Return to Sport Guideline: Hip Labral Repair & Femoroacetabular Impingement Syndrome
Abby Greaney, SPT, CSCS
Background:
Throughout our last couple of clinical rotations in early-mid 2021, I had the opportunity to work with multiple labral repair patients. I had no idea what I was doing or what to expect in the return to sport process because this is a diagnosis that we barely touched on during the program. I felt like I had limited knowledge about what to do, and was intimidated when first working with these patients. Then, in the fall of 2021 while creating a separate lecture for the MSK 2 course which I was a TA for, I learned more information about different surgical procedures and recovery, as well as multiple protocols and some “guidelines” that have been published by different authors. I became even more interested in learning about the RTS process after hip labral repair and eventually would like to work in the Sport-Ortho field with athletes who have had this procedure in the future.
Statement of Need:
While performing research about Hip Labral Repairs and FAI for the MSK 2 course in the UNC DPT program, I noticed that there is a lack of agreement in the Physical Therapy and Surgical realms for the proper timeline and criteria for Return to Sport (RTS). As this is becoming an increasingly performed surgery due to higher levels of athletics, sports with repetitive motions, “W sitting” in toddlers and young children and overall higher level of activity in the general population, there needs to be more of a consensus for what the proper timeline and criteria to return to activity actually is. Surgeries such as ACL reconstruction or Rotator Cuff Repair have large amounts of research to justify the RTS Guidelines that have been put in place for these procedures, but there is very little data in support of Hip Labral and FAI repairs. Unfortunately, there is also limited research about what is the proper timeline or what specific criteria is required for these patients to return to sport. Additionally, there are no RCTs or other forms of research performed to determine these things because it would be unethical to prescribe some patients a certain amount of therapy and not others.
Purpose:
The purpose of this project was to create a comprehensive RTS guideline that considered all available research and proposed one specific protocol. The target audience is clinicians, and there has been a clinician-friendly document provided for quick-use in the clinical setting.
Products:
RTS Guideline and Clinician-Friendly Document
In this folder, my full RTS guideline is uploaded in PDF form as well as the Clinician-Friendly document that PT’s can use in clinic as a shorter tool while treating patients.
https://drive.google.com/drive/folders/1Bwa7P6C6upXCdJqckQe1rMNBiDvZ-EZZ?usp=sharing
Protocols (including my Systematic Review of them)
There are many different protocols that can be found online for this procedure, but I have compiled quite a few throughout this process, both from online sources and from well-renowned surgeons. In addition to all of the protocols, I have included my personal systematic review that I performed for my guideline, to make all of the data more succinct.
https://drive.google.com/drive/folders/1N9tB1vIHAhMuuC_iE2FaUmrGC1jYXI-x?usp=sharing
Powerpoint Slides
(There was a lecture recorded to be used in the Topics in Sports Physical Therapy: PHYT 874 course in the future.)
Other Helpful Documents for Use in Clinic
While performing research and discussing parts of my guideline with my committee, I found these documents to be particularly helpful as accessory documents.
https://drive.google.com/drive/folders/1xZUPotzXLKVSSOC8crMXlQx3cobsRjxK?usp=sharing
Evaluation Component:
Throughout the course of completing this project, I kept in contact with all of my committee members for constant feedback on how to make my guideline and other products better. Additionally, I created an evaluation form for anyone who uses my products to let me know how useful they found them or how to improve them further.
Evaluation of Capstone Materials_Greaney
Self Assessment:
My personal learning objectives for this project were to learn more about the incidence/prevalence of hip labral repairs, to understand the RTS process, to learn how to communicate with surgeons about their protocols, to compile information from research into a succinct document that could be understood by other providers, and to better work with other team (committee) members to successfully fulfill this project. Now that the project has come to an end, I truly feel as though I was able to accomplish all of these goals and feel as though I even did more than I thought I was capable of. I feel as though the materials I produced are high quality, and will definitely be using my Clinician-Friendly document in my future practice.
Acknowledgements:
To Jennifer Cooke, thank you for being my advisor for this marathon of a project. You continuously gave me constructive feedback that allowed me to make this project the best that you and I knew I could and were extremely helpful in developing several of the products.
To Deidra (Debnam) Charity, thank you for being part of my committee and for being so prompt with feedback. You were constantly challenging me to make my products better and gave me several resources that I would never have found if you weren’t part of my committee. Additionally, thank you for allowing my material to be used for future Topics in Sports PT classes, I hope they can find the information helpful!
To Joe Tedesco, thank you for also being part of my committee. Some of the ideas you gave me to add to my RTS document were fantastic and your feedback on my large RTS guideline and on my final products was extremely helpful.
References:
As there were a lot of references, I did not include a specific list here, but all articles can be found referenced in my RTS Guideline and protocols can be found in the hyperlinked folder above.
2 Responses to “Return to Sport Guideline: Hip Labral Repair & Femoroacetabular Impingement Syndrome”
Jennifer Cooke
Well done here Abby! You created a very useful product for a subject in our profession that needed some growth and consolidation. Hopefully this can serve as a launching off place for clinicians and surgeons alike. You were always on time with your submissions and kept those of us who tended to be less on time 😉 on track! I look forward to seeing what the future holds for you in PT!!
robbey
Abby, this is an interesting topic to me as well! I have always been fascinated with the hip due to the complexity of this joint. I can completely understand there being more surgeries performed to manage this pathology due to the high demands our athletes are putting on their bodies. We’re getting faster, stronger, and more explosive by each passing year. Furthermore, your comprehensive review and consolidate all the research to build a guideline is extremely helpful for new grads and experience PTs. For new graduates, it will help us feel more confident treating our patients since everything is evidenced based. For experienced PTs, it will help update their knowledge and save them the time of finding all the research and synthesizing it. Your clinician document is well organized! I like how you go week by week and articulate what general domains to be worked on. Additionally, you add examples of exercises that can be introduced in each week. Furthermore, I thought it was helpful that you gave objective criteria to progress to the next phase (e.g. initial to intermediate) rather than strictly temporal criteria. This provides two great ideas we need to consider. First, being that it can tell us if the patient is not progressing as needed and we may need to get the surgeon to be more active in their care. Secondly, it confirms the patient can tolerate the introduction of harder exercises. Furthermore, I think it was awesome that you provided a return to running program. Since the labrum is a shock absorber, it’s pertinent that we load it progressively to allow it to heal and tolerate the increased load from running. Lastly, your differentiation between sports and the implications their activities have on the hip was detailed but concise. Your Capstone project is extremely thorough about hip labral injuries and FAIs. Your integration of charts made the material much easier to digest and comprehend. Well done!!