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Yuce S, Dzhavadov AA, Dikmen G, Ozden VE, Kocabey B, Parvizi J, Tozun R. Does Focused Gluteus Medius Muscle Stretching After Total Hip Arthroplasty Work? An Electromyographic Study. J Arthroplasty 2024:S0883-5403(24)00753-8. [PMID: 39053662 DOI: 10.1016/j.arth.2024.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND The hypothesis of this randomized, prospective study was that focused stretching of the gluteus medius muscle, in addition to generalized physical therapy, is likely to improve muscle reaction time and positively impact the return to function of the patient after primary total hip arthroplasty (THA). METHODS We prospectively recruited 28 patients undergoing primary THA from January 2021 to January 2023. The control group (13 patients) received a conventional rehabilitation protocol, while the intervention group (15 patients) received focused stretching exercises of the gluteus medius muscle in addition to the conventional rehabilitation protocol. Patients had preoperative and postoperative surface electromyography (sEMG) to assess muscle activity. RESULTS Patients in the intervention group after surgery had better muscle activation according to sEMG during walking and during one leg stance compared to the control group. Also, patients from the intervention group had better strength of the gluteus medius muscle after surgery, but this did not reach statistical significance. CONCLUSIONS The present prospective study demonstrated that implementation of focused gluteus medius muscle stretching results in statistically significantly higher muscle activation as measured by sEMG. The strength of the gluteus medius muscle is also higher as measured using a dynamometer, albeit not reaching statistical significance. Based on the findings of this sEMG study, it appears that focused stretching and strengthening of abductors muscles are beneficial.
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Affiliation(s)
- Selvi Yuce
- Acıbadem Maslak Hospital, Department of Orthopedcis and Traumatology, Istanbul, Turkiye
| | - Alisagib A Dzhavadov
- International Joint Centre (IJC), Acibadem Maslak Hospital, Istanbul, Turkiye; Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation
| | - Goksel Dikmen
- Acibadem Mehmet Ali Aydınlar University, Department of Orthopedics and Traumatology, Istanbul, Turkiye; International Joint Centre (IJC), Acibadem Maslak Hospital, Istanbul, Turkiye
| | - Vahit Emre Ozden
- Acibadem Mehmet Ali Aydınlar University, Department of Orthopedics and Traumatology, Istanbul, Turkiye; International Joint Centre (IJC), Acibadem Maslak Hospital, Istanbul, Turkiye
| | - Burcu Kocabey
- Acıbadem Maslak Hospital, Department of Orthopedcis and Traumatology, Istanbul, Turkiye
| | - Javad Parvizi
- Acibadem Mehmet Ali Aydınlar University, Department of Orthopedics and Traumatology, Istanbul, Turkiye; International Joint Centre (IJC), Acibadem Maslak Hospital, Istanbul, Turkiye
| | - Remzi Tozun
- Acıbadem Maslak Hospital, Department of Orthopedcis and Traumatology, Istanbul, Turkiye; International Joint Centre (IJC), Acibadem Maslak Hospital, Istanbul, Turkiye
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Mitomo S, Aizawa J, Hirohata K, Ohmi T, Ohji S, Furuya H, Kawasaki T, Sakai Y, Yagishita K, Okawa A. Effects of differences in femoral anteversion and hip flexion angle on hip abductor muscles activity during clam exercise in females. PLoS One 2024; 19:e0305515. [PMID: 38913672 PMCID: PMC11195955 DOI: 10.1371/journal.pone.0305515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 06/01/2024] [Indexed: 06/26/2024] Open
Abstract
This study aimed to determine differences in the hip abductor muscle activity during clam exercise at different hip flexion and femoral anteversion angles. Thirty healthy females were divided into two groups based on the femoral anteversion angle: the excessive femoral anteversion group and the normal group. Clam exercise was performed at three different hip flexion angles (60°, 45°, and 30°). Tensor fascia latae, gluteus medius, and superior portion of gluteus maximus activities were measured during the exercise, and the results were normalized to the activity during maximum voluntary isometric contraction to calculate the gluteal-to-tensor fascia latae muscle activation index. The superior portion of gluteus maximus activities at a hip flexion of 60° and 45° were greater than that at 30°. The excessive femoral anteversion group had a lower gluteal-to-tensor fascia latae muscle activation index than the normal group; the gluteal-to-tensor fascia latae muscle activation index for hip flexion at 60° was higher than that at 45°, and the gluteal-to-tensor fascia latae muscle activation index for hip flexion at 60° and 45° were higher than that at 30°. Therefore, the femoral anteversion angle and hip joint position were related to the activity of the hip abductor muscles during clam exercise. These findings may provide a rationale for instructing exercises to maximize the activity of the hip abductor muscles in individuals with an excessive femoral anteversion angle.
