[TheSutterDynasty]

Originally Posted by curves2000

I have done multiple rounds of physio and some chiropractic care but it doesn't seem to address the pain.

What did you do in therapy? Manipulations, muscle work, needling, machines? What exercises?

Originally Posted by curves2000

I would love some research material as this is a big decision. I am not an athlete or anything, just a regular Joe who's in pain and without a clue as to where this happened. I don't recall a specific injury at the gym or anything that would have caused this, just a nagging injury that has been going on for about 14 months.

Thanks for your suggestions and I would like to take you up on your offer. Are you a health care professional? You mentioned you have seen multiple labral tears so I am just wondering.


Thanks in advance!

Yep. It's not a bad way for me to do a new check up on latest research.

Before we get to the wonders of the science of surgery (and conservative care), keep in mind that science is really damn hard when it comes to musculoskeletal issues. The are hundreds of variables, not the least of which are:
-Differences in patient profile (which can be reasonably controlled)
-Differences in patient injury (even if they group a certain type of labral tear, there are a ton of different variables for each patient's injuries, ie an old strain here, weakness there, etc)
-Inconsistent and unvalidated outcome measures (the 'questionnaires' used to determine how much disability your injury brings)
-Wild differences in pre- and post-surgical care, activity levels, etc (again, attempted to be controlled)
-Among many others

Also, before even talking about labral tears let's clarify that imaging findings do not mean you are having symptoms from your structural problem. Many people are walking around with labral tears that have no idea (no pain). Here's a great infographic with attached references: http://www.aptei.ca/wp-content/uploa...ts-English.jpg

Surgery:

Here's a 2009 review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697339/

2016 article discussing a 2014 review (which I can't easily get full access for you to read if you're wanting to):
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5127940/

And here are some key things from both:

Spoiler!

Previously, it was believed that the labrum had little functional importance and that the appropriate treatment for symptomatic labral tears was excision [5, 42, 47, 114]. The philosophy has changed because of the evidence supporting the acetabular labrum’s role in preventing premature arthritis, enhancing stability of the hip joint, and participation in nociception and proprioception [56].

We are constantly learning more about the surgeries we perform - we know removing tissue is only a bad thing that we absolutely want to avoid if possible. The knee arthroscopy (debridements) are leading the way as there is now a lot of research showing no difference from 'scopes' in patients with knee arthritis. And yet an absurd number of people are still having them - and are probably accelerating the degeneration, weakness, and disability in their knee. I'm sure there are dozens of CPers waiting to tell us how much their knee scope helped them.

Spoiler!

The overall reported complication rate with arthroscopy of the hip ranges from 1.4% to 25% [2, 7, 8, 41, 42, 90, 93, 119, 128–132]. Complications after arthroscopy include deep venous thrombosis (DVT), articular damage, and neurovascular injury [7, 31]. The particular nerves at risk include the superior gluteal neurovascular bundle, lateral femoral cutaneous nerve, and the femoral neurovascular bundle due to portal placement, and the sciatic and pudendal nerves due to traction [31, 41, 90, 128, 130–132]. These nerve palsies are typically transient and resolve in a period of 2 h to 3 weeks [130, 131].

It's important to know some risks.

Spoiler!

Studies report varied results after arthroscopic debridement. Burnett and colleagues reported 89% of patients with continued “improved” status at an average of 16.5 months after arthroscopic debridement of a labral tear [13, 35]. Similar results are seen across the literature, including in multiple case studies [3, 13, 35, 38, 41, 42, 44, 48, 49, 54, 73, 115]. However, other studies show less conclusive results. In a study by Farjo et al., 28 patients who underwent arthroscopic debridement of a labral tear were questioned with regard to their pain, mechanical symptoms, general activity level, activities of daily living, work ability, and ability to return to sporting activities; Only 13 patients (46%) reported being “better” or “much better” in all of these categories when monitored for at least 1 year [41]. Santori and Villar included 58 patients for a mean follow-up of 3.5 years, who underwent resection of a labral tear, and when these patients where questioned with regard to whether or not they were satisfied with the results of their surgery, 39 (67.3%) reported being “pleased” with the results of the surgery, whereas 32.7% were not pleased [47]. Success rates are lower with worsening degrees of labral tear and secondary OA changes. McCarthy and colleagues reported that out of patients with stage 3 labral tears (diffuse tears that involve more that one anatomic region and are associated with more pronounced degenerative changes) 40% had good-to-excellent results compared with 91% good-to-excellent results in patients with stage 1 labral lesions (localized to one anatomic region with mild degenerative changes) [13, 38]. Farjo et al. [41] reported associated arthritic changes as a poor prognostic indicator to arthroscopic repair of labral tears. Only 21% of patients (3 out of 14) with arthritis detectable on radiographs had good results from surgery, compared with 75% of patients without arthritis. Furthermore, 43% of patients (6 out of 14) with arthritis went on to undergo total hip arthroplasty, whereas only 14% of patients (2 out of 14) without arthritis went on to have the arthroplasty. Byrd and Jones lent support to this, reporting a 31% improvement in average modified Harris Hip Score following debridement in patients with isolated labral tears versus an 18% improvement in patients with a labral tear and chondral injury [5, 90]. Other studies have shown similar results [13, 89, 90, 93, 115, 116, 133]. Arthroscopic detection of chondromalacia was an even stronger indicator of poor long-term prognosis [41].

Prognosis. There's a lot in there. Important to note is timelines used - these studies look at patients YEARS after (1 - 3.5 or more) the surgery. There's plenty of natural recovery taking place there too - trouble being some methodological issues in control groups to properly differentiate this.

Spoiler!

The largest, most recent, highest quality systematic review has analyzed 490 subjects from six unique investigations reporting labral repair outcomes [55•]. The modified Harris Hip Score, although not specifically developed or validated for non-arthritic patients with labral tears and FAI, was the most commonly reported (50 %) outcome measure. In comparison to debridement, labral repair consistently reported greater post-operative improvements in multiple patient-reported outcome scores (modified Harris Hip Score, Hip Outcome Score, Non-Arthritic Hip Score, and Merle d’Aubigne score). Study methodological quality was reported individually as fair, but GRADE recommendation as low. Future investigations should strive for high-quality, well-designed, prospective studies of subjects undergoing labral preservation with longer follow-up using both subjective patient-reported and objective clinician-measured outcome scores with appropriate psychometric properties.

This is a big problem with these studies - many are poor quality and the placebo effect / natural recovery is a huge variable.

The other consideration is that many of these studies and patients are undergoing post-operative therapy (often for months and months).