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Linek P, Booysen N, Sikora D, Stokes M. Functional movement screen and Y balance tests in adolescent footballers with hip/groin symptoms. Phys Ther Sport 2019; 39:99-106. [DOI: 10.1016/j.ptsp.2019.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/29/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
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Kotsifaki A, Korakakis V, Whiteley R, Van Rossom S, Jonkers I. Measuring only hop distance during single leg hop testing is insufficient to detect deficits in knee function after ACL reconstruction: a systematic review and meta-analysis. Br J Sports Med 2019; 54:139-153. [DOI: 10.1136/bjsports-2018-099918] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 04/08/2019] [Accepted: 04/10/2019] [Indexed: 01/08/2023]
Abstract
ObjectiveTo systematically review the biomechanical deficits after ACL reconstruction (ACLR) during single leg hop for distance (SLHD) testing and report these differences compared with the contralateral leg and with healthy controls.DesignSystematic review with meta-analysis.Data sourcesA systematic search in Pubmed (Ovid), EMBASE, CINAHL, Scopus, Web of Science, PEDro, SPORTDiscus, Cochrane Library, grey literature and trial registries, was conducted from inception to 1 April 2018.Eligibility criteria for selecting studiesStudies reporting kinematic, kinetic and/or electromyographic data of the ACLR limb during SLHD with no language limits.ResultsThe literature review yielded 1551 articles and 19 studies met the inclusion criteria. Meta-analysis revealed strong evidence of lower peak knee flexion angle and knee flexion moments during landing compared with the uninjured leg and with controls. Also, moderate evidence (with large effect size) of lower knee power absorption during landing compared with the uninjured leg. No difference was found in peak vertical ground reaction force during landing. Subgroup analyses revealed that some kinematic variables do not restore with time and may even worsen.ConclusionDuring SLHD several kinematic and kinetic deficits were detected between limbs after ACLR, despite adequate SLHD performance. Measuring only hop distance, even using the healthy leg as a reference, is insufficient to fully assess knee function after ACLR.PROSPERO trial registration number CRD42018087779.
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A Systematic Review of Proposed Rehabilitation Guidelines Following Anatomic and Reverse Shoulder Arthroplasty. J Orthop Sports Phys Ther 2019; 49:337-346. [PMID: 31021690 DOI: 10.2519/jospt.2019.8616] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) is indicated for patients with glenohumeral arthritis. In this procedure, the humeral head and glenoid surface are replaced with prosthetic components. Reverse total shoulder arthroplasty (RTSA) is indicated for patients with glenohumeral arthritis and a poorly functioning rotator cuff. In this procedure, a glenosphere articulates with a humerosocket. While those surgeries are commonly performed, a thorough review of the literature is required to determine the areas of agreement and variations in postoperative rehabilitation. OBJECTIVES To describe the literature on rehabilitation protocols following anatomic TSA and RTSA. METHODS For this systematic review, a computerized search was conducted in medical databases from inception to May 21, 2018 for relevant descriptive studies on TSA and RTSA rehabilitation protocols. The methodological index for nonrandomized studies tool and the modified Downs and Black tool for randomized controlled trials were used for assessment of the individual studies. RESULTS Sixteen studies met the inclusion criteria, of which 1 provided level I evidence, 1 provided level III evidence, 2 provided level IV evidence, and 12 provided level V evidence. Ten of the studies described rehabilitation guidelines for TSA and 6 described those for RTSA. Following TSA, the use of a sling was recommended for a duration that varied from 3 to 8 weeks, and 4 of the 10 published protocols included resisted exercise during the initial stage of healing (the first 6 weeks after surgery). Seven of 10 published protocols recommended limiting shoulder external rotation to 30° and that passive range of motion be fully restored by 12 weeks post surgery. Suggested use of a sling post RTSA varied from "for comfort only" to 6 weeks, motion parameters varied from no passive range of motion to precautionary range limits, and all protocols agreed on performing deltoid isometric exercises early post surgery. There was a high level of heterogeneity for the rehabilitation guidelines and associated precautions for both TSA and RTSA. CONCLUSION The majority of published protocols were descriptive in nature. Published rehabilitation strategies following TSA and RTSA are based on biomechanical principles, healing time frames, and exercise loading principles, with little consistency among protocols. There is a need to determine optimal rehabilitation approaches post TSA and RTSA based on clinical outcomes. LEVEL OF EVIDENCE Therapy, level 5. J Orthop Sports Phys Ther 2019;49(5):337-346. doi:10.2519/jospt.2019.8616.
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Walker D. Hip range of motion increases after a 12-week rest period in elite Australian Rules Football players. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2019. [DOI: 10.23736/s0393-3660.18.03802-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Active pelvic tilt is reduced in athletes with groin injury; a case-controlled study. Phys Ther Sport 2019; 36:14-21. [DOI: 10.1016/j.ptsp.2018.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/20/2018] [Accepted: 12/22/2018] [Indexed: 11/19/2022]
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Wörner T, Thorborg K, Eek F. Five-Second Squeeze Testing in 333 Professional and Semiprofessional Male Ice Hockey Players: How Are Hip and Groin Symptoms, Strength, and Sporting Function Related? Orthop J Sports Med 2019; 7:2325967119825858. [PMID: 30815497 PMCID: PMC6383089 DOI: 10.1177/2325967119825858] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Hip and groin problems are just as common in ice hockey as they are in soccer. The 5-second squeeze test (5SST) is a valid indicator of hip- and groin-related sporting function (self-reported function) in soccer and is suggested to be interpreted according to a "traffic light" approach in guiding the early identification and management of affected players. It is currently unknown how the 5SST relates to self-reported function and muscle strength in ice hockey players. Purpose To investigate correlations between the 5SST result, self-reported function, and hip muscle strength in ice hockey players. A further aim was to investigate the discriminative ability of the "traffic light" approach (numeric rating scale [NRS] score: 0-2 = green, 3-5 = yellow, 6-10 = red) regarding levels of self-reported function and strength. Study Design Cross-sectional study; Level of evidence, 3. Methods Professional and semiprofessional male ice hockey players (N = 333) performed the 5SST and completed the Sport subscale of the Copenhagen Hip and Groin Outcome Score (HAGOS). Bilateral adduction and abduction strength was measured using handheld dynamometry. Associations were estimated using Spearman rank-order correlations, and groups were compared using the Kruskal-Wallis test or analysis of variance. Standardized effect sizes (ESs) for differences in strength (Hedges g) and self-reported function (r) were provided. Results The 5SST result was significantly correlated with self-reported function (rho, -0.319; P < .01) and hip muscle strength (rho, -0.157 to -0.305; P < .01). The HAGOS Sport scores differed significantly between all 3 traffic light groups (ES, 0.23-0.33; P ≤ .005). Players with an NRS score >2 (yellow or red light) had lower adduction (ES ≥ 0.75; P < .001) and abduction strength (yellow: ES, 0.30; P = .031) (red: ES, 0.51; P = .058) than players with a green light. Conclusion The 5SST result was significantly correlated with self-reported function as well as hip muscle strength and was able to discriminate between the traffic light levels in ice hockey players. Players with a yellow or red light had reduced adduction and abduction strength compared with players with a green light (NRS score ≤2). Routine 5SSTs may allow the early identification of affected ice hockey players and indicate yellow and red light situations, in which players may benefit from load management and appropriate hip muscle strengthening.
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Affiliation(s)
- Tobias Wörner
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Kristian Thorborg
- Sports Orthopedic Research Center-Copenhagen, Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Frida Eek
- Department of Health Sciences, Lund University, Lund, Sweden
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The Association Between Passing Return-to-Sport Criteria and Second Anterior Cruciate Ligament Injury Risk: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2019; 49:43-54. [PMID: 30501385 DOI: 10.2519/jospt.2019.8190] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is no consensus on the components of return-to-sport (RTS) testing following anterior cruciate ligament (ACL) reconstruction or whether passing RTS criteria can reduce a patient's risk of reinjury. OBJECTIVES To determine whether impartial, criteria-based RTS decisions are associated with less risk of a second ACL injury (either graft failure or contralateral ACL injury). METHODS In this systematic review with meta-analysis, the authors conducted an electronic literature search in PubMed/MEDLINE, Embase, CINAHL, SPORTDiscus, and ProQuest Dissertations and Theses Global using database-specific vocabulary related to ACL reconstruction and return to sport. Individual study quality was assessed using the modified Downs and Black checklist, and overall quality of evidence was determined with the Grading of Recommendations Assessment, Development and Evaluation scale. Pooled risk difference (passed versus failed RTS criteria), injury incidence proportion, and the diagnostic accuracy of each RTS criterion were calculated. RESULTS Four studies met the selection criteria. Overall, 42.7% (95% confidence interval [CI]: 18%, 69%) of patients passed RTS criteria, and 14.4% (95% CI: 8%, 21%) of those who passed experienced a second ACL injury (graft rupture or contralateral ACL injury). There was a nonsignificant 3% reduced risk of a second ACL injury after passing RTS criteria (risk difference, -3%; 95% CI: -16%, 10%; I2 = 74%, P = .610). The evidence rating of the Grading of Recommendations Assessment, Development and Evaluation scale was "very low quality," due to imprecision and heterogeneity of the pooled risk difference estimate. CONCLUSION Passing RTS criteria did not show a statistically significant association with risk of a second ACL injury. The quality-of-evidence rating prevents a definitive conclusion on this question and indicates an opportunity for future research. LEVEL OF EVIDENCE Prognosis, Level 2a-. J Orthop Sports Phys Ther 2019;49(2):43-54. Epub 30 Nov 2018. doi:10.2519/jospt.2019.8190.