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Affiliation(s)
- Sho Mitomo
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Sports for Health Division, Japan Sports Agency, Tokyo, Japan
| | - Junya Aizawa
- Faculty of Health Science, Department of Physical Therapy, Juntendo University, Tokyo, Japan
- Clinical Center for Sports Medicine and Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenji Hirohata
- Clinical Center for Sports Medicine and Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takehiro Ohmi
- Clinical Center for Sports Medicine and Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shunsuke Ohji
- Clinical Center for Sports Medicine and Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hidetaka Furuya
- Department of Rehabilitation, Sonoda Third Hospital, Tokyo, Japan
- Department of Rehabilitation, Sonoda Medical Institute Tokyo Spine Center, Tokyo, Japan
| | - Tomoko Kawasaki
- Clinical Center for Sports Medicine and Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yayoi Sakai
- Department of Rehabilitation, Kawakita General Hospital, Tokyo, Japan
| | - Kazuyoshi Yagishita
- Clinical Center for Sports Medicine and Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Morgan A, Moore M, Derry K, Bi A, Brown J, Youm T, Kaplan D. Surgical Treatment and Outcomes for Gluteal Tendon Tears. Curr Rev Musculoskelet Med 2024; 17:157-170. [PMID: 38619805 DOI: 10.1007/s12178-024-09896-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE OF REVIEW Gluteus medius and minimus tears, or hip abductor tendon tears, are increasingly identified as a source of lateral hip pain. Once underappreciated and undertreated, they are now recognized as a cause of greater trochanteric pain syndrome and a pathology amenable to both nonoperative and operative modalities. This review summarizes relevant anatomy, clinical presentation, and treatment options for gluteus medius tears, focusing on surgical options. RECENT FINDINGS When surgical intervention is indicated, repair, reconstruction, or tendon transfer may be considered. Open and endoscopic repair techniques demonstrate similar outcomes with improvements in patient-reported outcomes and low complication and retear rates for both partial and full thickness tears. Variations in fixation construct and graft augmentations have been described, though clinical evidence remains limited to support specific techniques. Gluteus maximus transfer via open approach is a salvage option for the severely atrophied, retracted, or revision gluteus tendon; however, persistent limitations in abduction strength and gait abnormalities are common. Emerging evidence continues to evolve our understanding of surgical decision-making for gluteus tendon tears. The current literature supports either open or endoscopic repair techniques and open tendon transfer as a salvAage option. Further study is needed to determine the optimal fixation construct, the role of graft augmentation, and patient-related factors that influence postoperative outcomes.
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Affiliation(s)
- Allison Morgan
- Orthopaedic Department, Sports Medicine Division, NYU Langone Health, 301 E 17th Street, New York, NY, 10003, USA
| | - Michael Moore
- Orthopaedic Department, Sports Medicine Division, NYU Langone Health, 301 E 17th Street, New York, NY, 10003, USA
| | - Kendall Derry
- Orthopaedic Department, Sports Medicine Division, NYU Langone Health, 301 E 17th Street, New York, NY, 10003, USA
| | - Andrew Bi
- Orthopaedic Department, Sports Medicine Division, NYU Langone Health, 301 E 17th Street, New York, NY, 10003, USA
| | - Jahnya Brown
- Orthopaedic Department, Sports Medicine Division, NYU Langone Health, 301 E 17th Street, New York, NY, 10003, USA
| | - Thomas Youm
- Orthopaedic Department, Sports Medicine Division, NYU Langone Health, 301 E 17th Street, New York, NY, 10003, USA
| | - Daniel Kaplan
- Orthopaedic Department, Sports Medicine Division, NYU Langone Health, 301 E 17th Street, New York, NY, 10003, USA.
