Hip Arthroscopy / Labral Repair — Labral Repair with Capsulotomy

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

50% WB first 2 wks (foot flat, avoid anterior hip irritation from flexion); FFWB if microfracture noted in op report first 2 wks; WBAT with bilateral AD at 2 wks, unilateral crutch at 3 wks if pain low/minimal gait deviation, progressing to no AD if appropriate

Key Restrictions

No straight leg raises Phase I; PROM: extension 0 deg x4 wks, abduction 25-30 deg x3 wks, IR 0 deg x3 wks (not initiated until 3 wks), flexion/ER within tolerance; avoid forced/aggressive stretching Phase II; avoid SLR initially (psoas irritation risk); no contact activities Phase III

Timeline & Phases

Phase I, Immediate Rehabilitation (wks 1-4, begin POD 1-7): protect repaired tissue, restore ROM within guidelines, prevent muscular inhibition/gait abnormalities, diminish pain/inflammation, caregiver circumduction 1x/day; wks 1-2: PROM/manual treatment (long axis traction with circumduction/abduction, PROM flexion/ER pain-free), HEP (bent knee fallout, seated hamstring stretch, single knee to chest, prone quad stretch, quad/glute sets, ankle pumps), stationary bike without resistance, scar massage/STM to TFL/ITB/psoas/iliacus/adductors/piriformis/QL/paraspinals; wks 3-4: add IR/extension PROM, manual hip flexor stretch, prone IR/ER, hip flexor stretch off table edge, piriformis stretch, FABER stretch, adductor/abductor isometrics, SAQs, transverse abs isometrics, progress to unilateral crutch at wk 3 if appropriate; Phase II, Intermediate Rehabilitation (wks 4-12, criteria: low pain, minimal irritation, appropriate ROM progression): restore full hip ROM before strengthening, restore normal gait, progressive hip/pelvis/LE strengthening; continue PROM/stretches, FWB with minimal pain/gait deviation before strengthening, stationary bike resistance increase (elliptical at wk 6), clams, bridges, shallow squatting, step-ups, lateral step-ups, balance, medial step-down, avoid SLR (use step-ups/isometric SL holds/marching/prone planks for iliopsoas strengthening instead), core and gluteus medius/maximus focus to address FAI movement patterns (femoral IR, knee valgus, foot/ankle pronation); Phase III, Advanced Rehabilitation/Return to Sport (wks 12-18, criteria: symmetrical AROM, normalized gait, hip flexor strength >4/5, hip abd/add/ext/ER/IR strength >4+/5, SLS 30 sec, medial tap down without valgus collapse): full symmetrical muscular strength, restore pre-op cardiovascular endurance; squat progression, jump progression, hop progression, jog progression via ladder drills/carioca/slide board/elliptical then 5-phase walk-to-run program; no contact activities throughout

Notes

OSMS Rehabilitation Guidelines; one of three distinct OSMS labral repair protocols (capsulotomy, capsular plication, capsular repair/closure) — always refer to operative note for exact procedure; if gluteus medius/minimus repair also performed, follow the more restrictive gluteus medius protocol instead; walk-to-run progression sourced from OSU Sports Medicine (2012)