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Light N. The effect of acute match play loading on hip adductor strength and flexibility in soccer players. J Sports Med Phys Fitness 2019; 59:325-329. [DOI: 10.23736/s0022-4707.18.08194-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Reiman MP, Walker MD, Peters S, Kilborn E, Thigpen CA, Garrigues GE. Risk factors for ulnar collateral ligament injury in professional and amateur baseball players: a systematic review with meta-analysis. J Shoulder Elbow Surg 2019; 28:186-195. [PMID: 30392938 DOI: 10.1016/j.jse.2018.08.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 08/08/2018] [Accepted: 08/11/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Risk factors for ulnar collateral ligament injury (UCLI) are unclear despite increasing injury rates. We sought to summarize UCLI risk factors in baseball players. METHODS A computer-assisted search of 4 databases was performed using keywords related to UCLI risk factors. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for study methodology. Odds ratios and 95% confidence intervals were calculated for dichotomous outcomes, and mean differences and 95% confidence intervals were calculated for continuous outcomes using a random-effects model. RESULTS Thirteen studies qualified for inclusion. A greater nondominant (ND) shoulder internal rotation (IR) range of motion (ROM) at 90° abduction arm demonstrated strong evidence as a significant risk factor for UCLI (P < .001) compared with a control group. Mean overall velocity (P < .001), fastball velocity (P < .001), changeup velocity (P = .03), and curveball velocity (P = .01), as well as fewer years of player experience (P < .001), less humeral retrotorsion in the ND arm (P < .001), and greater absolute side-to-side differences in retrotorsion (P = .006) were all moderate-evidence risk factors compared with control groups. Strong evidence suggests total ROM arc at 90° abduction in the dominant arm was not a risk factor for UCLI (P = .81). CONCLUSIONS Greater ND shoulder IR ROM and less humeral retrotorsion (in professional and amateur players) as well as pitching velocity (in professional players) demonstrated strong to moderate evidence as risk factors for UCLI. Dominant arm total arc of motion, external, or IR ROM were not risk factors for UCLI. Standardized collection and reporting of risk factors is recommended to more clearly elucidate definitive risk factors for UCLI.
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Affiliation(s)
- Michael P Reiman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Merritt D Walker
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Scott Peters
- Toronto Blue Jays Baseball Club, Toronto, ON, Canada
| | - Elizabeth Kilborn
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Charles A Thigpen
- Program in Observational Clinical Research in Orthopedics, Center for Effectiveness in Orthopedic Research, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Grant E Garrigues
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
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Exercise Interventions for the Prevention and Treatment of Groin Pain and Injury in Athletes: A Critical and Systematic Review. Sports Med 2018; 47:2011-2026. [PMID: 28497284 DOI: 10.1007/s40279-017-0742-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Groin injury is a common musculoskeletal complaint for athletes competing in a variety of sports. The extent to which exercise interventions incorporating external load are an appropriate option for the treatment and prevention of groin injury in athletes is not yet clear. OBJECTIVES The aim of this review was to describe and evaluate exercise therapy interventions and outcomes for the treatment and prevention of groin injury with specific attention to application of external load. DATA SOURCES The databases Medline, PubMed, SPORTDiscus, Web of Science, and Cochrane were searched on 18 April 2016. STUDY ELIGIBILITY CRITERIA This review was registered as PROSPERO CRD42016037752 and a systematic search was conducted with the following inclusion criteria: any study design evaluating exercise interventions for the prevention or treatment of groin pain in athletes. DATA ANALYSIS Two independent authors screened search results, performed data extraction, assessed risk of bias using the modified Downs and Black appraisal tool and determined strength and level of evidence. Reporting standards for exercise interventions were assessed using the Consensus for Exercise Reporting Template (CERT). RESULTS A total of 1320 titles were identified with 14 studies satisfying the inclusion criteria, four (29%) of which demonstrated low risk of bias. Ten (71%) studies utilised external load as a component of the exercise intervention. Reporting standards for exercise intervention scores ranged from 0 to 63%. CONCLUSION There is limited evidence from level 2 and 3 studies indicating exercise therapy may reduce the incidence and hazard risk of sustaining a groin injury in athletes. There is strong evidence from level 4 studies indicating exercise therapy is beneficial as a treatment for groin injury in athletes in terms of symptom remission, return to sport and recurrence outcomes. However, there are limited studies with low risk of bias, and exercise interventions for the treatment of groin injury are poorly described.
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O'Brien J, Santner E, Finch CF. The inter-tester reliability of the squeeze and bent-knee-fall-out tests in elite academy football players. Phys Ther Sport 2018; 34:8-13. [DOI: 10.1016/j.ptsp.2018.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 06/20/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022]
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Devitt BM, Dissanayake R, Clair J, Napier RJ, Porter TJ, Feller JA, Webster KE. Isolated Posterior Cruciate Reconstruction Results in Improved Functional Outcome but Low Rates of Return to Preinjury Level of Sport: A Systematic Review and Meta-analysis. Orthop J Sports Med 2018; 6:2325967118804478. [PMID: 30386804 PMCID: PMC6204629 DOI: 10.1177/2325967118804478] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: Although isolated posterior cruciate ligament reconstruction (PCLR) has become a more frequently performed procedure, reports of functional outcomes and return-to-sport (RTS) rates to support its use are still limited. Purpose: To systematically review the literature to determine the rates of RTS and the functional outcomes of patients after isolated PCLR. Study Design: Systematic review: Level of evidence, 4. Methods: Two reviewers independently searched 5 databases for patient-based clinical studies with a minimum 2-year follow-up that analyzed functional outcome and RTS following isolated PCLR. Studies with multiligament knee reconstruction were excluded. Risk of bias was performed with a modified Downs and Black checklist. The primary outcomes were Tegner and Lysholm scores, rates of RTS, and International Knee Documentation Committee (IKDC) subjective scores. Secondary outcomes were IKDC objective scores, instrumented knee laxity assessment, and Telos radiographic analysis. Where feasible, these data were pooled via a random effects meta-analysis model. Results: Of the 240 titles identified, 14 studies were included. The median time from injury to surgery was 10.6 months (range, 6 weeks–21 years). The pooled mean postoperative Tegner and Lysholm scores were 5.7 (95% CI, 5.4-6.0) and 87.8 (95% CI, 85.6-90.0), respectively, following isolated PCLR; the pooled effect size between pre- and postoperative values was 2.8 (95% CI, 1.6-4.0) and 3.7 (95% CI, 2.6-4.9), respectively. An RTS rate of 44% (95% CI, 23%-66%) was identified. IKDC subjective scores improved to a pooled mean of 73.5 (95% CI, 62.8-84.1), with an effect size of 3.0 (95% CI, 0.4-5.6). The proportion of patients with postoperative IKDC objective scores of grade A/B was 82%. The pooled postoperative KT-1000/KT-2000 side-to-side difference was 3.4 mm (95% CI, 2.5-4.3 mm), with an effect size of 2.8 (95% CI, 1.1-4.5). The pooled postoperative Telos side-to-side difference measurement was 3.5 mm (95% CI, 2.8-4.3 mm), with an effect size of 3.9 (95% CI, 3.3-4.5). Conclusion: The results of this review demonstrate that while isolated PCLR results in a significant improvement in functional outcome scores and improved knee laxity, there is a low rate of return to preinjury level of sport. The prolonged period from injury to surgery might reduce functional improvement and RTS following reconstruction. Therefore, comparison of the outcomes of isolated PCLR and nonoperative treatment is impracticable owing to the potential for selection bias.
