Arthroscopic Repair vs Physical Therapy for Hip Injury

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Massachusetts General Hospital

Disqualifiers: Severe osteoarthritis, Hip dysplasia, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

Duration: 12 months

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine the best treatment for individuals with painful tears in the hip's acetabular labrum, a ring of cartilage around the hip joint. Researchers are comparing two treatments: acetabular labral repair (surgery to repair the tear) and physical therapy focused on strengthening the hip and surrounding muscles. The goal is to identify which method better alleviates pain and improves movement. Individuals experiencing symptoms like catching, clicking, or pain in the hip, especially when sitting or moving, might be suitable candidates for this trial. As an unphased trial, this study offers a unique opportunity to contribute to understanding the most effective treatment for hip labral tears.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. However, since non-steroidal anti-inflammatory drugs (NSAIDs) are mentioned as part of conservative treatment, you might be able to continue them. It's best to discuss this with the trial coordinators.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Previous studies have shown positive results for arthroscopic labral repair. Patients reported improved hip function and reduced pain after the procedure. Short-term and medium-term outcomes appear promising, with many experiencing relief within a few months. While there are some risks, the procedure is generally well-tolerated.

Research has shown that physical therapy focused on the hip area can also be effective. Patients often experience less pain and gain strength and function, with many returning to normal activities, including sports, after therapy. This non-surgical approach is generally safe and carries fewer risks than surgery.

Both options show promise for treating hip issues. The choice between surgery and physical therapy depends on individual needs and preferences. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these treatments for hip injuries because they offer distinct approaches compared to traditional methods. Hip arthroscopy with acetabular labral repair is unique because it directly addresses the structural issues in the hip joint, potentially providing a more permanent solution for those with significant labral tears. On the other hand, the specialized physical therapy focuses on strengthening the hip and hemi-pelvis area, including the lower back and core muscles, which could offer a less invasive option for patients and help prevent future injuries. These treatments provide new hope for improved recovery and long-term outcomes compared to standard care options like general physical therapy or conservative management without targeted intervention.

What evidence suggests that this trial's treatments could be effective for hip injury?

This trial will compare two treatment options for hip joint tears: surgery and physical therapy. Research has shown that both methods can improve hip function in individuals with hip joint tears. Participants may undergo hip arthroscopy surgery with acetabular labral repair, which studies have found significantly reduces pain and enhances daily function over several years. Nearly 90% of athletes returned to their sport after this surgery. Alternatively, participants may receive physical therapy focused on the hip and hemi-pelvis, which also shows promise, with significant improvements in hip function. Patients who chose physical therapy instead of surgery reported high levels of hip function, suggesting it can be a good alternative. Both treatments offer potential benefits, but the best choice may depend on individual circumstances. ^{4 6 7 8 9}

Who Is on the Research Team?

Scott D. Martin, MD

Principal Investigator

Massachusetts General Hospital

Are You a Good Fit for This Trial?

This trial is for individuals over 40 with hip pain and MRI-confirmed acetabular labrum tears, who haven't responded to other treatments and don't have severe osteoarthritis or conditions that surgery or physical therapy can't help. They must be willing to be randomly assigned a treatment and able to consent.

Inclusion Criteria

I am willing to be assigned to a study group by chance and understand the study details.

Availability of hip radiographs and MRI: needed to assess eligibility

I am over 40 and may have osteoarthritis not visible on scans.

Exclusion Criteria

You have tears in both sides of the hip joint's labrum, which makes it hard to measure how well you're improving after treatment.

My back pain is worse than my hip pain, or I have leg symptoms below the knee.

My condition is severe osteoarthritis with significant joint changes.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either conservative physical therapy treatment alone or arthroscopic surgical labral repair and physical therapy

12 months

Regular visits at baseline, 3 months, 6 months, and 12 months

Follow-up

Participants are monitored for safety and effectiveness after treatment, with assessments of hip function and pain

4 weeks

Long-term follow-up

Participants' longer-term functional outcomes are assessed at 2, 5, and 10 years

What Are the Treatments Tested in This Trial?

Interventions

• Acetabular Labral Repair
• Physical Therapy Focused on the Hip and Hemi-pelvis

Trial Overview The study compares two approaches for treating painful hip conditions: one group will undergo arthroscopic surgery to repair the torn labrum, while the other will receive specialized physical therapy focusing on the hip area.

How Is the Trial Designed?

Group I: Hip Arthroscopy Surgery with Acetabular Labral Repair Active Control 1 Intervention

Hip Arthroscopy Surgery with Acetabular Labral Repair

Group II: Physical Therapy Focused on the Hip and Hemi-pelvis Active Control 1 Intervention

Physical Therapy focusing on the hemipelvis strengthening, including the lower back, lower abdominal core, quadriceps, hamstrings, and gluteal muscles.

Who Is Running the Clinical Trial?

Massachusetts General Hospital

Lead Sponsor

Trials

3,066

Recruited

13,430,000+

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10563472/

Long-Term Outcomes of Primary Hip Arthroscopy With Labral ... Patients demonstrated significant postoperative improvements in pain, mHHS, iHOT-12, HOS-ADL, and HOS-SSS scores at 9 years postoperatively.

2. sciencedirect.com sciencedirect.com/science/article/pii/S2666061X25001853

Reported Rates of Labral Repair and Reconstruction in ... Among studies reporting labral repair and reconstruction during primary hip arthroscopy, the proportion of each procedure performed varies ...

3. nature.com nature.com/articles/s41598-023-36454-0

Comparative analysis between operative and non ... Weber et al. demonstrated that nearly 90% of athletes returned to sport following hip arthroscopies for labral pathology associated with femoral ...

4. clinicaltrials.gov clinicaltrials.gov/study/NCT03909178

Arthroscopic Labral Repair Versus Physical Therapy for ... The investigators found that patients with labral tears managed non-operatively appear to score highly on hip function outcome scores, preliminarily indicating ...

5. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9291338/

The clinical outcomes of arthroscopic hip labral repair The mHHS improved from 63.6 to 84.8 points, the hip outcome score (HOS) of activity daily living and sport increased from 78.1 to 91.3 and from ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8349583/

Arthroscopic acetabular labral reconstruction: a review - PMC It has been established that the restoration of labral anatomy and function are key factors to improve patient-reported outcome measurements ( ...

7. sciencedirect.com sciencedirect.com/science/article/pii/S221262871200059X

Arthroscopic Hip Labral Repair Treatment options for labral tears include debridement, repair, and reconstruction. Repair of the labrum has been shown to have better results than debridement.

8. bmjopensem.bmj.com bmjopensem.bmj.com/content/4/1/e000328

Clinical outcomes of arthroscopic repair of acetabular ... Arthroscopic labral repair was associated with a clinically significant improvement in mHHS after short-term (4 months) and medium-term (43 months) follow-up.

9. arthroscopyjournal.org arthroscopyjournal.org/article/S0749-8063(20)30712-X/fulltext

Irreparable Hip Labral Tears and Femoroacetabular ... Labral reconstruction incorporating the TAL may seal the deal. Both hip labral repair and reconstruction result in evidence-based excellent short-term outcomes ...