What are the next steps and treatment for a 14-year-old female with a 4-month history of hip pain diagnosed as a nondisplaced attachment and tear of the anterior superior labrum of the left hip, with persistent pain despite physical therapy?

From the Guidelines

For a 14-year-old female with a nondisplaced labral tear in the left hip who has persistent pain despite physical therapy, the next steps should include a multidisciplinary approach, prioritizing conservative management to minimize the risk of further complications and promote optimal recovery. I recommend continuing modified physical therapy with a focus on hip stabilization exercises, core strengthening, and gradual return to activities, combined with pain management using NSAIDs like ibuprofen (400-600mg every 6-8 hours with food) or naproxen (250-500mg twice daily with food) for short-term relief, as suggested by general medical guidelines 1. Activity modification is crucial—avoiding movements that exacerbate pain while maintaining general fitness through low-impact activities like swimming or stationary cycling.

Given the patient's age and the nature of the injury, it is essential to consider the potential for growth-related factors that might contribute to hip impingement, and thus, a thorough assessment of biomechanical issues and proper technique during sports is necessary 1. A follow-up MRI arthrogram may be warranted to reassess the tear's status, especially if there are significant changes in symptoms or if conservative management fails to improve the condition.

If pain persists after 2-3 more months of conservative treatment, referral to a pediatric orthopedic surgeon specializing in hip preservation is appropriate to discuss minimally invasive options like arthroscopic repair, considering the limited evidence supporting articular cartilage repair for small lesions of delaminated cartilage 1. The goal is to balance the need for effective pain management and functional improvement with the potential risks and benefits of surgical intervention, always prioritizing the patient's quality of life and long-term outcomes.

From the Research

Next Steps and Treatment

The patient, a 14-year-old female, has been diagnosed with a nondisplaced attachment and tear of the anterior superior labrum of the left hip, and has completed physical therapy but still experiences persistent pain. The next steps and treatment options can be considered as follows:

• Conservative treatment may not be sufficient, as the patient has already completed physical therapy and still experiences pain 2
• Surgical treatment, including labral debridement, labral repair, and labral reconstruction, may be indicated 2, 3
• Arthroscopic treatment of femoroacetabular impingement and labral tears can provide significant improvement in symptoms, with labral repair potentially providing superior results to labral resection 3
• However, patients with underlying hip morphologic abnormalities, such as developmental dysplasia of the hip, may not benefit from isolated arthroscopic treatment of the labrum and may require additional surgical procedures 4

Considerations

• The patient's age and activity level should be taken into account when considering treatment options 5, 3
• The presence of any underlying hip morphologic abnormalities should be evaluated and considered in the treatment plan 4
• The patient's persistent pain and lack of response to conservative treatment should be carefully evaluated to determine the best course of treatment 2, 3