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Judd DL, Cheuy V, Peters A, Graber J, Hinrichs-Kinney L, Forster JE, Christiansen CL, Stevens-Lapsley JE. Incorporating Functional Strength Integration Techniques During Total Hip Arthroplasty Rehabilitation: A Randomized Controlled Trial. Phys Ther 2024; 104:pzad168. [PMID: 38102757 DOI: 10.1093/ptj/pzad168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/01/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Total hip arthroplasty (THA) is a common orthopedic procedure that alleviates pain for millions of individuals. Yet, persistent physical function deficits, perhaps associated with movement compensations, are observed after THA. These deficits negatively affect quality of life and health for many individuals. Functional strength integration (FSI) techniques combine muscle strength training with specific movement retraining to improve physical function. This study aimed to determine if FSI would improve functional performance through remediation of movement compensations for individuals after THA. METHODS A double-blind randomized controlled trial was conducted. Ninety-five participants were randomized to either the FSI or control (CON) group for an 8-week intervention. The FSI protocol included exercise to improve muscular control and stability around the hip to minimize movement compensation during daily activity. The CON protocol included low-load resistance exercise, range-of-motion activities, and patient education. Functional performance, muscle strength, and self-reported outcomes were measured preoperatively, midway and after intervention, and 6 months after THA. Change from preoperative assessment to each time point was measured, and between-group differences were assessed. RESULTS There were minimal differences in outcomes between groups at the first postoperative assessment. There were no statistically significant between-group differences in the later assessments, including the primary endpoint. Both groups improved functional outcomes throughout the study period. CONCLUSION The FSI intervention did not result in greater improvements in function after THA compared to the CON intervention. Future work should further investigate additional biomechanical outcomes, timing of the FSI protocol, effective dosing, and patient characteristics predictive of success with FSI. IMPACT Recovery after THA is complex, and individuals after THA are affected by persistent movement deficits that affect morbidity and quality of life. The present study suggests that either approach to THA rehabilitation could improve outcomes for patients, and that structured rehabilitation programs may benefit individuals after THA.
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Affiliation(s)
- Dana L Judd
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Victor Cheuy
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, California, USA
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Amy Peters
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Jeremy Graber
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Lauren Hinrichs-Kinney
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Jeri E Forster
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- US Department of Veterans Affairs, Rocky Mountain Mental Illness, Research, Education and Clinical Center, Aurora, Colorado, USA
| | - Cory L Christiansen
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
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Lim DP, Lazaro LE, Kyhos JF, Chau MM, Ladnier KJ, Nelson TJ, Eberlein SA, Banffy MB, Metzger MF. Contributions of the Abductor Muscles to Rotational and Distractive Stability of the Hip in a Biomechanical Cadaveric Model. Orthop J Sports Med 2024; 12:23259671241231984. [PMID: 38444567 PMCID: PMC10913509 DOI: 10.1177/23259671241231984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/23/2023] [Indexed: 03/07/2024] Open
Abstract
Background The gluteus minimus (GMin) and gluteus medius (GMed) are important dynamic stabilizers of the hip, but quantitative data on their biomechanical roles in stabilizing the hip are currently lacking. Purpose To (1) establish a reproducible biomechanical cadaveric model of the hip abductor complex and (2) characterize the effects of loading the GMin and GMed on extraneous femoral rotation and distraction. Study Design Controlled laboratory study. Methods A total of 10 hemipelvises were tested in 4 muscle loading states: (1) unloaded, (2) the GMin loaded, (3) the GMed loaded, and (4) both the GMin and GMed loaded. Muscle loads were applied via cables, pulleys, and weights attached to the tendons to replicate the anatomic lines of action. Specimens were tested under internal rotation; external rotation; and axial traction forces at 0°, 15°, 30°, 60°, and 90° of hip flexion. Results When loaded together, the GMin and GMed reduced internal rotation motion at all hip flexion angles (P < .05) except 60° and reduced external rotation motion at all hip flexion angles (P < .05) except 0°. Likewise, when both the GMin and GMed were loaded, femoral distraction was decreased at all angles of hip flexion (P < .05). Conclusion The results of this study demonstrated that the GMin and GMed provide stability against rotational torques and distractive forces and that the amount of contribution depends on the degree of hip flexion. Clinical Relevance Improved understanding of the roles of the GMin and GMed in preventing rotational and distractive instability of the hip will better guide treatment of hip pathologies and optimize nonoperative and operative therapies.
