DOI QR코드

DOI QR Code

The Short-term Outcomes of Physiotherapy for Patients with Acetabular Labral Tears: An Analysis according to Severity of Injury in Magnetic Resonance Imaging

  • Makoto Kawai (Department of Rehabilitation, Sapporo Medical University Hospital) ;
  • Kenji Tateda (Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine) ;
  • Yuma Ikeda (Department of Rehabilitation, Sapporo Medical University Hospital) ;
  • Ima Kosukegawa (Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine) ;
  • Satoshi Nagoya (Department of Musculoskeletal Biomechanics and Surgical Development, Sapporo Medical University) ;
  • Masaki Katayose (Department of Rehabilitation, Sapporo Medical University Hospital)
  • Received : 2021.03.19
  • Accepted : 2021.06.25
  • Published : 2022.03.31

Abstract

Purpose: The aim of this study was to evaluate the short-term outcome of physiotherapy in patients with acetabular labral tears and to assess the effectiveness of physiotherapy according to the severity of the labral tear. Materials and Methods: Thirty-five patients who underwent physiotherapy for treatment of symptomatic acetabular labral tears 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. The International Hip Outcome Tool 12 (iHOT12) was use for evaluation of outcome scores pre- and post-intervention. Results: The mean iHOT12 score showed significant improvement from 44.0 to 73.6 in 4.7 months. Compared with pre-intervention scores, significantly higher post-intervention iHOT12 scores were observed for Czerny stages I and II tears (all P<0.01). However, no significant difference was observed between pre-intervention and post-intervention iHOT12 scores for stage III tears (P=0.061). In addition, seven patients (20.0%) had positive microinstability findings and 22 patients (62.9%) had findings of extra-articular pathologies. Of the 35 patients, eight patients (22.9%) underwent surgical treatment after failure of conservative management; four of these patients had Czerny stage III tears. Conclusion: The iHOT12 score of patients with acetabular labral tears was significantly improved by physiotherapy in the short-term period. Improvement of the clinical score by physiotherapy may be poor in patients with severe acetabular labral tears. Determining the severity of acetabular labral tears can be useful in determining treatment strategies.

Keywords

Acknowledgement

This study was supported by a grant from the Japan Society for the Promotion of Science (grant No. 20K19380). We are grateful for support from Mitsunori Kaya, PhD, on supporting the diagnosis and Ryosuke Motomura, PT, on performing functional evaluations and physiotherapy for patients.

