Hip Labral Reconstruction Protocol

Phase I Post-op (day 1 through 4 weeks):

Goals:

• Protect integrity of the reconstructed labrum.
• Restore ROM within restrictions.
• Normalize gait pattern beginning with bilateral axillary crutches 20% weight bearing for 4 weeks. Progress to WBAT at 4 weeks. May then wean from crutches when pain free gait without limp.
• Prevent muscular inhibition gluteus medius and maximus.

Precautions:

• Limit hip flexion to 90 degrees for the first 2 weeks post-op then gradual progression as tolerated.
• If microfracture maintain 20% WB for 6 weeks post-op with normal gait pattern.
• Stress IR ROM greater than ER ROM, no aggressive ER stretching.
• No SLR supine.

Exercise program:
Week 1

• Ankle pumps, quad sets, glut sets.
• Heel slides.
• Isometric hip ADD bolster between knees.
• Partial curl up.
• Standing hip ABD, EXT, marching to 90 degrees no resistance.
• Stationary bike low resistance 90 degrees hip flexion maximum.
• PROM emphasis on hip IR in supine with 0 degrees hip flexion.

Week 2

• Prone active hip IR/ER.
• Hip ABD isometrics.
• Standing hip IR with knee on stool.
• Supine hip ABD slides.
• Hip flexor, hamstring, and quad stretch. Avoid any active hip flexor activity with hamstring stretch.
• Progress core strengthening.
• Water walking chest deep if incisions are well healed. Standing hip march, ABD,EXT in water when available.
• Wall squats 30 degrees knee flexion.
• Heel lifts.
• Isometric terminal knee extension.
• Continue PROM emphasis on hip IR in supine with 0 degrees hip flexion.

Week 3 and 4

• Sidelying hip ABD/ER “clams”.
• Sidelying hip ABD and prone hip EXT AROM.
• Bridge with tubing at knees.
• Kneeling hip flexor stretch.

Phase II Post-op (Weeks 5-6):

Goals:

• Restore full ROM.
• Increase strength.
• Normalize gait pattern.

Exercise program:

• Progress closed chain strengthening.
• Leg press.
• Mini squats.
• Single leg balance.
• Forward step ups.
• Lateral step ups.
• Continue to progress core strength i.e. plank.
• Swim with flutter kick.

Phase III Post-op (Weeks 7-15):

Goals:

• Restore cardiovascular endurance.
• Maximize strength, balance, and proprioception.

Exercise Program:

• Continue progressive strengthening.
• Side step with theraband resistance.
• Stairmaster.
• Lunges progressing to walking lunges at 8 weeks post-op.
• Aerobic stepping as tolerated at 12 weeks post-op.
• Aquajogging when available at 12 weeks post-op.

Phase IV Post-op (Week 16):

Before beginning Phase IV a 16 week functional test must be successfully completed.

Exercise Program

• Continue progressive hip strength and flexibility as above.
• Progression to a graduated running progression.
• Progression to a graduated double leg plyometric program uniplanar.

Phase V Post-op (week 20):

Before beginning Phase V a 20 week functional test must be successfully completed.

• Continue progressive strength and flexibility.
• Continue progressive running.
• Progressive agility work.
• Progress plyometrics to double leg multiplanar and single leg uniplanar.
• Return to sport progression.

Discharge formal physical therapy. Continue gym program. Return to sport at approximately 6 ½ to 7 months pending Physician release.