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Affiliation(s)
- Brian M Devitt
- OrthoSport Victoria, Epworth Healthcare, Melbourne, Australia
| | | | - Joseph Clair
- OrthoSport Victoria, Epworth Healthcare, Melbourne, Australia
| | | | | | - Julian A Feller
- OrthoSport Victoria, Epworth Healthcare, Melbourne, Australia
| | - Kate E Webster
- School of Allied Health, La Trobe University, Melbourne, Australia
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Wollin M, Thorborg K, Welvaert M, Pizzari T. In-season monitoring of hip and groin strength, health and function in elite youth soccer: Implementing an early detection and management strategy over two consecutive seasons. J Sci Med Sport 2018; 21:988-993. [DOI: 10.1016/j.jsams.2018.03.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/15/2018] [Accepted: 03/07/2018] [Indexed: 10/17/2022]
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Risk Factors for Groin Injury and Groin Symptoms in Elite-Level Soccer Players: A Cohort Study in the Dutch Professional Leagues. J Orthop Sports Phys Ther 2018; 48:704-712. [PMID: 29792105 DOI: 10.2519/jospt.2018.7990] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Groin injury and groin symptoms are common in soccer players. The relationship of groin injury and groin symptoms to reduced hip range of motion (ROM) and previous injury is unclear. Objectives To conduct a retrospective assessment of associations between previous injury and preseason hip ROM and preseason prevalence of severe groin symptoms, and to prospectively identify risk factors for within-season groin injury. Methods During the period of 2015 to 2016, 190 players from 9 Dutch professional soccer clubs participated in this cohort study with prospective and retrospective elements. Univariate and multivariate logistic regressions were used to predict preseason severe groin symptoms, identified using the Copenhagen Hip and Groin Outcome Score, from a history of previous groin injury, general injury (minimum of 1 week in duration) in the previous season, and hip ROM. Cox regression was used to predict within-season groin injury. Results Point prevalence of severe groin symptoms was 24% and within-season incidence of groin injury was 11%. Total, training, and match groin injury incidences were 0.5, 0.2, and 2.6 injuries per 1000 playing hours, respectively. A history of more than 1 previous groin injury was associated with current severe groin symptoms (odds ratio = 3.0; 95% confidence interval: 1.0, 8.3; P = .038). General injury sustained in the previous season (ankle, knee, thigh, shoulder; median, 9 weeks of time loss) was a risk factor for groin injury (hazard ratio = 5.1; 95% confidence interval: 1.8, 14.6; P = .003). Conclusion Severe injuries in the previous season to locations other than the groin increase the risk of groin injury the next season. A history of groin injury is associated with current severe groin symptoms. Preseason hip ROM does not identify players at risk for groin injury. Level of Evidence Prevention, level 2b. J Orthop Sports Phys Ther 2018;48(9):704-712. Epub 23 May 2018. doi:10.2519/jospt.2018.7990.
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Reiman MP, Peters S, Rhon DI. Most Military Service Members Return to Activity Duty With Limitations After Surgery for Femoroacetabular Impingement Syndrome: A Systematic Review. Arthroscopy 2018; 34:2713-2725. [PMID: 30173813 DOI: 10.1016/j.arthro.2018.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 05/03/2018] [Accepted: 05/07/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Determine which proportion of active-duty service members return to duty (RTD), RTD without limitations, which surgical intervention returns these personnel at a better proportion and with the ability to perform their military duties after surgery compared with the pre-injury state. METHODS A computer-assisted search of MEDLINE, EMBASE and SCOPUS databases was performed with keywords related to RTD for femoroacetabular impingement (FAI) syndrome. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for study methodology. Methodologic quality of individual studies was assessed with the Methodological Index for Non-Randomized Studies scale. RESULTS A total of 5 studies (884 service members/886 hips) qualified for inclusion. Limited evidence from level III to IV studies indicates that service members RTD at a proportion ranging from 57% (95% confidence interval [CI]: 53% to 62%) to 84% (95% CI: 73% to 91%), but only 39% (95% CI: 35% to 44%) to 59% (95% CI: 49% to 69%) do so without limitations. Mean duration of follow-up was 33.2 ± 11.3 months. No studies reported on actual duty requirements before versus after surgery, RTD criteria, or career longevity. Only 1 of 5 studies reported the RTD time-frame (mean 5 months). Only 2 of 5 studies reported complications, with a rate of 9.4% ± 6.3%. Three of 5 studies reported failures at a rate of 7.2% ± 4.7%, respectively. Femoroplasty (mean 56% of procedures in 4 studies) and acetabuloplasty (mean 55% of procedures in 4 studies) were the most commonly used procedures in studies reporting. CONCLUSIONS RTD is poorly defined in the included studies. Limited evidence substantiates that approximately 75% of service members remain on active duty for at least 1 to 2 years after surgery for FAI syndrome, whereas only approximately 47% do so without limitations at mid-term follow-up. Similarly, despite improvements in patient-reported outcome measures, service members still report continued pain and functional limitations after FAI syndrome surgery. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.
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Affiliation(s)
- Michael P Reiman
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina.
| | - Scott Peters
- Toronto Blue Jays Baseball Club, Toronto, Canada
| | - Daniel I Rhon
- Physical Therapy, Baylor University, Waco, Texas, U.S.A; Clinical Outcomes Research, Center for the Intrepid, Brooke Army Medical Center, San Antonio, Texas, U.S.A
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Light N, Gimpel M, Sparks S, Bowen L, Bruce-Low S, Hughes-Jones Z. Associations between adductor strength; flexibility and self-reported symptoms in elite professional footballers: a case series. SCI MED FOOTBALL 2018. [DOI: 10.1080/24733938.2018.1501159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Neil Light
- Department of Sport and Exercise Sciences, University of Chichester, Chichester, UK
| | - Mo Gimpel
- Southampton Football Club, Southampton, UK
| | | | | | | | - Zoe Hughes-Jones
- Department of Sport and Exercise Sciences, University of Chichester, Chichester, UK
- Southampton Football Club, Southampton, UK
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Multidisciplinary Assessment of 100 Athletes With Groin Pain Using the Doha Agreement: High Prevalence of Adductor-Related Groin Pain in Conjunction With Multiple Causes. Clin J Sport Med 2018; 28:364-369. [PMID: 28654441 DOI: 10.1097/jsm.0000000000000469] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the prevalence of different causes of groin pain in athletes using the recent Doha consensus classification of terminology and definitions of groin pain in athletes. DESIGN Descriptive epidemiological study. SETTING Multidisciplinary sports groin pain clinic at Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar. PATIENTS The clinical records of 100 consecutive athletes with complaints of groin pain who attended the multidisciplinary sports groin pain clinic between January and December 2014 were analyzed. MAIN OUTCOME MEASURES The causes of groin pain were categorized according to terminology and definitions agreed upon at the Doha consensus meeting on groin pain classification in athletes. The classification system has 3 main subheadings; defined clinical entities for groin pain (adductor-related, iliopsoas-related, inguinal-related, and pubic-related groin pain), hip-related groin pain, and other causes of groin pain in athletes. RESULTS The majority of athletes were male (98%) soccer players (60%). Multiple causes for groin pain were found in 44% of the athletes. Adductor-related groin pain was the most prevalent defined clinical entity (61% of athletes), and pubic-related groin pain was the least prevalent (4% of athletes). CONCLUSIONS Adductor-related groin pain is the most commonly occurring clinical entity in this athlete population in mainly kicking and change of direction sports and frequently, multiple causes are found. CLINICAL RELEVANCE This is the first study to use the Doha agreement classification system and highlights the prevalence of adductor-related groin pain and that often multiple clinical entities contribute to an athlete's groin pain. Consequently, prevention programs should be implemented with these factors in mind.
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Milani CJE, Moley PJ. Advanced Concepts in Hip Morphology, Associated Pathologies, and Specific Rehabilitation for Athletic Hip Injuries. Curr Sports Med Rep 2018; 17:199-207. [PMID: 29889149 DOI: 10.1249/jsr.0000000000000492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Hip and groin injuries comprise up to 17% of athletic injuries and can pose rehabilitation challenges for many athletes. Injuries involving abnormal femoral acetabular morphology, reduced range of motion, and decreased lumbopelvic strength and endurance also may increase the risk of injury to lower extremities and delay return to play if proper rehabilitation does not take place. The rehabilitation of athletic hip injuries requires a multifaceted interdisciplinary approach that manages the interplay of multiple factors to restore preinjury function and facilitate return to play. Emphasis should be placed on activity modification, preservation of the arcs of range of motion, functional strengthening of the lumbopelvic core, and optimization of proprioceptive and neuromechanical strategies. Communication between providers and the injured athlete also is crucial to ensure that proper therapeutic approaches are being applied.
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Affiliation(s)
- Carlo J E Milani
- Department of Physiatry, Hospital for Special Surgery, Darien, CT
| | - Peter J Moley
- Department of Physiatry, Hospital for Special Surgery, New York, NY
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69
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Mandema L, Tak I, Mooij B, Groeneweg R, Bakker E, van Veldhoven P. Assessment of cam morphology of the hip with ultra sound imaging by physical therapists is reliable and valid. Phys Ther Sport 2018; 32:167-172. [PMID: 29793125 DOI: 10.1016/j.ptsp.2018.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/21/2018] [Accepted: 04/10/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Femoroacetabular impingement syndrome is considered present when a combination of clinical symptoms, signs and morphological features of the hip co-exist. Imaging is increasingly popular in primary health care settings with physical therapists performing ultrasound (US). OBJECTIVE The aim of this study was to assess the diagnostic accuracy and inter-rater reliability of ultrasound in determining presence of cam morphology. DESIGN A concurrent validity and inter-rater reliability study. METHODS The presence of cam morphology of the hip was determined by α angle measures using Kinovea software. A cam was defined present when the α angle >60°. The index test was US and radiographs served as a gold standard. RESULTS Correlation between the radiographic α angle and ultrasound measures was r = 0.82 (p < 0.01). Inter-rater reliability was high with an ICC of 0.74 (95% CI 0.61-0.84). The predictive value for presence of cam morphology had a sensitivity of 79% and a specificity of 94%. The positive predictive value was 79% whereas the negative predictive value was 94%. Total accuracy was 90%. CONCLUSIONS Ultrasound conducted by trained physical therapists is a valid, reliable, specific and sensitive diagnostic tool to assess the presence of cam morphology.
