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Management of Labral Tears in the Hip: A Consensus Statement.

Bogdan A Matache^1,2, Étienne L Belzile³, Olufemi R Ayeni⁴

¹The Ottawa Hospital, Ottawa, Ontario, Canada.

Orthopaedic Journal of Sports Medicine

|January 27, 2025

Summary

Canadian sports medicine physicians reached consensus on hip labral tear diagnosis and management. Key agreements include prognostic factors for surgery and return to play (RTP) timelines.

Keywords:

femoroacetabular impingement hip, hip arthroscopy labral repair labral tears nonoperative management

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Published on: November 8, 2024

Area of Science:

Orthopedics
Sports Medicine
Surgical Innovation

Background:

Inconsistent workup of hip labral tears leads to delayed treatment and increased healthcare costs.
Standardized diagnostic and management protocols are needed for hip labral tears.

Purpose of the Study:

To establish consensus statements among Canadian sports medicine physicians on hip labral tear diagnosis, management, and rehabilitation.
To improve consistency in treating hip labral tears through expert agreement.

Main Methods:

A modified Delphi process was used with 40 Canadian sports medicine physicians (50% orthopaedic surgeons).
Physicians were divided into 4 working groups focusing on specific subtopics.
Consensus levels were defined as 80-89% (consensus), 90-99% (strong consensus), and 100% (unanimous consensus).

Main Results:

Unanimous consensus was reached on prognostic factors (age, pain, dysplasia, degeneration) influencing surgical success.
Strong agreement exists on symptom clusters (anterior groin pain, hyperflexion pain, catching pain) indicative of labral tears.
Radiographic standards (AP pelvis, 45° Dunn view) and the utility of diagnostic injections were agreed upon.

Conclusions:

High agreement (76% unanimous/strong consensus) was achieved on hip labral tear management between nonoperative and operative physicians.
Consensus was reached on return to play (RTP) timing, prognostic factors, and nonoperative training initiation.
Areas lacking consensus include orthobiologics, bilateral surgery indications, and postoperative restrictions (ROM, weight-bearing, bracing).