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

Abstract

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.