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70
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Mosler AB, Weir A, Serner A, Agricola R, Eirale C, Farooq A, Bakken A, Thorborg K, Whiteley RJ, Hölmich P, Bahr R, Crossley KM. Musculoskeletal Screening Tests and Bony Hip Morphology Cannot Identify Male Professional Soccer Players at Risk of Groin Injuries: A 2-Year Prospective Cohort Study. Am J Sports Med 2018; 46:1294-1305. [PMID: 29585730 DOI: 10.1177/0363546518763373] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Musculoskeletal hip/groin screening tests are commonly performed to detect at-risk individuals. Bony hip morphology is considered a potential intrinsic risk factor but has not been examined prospectively. PURPOSE To evaluate the association between intrinsic risk factors identified from musculoskeletal and radiographic screening tests and hip/groin injuries leading to time loss from training and/or match play in professional male soccer players. STUDY DESIGN Prospective cohort study; Level of evidence, 2. METHODS Male professional soccer players, aged ≥18 years, underwent screening specific for hip/groin pain during 2 consecutive seasons of the Qatar Stars League. The screening battery included pain provocation, range of motion, and strength tests as well as a hip radiographic examination. The radiographic examination included an anteroposterior pelvic view and 45° Dunn view, with bony hip morphology determined using quantitative methods. Time-loss (≥1 day) hip/groin injuries and individual player exposure (training and match play) were recorded prospectively, and injuries were categorized as adductor-related, inguinal-related, iliopsoas-related, pubic-related, or hip-related groin pain, or "other," as recommended in the Doha agreement. We calculated hazard ratios (HRs) from univariate and multivariate Cox regression models to assess the relationship between potential risk factors and hip/groin injuries. RESULTS There were 438 players, completing 609 player seasons, and 113 hip/groin injuries that met the criteria for inclusion, with 85 injuries categorized as adductor-related. The proportion of players with bony morphological variants was the following: cam, 71%; pincer, 5%; and acetabular dysplasia, 13%. Previous hip/groin injuries (HR, 1.8; 95% CI, 1.2-2.7) and eccentric adduction strength were associated with the risk of hip/groin injuries. Higher (>1 SD above the mean) than normal eccentric adduction strength was associated with an increased risk for all hip/groin injuries (HR, 1.6; 95% CI, 1.0-2.5). Lower (<1 SD below the mean) than normal eccentric adduction strength was associated with an increased risk for adductor-related injuries (HR, 1.7; 95% CI, 1.0-3.0). No other musculoskeletal screening test or bony hip morphology variables were associated with the injury risk. CONCLUSION Previous groin injuries and eccentric adduction strength were associated with the risk of groin injuries. However, these associations were not strong enough to identify an "at-risk" individual, and therefore, musculoskeletal screening tests were not useful to dictate individualized prevention strategies. Bony hip morphology was not associated with the risk of groin injuries.
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Affiliation(s)
- Andrea B Mosler
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Adam Weir
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Center for Groin Injuries, Department of Orthopaedics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Andreas Serner
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Rintje Agricola
- Department of Orthopaedics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | | - Arnhild Bakken
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Kristian Thorborg
- Sports Orthopedic Research Center-Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Rod J Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Per Hölmich
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Sports Orthopedic Research Center-Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Roald Bahr
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
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Clinical Examination, Diagnostic Imaging, and Testing of Athletes With Groin Pain: An Evidence-Based Approach to Effective Management. J Orthop Sports Phys Ther 2018; 48:239-249. [PMID: 29510653 DOI: 10.2519/jospt.2018.7850] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Synopsis Groin pain is common in athletes who participate in multidirectional sports and has traditionally been considered a difficult problem to understand, diagnose, and manage. This may be due to sparse historical focus on this complex region in sports medicine. Until recently, there has been little agreement regarding terminology, definitions, and classification of groin pain in athletes. This has made clear communication between clinicians difficult, and the results of research difficult to interpret and implement into practice. However, during the past decade, the field has evolved rapidly, and an evidence-based understanding is now emerging. This clinical commentary discusses the clinical examination (subjective history, screening, physical examination); imaging; testing of impairments, function, and performance; and management of athletes with groin pain in an evidence-based framework. J Orthop Sports Phys Ther 2018;48(4):239-249. Epub 6 Mar 2018. doi:10.2519/jospt.2018.7850.
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Hip Strength and Range of Movement Are Associated With Dynamic Postural Control Performance in Individuals Scheduled for Arthroscopic Hip Surgery. J Orthop Sports Phys Ther 2018; 48:280-288. [PMID: 29607762 DOI: 10.2519/jospt.2018.7946] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Cross-sectional. Background Hip pain is associated with reduced muscle strength and range of movement (ROM). These impairments may contribute to decreased postural stability and balance. The Star Excursion Balance Test (SEBT) is a reliable and valid method to measure dynamic postural control. Objectives To evaluate the association between SEBT performance and hip strength, hip ROM, trunk endurance, and group characteristics in individuals with hip pain. Methods One hundred eleven individuals with hip pain, scheduled for arthroscopic hip surgery, were matched with 62 healthy controls. Hip ROM and muscle strength, trunk endurance, and SEBT reach were measured prior to surgery. Data were analyzed for between-group differences using t tests, and associations between SEBT reach and hip strength, hip ROM, and population characteristics were evaluated with Pearson correlation coefficients and stepwise backward regression analyses. Results Star Excursion Balance Test performance (P<.01), hip strength (P<.01), and hip ROM (P<.05) were lower in the presurgery group compared to controls. In the presurgery group, when adjusted for height and weight, hip flexion strength and internal rotation ROM accounted for 44% of the variance in anteromedial SEBT reach. In the posteromedial direction, hip adduction strength and sex accounted for 53% of the variance. For the posterolateral direction, hip adduction and internal rotation strength accounted for 46% of reach variance. Conclusion The individuals who were scheduled for arthroscopic hip surgery were significantly weaker, had less hip mobility, and had reduced dynamic balance compared to controls. In this population, dynamic balance performance was associated with various hip strength and ROM measurements in a direction-specific manner. J Orthop Sports Phys Ther 2018;48(4):280-288. doi:10.2519/jospt.2018.7946.
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Is Bony Hip Morphology Associated With Range of Motion and Strength in Asymptomatic Male Soccer Players? J Orthop Sports Phys Ther 2018; 48:250-259. [PMID: 29548272 DOI: 10.2519/jospt.2018.7848] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Cross-sectional cohort study. Objectives To investigate the relationship between musculoskeletal screening findings and bony hip morphology in asymptomatic male soccer players. Background Athletes with femoroacetabular impingement (FAI) syndrome have cam and/or pincer morphology, pain on orthopaedic testing, and often reduced hip range of motion (ROM) and strength. However, cam and pincer morphology is also common in asymptomatic hips. Therefore, it is currently unknown whether the ROM and strength deficits observed in athletes with FAI syndrome result from the variance in their bony hip morphology or from their hip condition. Methods Male professional soccer players in Qatar were screened specifically for hip/groin pain in 2 consecutive seasons. The screening battery included pain provocation, ROM and strength tests, and hip radiographs. Univariate and multivariate regression analyses, using generalized estimating equations, evaluated the relationship between musculoskeletal screening findings and each bony hip morphological variant (cam, large cam, pincer, and acetabular dysplasia). Results Asymptomatic hips with cam and large cam morphology were associated with lower internal rotation ROM and bent-knee fall-out, and with a higher likelihood of pain on provocation testing. Pincer morphology was associated with lower abduction ROM and higher abduction strength. Acetabular dysplasia was associated with higher abduction ROM. Each association was weak and demonstrated poor or failed discriminatory power. Conclusion Bony hip morphology is associated with hip joint ROM and abduction strength, but musculoskeletal screening tests have a poor ability to discriminate between the different morphologies. J Orthop Sports Phys Ther 2018;48(4):250-259. doi:10.2519/jospt.2018.7848.
