Nonoperative Management of Labral Tears of the Hip in Adolescent Athletes: Description of Sports Participation, Interventions, Comorbidity, and Outcomes.

CONTEXT: Hip injury among young athletes is increasing, especially hip labral tears. Some tears may require surgical intervention, especially if they are associated with boney pathology such as femoroacetabular impingement (FAI). A protocol for nonoperative treatment of the hip labral tears is not well established. OBJECTIVE: To identify current nonoperative treatment options, comorbidities, sports participation, and outcomes of adolescent athletes who were diagnosed with hip labral tears. STUDY DESIGN: Retrospective chart review. SETTING: A regional tertiary level medical and academic institution. PARTICIPANTS: Physically active 8- to 20-year-old males and females who were diagnosed with hip labral tears in 2010 to 2013. MAIN OUTCOME MEASURES: Nonoperative treatment interventions including physical therapy (PT), intraarticular injection (IAI), the type of sports participation, and comorbidity were extracted. STATISTICAL ANALYSIS: Descriptive statistics and χ tests were used with a priori alpha level <0.05. RESULTS: Among 76 adolescent athletes who were diagnosed with hip labral tear, 52 (68.4%) had PT, 55 (72.4%) received IAI, and 43 (56.6%) experienced both PT and IAI interventions. Top 3 sports participated were dance (18.4%), soccer (14.5%), and gymnastics (7.9%). The most common comorbidity was FAI, which was observed in 46 individuals (60.5%). Although there was no difference in a proportion of FAI cases between sexes, a greater proportion of surgical cases were observed among hip labrum-injured athletes with FAI compared with those without FAI (P = 0.032). CONCLUSIONS: Adolescent athletes with hip labral tears often receive PT, IAI, and a combination of both, as nonoperative treatment options in this study cohort. The adolescent athletes who sustained hip labral tears with comorbidity of FAI had significantly greater proportion of surgical cases after nonoperative treatments.

The Reliability and Validity of a Pediatric Back Outcome Measure.

OBJECTIVE: Young athletes not uncommonly complain of back pain. Many patient-reported outcome measures are used to evaluate back pain, but none have been designed specifically to assess young, athletic patients. The Micheli Functional Scale (MFS) was developed to measure impairment due to back pain in this population. This study examined the reliability, validity, and responsiveness of the MFS used in routine clinical assessments. DESIGN: Retrospective Cohort Study. SETTING: Pediatric sports medicine specialty clinic. INTERVENTIONS: Patients presenting with a chief concern of back pain over 1 year (n = 93) were enrolled in the study. Study subjects were administered the MFS and the revised Oswestry Disability Index (ODI) at each visit as part of routine clinical care. MAIN OUTCOME MEASURES: Reliability of the MFS was assessed by calculating Cronbach alpha (α). Concurrent validity was determined by measuring Spearman coefficient (rs) for the correlations between the MFS and ODI. RESULTS: Ninety-three patients (50 female, 43 male), mean age 14.1 ± 2.3 years were enrolled and 242 clinic encounters (71 initial/171 follow-up visits) analyzed. The MFS had acceptable item reliability (α = 0.786) and concurrent validity: the MFS and ODI were strongly and positively correlated [rs = 0.824 (P < 0.001)]. The MFS was comparatively more reliable and valid when used in follow-up versus initial visits. CONCLUSIONS: The MFS is a reliable and valid instrument in assessing young athletes with back pain, although the instrument has different performance characteristics on initial versus follow-up assessments. Further work is needed to refine the MFS to enhance the instrument's reliability, validity, and responsiveness. CLINICAL RELEVANCE: This study provides further insight into an outcome measure of clinical use in evaluating young athletes with back pain.

Epidural Steroid Injections for Radiculopathy and/or Back Pain in Children and Adolescents: A Retrospective Cohort Study With a Prospective Follow-Up.

BACKGROUND AND OBJECTIVES: Epidural steroid injections (ESIs) are commonly performed for adults with spinal pain and/or radiculopathy. Previous pediatric ESI case series were not identified by literature review. The primary aim of this study was to examine the safety and provisional outcomes of pediatric ESIs. METHODS: With institutional review board approval, medical records were reviewed for patients aged 9 to 20 years receiving a first ESI at Boston Children's Hospital from 2003 through 2013. A subset of patients completed a Web-based follow-up questionnaire. Descriptive statistics included frequencies, medians, interquartile ranges, and Kaplan-Meier methods. Statistical comparisons were made using Wilcoxon rank sum, χ2, Fisher exact, and Cox proportional hazards regression analyses. RESULTS: A total of 224 patients aged 9 to 20 years underwent 428 ESIs. One hundred seventy-four (76.0%) patients had a lumbar disc herniation with radiculopathy; the others had a spectrum of other spinal disorders. There were no serious adverse events, hospitalizations, dural punctures, or nerve injuries. During follow-up, 69 (41.6%) of 166 previously nonoperated lumbar disc plus radiculopathy patients underwent discectomy at a median time of 128 days (interquartile range, 76-235 days) after first injection. Degrees of straight-leg raising at presentation was significantly associated with subsequent discectomy. On follow-up, patients who did and did not undergo discectomy had low pain scores and high function scores. CONCLUSIONS: Children and adolescents can receive ESIs under conscious sedation with good safety. Further prospective studies may better define the role for these injections in the comprehensive management of pediatric spinal pain disorders.