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Keywords

Clinical Practice in Athletic Training

Abstract

Background: The hip and groin injury rate in female collegiate lacrosse players has been reported to be 35.06 per 100,000 athlete exposures yet the frequency of acetabular labral tears (ATL) remains unclear. Sports which involve repeated bouts of running in combination with frequent twisting and pivoting motions, have been suggested to have a higher prevalence rate of ALT. This level 3 case study will discuss the unique presentation of bilateral ALTs in a female collegiate lacrosse player. Patient: Patient is a 19-year-old Division I collegiate women’s lacrosse player who first presented with pain in her left hip while at home during summer break. The patient could not recall a specific MOI and was initially evaluated and treated by a physical therapist. Since symptoms persisted, she was referred to a sports medicine physician who prescribed diagnostic imaging. Findings revealed a cam pincer lesion on the femoral head accompanied with an ALT. Upon returning to campus, the patient reported to the athletic training clinic complaining of left hip pain and instability after practice involving cutting, sprinting, and high-volume exercises. The patient outlined the previous months to the team athletic trainer, who performed an additional evaluation on her left hip. The athletic trainer developed a rehabilitation plan that centered on pain control and increasing stability while permitting the athlete to play as tolerated with certain limitations. Four weeks after, the patient began complaining of pain in her right hip. Despite having full strength and ROM, she underwent an MRI on her right hip, which revealed an ALT. Following this new diagnosis, the patient was removed from practice until she met with the orthopedic surgeon. At this meeting, the physician discussed both non-operative and operative treatment options. Ultimately, the patient opted for surgery which occurred 3 months following her initial presentation to the athletic training clinic. The patient continued rehabilitation for roughly 4 weeks until the first surgery, an arthroscopic acetabuloplasty of her left hip. Six weeks later, the patient underwent an arthroscopy with correction of impingement of her right hip. Intervention or Treatment: Following the initial injury presentation (left hip), the patient’s rehabilitation program focused on strengthening the gluteal and abdominal muscle groups. Upon return to campus, the team athletic trainer developed an approach centered on pain control and increasing stability which allowed the patient to participate in practice as tolerated. Following the diagnosis of a right hip ALT, conservative and operative interventions were presented. The patient opted for surgery and underwent separate procedures for her left and right hips. Outcomes or other Comparisons: Despite having bilateral hip labral tears, the patient maintained a high level of strength and function. During the 4 months between her initial diagnosis (left hip) and discovery of ALT in her right hip, the patient participated in all strength and conditioning sessions and limited field work. In the weight room, she scored in the top 2% of all her teammates across the three lower body test lifts: front squat, hex bar deadlift, and Romanian deadlift. Conclusions: Recent evidence has reported the use of both conservative and operative management for patients diagnosed with ALTs, with accompanying symptomatic femoroacetabular impingement (FAI) being a primary reason for surgery. In this case, the patient was symptomatic in both hips with presence of FAI in the left. Consequently, the athlete opted for surgical intervention to both hips, spaced six weeks apart. Clinical Bottom Line: Athletes diagnosed with an ALT with FAI may still present with optimal lower body strength, making the decision for treatment more challenging. In these cases, it is important that the sports medicine team discuss all options with the athlete so an appropriate management plan can be instituted.

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