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The success of return to sport after ulnar collateral ligament injury in baseball: a systematic review and meta-analysis. J Shoulder Elbow Surg 2018; 27:561-571. [PMID: 29433647 DOI: 10.1016/j.jse.2017.12.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 11/17/2017] [Accepted: 12/03/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ulnar collateral ligament injury (UCLI) has significantly increased in overhead sports during the past 2 decades. Differences in return to sport (RTS) and RTS at previous level (RTSP) after UCLI have not been differentiated. METHODS A computer-assisted literature search of PubMed, CINAHL, Embase, and SportDiscus databases using keywords related to RTS for UCLI was implemented. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for study methodology. Quality assessment was conducted using a modified Downs and Black scale. RESULTS A total of 22 retrospective, level 3b or 4, studies (n = 2289) qualified for analysis. Overall RTS proportion was 90% (95% confidence interval [CI], 86%-94%) and overall RTSP proportion was 79% (95% CI, 75%-84%), both with significant heterogeneity (P < .001, I2 = 74%-84%). RTS and RTSP proportions were 89% (95% CI, 83%-94%) and 78% (95% CI, 72%-83%) for Major League Baseball players, 91% (95% CI, 77%-99%) and 67% (95% CI, 52%-81%) for Minor League Baseball players, 95% (95% CI, 75%-100%) and 92% (95% CI, 82%-98%) for collegiate players, and 93% (95% CI, 81%-100%) and 83% (95% CI, 77%-89%) for high school players, respectively. Increased earned run average, walks, and hits per inning pitched, decreased innings pitched, and decreased fastball velocity were found after UCLI. CONCLUSION Low-level, high-bias evidence demonstrates overall RTS proportion is higher than RTSP, regardless of treatment type for UCLI. Although RTS proportions remained consistent across various levels of play, RTSP proportions were lower in professional players, particularly Minor League Baseball compared with collegiate and high school players. Pitching performance significantly decreased postoperatively in most studies.
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Light N, Smith N, Delahunt E, Thorborg K. Hip and groin injury management in English youth football: a survey of 64 professional academies. SCI MED FOOTBALL 2018. [DOI: 10.1080/24733938.2018.1441536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Neil Light
- Department of Sport and Exercise Sciences, University of Chichester, Chichester, UK
| | - Neal Smith
- Department of Sport and Exercise Sciences, University of Chichester, Chichester, UK
| | - Eamonn Delahunt
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Kristian Thorborg
- Department of Orthopedic Surgery, Sports Orthopedic Research Center - Copenhagen (SORC-C), Copenhagen University Hospital, Amager-Hvidovre, Copenhagen, Denmark
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Tak I, Pope D, Engelaar L, Gouttebarge V, Barendrecht M, Van den Heuvel S, Kerkhoffs G, Langhout R, Stubbe J, Weir A. Infographic. Is lower hip range of motion a risk factor for groin pain in athletes? A systematic review with clinical applications. Br J Sports Med 2018; 52:1022-1023. [PMID: 29449206 DOI: 10.1136/bjsports-2017-098535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Igor Tak
- Manual Therapy and Sports Rehabilitation, Physiotherapy Utrecht Oost, Utrecht, The Netherlands.,Academic Center for Evidence Based Sports Medicine (ACES), Academic Medical Center Amsterdam, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam, The Netherlands.,AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - David Pope
- Clinical Edge, Terrigal, New South Wales, Australia
| | | | - Vincent Gouttebarge
- Coronel Institute of Occupational Health, Academic Medical Center, Amsterdam, The Netherlands
| | - Maarten Barendrecht
- Dutch Center for Allied Health Care, Amersfoort, The Netherlands.,Master Physical Therapy in Sports, Avans+ Improving Professionals, Breda, The Netherlands
| | | | - Gino Kerkhoffs
- Academic Center for Evidence Based Sports Medicine (ACES), Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Rob Langhout
- Manual Therapy and Sports Rehabilitation, Physiotherapy Dukenburg Nijmegen, Nijmegen, The Netherlands
| | - Janine Stubbe
- School of Sports & Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Adam Weir
- Department of Sports Medicine, Aspetar Hospital, Doha, Qatar
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Esteve E, Rathleff MS, Vicens-Bordas J, Clausen MB, Hölmich P, Sala L, Thorborg K. Preseason Adductor Squeeze Strength in 303 Spanish Male Soccer Athletes: A Cross-sectional Study. Orthop J Sports Med 2018; 6:2325967117747275. [PMID: 29349093 PMCID: PMC5768277 DOI: 10.1177/2325967117747275] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Hip adductor muscle weakness and a history of groin injury both have been identified as strong risk factors for sustaining a new groin injury. Current groin pain and age have been associated with hip adductor strength. These factors could be related, but this has never been investigated. Purpose: To investigate whether soccer athletes with past-season groin pain and with different durations of past-season groin pain had lower preseason hip adductor squeeze strength compared with those without past-season groin pain. We also investigated whether differences in preseason hip adductor squeeze strength in relation to past-season groin pain and duration were influenced by current groin pain and age. Study Design: Cross-sectional study; Level of evidence, 3. Methods: In total, 303 male soccer athletes (mean age, 23 ± 4 years; mean weight, 74.0 ± 7.9 kg; mean height, 178.1 ± 6.3 cm) were included in this study. Self-reported data regarding current groin pain, past-season groin pain, and duration were collected. Hip adductor squeeze strength was obtained using 2 different reliable testing procedures: (1) the short-lever (resistance placed between the knees, feet at the examination bed, and 45° of hip flexion) and (2) the long-lever (resistance placed between the ankles and 0° of hip flexion) squeeze tests. Results: There was no difference between those with (n = 123) and without (n = 180) past-season groin pain for hip adductor squeeze strength when adjusting for current groin pain and age. However, athletes with past-season groin pain lasting longer than 6 weeks (n = 27) showed 11.5% and 15.3% lower values on the short-lever (P = .006) and long-lever (P < .001) hip adductor squeeze strength tests, respectively, compared with those without past-season groin pain. Conclusion: Male soccer athletes with past-season groin pain lasting longer than 6 weeks are likely to begin the next season with a high-risk groin injury profile, including a history of groin pain and hip adduction weakness.
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Affiliation(s)
- Ernest Esteve
- Sportclínic, Physiotherapy and Sports Training Centre, Girona, Spain.,School of Health and Sport Sciences (EUSES), University of Girona, Salt, Spain
| | - Michael Skovdal Rathleff
- Center for Sensory-Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
| | - Jordi Vicens-Bordas
- Sportclínic, Physiotherapy and Sports Training Centre, Girona, Spain.,School of Health and Sport Sciences (EUSES), University of Girona, Salt, Spain
| | - Mikkel Bek Clausen
- Sports Orthopedic Research Center-Copenhagen, Department of Orthopedic Surgery, Amager-Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Physiotherapy and Occupational Therapy, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark
| | - Per Hölmich
- Sports Orthopedic Research Center-Copenhagen, Department of Orthopedic Surgery, Amager-Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
| | - Lluís Sala
- Sportclínic, Physiotherapy and Sports Training Centre, Girona, Spain
| | - Kristian Thorborg
- Sports Orthopedic Research Center-Copenhagen, Department of Orthopedic Surgery, Amager-Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark.,Physical Medicine and Rehabilitation Research-Copenhagen, Amager-Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
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78
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Short S, Short G, Strack D, Anloague P, Brewster B. A COMBINED TREATMENT APPROACH EMPHASIZING IMPAIRMENT-BASED MANUAL THERAPY AND EXERCISE FOR HIP-RELATED COMPENSATORY INJURY IN ELITE ATHLETES: A CASE SERIES. Int J Sports Phys Ther 2017; 12:994-1010. [PMID: 29158960 PMCID: PMC5675375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND/PURPOSE Athletes experiencing hip, groin, and low back pain often exhibit similar clinical characteristics. Individuals with hip, groin and low back pain may have the presence of multiple concurrent pathoanatomical diagnoses. Regardless, similar regional characteristics and dysfunction may contribute to the patient's chief complaint, potentially creating a sub-group of individuals that may be defined by lumbopelvic and hip mobility limitations, motor control impairments, and other shared clinical findings. The purpose of this case series is to describe the conservative management of elite athletes, within the identified aforementioned sub-group, that emphasized regional manual therapy interventions, and therapeutic exercise designed to improve lumbopelvic and hip mobility, stability and motor control. CASE DESCRIPTIONS Five elite athletes were clinically diagnosed by a physical therapist with primary pathologies including adductor-related groin pain (ARGP), femoral acetabular impingement (FAI) with acetabular labral lesion and acute, mechanical low back pain (LBP). Similar subjective, objective findings and overall clinical profiles were identified among all subjects. Common findings aside from the chief complaint included, but were not limited to, decreased hip range of motion (ROM), impaired lumbopelvic motor control and strength, lumbar hypomobility in at least one segment, and a positive hip flexion-adduction-internal rotation (FADIR) special test. A three-phase impairment-based physical therapy program was implemented to resolve the primary complaints and return the subjects to their desired level of function. Acute phase rehabilitation consisted of manual therapy and fundamental motor control exercises. Progression to the sub-acute and terminal phases was based on improved subjective pain reports and progress with functional impairments. As the subjects progress through the rehabilitation phases, the delivery of physical therapy interventions were defined by decreased manual therapies and an increased emphasis and priority on graded exercise. OUTCOMES Significant reductions in reported pain (>2 points Numeric Pain Rating Scale), improved reported function via functional outcome measures (Hip and Groin Outcome Score), and continued participation in sport occurred in all five cases without the need for surgical intervention. DISCUSSION The athletes described in this case series make up a common clinical sub-group defined by hip and lumbopelvic mobility restrictions, lumbopelvic and lower extremity motor control impairments and potentially other shared clinical findings. Despite differences in pathoanatomic findings, similar objective findings were identified and similar treatment plans were applied, potentially affecting the movement system as a whole. Subjects were conservatively managed allowing continued participation in sport within their competitive seasons. CONCLUSION Comprehensive conservative treatment of the athletes with shared impairments, as described in this case series, may be of clinical importance when managing athletes with hip, groin, and low back pain. LEVEL OF EVIDENCE Therapy, Level 4, Case Series.