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Affiliation(s)
- Daniel P. Lim
- Kerlan-Jobe Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Lionel E. Lazaro
- Kerlan-Jobe Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Justin F. Kyhos
- Kerlan-Jobe Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael M. Chau
- Kerlan-Jobe Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Karen J. Ladnier
- Kerlan-Jobe Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Trevor J. Nelson
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Samuel A. Eberlein
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael B. Banffy
- Kerlan-Jobe Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Melodie F. Metzger
- Orthopaedic Biomechanics Laboratory, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Linhart C, Mehrens D, Gellert LM, Ehrnthaller C, Gleich J, Lampert C, Lerchenberger M, Böcker W, Neuerburg C, Zhang Y. Gluteal Muscle Fatty Atrophy: An Independent Risk Factor for Surgical Treatment in Elderly Patients Diagnosed with Type-III Fragility Fractures of the Pelvis. J Clin Med 2023; 12:6966. [PMID: 38002581 PMCID: PMC10671837 DOI: 10.3390/jcm12226966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 10/27/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Gluteal muscle fatty atrophy (gMFA) might impair pelvic stability and negatively influence remobilization in patients with fragility fractures of the pelvis (FFP). This study aimed to investigate the association between gMFA and surgical indication in patients with FFP. METHODS AND MATERIALS A retrospective analysis of 429 patients (age ≥80) diagnosed with FFP was performed. gMFA of the gluteus maximus, medius, and minimus was evaluated using a standard scoring system based on computer tomography images. RESULTS No significant difference was found in gMFA between genders or among FFP types. The severity of gMFA did not correlate with age. The severity of gMFA in the gluteus medius was significantly greater than in the gluteus maximus, whereas the most profound gMFA was found in the gluteus minimus. gMFA was significantly more severe in patients who underwent an operation than in conservatively treated patients with type-III FFP, and an independent correlation to surgical indication was found using logistic regression. CONCLUSION Our findings imply that gMFA is an independent factor for surgical treatment in patients with type-III FFP. Besides focusing on the fracture pattern, the further evaluation of gMFA could be a feasible parameter for decision making toward either conservative or surgical treatment of type-III FFP.
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Affiliation(s)
- Christoph Linhart
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany; (C.L.); (L.M.G.); (C.E.); (J.G.); (C.L.); (M.L.); (W.B.); (C.N.)
| | - Dirk Mehrens
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany;
| | - Luca Maximilian Gellert
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany; (C.L.); (L.M.G.); (C.E.); (J.G.); (C.L.); (M.L.); (W.B.); (C.N.)
| | - Christian Ehrnthaller
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany; (C.L.); (L.M.G.); (C.E.); (J.G.); (C.L.); (M.L.); (W.B.); (C.N.)
| | - Johannes Gleich
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany; (C.L.); (L.M.G.); (C.E.); (J.G.); (C.L.); (M.L.); (W.B.); (C.N.)
