Carolinas Research Day 2021

ACETABULAR LABRAL TEARS IN DIVISION 1 COLLEGIATE ATHLETES: A COMPARATIVE ANALYSIS OF OPERATIVE VERSUS CONSERVATIVE MANAGEMENT Andres D. Maeso 1 , Scott Hyland, DO 2 , Mark Rodgers, DO 1,3 , Mike Goforth, MS, ATC 3 , P. Gunnar Brolinson, DO 1,3 1 Edward Via College of Osteopathic Medicine; Blacksburg, VA, 2 Ohio Health Doctors Hospital; Columbus, OH, 3 Virginia Tech Sports Medicine; Blacksburg, VA Abstract Results Conclusions

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Background: • The acetabular labrum in the hip serves several important functions such as shock absorption, joint lubrication, pressure distribution, and providing stability to the joint surface. • Acetabular labral tears have shown to be difficult to diagnose and manage in an active and competitive athletic population. • The comparison between operative and conservative management and its correlation with return to play needs to be further reviewed. Purpose: • To perform data analysis comparing NCAA Division 1 collegiate athletes at Virginia Tech (VT) undergoing operative and non-operative management of their acetabular labral injuries Methods: • Retrospective cohort study • 47 subjects met inclusion criteria Results: • 55% of individuals managed conservatively vs. 79% undergoing surgery (p-value = 0.1082) were able to return to their respective sport following treatment. Conclusion : • There is no statistically significant difference in operative versus conservative management of acetabular labral tears in our study. • However, the clinical outcomes suggest a trend towards operative vs. non- operative management as a higher percent of athletes return to play. • We recommend an individual case-based approach to the patient.

References Discussion: • There was significant difference in operative vs. conservative management (79% vs 55%) regarding return to play. Despite this clinical trend, our analysis did not reach statistical significance (p- value = 0.1082) (Table 2). • Of those treated non-operatively, most continued to compete while simultaneously participating in conservative management, Osteopathic Manipulative Management (OMM), and physical therapy. Despite this clinical trend, our analysis did not reach statistical significance for days to return to play (p-value = 0.2245) (Table 3). • Clinically, our results suggest that in our cohort, athletes treated operatively have a higher percentage of return to Division 1 competition but have longer recovery times (Table 2 & 3). • Those treated conservatively were typically able to continue to compete and did not require lost time from sport (Table 3). Limitations and Future Studies: • Lack of consistent follow up for all subjects and release to return to play limited the secondary subset data analysis. • All sports were included in this study. A more sport specific analysis may be appropriate as hip labral biomechanical loads vary greatly specific to the unique athletic demands of the sport. • All hip arthroscopy procedures were included (debridement vs repairs), which may have also influenced our analysis. • Further investigation of the impact of OMM and return to play for both operatively vs. non-operatively treated subjects may be valuable in assessing its influence on return to sport. 1. Bharam S, Philippon MJ. Diagnosis and management of acetabular labral tears in the athlete. International SportMed Journal. 2008;9(1):1-11. 2. Conaway W, Martin SD, Agrawal R. Predictors of Outcomes of Non-Surgical Management for Acetabular Labral Tears. Orthopaedic Journal of Sports Medicine. 2018;6(3_suppl). doi:10.1177/2325967118s00008. 3. Fiz N, Sanchez M. Comparison between Classical and Less Invasive Technique for Arthroscopic Surgery in FAI. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2013;29(12). doi:10.1016/j.arthro.2013.09.055. 4. Groh MM, Herrera J. A comprehensive review of hip labral tears. Current Reviews in Musculoskeletal Medicine. 2009;2(2):105-117. doi:10.1007/s12178-009-9052-9. 5. Larson C, Clohisy J, Beaule P, Kelly B, Giveans MR, Samuelson K. Complications after Hip Arthroscopy: A Prospective, Multicenter Study Using a Validated Grading Classification. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2013;29(12). doi:10.1016/j.arthro.2013.09.046. 6. Naal FD, Miozzari HH, Wyss TF, Nötzli HP. Surgical Hip Dislocation for the Treatment of Femoroacetabular Impingement in High-Level Athletes. The American Journal of Sports Medicine. 2010;39(3):544-550. doi:10.1177/0363546510387263. 7. Nance E, Hamula M, Bharam S. Staged Arthroscopic Labral Reconstruction with Allograft for Labral Deficiency in Femoroacetabular Impingement. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2013;29(12). doi:10.1016/j.arthro.2013.09.059.

Return to Play – Surgical Versus Conservative Management

Returned to play

P-value

Management

Yes

No

Total

Surgical

23 (79%)

6 (21%)

29

0.1082

Conservative

10 (55%)

8 (44%)

18

47

Table 2. Cohort analysis to assess return to play in their respective sport following operative versus non- operative management of hip labral pathology .

Days to return – Surgical Versus Conservative Management

Methods and Study Design

Management

n

Mean Std Dev T-test p-value

• Retrospective Cohort Study • Data was collected as a convenience sample from 2005 - 2020 using Electronic Medical Records at VT Sports Medicine • All 22 VT sports were included • 47 subjects • All subjects had confirmatory MRI diagnosis of hip labral tear

Surgical

22

324

222.6

0.2245

Conservative

2

122

125.9

Characteristic

Overall

Table 3. Cohort analysis to assess days to return to play in their respective sport following operative versus non-operative management of hip labral pathology. Most conservatively managed subjects continued to participate despite being clinically diagnosed with a labral tear.

Age (years)

20.2

Male

23 24

Female

Top Sports of participants Football

Statistical Analysis • After data collection, statistics were analyzed with means, standard deviations, and compared using Student’s t-tests. Frequencies were calculated for continuous variables and compared using Fisher’s exact test for increased accuracy in small proportion analysis. A significance level of p < 0.05 was set prior to investigation.

8 6 5 5 4 4

Acknowledgements

Cross Country

Lacrosse Basketball

• Thank you to Dr. Brolinson for his support and continued mentorship. • Thank you to Dr. Cheng for providing the statistical analysis of our data. • Thank you to Virginia Tech Sports Medicine for allowing us access to the Electronic Medical Records. • Thank you to the Edward Via College of Osteopathic Medicine for the opportunity and support of this project.

Soccer

Volleyball

Table 1. Characteristics of participants included in cohort.

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