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Affiliation(s)
- Steve Short
- Regis University Orthopaedic Manual Physical Therapy Fellowship, Denver, CO, USA
| | | | - Donald Strack
- Regis University Orthopaedic Manual Physical Therapy Fellowship, Denver, CO, USA
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79
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Frangiamore S, Mannava S, Geeslin AG, Chahla J, Cinque ME, Philippon MJ. Comprehensive Clinical Evaluation of Femoroacetabular Impingement: Part 1, Physical Examination. Arthrosc Tech 2017; 6:e1993-e2001. [PMID: 29399467 PMCID: PMC5792748 DOI: 10.1016/j.eats.2017.03.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/07/2017] [Indexed: 02/03/2023] Open
Abstract
A thorough evaluation of the hip must include a comprehensive medical and surgical history focused on the hip joint, surrounding soft tissues, and the associated structures of the spine, pelvis, and lower extremities. These details can guide the physical examination and provide insight into the cause of the patient's chief complaints. A proper examination includes physical examination while the patient is in the upright, supine, prone, and lateral position, as well as an evaluation of gait. Guided by a thorough history, the physical examination enables the surgeon to distinguish between intra-articular and extra-articular contributors to hip pain, selection of appropriate imaging modalities, and ultimately supports medical decision making.
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Affiliation(s)
| | - Sandeep Mannava
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Mark E. Cinque
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Marc J. Philippon
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.,The Steadman Clinic, Vail, Colorado, U.S.A.,Address correspondence to Marc J. Philippon, M.D., Steadman Philippon Research Institute, The Stedman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO 81657, U.S.A.Steadman Philippon Research InstituteThe Stedman Clinic181 West Meadow DriveSuite 400VailCO81657U.S.A.
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80
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Devitt BM, Bell SW, Ardern CL, Hartwig T, Porter TJ, Feller JA, Webster KE. The Role of Lateral Extra-articular Tenodesis in Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review With Meta-analysis and Best-Evidence Synthesis. Orthop J Sports Med 2017; 5:2325967117731767. [PMID: 29124075 PMCID: PMC5661757 DOI: 10.1177/2325967117731767] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background The role of lateral extra-articular tenodesis (LEAT) to augment primary anterior cruciate ligament reconstruction (ACLR) remains controversial. Purpose To determine whether the addition of LEAT to primary ACLR provides greater control of rotational laxity and improves clinical outcomes compared with ACLR alone and to assess the impact of early versus delayed ACLR. Study Design Systematic review; Level of evidence, 3. Methods Two reviewers independently searched 7 databases for randomized and nonrandomized clinical studies comparing ACLR plus LEAT versus ACLR alone. Animal, cadaveric, and biomechanical studies; revision or repair procedures; and studies using synthetic ligaments and multiligamentous-injured knees were excluded. Risk of bias was assessed with a modified Downs and Black checklist. The primary outcome was postoperative pivot shift. These data were pooled by use of a fixed-effects meta-analysis model. The studies were divided into delayed (>12 months) and early (≤12 months) reconstruction groups for meta-analysis. A best-evidence synthesis was performed on the remaining outcome measures. Results Of 387 titles identified, 11 articles were included (5 of high quality). Meta-analysis of postoperative pivot shift in 3 studies of delayed primary ACLR showed a statistically significant difference for the pivot-shift test in favor of ACLR with LEAT (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.24-0.81; P = .008; I2 = 0). Meta-analysis of 5 studies of early primary ACLR found no statistically significant difference with the addition of LEAT (OR, 0.60; 95% CI, 0.33-1.09; P = .10; I2 = 33%). Insufficient evidence was available to determine whether the addition of LEAT had any effect on clinical, objective, subjective, and functional outcomes. Conclusion In primary ACLR, no evidence is available showing additional benefit of LEAT in reducing the postoperative pivot shift in early reconstructions (≤12 months); however, LEAT may have a role in delayed ACLR. Strong evidence exists that a combined ACLR and LEAT reduces lateral femoral translation, but there is insufficient evidence to identify any benefit for other clinical outcomes.
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Affiliation(s)
- Brian M Devitt
- OrthoSport Victoria, Epworth Healthcare, Melbourne, Australia.,School of Allied Health, La Trobe University, Melbourne, Australia
| | - Stuart W Bell
- OrthoSport Victoria, Epworth Healthcare, Melbourne, Australia
| | | | - Taylor Hartwig
- OrthoSport Victoria, Epworth Healthcare, Melbourne, Australia
| | | | - Julian A Feller
- OrthoSport Victoria, Epworth Healthcare, Melbourne, Australia
| | - Kate E Webster
- School of Allied Health, La Trobe University, Melbourne, Australia
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81
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Janse van Rensburg L, Dare M, Louw Q, Crous L, Cockroft J, Williams L, Olivier B. Pelvic and hip kinematics during single-leg drop-landing are altered in sports participants with long-standing groin pain: A cross-sectional study. Phys Ther Sport 2017. [DOI: 10.1016/j.ptsp.2017.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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82
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Larson CM, Ross JR, Kuhn AW, Fuller D, Rowley DM, Giveans MR, Stone RM, Bedi A. Radiographic Hip Anatomy Correlates With Range of Motion and Symptoms in National Hockey League Players. Am J Sports Med 2017; 45:1633-1639. [PMID: 28298064 DOI: 10.1177/0363546517692542] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip disorders in athletes have been increasingly recognized. PURPOSE To characterize radiographic hip anatomy for National Hockey League (NHL) players and correlate it with hip range of motion and hip symptoms and/or surgery. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Fifty-nine professional hockey players (118 hips) with 1 NHL organization (mean age, 24.2 years; range, 18-36) prospectively underwent history and physician examination by 2 independent orthopaedic surgeons. Current or previous groin and/or hip pain or surgery was noted. Anteroposterior (AP) pelvis and bilateral Dunn lateral radiographs were obtained for all players with assessment of hip morphology by 2 blinded independent orthopaedic surgeons. RESULTS Good to very good reliability of radiographic assessments was noted (intraclass correlation coefficients = 0.749-0.958). Sixty-four percent of athletes had a positive crossover sign, while 86% and 60% had a positive posterior wall sign and a prominent ischial spine sign, respectively. Twenty-one percent of hips demonstrated dysplastic acetabular features (lateral center edge angle <25°). Eighty-five percent and 89% of hips demonstrated cam-type morphology based on alpha angle (>50° Dunn lateral) and head-neck offset, respectively. Good to very good reliability was noted for ROM assessments (intraclass correlation coefficient >0.69). Mean hip flexion was 107.4º ± 6.7º, and mean hip internal rotation was 26.1º ± 6.6º. Thirty-one percent of hips had a history of hip-related pain and/or surgery. Higher AP, Dunn lateral, and maximal alpha angles correlated with decreased hip internal rotation ( P = .004). Greater AP alpha angle correlated with decreased hip extension/abduction ( P = .025), and greater Dunn lateral and maximal alpha angle correlated with decreased hip flexion/abduction ( P = .001). A positive posterior wall sign correlated with increased straight hip abduction, while other radiographic acetabular parameters were not predictive of range of motion. Only decreased hip external rotation and total arc of motion correlated with an increased risk for current or prior hip symptoms or surgery ( P < .001). CONCLUSION Hip anatomy in NHL players is characterized by highly prevalent cam-type morphology (>85%) and acetabular retroversion (>60%). In addition, acetabular dysplasia (21%) was relatively common. Greater cam-type morphology correlated with decreased hip range of motion, and a positive crossover sign correlated with increased hip abduction. Decreased hip external rotation and total arc of motion were predictive of hip-related pain and/or surgery.