| | - Christopher Lampert
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany; (C.L.); (L.M.G.); (C.E.); (J.G.); (C.L.); (M.L.); (W.B.); (C.N.)
| | - Maximilian Lerchenberger
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany; (C.L.); (L.M.G.); (C.E.); (J.G.); (C.L.); (M.L.); (W.B.); (C.N.)
| | - Wolfgang Böcker
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany; (C.L.); (L.M.G.); (C.E.); (J.G.); (C.L.); (M.L.); (W.B.); (C.N.)
| | - Carl Neuerburg
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany; (C.L.); (L.M.G.); (C.E.); (J.G.); (C.L.); (M.L.); (W.B.); (C.N.)
| | - Yunjie Zhang
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, 81377 Munich, Germany; (C.L.); (L.M.G.); (C.E.); (J.G.); (C.L.); (M.L.); (W.B.); (C.N.)
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Harper KD, Park KJ, Incavo SJ. Management of Hip Abductor Tears and Recalcitrant Trochanteric Bursitis in Native Hips. J Am Acad Orthop Surg 2023; 31:e769-e777. [PMID: 37647539 DOI: 10.5435/jaaos-d-23-00224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/10/2023] [Indexed: 09/01/2023] Open
Abstract
Hip abductor tears have recently gained recognition as a more prevalent injury than previously thought. This article will detail the pathophysiology of injury, physical symptoms commonly found at presentation, diagnostic imaging to best diagnose tears and when they should be ordered, and how to properly classify the injury and finally summarize the treatment options available with expert opinions about which are most successful.
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Affiliation(s)
- Katharine D Harper
- From the Department of Orthopedic Surgery, Washington DC Veterans Affairs Medical Center, Washington, DC (Harper and Incavo) and the Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas (Park)
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Koutserimpas C, Piagkou M, Karaiskos I, Karamitros A, Raptis K, Kourelis K, Christodoulou N. Modified Anterolateral Minimally Invasive Surgery (ALMIS) for Total Hip Replacement: Anatomical Considerations, Range of Motion and Clinical Outcomes. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1520. [PMID: 37763639 PMCID: PMC10533114 DOI: 10.3390/medicina59091520] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/13/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: In the modified anterolateral minimally invasive surgery (ALMIS) for total hip arthroplasty (THA), the intermuscular plane between the tensor fasciae latae and the gluteus maximus (GM) is exposed, while the anterior ¼ of the GM is detached. There are scarce data regarding this surgical approach. The purpose of the present study is to thoroughly describe this approach, encompassing the anatomical background, and to present the results of a retrospective two-center study of 603 patients. Materials and Methods: The present study includes a two-center retrospective observational cohort of 603 patients undergoing the ALMIS technique with minimum 5-year follow-up. Demographics were recorded, while range of motion (ROM) of the hip joint and the Harris Hip Score (HHS) were evaluated preoperatively, at 1, 3 and 12 months postoperatively and at the final follow-up (>5 years). Surgery-related complications were also recorded. Results: The studied population's mean age was 69.4 years, while most of them were females (397; 65.8%). The mean follow-up was 6.9 years. The median HHS at the 1-month follow-up was 74, compared to the 47 preoperatively (p-value < 0.0001). At the final follow-up, median HHS was 94. At the 1-month follow-up, mean adduction was 19.9° (compared to 15.4° preoperatively; p < 0.0001), mean abduction 24.3° (18.2° preoperatively; p < 0.0001), mean flexion 107.8° (79.1° preoperatively; p < 0.0001), mean external rotation 20.1° (12.1° preoperatively; p < 0.0001) and mean internal rotation 15.3° (7.2° preoperatively; p < 0.0001). ROM further improved until the final follow-up; mean adduction reached 22°, mean abduction 27.1°, mean flexion 119.8°, mean external rotation 24.4° and mean internal rotation 19.7°. Regarding complications, 1.3% of the sample suffered anterior traumatic dislocation, in 1.8% an intraoperative femoral fracture occurred, while 1.2% suffered periprosthetic joint infection. Conclusions: The modified ALMIS technique exhibited excellent clinical outcomes at short-, mid- and long-term follow-up, by significantly improving hip ROM and the HHS. Careful utilization of this technique, after adequate training, should yield favorable outcomes, while minimal major complications should be expected.
