Hip labral tear: surgery or just therapy? new study aims to settle the debate

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: 1. Age 40 or greater: higher likelihood or undetectable OA on imaging 2. Symptoms consistent with a tear of the acetabular labrum (at least one: catching, clicking, popping, pain with sitting, episodic pain, pain with hip flexion, adduction, and/or internal rotation): asymptomatic labral tears do exist in the general population however there is not definitive evidence to suggest treatment of asymptomatic tears is beneficial. 3. Symptoms not due to some other acute process in or around the hip (including septic arthritis, osteonecrosis, hemarthrosis, iliotibial band syndrome, fractures of the femoral neck or head, fractures of the acetabulum, greater trochanteric pain syndrome, sacroiliac joint pain, piriformis syndrome, low back pain associated with hip pain and not knee nor acute low back injury): certain conditions are not treatable by either arthroscopy or physical therapy. Some of these conditions can be managed with physical therapy but not arthroscopy. 4. Availability of hip radiographs and MRI: needed to assess eligibility 5. Evidence on MRI of a tear of the acetabular labrum: documentation of acetabular labrum tear 6. Willingness to undergo randomization and ability to understand and sign informed consent document: ability to understand study and consent willingly Exclusion Criteria: 1. Less than 2 mm of joint space on standing plain anterior-posterior radiographs of the hip: indicative of severe osteoarthritic disease and the patient would benefit more from a total hip replacement 2. Developmental dysplasia of the hip: distorted acetabular anatomy and biomechanics 3. Kellgren-Lawrence Grade 4 changes: classified as large osteophytes, marked narrowing of joint space, severe sclerosis, and definite deformity of bone contour; indicative of severe OA 4. Tonnis Grade 3 changes: classified as large cysts in the head or acetabulum, severe narrowing or obliteration of the joint space, severe deformity of the head, and necrosis; indicative of OA 5. Unexpected pathology at the time of arthroscopy: source of pain less likely to due dysfunction of the labrum and more likely due to aberrant extra-articular biology 6. Same site surgery: complex anatomy 7. Back pain greater than hip pain or back pain associated with leg symptoms below the knee: source of pain less likely to be originating from the hip and more likely to be referred from the back/spine 8. Back pain associated with positive neural tension signs e.g. positive slump test, positive SLR (straight leg raise), positive reflex changes or drop foot: source of pain less likely to be originating from the hip and more likely to be referred from the back/spine 9. Knee pain greater than hip pain: source of pain less likely to be originating from the hip and more likely to referred from the knee 10. Bilateral tears of the acetabular labrum: difficult to gauge patient progress after treatment 11. Contraindication to surgery or physical therapy: cannot tolerate either treatment grouping 12. Alternate form of PT for greater than 6 weeks: will negatively augment results. May affect recruitment.