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Affiliation(s)
- Christopher M Larson
- Minnesota Orthopedic Sports Medicine Institute, Twin Cities Orthopedics, Edina, Minnesota, USA
| | - James R Ross
- Boca Care Orthopedics, Boca Raton Regional Hospital, Boca Raton, Florida, USA.,College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Andrew W Kuhn
- Department of Orthopaedic Surgery-MedSport, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Donnie Fuller
- Minnesota Wild Hockey Club, National Hockey League, St Paul, Minnesota, USA
| | - David M Rowley
- Fairview/MOSMI Orthopedic Fellowship Program, Minneapolis, Minnesota, USA
| | - M Russell Giveans
- Minnesota Orthopedic Sports Medicine Institute, Twin Cities Orthopedics, Edina, Minnesota, USA
| | - Rebecca M Stone
- Minnesota Orthopedic Sports Medicine Institute, Twin Cities Orthopedics, Edina, Minnesota, USA
| | - Asheesh Bedi
- Department of Orthopaedic Surgery-MedSport, University of Michigan Medical School, Ann Arbor, Michigan, USA
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83
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Drew MK, Raysmith BP, Charlton PC. Injuries impair the chance of successful performance by sportspeople: a systematic review. Br J Sports Med 2017; 51:1209-1214. [DOI: 10.1136/bjsports-2016-096731] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2017] [Indexed: 01/08/2023]
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84
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Tak I, Engelaar L, Gouttebarge V, Barendrecht M, Van den Heuvel S, Kerkhoffs G, Langhout R, Stubbe J, Weir A. Is lower hip range of motion a risk factor for groin pain in athletes? A systematic review with clinical applications. Br J Sports Med 2017; 51:1611-1621. [PMID: 28432076 PMCID: PMC5754850 DOI: 10.1136/bjsports-2016-096619] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Whether hip range of motion (ROM) is a risk factor for groin pain in athletes is not known. OBJECTIVES To systematically review the relationship between hip ROM and groin pain in athletes in cross-sectional/case-control and prospective studies. STUDY DESIGN Systematic review, prospectively registered (PROSPERO) according to PRISMA guidelines. METHODS Pubmed, Embase, CINAHL and SPORTDiscus were systematically searched up to December 2015. Two authors performed study selection, data extraction/analysis, quality assessment (Critical Appraisal Skills Programme) and strength of evidence synthesis. RESULTS We identified seven prospective and four case-control studies. The total quality score ranged from 29% to 92%. Heterogeneity in groin pain classification, injury definitions and physical assessment precluded data pooling. There was strong evidence that total rotation of both hips below 85° measured at the pre-season screening was a risk factor for groin pain development. Strong evidence suggested that internal rotation, abduction and extension were not associated with the risk or presence of groin pain. CONCLUSION Total hip ROM is the factor most consistently related to groin pain in athletes. Screening for hip ROM is unlikely to correctly identify an athlete at risk of developing groin pain because of the small ROM differences found and poor ROM measurement properties.
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Affiliation(s)
- Igor Tak
- Manual Therapy and Sports Rehabilitation, Physiotherapy Utrecht Oost, Utrecht, The Netherlands.,Academic Center for Evidence based Sports Medicine (ACES), AMC, Amsterdam, The Netherlands
| | | | - Vincent Gouttebarge
- Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Maarten Barendrecht
- Dutch Center for Allied Health Care, Amersfoort, The Netherlands.,Master Physical Therapy in Sports, Avans+ Improving Professionals, Breda, The Netherlands
| | | | - Gino Kerkhoffs
- Department of Orthopedic Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Rob Langhout
- Manual Therapy and Sports Rehabilitation, Physiotherapy Dukenburg Nijmegen, Nijmegen, The Netherlands
| | - Janine Stubbe
- School of Sports & Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Codarts University of the arts, Rotterdam, The Netherlands
| | - Adam Weir
- Department of Sports Medicine, Aspetar hospital, Doha, Qatar
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85
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Drew MK, Lovell G, Palsson TS, Chiarelli PE, Osmotherly PG. Australian football players experiencing groin pain exhibit reduced subscale scores of Activities of Daily Living and Sport and Recreation on the HAGOS questionnaire: A case-control study. Phys Ther Sport 2017; 26:7-12. [PMID: 28549243 DOI: 10.1016/j.ptsp.2017.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 04/11/2017] [Accepted: 04/18/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To report normative responses to the HAGOS questionnaire for Australian football players and to determine whether any of the HAGOS questionnaire sub scales can differentiate players with and without groin pain. DESIGN Case-control. SETTING Clinical setting. PARTICIPANTS Professional (n = 66) and semi-professional (n = 9) Australian football (AF) players with current groin pain (n = 16) and controls (n = 57) without current groin pain. MAIN OUTCOME MEASURE The HAGOS subscales were compared between players with and without groin pain using the Wilcoxon rank-sum test with effect sizes (ES) calculated. Floor and ceiling effects were examined. A post-hoc factor analysis was undertaken. RESULTS Participants with current groin pain showed lower Physical Function of Daily Living (PFDL) and Physical Function in Sport and Recreation (PFSR) subscale scores (p < 0.05, ES: 0.77 and 0.90 respectively). Any groin pain (current and/or historical) lowered the Pain and Quality of Life (QOL) subscale scores (p < 0.05, ES: 0.38 and 0.72 respectively). Factor analysis showed 8 significant factors with one main factor identified representing items describing forceful activities (Eigenvalue = 18.02, Proportion = 0.49). CONCLUSIONS The HAGOS can distinguish AF players with current groin pain in the PFDL and PFSR subscales but not in the other four subscales. Any current or historical groin pain lowers scores on the QOL and Pain sub scales. LEVEL OF EVIDENCE Aetiology, Individual Case-Control Study, Level 3b.
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Affiliation(s)
- Michael K Drew
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia; Department of Physical Therapies, Australian Institute of Sport, Canberra, Australia.
| | - Gregory Lovell
- Department of Sports Medicine, Australian Institute of Sport, Canberra, Australia
| | - Thorvaldur S Palsson
- Center for Neuroplasticity and Pain (CNAP), SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Pauline E Chiarelli
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Peter G Osmotherly
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
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86
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Hip strength and range of motion: Normal values from a professional football league. J Sci Med Sport 2017; 20:339-343. [DOI: 10.1016/j.jsams.2016.05.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 05/17/2016] [Accepted: 05/23/2016] [Indexed: 11/30/2022]
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87
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A new clinical test for measurement of lower limb specific range of motion in football players: Design, reliability and reference findings in non-injured players and those with long-standing adductor-related groin pain. Phys Ther Sport 2017; 23:67-74. [DOI: 10.1016/j.ptsp.2016.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 07/26/2016] [Accepted: 07/27/2016] [Indexed: 11/18/2022]
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88
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Worse self-reported outcomes but no limitations in performance-based measures in patients with long-standing hip and groin pain compared with healthy controls. Knee Surg Sports Traumatol Arthrosc 2017; 25:101-107. [PMID: 27056690 DOI: 10.1007/s00167-016-4101-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 03/22/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE This study aimed to evaluate patient-reported outcomes as well as lower extremity and trunk muscle function in patients with long-standing hip and groin pain, in comparison with matched, healthy controls. It was hypothesized that patients with long-standing hip and groin pain would report more deficiency on the Copenhagen Hip and Groin Outcome Score (HAGOS) and have worse outcomes on performance-based measures than healthy controls. METHODS Nineteen patients with long-standing hip and groin pain and 19 healthy, activity level-, age-, gender-, and weight-matched controls were assessed with the HAGOS for self-reported outcomes, and a parallel squat (w/kg), single-leg triple jump (cm), single-leg rise (n), barbell roll-out (% of height), and plank test (s) for performance-based measures. Independent sample t test was performed to assess between-group differences. The paired t test was used to analyse between-limb differences in unilateral performance tasks. RESULTS The patients had worse scores than the controls in all HAGOS subscales (p ≤ 0.001), while no statistically significant differences were observed for any performance measure between groups or between symptomatic and non-symptomatic limbs. CONCLUSIONS Despite significant self-reported functional limitations on the HAGOS, there were no significant differences between groups in performance-based strength or power measures. The results of this study highlight the need to identify performance-based measures, sensitive to functional deficiencies in patients with long-standing hip and groin pain in order to complement the clinical picture obtained by patient-reported outcomes such as the HAGOS. LEVEL OF EVIDENCE III.
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89
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The ability of athletes with long-standing groin pain to maintain a stable lumbopelvic position: A laboratory study. Phys Ther Sport 2017; 23:45-49. [DOI: 10.1016/j.ptsp.2016.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 05/10/2016] [Accepted: 06/24/2016] [Indexed: 11/19/2022]
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90
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Bakken A, Targett S, Bere T, Adamuz MC, Tol JL, Whiteley R, Wilson MG, Witvrouw E, Khan KM, Bahr R. Health conditions detected in a comprehensive periodic health evaluation of 558 professional football players. Br J Sports Med 2016; 50:1142-50. [PMID: 27012663 DOI: 10.1136/bjsports-2015-095829] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Despite the widespread use of periodic health evaluation (PHE) to detect and prevent injury and illness in athletes, its effectiveness in detecting health conditions and relevant risk factors is still debated. AIM To assess health conditions detected by a comprehensive PHE in professional male football players and evaluate their consequences for participation clearance. METHODS A total of 558 professional football players in Qatar completed a PHE prior to the 2013 or 2014 seasons: history, general medical (including blood test), cardiovascular (12-lead ECG and echocardiography) and a musculoskeletal examination, including a specific test battery targeting lower extremity strength and flexibility. On the basis of the PHE, players were either cleared or not cleared for participation. RESULTS In 533 players (95.5%), at least one health condition was detected requiring treatment or follow-up. Vitamin D deficiency or insufficiency (≤30 ng/mL) was the most common medical condition (n=499, 89.4%), followed by hepatitis B non-immunity or infection (n=164, 29.4%). Cardiac screening identified 48 players (8.6%) with one or more abnormal findings (ECG (n=19, 3.4%) and echocardiography (n=14, 2.5%)). Musculoskeletal conditions were observed in 180 players (32.3%); injuries to or strength deficits of the hip/groin and thigh accounted for the largest proportion. Medical clearance was temporarily not given in 69 players (12.4%), while further examinations were being conducted. One player was disqualified from competitive football. CONCLUSIONS PHE revealed a high prevalence of health conditions requiring treatment or follow-up in professional footballers; however, only 12.4% of conditions impacted on final clearance for participation.