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Affiliation(s)
- Christos Koutserimpas
- Department of Orthopedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, Kanellopoulou Av, 11525 Athens, Greece; (I.K.)
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece
| | - Maria Piagkou
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece
| | - Ilias Karaiskos
- Department of Orthopedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, Kanellopoulou Av, 11525 Athens, Greece; (I.K.)
| | - Athanasios Karamitros
- Department of Orthopedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, Kanellopoulou Av, 11525 Athens, Greece; (I.K.)
| | - Konstantinos Raptis
- Department of Orthopedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, Kanellopoulou Av, 11525 Athens, Greece; (I.K.)
| | - Konstantinos Kourelis
- Department of Orthopedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, Kanellopoulou Av, 11525 Athens, Greece; (I.K.)
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Yasuda T, Ota S, Mitsuzawa S, Yamashita S, Tsukamoto Y, Takeuchi H, Onishi E. Preoperative Lower-Limb Muscle Predictors for Gait Speed Improvement after Total Hip Arthroplasty for Patients with Osteoarthritis. J Pers Med 2023; 13:1279. [PMID: 37623529 PMCID: PMC10455813 DOI: 10.3390/jpm13081279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 08/26/2023] Open
Abstract
This study aimed to identify preoperative lower-limb muscle predictors for gait speed improvement after total hip arthroplasty (THA) with hip osteoarthritis. Gait speed improvement was evaluated as the subtraction of preoperative speed from postoperative speed. The preoperative muscle composition of ipsilateral hip abductors was evaluated using computed tomography. The females (n = 45) showed smaller total cross-sectional areas of the gluteal muscles than the males (n = 13). The gluteus maximus in the females showed lower lean muscle mass area (LMM) and higher ratios of the intramuscular fat area and the intramuscular adipose tissue area to the total muscle area (TM) than the males. Regression analysis revealed that LMM/TM of the glutei medius and minimus may correlate negatively with postoperative improvement in gait speed. Receiver operating characteristic curve analysis for prediction of minimum clinically important improvement in gait speed at ≥0.32 m/s resulted in the highest area under the curve for TM in the upper portion of the gluteus maximus with negative correlation. The explanatory variables of hip abductor muscle composition predicted gait speed improvement after THA more precisely in the females compared with the total group of both sexes. Preoperative muscle composition should be evaluated separately based on sex for the achievement of clinically important improvement in gait speed after THA.
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Affiliation(s)
- Tadashi Yasuda
- Department of Orthopaedic Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminami-machi, Chuo-ku, Kobe 650-0047, Japan
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Sun L, Song W, Zhang Z, Xu Z, Sun M, Gao G, Jiang H, Ju C. Femoral offset restoration affects the early outcome of revision in patients with periprosthetic femoral fractures of Vancouver B2 - a single-center retrospective cohort study. BMC Musculoskelet Disord 2023; 24:567. [PMID: 37434207 DOI: 10.1186/s12891-023-06694-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/04/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Femoral offset (FO) restoration plays an important role in improving the prognosis and quality of life of patients undergoing hip replacement. However, it is not given enough attention in revisions among patients with periprosthetic femoral fractures (PPFFs); instead, more attention is given to reduction, fixation of fractures and stabilizing prostheses. The primary objective of this study was to evaluate the effect of FO restoration on the function of the hip joint in revisions of patients with PPFF of Vancouver B2. Moreover, we studied whether there is a difference in FO restoration between modular and nonmodular stems. METHODS A retrospective review of 20 patients with PPFF of Vancouver B2 revised with a tapered fluted modular titanium stem and 22 patients with PPFF of Vancouver B2 revised with a tapered fluted nonmodular titanium stem from 2016 to 2021 was conducted. Based on the difference between the FO of the affected side and that of the healthy side, 26 patients were allocated into Group A (difference ≤ 4 mm), and 16 patients were allocated into Group B (difference > 4 mm). The postoperative Harris Hip Score (HHS), range of motion of the hip joint, length of both lower limbs and dislocation were compared between Group A and Group B. The proportions of patients with FO restoration (difference ≤ 4 mm) and stem subsidence were compared between the modular and nonmodular groups. RESULTS The mean follow-up time was 34.3 ± 17.3 months, and all cases achieved fracture healing at the last visit. Patients in Group A had a higher HHS, larger range of abduction, fewer dislocations and less limb length discrepancy (LLD). Patients in the modular group had a higher proportion of FO restoration and less subsidence. CONCLUSION FO restoration improves postoperative hip joint function and reduces dislocation and LLD in revisions of patients with PPFF of Vancouver B2. Compared with nonmodular prostheses, modular prostheses tend to be easier for FO restoration under complex circumstances.
