Clinical Outcomes of Physiotherapy for Patients with Acetabular Labral Tears: An Analysis According to Severity of Injury

Background: Arthroscopic labral repair is an effective treatment for femoroacetabular impingement (FAI) and acetabular labral injury. However, the effectiveness of physiotherapy treatment is controversial. Previous studies that analyzed the outcome of physiotherapy for patients with FAI or acetabular labral tears did not consider damaged tissues or the severity of the acetabular labral tear. This study aimed to evaluate (1) the short-term outcome of physiotherapy in patients with acetabular labral tears confirmed by magnetic resonance imaging (MRI) and (2) the effectiveness of physiotherapy according to the severity of the labral tear.Methods: Thirty-five patients who underwent physiotherapy for symptomatic acetabular labral tears from August 2013 to July 2018 were enrolled. We evaluated the severity of the acetabular labral tears, which were classified based on the Czerny classification system using 3-T MRI. Clinical findings of microinstability and extra-articular pathologies of the hip joint were also examined. Outcome scores were evaluated using the International Hip Outcome Tool 12 (iHOT12) at pre- and post-intervention.Results: The mean iHOT12 score significantly improved from 44.0 to 73.5 in 4.7 months. The post-intervention iHOT12 scores were significantly higher than the pre-intervention scores at stages I (pre 51.0, post 74.4; P=0.004) and II (pre 44.8, post 81.2; P<0.001). However, there were no significant differences between the pre-intervention and post-intervention iHOT12 scores at stage III (pre 36.6, post 60.8; P=0.061). Furthermore, 7 patients (20.0%) had positive microinstability tests, and 22 (62.9%) had findings of extra-articular pathologies. Of 35 patients, 8 (22.9%) underwent surgical treatment after failure of conservative management, of whom 4 had Czerny stage III.Conclusions: Physiotherapy significantly improved the iHOT12 score of patients with acetabular labral tears in the short-term period. In patients with severe acetabular labral tear, improvement of clinical score by physiotherapy may be poor. Identifying the severity of acetabular labral tears can be useful in determining treatment strategies.

Use of a Hip Spica for Management of an Acetabular Labral Tear in a Female Collegiate Gymnast: A Case Report

The patient was a 20-year-old female gymnast complaining of lateral hip pain, posterior to the greater trochanter, that increased with hip extension and external rotation. Over the course of 1 month during the season, pain progressively shifted to the groin and hip extension and external rotation became limited. A minimally painful exercise program was implemented in conjunction with a supportive hip spica, assisting extension and external rotation while limiting flexion and internal rotation during therapeutic exercise. The resulting implementation of a hip spica is a novel way to reduce pain and improve function to augment current conservative treatments.

MRI Evaluation of Painful Hip Joint

Background: The hip is a stable, major weight-bearing joint with significant mobility. It can be involved by numerous pathological conditions like congenital and developmental, infective, arthritic, and neoplastic. Hence, early diagnosis and characterization of pathology play a vital role for the clinicians in proper management and follow-up of the disease. This study aimed to evaluate the role of MRI in the diagnosis of painful hip pathology. Subjects and Methods: This study was a prospective study; total 50 patients were included in this study. This study was conducted at the Department of Radio-Diagnosis, Rajindra Hospital, Patiala. MR Imaging was done with a 1.5 Tesla superconductive scanner (Siemens 1.5 T Magnetom AERA MRI Machine). Results: 26 out of 69 total hip joints affected (including bilateral) were diagnosed as avascular necrosis, 14 hips as osteoarthritis, and 10 hips as septic arthritis. Inflammatory arthritis was diagnosed in 7 hips, femoroacetabular impingement and an acetabular labral tear in 2 hips each. 2 cases were reported as normal hip joint and 1 case each was reported as a primary and metastatic tumor. Conclusion: MRI is the method of choice in characterizing the various disorders of the hip joint, and it can point out specific features leading to an accurate diagnosis of the painful hip joint.

Outcomes After Arthroscopic Repair in Patients With Tears of Hypertrophic Versus Morphologically Normal Acetabular Labra

Background: Recently, a hypertrophic labrum has been reported in the absence of hip dysplasia, which can possibly contribute to an acetabular labral tear. Purpose: To compare the clinical outcomes and complications, including the incidence of iatrogenic acetabular labrum and cartilage injury, in patients with tears of hypertrophic versus morphologically normal acetabular labra over a minimum follow-up period of 2 years and to assess the morphologic changes at follow-up computed tomography arthrography in the 2 groups. Study Design: Cohort study; Level of evidence, 3. Methods: Between January 2010 and December 2016, 20 patients (22 hips) with a hypertrophic labrum underwent arthroscopic hip surgery. A total of 22 patients (22 hips) without a hypertrophic labrum were assigned to the control group based on matching criteria, including age, sex, body mass index, labral tear, and labral repair. Clinical outcomes were assessed with the visual analog scale score, UCLA activity scale score (University of California, Los Angeles), and modified Harris Hip Score. Radiologic outcomes were assessed through serial radiography. Patients were followed for at least 2 years. Results: The mean age at surgery was 42 years. The most common cause of arthroscopic surgery in the study group was an isolated acetabular labral tear without any bony structural abnormalities (68.2%, 15 of 22 hips). All improvements in both groups were statistically significant at the last postoperative follow-up ( P < .001). Although the radiologic and clinical outcomes were not significantly different between the groups, the complication rates, including iatrogenic labral perforations and cartilage injury, were significantly higher in patients with hypertrophic acetabular labral tears (9 vs 3, P = .042). The patient-reported satisfaction scores at the last postoperative follow-up were 8.4 and 7.9 in the study and control groups, respectively ( P = .351). Conclusion: The high rates of patient-reported satisfaction and the clinical outcomes after arthroscopic repair in both groups are encouraging. Arthroscopic treatment in patients with hypertrophic acetabular labral tears should be carefully performed to prevent iatrogenic injury during the surgery, and isolated hypertrophic labral tears can have good results after repair.