A single-surgeon randomized controlled trial comparing hip arthroscopy plus physical therapy versus physical therapy alone for symptomatic acetabular labral tears in patients over 40 with limited osteoarthritis (Tönnis 0-2). This is the first RCT to report outcomes beyond 12 months in this older population. It asks whether advanced age should limit the indication for arthroscopic labral repair.
When a patient over 40 has a symptomatic FAI-related labral tear with only limited arthritis (Tönnis 0-2), do not reflexively deny them arthroscopy on the basis of age. This trial shows the true prognostic factor is chondral damage. Age was not an independent predictor of poor outcome (OR 1.00), while Tönnis grade was (grade 2 OR 0.22). Read the cartilage, not the birthday.
Interpret the 24-month ITT wash-out carefully. It looks like surgery and PT converge, but that is an artifact of the 71% crossover rate. The as-treated and treatment-failure analyses show a real and durable surgical advantage that PT alone never reaches.
A trial of structured PT first is reasonable and safe. Delaying surgery up to about 6 months did not compromise later results, and it let some patients avoid the operation entirely. Advanced osteoarthritis, however, remains a genuine contraindication to arthroscopy.
A single-surgeon randomized controlled trial comparing hip arthroscopy plus physical therapy versus physical therapy alone for symptomatic acetabular labral tears in patients over 40 with limited osteoarthritis (Tönnis 0-2). This is the first RCT to report outcomes beyond 12 months in this older population. It asks whether advanced age should limit the indication for arthroscopic labral repair.
When a patient over 40 has a symptomatic FAI-related labral tear with only limited arthritis (Tönnis 0-2), do not reflexively deny them arthroscopy on the basis of age. This trial shows the true prognostic factor is chondral damage. Age was not an independent predictor of poor outcome (OR 1.00), while Tönnis grade was (grade 2 OR 0.22). Read the cartilage, not the birthday.
Interpret the 24-month ITT wash-out carefully. It looks like surgery and PT converge, but that is an artifact of the 71% crossover rate. The as-treated and treatment-failure analyses show a real and durable surgical advantage that PT alone never reaches.
A trial of structured PT first is reasonable and safe. Delaying surgery up to about 6 months did not compromise later results, and it let some patients avoid the operation entirely. Advanced osteoarthritis, however, remains a genuine contraindication to arthroscopy.