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A normal labral recess is also present Stage 1B Similar to stage 1A but are thickened and no labral recess is present Stage 2A An extension of contrast into the labrum without detachment from the acetabulum, triangular, and have a labral recess Stage 2B Like stage 2A but thickened, and the labral recess is not present Stage 3A Labrum is detached from the acetabulum but triangular in shape Stage 3B Like stage 3A but thickened Blankenbaker Classification MR arthrography classification of labral tears [25] Type 1 Frayed: Irregular margins of the labrum without a discrete tear Type 2 Flap tear: Contrast extending into or through the labral substance Type 3 Peripheral longitudinal: Contrast partially or completely between the labral base and acetabulum labral detachment Type 4 Thickened and distorted and thus likely unstable Management Nonoperative Indications Generally initial treatment of choice Relative rest Physical Therapy Trial for 10-12 weeks Somewhat controversial Some have argued that there is no benefit in acetabular labral tears [26] Medications Hip Corticosteroid Injection May have both a therapeutic and diagnostic role Platelet Rich Plasma 8 patients improved symptoms at up to 8 weeks in this small study [27] Hip Paralabral Cyst Aspiration and Injection If paralabral cyst present, can aspirate/ inject Operative Indications Symptoms that have failed to improve with nonoperative modalities Technique Arthroscopic labral debridement Arthroscopic labral repair Rehab and Return to Play Rehabilitation 4 Phase Post-arthroscopic rehab proposed by Holling [28] Phase 1 (0-4 weeks): emphasis on non-weight bearing modalities Phase 2 (4-8 weeks): progressive weight bearing as tolerated Phase 3 (8-12 weeks): dynamic movements, self stretching Phase 4 (12+ weeks): sport specific movements Return to Play O'connor et al RTP criteria [29] Timeline Conditional criteria Description of measurements assessing the conditional criteria Specific rehabilitation protocol Chen et al return to running after arthroscopy [30] Three months of physical therapy Demonstration good stability while performing 30 consecutive single leg squats Kraeutler et al return to running [31] Walking program Quick response and plyometric routine with progression to a walk/jog program, Return to distance running Kuhn et al rehabilitation program [32] Running at 16 weeks on anti-gravity treadmill Running at 20 weeks on traditional treadmill Prognosis and Complications Prognosis Arthroscopic debridement Burnett et al: 89% of patients with continued improved status at an average of 16.5 months after arthroscopic debridement of a labral tear [12] Farjo et al: 13/28 (46%) of patients reported being better or much better when monitored for at least 1 year following arthroscopic debridement [33] Santori et al: at a mean of 3.5 years follow up, 39 (67.3%) reported being pleased with the results of the surgery, whereas 32.7% were not pleased [34] Return to Play Elwood et al: 94% of elite athletes return to play after an average of 6.8 months following arthroscopic repair [35] Complications Chronic hip pain Inability to return to sport Hip Osteoarthritis Paralabral Cyst See Also Internal External Sports Medicine Review Hip Pain: References Dameron TB

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