Tear of the Acetabular Labrum

1. By Sean Ceci Tear of the Acetabular Labrum

2. Function Shape Nerve Supply Blood Supply Thickness Acetabular Labrum Anatomy

3. Chief Complaint History! Observation ROM Palpation Imaging Clinical Diagnosis

5. Traumatic Idiopathic Mechanism

6. Types of Tears • Buckethandle • Watershed • Location of Tear • Anterior • Posterior Pathology

7. Immediate • Reduce pain • Reduce weightbearing • Refer • Long Term Conservative • Correct postural and gait mechanics • Strengthen hip muscularature and correct imbalances • NSAIDS • Increase ROM • Joint Mobilization • Partial Weight-bearing • Longer Term Surgical • Arthroscopy Treatment

8. Arthroscopy, the Gold Standard Pre surgical rehabilitation Surgical Procedure

9. Short Term Goals • Reduce pain, swelling • Prevent atrophy • Prevent clotting and DVT • Restore ROM • Restore nutrient flow to labrum • Long Term Goals • Return patient to full strength bilaterally • Eliminate predisposing factors • Return to play and activity pain free Goals of Rehabilitation Post Surgery

10. Reduce • Pain • Swelling • Inflammation • Restore ROM • Passive ROM in all hip motions while avoiding end ranges • Active ROM in all knee, ankle, and foot motions • Cardiovascular • Stationary cycle without resistance • Upper limb ergometer • Stretching Phase I (Weeks 1 – 3)*

11. Massage Therapy • Efflurage • Core Strengthening Exercises • Must maintain neutral spine • Start with Pelvic Tilts • Aquatic Therapy • Active ROM • Start with shallow water progress to deep water • Joint mobilizations • Can perform freestyle, backstroke or butterfly is no pain is induced for cardio work Phase I (cont’d)

12. Patient must have full PROM without pain Must be able to fully weightbear without pain Moving from Phase I to II

13. Strengthening phase • Begin Hip AROM strengthening in all motions. • Theraband • Cuffweights • Isometric -> isotonic -> closed chain -> open chain • NO SLR! • Cardiovascular • Gentle running can begin • Isokinetic Exercise • High speed (>180°/s) • Hip flexion/extension, abduction/adduction, knee flexion/extension • Lower speed as strength increases • Proprioception and neuromuscular exercises • Balance training • Joint movement reproduction with goniometer Phase II (Weeks 4-8)*

14. Strength is 80% or higher than uninvolved side. Patient has demonstrated ability to perform correct biomechanics and posture Moving From Phase II to III

15. Plyometrics • Grades 2 and 3 exercises • Incline bounds, jump from box, incremental vertical jump • Sport specific drills • Pertinent to patient • Agility training • Ladders, shuttle runs Phase III (Week 9 – RTP)*

16. Full strength compared bilaterally Game situations can be completed Gait, posture, and imbalances are corrected Mental readiness Surgeon Follow Up Return to Play Guidelines

17. ‘No current studies investigating the effects of rehabilitation on pre or postarthroscopic patients’ • Common problems • Conservative approach • Surgical approach • Prognosis • Positive for surgical procedures • Most return within 4 months Discussion

18. Questions

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