References

  1. Ferguson SJ, Bryant JT, Ganz R, Ito K. An in vitro investigation of the acetabular labral seal in hip joint mechanics. J Biomech. 2003;36:171-8.  https://doi.org/10.1016/S0021-9290(02)00365-2
  2. Nepple JJ, Carlisle JC, Nunley RM, Clohisy JC. Clinical and radiographic predictors of intra-articular hip disease in arthroscopy. Am J Sports Med. 2011;39:296-303.  https://doi.org/10.1177/0363546510384787
  3. Burnett RS, Della Rocca GJ, Prather H, Curry M, Maloney WJ, Clohisy JC. Clinical presentation of patients with tears of the acetabular labrum. J Bone Joint Surg Am. 2006;88:1448-57.  https://doi.org/10.2106/JBJS.D.02806
  4. Smith MV, Panchal HB, Ruberte Thiele RA, Sekiya JK. Effect of acetabular labrum tears on hip stability and labral strain in a joint compression model. Am J Sports Med. 2011;39 Suppl:103S-10S.  https://doi.org/10.1177/0363546511400981
  5. Jo S, Lee SH, Wang SI, Smith B, O'Donnell J. The role of arthroscopy in the dysplastic hip-a systematic review of the intra-articular findings, and the outcomes utilizing hip arthroscopic surgery. J Hip Preserv Surg. 2016;3:171-80.  https://doi.org/10.1093/jhps/hnv071
  6. Riff AJ, Kunze KN, Movassaghi K, et al. Systematic review of hip arthroscopy for femoroacetabular impingement: the importance of labral repair and capsular closure. Arthroscopy. 2019;35:646-56.e3.  https://doi.org/10.1016/j.arthro.2018.09.005
  7. Emara K, Samir W, Motasem el H, Ghafar KA. Conservative treatment for mild femoroacetabular impingement. J Orthop Surg (Hong Kong). 2011;19:41-5.  https://doi.org/10.1177/230949901101900109
  8. Pennock AT, Bomar JD, Johnson KP, Randich K, Upasani VV. Nonoperative management of femoroacetabular impingement: a prospective study. Am J Sports Med. 2018;46:3415-22.  https://doi.org/10.1177/0363546518804805
  9. Griffin DR, Dickenson EJ, Wall PDH, et al. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. Lancet. 2018;391:2225-35.  https://doi.org/10.1016/S0140-6736(18)31202-9
  10. Mansell NS, Rhon DI, Meyer J, Slevin JM, Marchant BG. Arthroscopic surgery or physical therapy for patients with femoroacetabular impingement syndrome: a randomized controlled trial with 2-year follow-up. Am J Sports Med. 2018;46:1306-14.  https://doi.org/10.1177/0363546517751912
  11. Weir A, Brukner P, Delahunt E, et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med. 2015;49:768-74.  https://doi.org/10.1136/bjsports-2015-094869
  12. Rankin AT, Bleakley CM, Cullen M. Hip joint pathology as a leading cause of groin pain in the sporting population: a 6-year review of 894 cases. Am J Sports Med. 2015;43:1698-703.  https://doi.org/10.1177/0363546515582031
  13. Frank JM, Harris JD, Erickson BJ, et al. Prevalence of femoroacetabular impingement imaging findings in asymptomatic volunteers: a systematic review. Arthroscopy. 2015;31:1199-204.  https://doi.org/10.1016/j.arthro.2014.11.042
  14. Griffin DR, Parsons N, Mohtadi NG, Safran MR; Multicenter Arthroscopy of the Hip Outcomes Research Network. A short version of the International Hip Outcome Tool (iHOT12) for use in routine clinical practice. Arthroscopy. 2012;28:611-6; quiz 616-8.  https://doi.org/10.1016/j.arthro.2012.02.027
  15. Domb BG, Stake CE, Lindner D, El-Bitar Y, Jackson TJ. Arthroscopic capsular plication and labral preservation in borderline hip dysplasia: two-year clinical outcomes of a surgical approach to a challenging problem. Am J Sports Med. 2013;41:2591-8.  https://doi.org/10.1177/0363546513499154
  16. Economopoulos KJ, Kweon CY, Gee AO, Morris ST, Hassebrock JD, Chhabra A. The Pull Test: a dynamic test to confirm hip microinstability. Arthrosc Sports Med Rehabil. 2019;1:e67-74.  https://doi.org/10.1016/j.asmr.2019.07.006
  17. Kaya M. Impact of extra-articular pathologies on groin pain: an arthroscopic evaluation. PLoS One. 2018;13:e0191091. 
  18. Czerny C, Hofmann S, Neuhold A, et al. Lesions of the acetabular labrum: accuracy of MR imaging and MR arthrography in detection and staging. Radiology. 1996;200:225-30.  https://doi.org/10.1148/radiology.200.1.8657916
  19. Crespo-Rodriguez AM, De Lucas-Villarrubia JC, Pastrana-Ledesma M, Hualde-Juvera A, Mendez-Alonso S, Padron M. The diagnostic performance of non-contrast 3-Tesla magnetic resonance imaging (3-T MRI) versus 1.5-Tesla magnetic resonance arthrography (1.5-T MRA) in femoroacetabular impingement. Eur J Radiol. 2017;88:109-16.  https://doi.org/10.1016/j.ejrad.2016.12.031
  20. Horner NS, Ekhtiari S, Simunovic N, Safran MR, Philippon MJ, Ayeni OR. Hip arthroscopy in patients age 40 or older: a systematic review. Arthroscopy. 2017;33:464-75.e3.  https://doi.org/10.1016/j.arthro.2016.06.044
  21. Tian CY, Wang JQ, Zheng ZZ, Ren AH. 3.0 T conventional hip MR and hip MR arthrography for the acetabular labral tears confirmed by arthroscopy. Eur J Radiol. 2014;83:1822-7.  https://doi.org/10.1016/j.ejrad.2014.05.034
  22. Linda DD, Naraghi A, Murnaghan L, Whelan D, White LM. Accuracy of non-arthrographic 3T MR imaging in evaluation of intra-articular pathology of the hip in femoroacetabular impingement. Skeletal Radiol. 2017;46:299-308. https://doi.org/10.1007/s00256-016-2551-z