(Poster 100) Labral Hip Tears as a Cause of Chronic Pelvic Pain in Women: A Scoping Review

Objectives: The purpose of this comprehensive scoping review is to summarize the existing literature exploring the relationship between musculoskeletal pathologies of the hip and gynecologic pain and to specifically highlight any gaps in the current knowledge on the link between acetabular labral hip tears and chronic pelvic/vulvar pain.

Methods: The scoping review was structured and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). In collaboration with the research team, a medical librarian developed and executed comprehensive searches in Ovid MEDLINE, Ovid Embase, CINAHL, Scopus, Web of Science Core Collection, and Cochrane Library (via Wiley) from inception to May 11, 2024. All study designs were included. Studies that reported findings in women aged 18 and older with pelvic pain and hip pain or pathology were included. Studies examining men, individuals under 18 years of age, and animals were excluded. All articles exported from literature searches were screened by a team of nine reviewers, ensuring each abstract/title and full text was reviewed by two independent reviewers. Data extraction was conducted by two independent reviewers, with conflict resolution performed by a third reviewer.

Results: The search yielded a total of 4906 articles, of which 1989 duplicates were removed. After title/abstract and full text screening, 44 studies were included for data extraction: 18 case reports, 9 narrative reviews, 9 case series, 5 retrospective cohort studies, 1 scoping review, 1 literature review and 1 practice guideline. Articles referring to musculoskeletal pathologies contributing to pelvic pain were common, with femoroacetabular impingement being the most frequently mentioned in 10 articles. Labral tears were mainly mentioned in the context of improvements in sexual pain post-corrective hip surgeries, or were broadly mentioned in narrative reviews as a possible cause of pelvic pain. However, few reviews specifically discussed the pathophysiologic mechanism underlying the association between labral tears and pelvic pain. Through thematic analyses, four major themes emerged: (1) There are close anatomic relationships and pain referral patterns between structures in the hip and pelvis; (2) Musculoskeletal pathologies should be considered as part of the differential diagnosis when investigating gynecologic/chronic pelvic pain; (3) Gynecologic pain should be diagnosed and treated by a multidisciplinary team; and (4) Symptoms are best addressed using customized approaches and individualized interventions.

Conclusions: This scoping review highlights a growing recognition of the interplay between musculoskeletal hip pathologies and gynecologic pain, particularly in the context of femoroacetabular impingement. However, despite frequent references to labral tears, their specific role in chronic pelvic pain remains underexplored and poorly characterized in the current literature. The findings underscore the need for interdisciplinary diagnostic approaches and high-quality research to clarify the etiologic contributions of labral pathology to chronic pelvic and gynecologic symptoms.