Acetabular Labral Tear Kelsey Everhart Michelle Roberts Shelby Philip

Mechanism of injury Sporting activities that involve repetitive external rotation and have shown to be risk factors for labral tears include: ▫Soccer ▫Hockey ▫Golf ▫Ballet ▫Running/sprinting Torsional and twisting movements along with hyperabduction, hyperextension, and hyperextension with lateral rotation all have been influential factors that are considered to lead to labral tears.

MOI Cont’d Although these factors are deemed legitimate criteria for labral tears over 74% reported labral tears are not associated or linked back to any known or specific cause. This applies to the athletic population, where labral tears are typically seen as a result of repetitive stress rather than an isolated damaging event.

Description of injury There are typically two types of labral tears: ▫1. Detached labrum from the labral cartilage junction ▫2. Intrasubstance tears  Structural abnormalities such as, dysplasia and Perthe’s disease

Evaluation In studies of patients with hip or groin pain, % of patients were later found to have a labral tear. ▫Reported age of people with hip pain ranged from 8 to 75 years old. 90% of patients with a torn labrum reported consistent hip pain in the anterior hip or groin region, this is more consistent with an anterior labral tear Patients will report popping or clicking along with locking or catching.

Evaluation Patients report a long duration of symptoms, averaging at about 2 years. This can be attributed to the difficulty in recognizing an acetabular labral tear as the source of the patients hip pain.

Evaluation To identify an anterior labral tear, the patient’s leg is brought into full flexion, lateral rotation, and full abduction and is then taken into extension with medial rotation and adduction. To identify a posterior labral tear, the patients leg is brought into extension, abduction and lateral rotation and then brought into flexion with medial rotation and adduction. If a tear is present, these positions will elicit sharp pain with or without the presence of a click.

Differential Diagnosis Hernia Athletic pubalgia Trochanteric bursitis Osteitis pubis Adductor strain Snapping hip syndrome Osteochondral defect

Conservative Treatment Non steroidal anti-inflammatory medications Rest ▫May include traction With no improvement in 4 weeks a hip arthroscopy is indicated

Arthroscopic Treatment Used to diagnose and treat Arthroscopic debridement ▫Shavers used to debride the labrum Detached labral tears are secured with bioabsorbable sutures

Postoperative Care Simple arthroscopic debridement ▫Few restrictions Femoral neck osteoplasty, rim trimming, and labral repair ▫Protected weight bearing (3 weeks)  Hip brace (1 st week) ▫Continuous passive motion  Begin immediately following surgery

Postoperative Care (cont.) ▫Passive range of motion  Assistance from physical therapist or athletic trainer ▫Active and active assisted exercises  Performed in gravity eliminating positions  Stationary bike without resistance ▫Once full range of motion and weight bearing achieved  Strengthening exercises  Endurance exercises  Sport specific exercises  Return to play

Corrective Exercises Reducing anterior forces on the hip ▫Ensure proper hip alignment Correction of primary use of quadriceps femoris and hamstring muscles ▫Controlling hip abductors, deep lateral rotators, gluteus maximus, and iliopsoas muscles Gait assessment ▫Correcting knee hyperextension because may cause hip hyperextension Modification of activities of daily living ▫Example: avoid rotating the hip while fully weight bearing such as when getting out of a car

Specific Return to Play Criteria The athlete must have: ▫sufficient muscular endurance ▫ sufficient eccentric control ▫the ability to generate power before returning to competition. Their running should be progressed and eventually should move into lateral movement. There are specific RTP assessments that the athlete must clear: ▫Dynamic functional activities with resistance (Examples: SL Squat, Lateral bounding, forward/backward jogging) The athlete should be assessed on their ability to utilize sufficient neuromuscular control during multi-planar movements that are similar to their particular sport.

References Bharam S, Philippon M. Diagnosis and management of acetabular labral tears in the athlete. International Sportmed Journal [serial online]. March 2008;9(1):1-11. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed March 25, 2013 Garrison C, Osler M, Singleton S. Rehabilitation after Arthroscopy of an Acetabular Labral Tear. North American Journal of Sports Physical Therapy. November 2007; 2(4): Lewis C, Sahrmann S. Acetabular Labral Tears. Physical Therapy [serial online]. January 2006;86(1): Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed March 25, 2013

References Narvani A, Tsiridis E, Tai C, Thomas P. Acetabular labrum and its tears. British Journal Of Sports Medicine [serial online]. June 2003;37(3): Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed April 9, Paluska S. An Overview of Hip Injuries in Running. Sports Medicine [serial online]. August 2005;35(11): Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed March 25, Walker J. Physical Therapy Management Following Femoroacetabular Impingement Correction and Acetabular Labral Repair: A Case Report. Doctor of Physical Therapy Research Papers. 2012; Paper 19.