Improvement in Functional Outcome Scores Despite Persistent Pain With 1 Year of Nonsurgical Management for Acetabular Labral Tears With or Without Femoroacetabular Impingement

Abstract

Background: Acetabular labral tears are increasingly recognized as a source of hip pain in a younger active population. Given the significant focus on surgical intervention, there has been limited investigation on the nonsurgical management and natural history of such injuries.

Hypothesis: Patients undergoing nonsurgical treatment for symptomatic acetabular labral tears experience functional improvement based on patient-reported outcome measures over the course of 1 year.

Study design: Case series; Level of evidence, 4.

Methods: Seventy-one patients were identified who had acetabular labral injuries confirmed by magnetic resonance imaging or arthrography, received a minimum of 1 year of nonsurgical treatment, and completed baseline functional outcome questionnaires: modified Harris Hip Score (mHHS), Hip Outcome Score (HOS)-Activities of Daily Living, HOS-Sports, and iHOT-33 (International Hip Outcome Tool-33). Of these, 52 (73.2%) completed the minimum 1-year follow-up questionnaires. Chart review was conducted to obtain demographic information. Statistical significance ( P < .05) was determined by paired t test, independent samples t test, and chi-square test.

Results: Twenty-two male and 30 female patients completed 1-year follow-up questionnaires. Mean ± SD follow-up time was 16.2 ± 3.1 months. The cohort had a mean age of 38.9 ± 9.3 years. Baseline radiographs demonstrated minimal arthritis (Tönnis grades 0-2). Mean alpha angle differed significantly between men and women at 52.9°± 8.6° and 46.3°± 8.5°, respectively. At 1-year follow-up, patients experienced a significant improvement in all 4 functional outcome measures (mHHS: 72.6 vs 81.8, HOS-Activities of Daily Living: 78.6 vs 86.4, HOS-Sports: 56.0 vs 71.1, iHOT-33: 47.5 vs 67.9). Patients with and without femoroacetabular impingement demonstrated a significant improvement in the mHHS. However, 48.1% reported no improvement in their pain; 69.2% were limited in their activities; and 40.4% were still considering surgery. Overall, 71.2% were satisfied with nonsurgical treatment.

Conclusion: Patients with symptomatic labral tears can experience functional improvement after a minimum 1 year of nonsurgical treatment in the presence and absence of femoroacetabular impingement. However, many report residual pain, alteration of their activities, and interest in surgery. This information is important when patients are counseled in the treatment options for this injury. Identifying the population that responds best to nonsurgical management and comparing outcomes with those undergoing surgical management should be the focus of future research. Longer-term follow-up may be necessary to reevaluate pain, function, and return to activities.

Keywords: acetabular labrum; femoroacetabular impingement; hip pain; labral tear; nonsurgical management.