Naessig Sara, Kucharik Michael, Meek Wendy, Eberlin Christopher, Martin Scott
Sports Medicine Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Mass General Brigham, Boston, Massachusetts, USA. .
Orthop J Sports Med. 2022 Feb 8;10(2):23259671211071073. doi: 10.1177/23259671211071073. eCollection 2022 Feb.
Many of the current rehabilitation programs for patients undergoing hip arthroscopy fail to consider the progression of soft tissue healing and inflammation that can be heightened due to aggressive therapy to the operative hip in the immediate postoperative period.
It was hypothesized that introducing conservative physical therapy (PT) preoperatively along with a slow progression to return to activity using a structured, patient-guided postoperative program would improve patient outcomes.
Case series; Level of evidence, 4.
The authors conducted a retrospective review of patients who received a hip arthroscopy, were at least 18 years old, and who had completed the following patient-reported outcomes (PROs) at 1-year follow-up: modified Harris Hip Score (mHHS), Hip Outcome Score, Nonarthritic Hip Score, International Hip Outcome Tool-33, and Lower Extremity Functional Scale. Patients who underwent previous surgery on the ipsilateral hip and those with cartilage erosion down to exposed subchondral bone (Outerbridge grade 4) were excluded. Paired-samples tests were used to compare the change in PRO scores at 3-month, 6-month, and 1-year follow-up, and the percentage of patients who achieved minimal clinically important difference (MCID) and substantial clinical benefit (SCB) thresholds on the mHHS were stratified according to their Outerbridge grade (0-3).
Overall, 202 patients (53% female, 47% male) were included in the analysis. Significant improvement was seen from 3 to 6 months on all PRO measures and from 6 months to 1 year on all but the mHHS ( < .05 for all except the mHHS). A significantly smaller percentage of patients with Outerbridge grade 3 cartilage damage achieved the MCID and SCB on the mHHS compared with those with grade 0, both at 6 months (grade 3 vs 0: 20% vs 63.2% [MCID]; 18.0% vs 52.6% [SCB]; both = .03) and 1 year (grade 3 vs 0: 22.0% vs 57.9% [MCID]; 14.0% vs 52.6% [SCB]; both < .05).
A structured, patient-guided PT protocol after arthroscopic acetabular labral repair can significantly improve postoperative outcomes.
目前许多针对接受髋关节镜检查患者的康复计划未能考虑软组织愈合和炎症的进展情况，在术后即刻对手术髋关节进行积极治疗可能会加剧这种情况。
假设术前引入保守物理治疗（PT），并通过结构化的、以患者为导向的术后计划缓慢恢复活动，将改善患者的预后。
病例系列；证据等级，4级。
作者对接受髋关节镜检查、年龄至少18岁且在1年随访时完成以下患者报告结局（PROs）的患者进行了回顾性分析：改良Harris髋关节评分（mHHS）、髋关节结局评分、非关节炎髋关节评分、国际髋关节结局工具-33和下肢功能量表。排除同侧髋关节既往接受过手术的患者以及软骨侵蚀至暴露的软骨下骨（Outerbridge 4级）的患者。采用配对样本检验比较3个月、6个月和1年随访时PRO评分的变化，并根据Outerbridge分级（0-3级）对在mHHS上达到最小临床重要差异（MCID）和显著临床获益（SCB）阈值的患者百分比进行分层。
总体而言，202例患者（53%为女性，47%为男性）纳入分析。所有PRO指标在3至6个月时有显著改善，除mHHS外，所有指标在6个月至1年时均有显著改善（除mHHS外，所有P<0.05）。与0级患者相比，Outerbridge 3级软骨损伤患者在6个月（3级与0级：20%与63.2%[MCID]；18.0%与52.6%[SCB]；两者P = 0.03）和1年（3级与0级：22.0%与57.9%[MCID]；14.0%与52.6%[SCB]；两者P<0.05）时在mHHS上达到MCID和SCB的患者百分比显著更低。
关节镜下髋臼盂唇修复术后采用结构化的、以患者为导向的PT方案可显著改善术后结局。
