living, before and after their last Prolotherapy treatment.

Results:

• In these 94 hips, pain levels decreased from 7.0 to 2.4 after Prolotherapy;
• 89% experienced more than 50% of pain relief with Prolotherapy;
• more than 84% showed improvements in walking and exercise ability, anxiety, depression, and overall disability;
• 54% were able to completely stop taking pain medications.

We concluded: “Prolotherapy used on patients who presented with over five years of unresolved hip pain were shown in this retrospective pilot study to improve their quality of life even 19 months subsequent from their last Prolotherapy session.

The 61 patients with 94 hips treated reported significantly less pain, stiffness, crunching sensation, disability, depressed and anxious thoughts, medication and other pain therapy usage, as well as improved walking ability, range of motion, sleep, exercise ability, and activities of daily living. This included patients who were told there were no other treatment options for their pain or that surgery was their only option. The results confirm that Prolotherapy is a treatment that should be highly considered for people suffering from chronic hip pain.”

References

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