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Affiliation(s)
- Arnhild Bakken
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Stephen Targett
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Tone Bere
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Department of Orthopaedics, Oslo University Hospital, Oslo, Norway
| | | | - Johannes L Tol
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar The Sports Physician Group, Department of Sports Medicine, St Lucas Andreas Hospital, Amsterdam, The Netherlands Amsterdam Center of Evidence Based Sports Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Rod Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Mathew G Wilson
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Research Institute of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK Research Institute of Sport and Exercise Sciences, University of Canberra, Australia
| | - Erik Witvrouw
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Karim M Khan
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Roald Bahr
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
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91
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Delahunt E, Thorborg K, Khan KM, Robinson P, Hölmich P, Weir A. Minimum reporting standards for clinical research on groin pain in athletes. Br J Sports Med 2016; 49:775-81. [PMID: 26031644 PMCID: PMC4484363 DOI: 10.1136/bjsports-2015-094839] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Groin pain in athletes is a priority area for sports physiotherapy and sports medicine research. Heterogeneous studies with low methodological quality dominate research related to groin pain in athletes. Low-quality studies undermine the external validity of research findings and limit the ability to generalise findings to the target patient population. Minimum reporting standards for research on groin pain in athletes are overdue. We propose a set of minimum reporting standards based on best available evidence to be utilised in future research on groin pain in athletes. Minimum reporting standards are provided in relation to: (1) study methodology, (2) study participants and injury history, (3) clinical examination, (4) clinical assessment and (5) radiology. Adherence to these minimum reporting standards will strengthen the quality and transparency of research conducted on groin pain in athletes. This will allow an easier comparison of outcomes across studies in the future.
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Affiliation(s)
- Eamonn Delahunt
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland Institute for Sport and Health, University College Dublin, Dublin, Ireland
| | - Kristian Thorborg
- Sports Orthopedic Research Center-Copenhagen (SORC-C), Arthroscopic Center Amager, Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Karim M Khan
- Aspetar Sports Groin Pain Center, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Philip Robinson
- Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals, University of Leeds, Leeds, UK
| | - Per Hölmich
- Sports Orthopedic Research Center-Copenhagen (SORC-C), Arthroscopic Center Amager, Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark Aspetar Sports Groin Pain Center, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Adam Weir
- Aspetar Sports Groin Pain Center, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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92
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Weir A, Brukner P, Delahunt E, Ekstrand J, Griffin D, Khan KM, Lovell G, Meyers WC, Muschaweck U, Orchard J, Paajanen H, Philippon M, Reboul G, Robinson P, Schache AG, Schilders E, Serner A, Silvers H, Thorborg K, Tyler T, Verrall G, de Vos RJ, Vuckovic Z, Hölmich P. Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med 2016; 49:768-74. [PMID: 26031643 PMCID: PMC4484366 DOI: 10.1136/bjsports-2015-094869] [Citation(s) in RCA: 295] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Heterogeneous taxonomy of groin injuries in athletes adds confusion to this complicated area. Aim The ‘Doha agreement meeting on terminology and definitions in groin pain in athletes’ was convened to attempt to resolve this problem. Our aim was to agree on a standard terminology, along with accompanying definitions. Methods A one-day agreement meeting was held on 4 November 2014. Twenty-four international experts from 14 different countries participated. Systematic reviews were performed to give an up-to-date synthesis of the current evidence on major topics concerning groin pain in athletes. All members participated in a Delphi questionnaire prior to the meeting. Results Unanimous agreement was reached on the following terminology. The classification system has three major subheadings of groin pain in athletes: 1. Defined clinical entities for groin pain: Adductor-related, iliopsoas-related, inguinal-related and pubic-related groin pain. 2. Hip-related groin pain. 3. Other causes of groin pain in athletes. The definitions are included in this paper. Conclusions The Doha agreement meeting on terminology and definitions in groin pain in athletes reached a consensus on a clinically based taxonomy using three major categories. These definitions and terminology are based on history and physical examination to categorise athletes, making it simple and suitable for both clinical practice and research.
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Affiliation(s)
- Adam Weir
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | - Eamonn Delahunt
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland Institute for Sport and Health, University College Dublin, Dublin, Ireland
| | - Jan Ekstrand
- Football Research Group, Department of Medicine and Health, University of Linköping, Linkoping, Sweden
| | - Damian Griffin
- Warwick Medical School, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Karim M Khan
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Greg Lovell
- Australian Institute of Sport, Bruce, Australian Capital Territory, Australia
| | | | | | - John Orchard
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Hannu Paajanen
- Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Marc Philippon
- The Steadman Clinic, Steadman Philippon Research Institute, Vail, Colorado, USA McMaster University, Hamilton, Ontario, Canada University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Gilles Reboul
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Hernia Center, Clinique du Sport, Merignac, France
| | - Philip Robinson
- Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals, University of Leeds, Leeds, UK
| | - Anthony G Schache
- Department of Mechanical Engineering, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ernest Schilders
- Fortius Clinic, Leeds Beckett University, The Wellington Hospital, London, UK
| | - Andreas Serner
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Amager-Hvidovre Hospital, Copenhagen, Denmark
| | - Holly Silvers
- Santa Monica Sports Medicine Foundation & Institute for Sports Science, University of Delaware, Delaware, USA
| | - Kristian Thorborg
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Amager-Hvidovre Hospital, Copenhagen, Denmark
| | - Timothy Tyler
- The Nicholas Institute of Sports Medicine & Athletic Trauma @ Lenox Hill Hospital, New York, New York, USA
| | - Geoffrey Verrall
- SPORTSMED.SA Sports Medicine Clinic, Adelaide, South Australia, Australia
| | - Robert-Jan de Vos
- Department of orthopaedics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Zarko Vuckovic
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Per Hölmich
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Amager-Hvidovre Hospital, Copenhagen, Denmark
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93
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Reiman MP, Sylvain J, Loudon JK, Goode A. Return to sport after open and microdiscectomy surgery versus conservative treatment for lumbar disc herniation: a systematic review with meta-analysis. Br J Sports Med 2015; 50:221-30. [PMID: 26491033 DOI: 10.1136/bjsports-2015-094691] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Lumbar disc herniation has a prevalence of up to 58% in the athletic population. Lumbar discectomy is a common surgical procedure to alleviate pain and disability in athletes. We systematically reviewed the current clinical evidence regarding athlete return to sport (RTS) following lumbar discectomy compared to conservative treatment. METHODS A computer-assisted literature search of MEDLINE, CINAHL, Web of Science, PEDro, OVID and PubMed databases (from inception to August 2015) was utilised using keywords related to lumbar disc herniation and surgery. The design of this systematic review was developed using the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Methodological quality of individual studies was assessed using the Downs and Black scale (0-16 points). RESULTS The search strategy revealed 14 articles. Downs and Black quality scores were generally low with no articles in this review earning a high-quality rating, only 5 articles earning a moderate quality rating and 9 of the 14 articles earning a low-quality rating. The pooled RTS for surgical intervention of all included studies was 81% (95% CI 76% to 86%) with significant heterogeneity (I(2)=63.4%, p<0.001) although pooled estimates report only 59% RTS at same level. Pooled analysis showed no difference in RTS rate between surgical (84% (95% CI 77% to 90%)) and conservative intervention (76% (95% CI 56% to 92%); p=0.33). CONCLUSIONS Studies comparing surgical versus conservative treatment found no significant difference between groups regarding RTS. Not all athletes that RTS return at the level of participation they performed at prior to surgery. Owing to the heterogeneity and low methodological quality of included studies, rates of RTS cannot be accurately determined.
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Affiliation(s)
- Michael P Reiman
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jonathan Sylvain
- Department of Rehabilitation and Sports Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Janice K Loudon
- Department of Physical Therapy Education, Rockhurst University, Kansas City, Missouri, USA
| | - Adam Goode
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
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94
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Weir A. Thousand mile journey. Part II: collaborative steps to advance the management of groin pain in athletes. Br J Sports Med 2015; 49:763. [PMID: 26031639 DOI: 10.1136/bjsports-2015-094907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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