Intra-articular Platelet-Rich Plasma for Acetabular Labral Tears

Acetabular labral tears (ALT) have been reported to have a prevalence of 22-55% in patients presenting with hip or groin pain. Etiologies of ALT include femoral acetabular impingement (FAI) as the most common followed by trauma, degeneration, dysplasia, hypermobility, etc. The fibrocartilaginous acetabular labrum is an important structure in the maintenance of hip perseveration and biomechanics. Several functions include decreasing stress on articular surfaces by increasing surface contact area, maintaining a pressurized layer of intra-articular fluid to distribute mechanical forces, and assisting in joint stability. The consequences of labral pathology are not fully understood, however, prior studies have indicated that there is a correlation between acetabular labral lesions and chondral injury contributing to the development of early degenerative hip disease.

Based on current evidence, it is suggested that the highest degree of clinical accuracy in the diagnosis of a symptomatic acetabular labral tear is with a combination of clinical history, physical examination, advanced imaging such as magnetic resonance imaging (MRI) or magnetic resonance angiography (MRA), and diagnostic injection. Conservative management trials are often considered for initial treatment and include relative rest, activity modification, anti-inflammatory medication, and physical therapy with the potential for intra-articular injections including corticosteroids. If conservative management is unsuccessful, arthroscopic intervention with resection, refixation, or reconstruction is often considered. If conservative management is unsuccessful, arthroscopic intervention with resection, refixation, or reconstruction is often considered.

According to a recent systematic review and meta-analysis, there is promising evidence that platelet rich plasma (PRP) is an effective treatment for hip osteoarthritis. However, there is limited evidence regarding PRP treatment for ALT. To date, there is only one pilot study published evaluating 8 patients diagnosed with ALT who underwent ultrasound guided intra-articular hip injection with PRP. Optimistically, this study did reveal significant differences from baseline in function and pain scores at short term follow-up. However, the study lacked many important details including information about the injectate (the composition of the blood and PRP) which is vital to include in studies of these types. Therefore, the purpose of this study is to fully evaluate the effects of PRP treatment on the clinical outcomes of ALT prospectively in a larger cohort of patients.

Inclusion criteria

• Age ≤49 years old (i.e., 18 - 49 years old)
• Hip or groin pain with at least 1 positive provocative labral hip maneuver (i.e., Flexion, Adduction, Internal Rotation (FADIR) test, subspine impingement test, scour)
• Radiographs with Tonnis grade < 2 (i.e., 0 or 1)
• MRI or MRA hip with evidence of acetabular labral tear
• Failure of at least 6 weeks of conservative management [i.e., activity modification, non-steroidal anti-inflammatory drugs (NSAIDs), and/or physical therapy (PT), other intra-articular injection etc.]
• Prior diagnostic ultrasound guided hip injection with anesthetic-only providing ≥50% pain relief

Exclusion criteria

• Any prior surgery to the affected hip
• Imaging with evidence of avascular necrosis of the affected hip
• Imaging with evidence of hip dysplasia (i.e. lateral center edge angle of ≤20 degrees)
• Alpha angle of ≥55 degrees of the affected hip
• Intra-articular hip injection within the last 6 months to the affected hip of any injectate with the exception of anesthetic
• Active systemic infection requiring antibiotics or local infection at the site of the injection
• Any prior intra-articular infection of the affected hip
• Any prior fracture of the affected femur or pelvis
• Blood dyscrasia or malignancy
• Non-ambulatory patients
• Patient seeking care with active litigation pending
• Body mass index (BMI) ≥ 35 kg/m2
• Systemic inflammatory arthropathy
• Oral steroids consumed within the last three months