Nonoperative Management of Labral Tears of the Hip in Adolescent Athletes: Description of Sports Participation, Interventions, Comorbidity, and Outcomes

Cianci, Andrea; Sugimoto, Dai; Stracciolini, Andrea; Yen, Yi‐Meng; Kocher, Mininder S.; d’Hemecourt, Pierre A.

doi:10.1097/jsm.0000000000000503

Cited by 26 publications

(18 citation statements)

References 23 publications

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“…Hunt et al 14 reported less promising outcomes with a nonoperative approach, with 61% of their 18 patients with FAI syndrome requiring surgery. Cianci et al 7 found that 76% of patients treated nonoperatively went on to surgery and that patients with radiographic FAI and labral tears were more likely to require operative treatment.…”

Section: Discussionmentioning

confidence: 99%

Nonoperative Management of Femoroacetabular Impingement: A Prospective Study

et al. 2018

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Background: The literature has given little attention to the nonoperative management of femoroacetabular impingement (FAI) syndrome despite a rapidly expanding body of research on the topic. Purpose: To perform a prospective study utilizing a nonoperative protocol on a consecutive series of patients presenting to our clinic with FAI syndrome. Study Design: Cohort study; Level of evidence, 2. Methods: Between 2013 and 2016, patients meeting the following criteria were prospectively recruited in a nonoperative FAI study: no prior hip surgery, groin-based pain, a positive impingement test, and radiographic FAI syndrome. The protocol consisted of an initial trial of rest, physical therapy, and activity modification. Patients who remained symptomatic were then offered an image-guided intra-articular steroid injection. Patients with recurrent symptoms were then offered arthroscopic treatment. Outcome scores were collected at 12 and 24 months. Statistical analysis was performed to identify risk factors for the need for operative treatment and to determine patient outcomes based on FAI type and treatment. Results: Ninety-three hips (n = 76 patients: mean age, 15.3 years; range, 10.4-21.4 years) were included in this study and followed for a mean ± SD 26.8 ± 8.3 months. Sixty-five hips (70%) were managed with physical therapy, rest, and activity modification alone. Eleven hips (12%) required a steroid injection but did not progress to surgery. Seventeen hips (18%) required arthroscopic management. All 3 groups saw similar improvements in modified Harris Hip Score ( P = .961) and nonarthritic hip score ( P = .975) with mean improvements of 20.3 ± 16.8 and 13.2 ± 15.5, respectively. Hips with cam impingement and combined cam-pincer impingement were 4.0 times more likely to meet the minimal clinically important difference in modified Harris Hip Score ( P = .004) and 4.4 times more likely to receive surgical intervention ( P = .05) than patients with pincer deformities alone. Participants in team sports were 3.0 times more likely than individual sport athletes to return to competitive activities ( P = .045). Conclusion: A majority (82%) of adolescent patients presenting with FAI syndrome can be managed nonoperatively, with significant improvements in outcome scores at a mean follow-up of 2 years. Clinical Relevance: A nonoperative approach should be the first-line treatment for young active patients with symptomatic FAI syndrome.

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Section: Discussionmentioning

confidence: 99%

Nonoperative Management of Femoroacetabular Impingement: A Prospective Study

et al. 2018

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“…However, the patients who have labral tear with FAI present a higher rate of surgery compared with those with isolated labral tear (51.3% vs. 25.0% with statistically significant difference), which indicates that that FAI comorbidity with hip labral tears increases the risk of surgery after non-operative management. [36]…”

