REHABILITIATION OF THE HIP

To report the current knowledge of the diagnosis and treatment of acetabular labral tears.

A search of the MEDLINE, CINAHL, and Science Direct indexing systems (1966 to September 2004) was conducted using the following key indexing terms: labrum, labral, hip, acetabulum, injury, and treatment. One hundred eighty-six publications were sourced using this methodology and were considered in this review. The literature was sorted according to publication date and relevance.

There is a small amount of literature on the topic of labral lesions. This is particularly true of the use of conservative (manual therapy) methods for the treatment of labral lesions. The literature on surgical diagnosis and management is more mature; however, longer-term follow-up studies are required to conclusively show the benefit of surgical intervention.

Early diagnosis is important as labral tears may be linked to the progression of hip osteoarthritis. Initial treatment consisting of partial weight-bearing may respond if initiated early. Arthroscopy currently represents the gold standard in both the diagnosis and treatment of labral tears. Future research must investigate the long-term outcomes of partial labrectomy, as well as the efficacy of conservative approaches to care (J Manipulative Physiol Ther 2005;28:000-000).

Hip arthroscopy by the supine approach has proven to be an effective and reproducible procedure. Patientpositioning is easy and time-efficient. It utilizes standard operating room (OR) equipment. The OR layout is user-friendly, and the orientation is familiar to orthopedic surgeons. Additionally, there may be less concern for intra-abdominal fluid extravasation. Specialized instrumentation facilitates access to the joint. Standard portal placements allow optimal visualization and instrumentation, thus accommodating diagnostic and operative arthroscopy for a variety of conditions. Specific considerations regarding the anatomy of this region include the ball and socket architecture of the joint, the dense surrounding soft tissue envelope, and limits on distractibility. Each of these presents unique challenges to arthroscopy but are overcome by understanding and applying the basic principles necessary for successfully performing this procedure.