Section: Methodsmentioning

confidence: 99%

Diagnosis and treatment of labral tear

Chen

Yang

2019

Chinese Medical Journal

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Objective:To review the literature regarding diagnosis and treatment of labral tear.Data sources:A systematic search was performed in PubMed using various search terms and their combinations including hip, labrum, acetabular labral tear, arthroscopy, diagnosis, and anatomy.Study selection:For each included study, information regarding anatomy, function, etiology, diagnosis, and management of acetabular labral tear was extracted.Results:Five hundred and sixty abstracts about anatomy, function, etiology, diagnosis, and management of acetabular labral tear were reviewed and 66 selected for full-text review. The mechanism of labral tear has been well explained while the long-term outcomes of various treatment remains unknown.Conclusions:Labral tear is generally secondary to femoroacetabular impingement, trauma, dysplasia, capsular laxity, and degeneration. Patients with labral tear complain about anterior hip or groin pain most commonly with a most consistent physical examination called positive anterior hip impingement test. Magnetic resonance arthrography is a reliable radiographic examination with arthroscopy being the gold standard. Conservative treatment consists of rest, non-steroidal anti-inflammatory medication, pain medications, modification of activities, physical therapy, and intra-articular injection. When fail to respond to conservative treatment, surgical treatment including labral debridement, labral repair, and labral reconstruction is often indicated.

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“…Yin et al 73 found acetabular labral injuries accounted for 5.9% of all injuries in the pediatric dance population. In fact, Cianci et al 74 found the highest number of labral tears (18.4%) were sustained by dancers versus other athletes over a 3-year prospective chart review of patients 8 to 20 years of age. While imaging studies by Kolo et al 37 found the number of labral lesions in female pre-professional and professional ballet dancers was not significantly different than controls, the dancers had more severe lesions, particularly in the superior and posterosuperior regions.…”

Section: Common Conditions Ligamentum Teres Rupturementioning

confidence: 99%

Hip Instability in Ballet Dancers: A Narrative Review

et al. 2021

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Background: Dancers possess a large degree of hip range of motion that results from a combination of innate and acquired osseous morphology and permissive soft tissues. Generalized hypermobility in dancers may predispose them to a spectrum of hip instability. The objective of this narrative review is to discuss the anatomical characteristics, pathogenesis, risk factors, clinical signs and symptoms, management, and outcomes of hip instability treatments in dancers.Methods: A retrospective search was performed beginning November 1, 2017, for English language articles regarding hip stability in the dancer. Key words used included but were not limited to: dance(r), ballet, hip, hypermobility, range of motion, instability, microinstability, and laxity. PubMed, Scopus, and MEDLINE databases were used.Results: Forty-three studies were analyzed. Groin pain was found to be the most common presenting symptom of hip instability. A variety of impingement and instability signs may be elicited during physical examination. Hypermobility is frequently observed and is thought to be a necessity for participation in elite levels of ballet. Radiographs and advanced planar imaging (magnetic resonance imaging and computed tomography) should be scrutinized to evaluate for dysplasia, cam, pincer, subspine, and rotational morphologies. Dysplasia (low volume acetabulum), cam morphology, femoral retroversion, and coxa valga are common findings in the ballet dancers’ hip. Labral injuries and ligamentum teres tears are common and may potentiate instability in the hip. Management options include education, oral non-opioid medications, activity modification, exercise prescription, and surgery. Reported outcomes of these treatments in ballet are limited.Conclusion: Hip hypermobility is prevalent in the ballet population and is a clear advantage. However, it may increase the risk of instability. It is important to identify the multifactorial osseous and soft tissue etiology of hip or groin pain in dancers. Practitioners should have a high level of suspicion for hip instability in the dancer presenting with hip pain and treat accordingly. There is a significant need for increased quantity and quality of investigation into the outcomes of treatment for hip instability in the dancer.

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Nonoperative Management of Labral Tears of the Hip in Adolescent Athletes: Description of Sports Participation, Interventions, Comorbidity, and Outcomes

Cited by 26 publications

References 23 publications

Nonoperative Management of Femoroacetabular Impingement: A Prospective Study

Nonoperative Management of Femoroacetabular Impingement: A Prospective Study

Diagnosis and treatment of labral tear

Hip Instability in Ballet Dancers: A Narrative Review

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