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Affiliation(s)
- Lei Sun
- Department of Orthopaedics, Wendeng Orthopaedic Hospital of Shandong Province, Weihai, 264400, China
| | - Wenjing Song
- Department of Orthopaedics, Wendeng Orthopaedic Hospital of Shandong Province, Weihai, 264400, China
| | - Zhongyuan Zhang
- Department of Orthopaedics, Wendeng Orthopaedic Hospital of Shandong Province, Weihai, 264400, China
| | - Ziyao Xu
- Department of Orthopaedics, Wendeng Orthopaedic Hospital of Shandong Province, Weihai, 264400, China
| | - Mengshuai Sun
- Department of Orthopaedics, Wendeng Orthopaedic Hospital of Shandong Province, Weihai, 264400, China
| | - Guangling Gao
- Department of Orthopaedics, Wendeng Orthopaedic Hospital of Shandong Province, Weihai, 264400, China
| | - Hongjiang Jiang
- Department of Orthopaedics, Wendeng Orthopaedic Hospital of Shandong Province, Weihai, 264400, China
| | - Changjun Ju
- Department of Orthopaedics, Wendeng Orthopaedic Hospital of Shandong Province, Weihai, 264400, China.
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Kumar S, Mohanan S, Vattoth AL, Bajaj G, Pandey T. Anatomy and Biomechanics of Lower Extremity Tendons: Imaging Implications. Semin Ultrasound CT MR 2023. [DOI: 10.1053/j.sult.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
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12
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Chong F, Fan W, Liu L, Zhang Y, Lin H, Huang B. Correlation Between Atrophy of the Gluteus Medius Muscle and Symptoms of Lumbar Spinal Stenosis. World Neurosurg 2023; 172:e177-e184. [PMID: 36603649 DOI: 10.1016/j.wneu.2022.12.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Lower muscular weakness and gait disturbance are typical lumbar spinal stenosis (LSS) symptoms. Gait initiation and standing balance function are dependent on hip muscle groups, particularly gluteus medius (GMed). However, alterations to GMed in patients with LSS have not been studied. Therefore, we evaluated the impact of LSS on GMed in this study. METHODS This study included 96 participants divided into the LSS and non-LSS groups. A total of 48 patients with LSS and unilateral buttock pain underwent T2-weighted magnetic resonance imaging of GMed, and 48 age- and sex-matched controls formed the control group. Differences between the cross-sectional areas (CSAs) on both sides of GMed were compared between the 2 groups. Additionally, correlations among patient characteristics, clinical evaluation, and radiological measurement data with a decrease in the CSA of GMed were assessed in the LSS group. RESULTS A significant difference was observed in the bilateral discrepancy of the GMed CSA between the LSS and non-LSS groups. For patients with LSS with unilateral buttock pain, 81% had reduced CSA of GMed. Regression analysis revealed that buttock pain was an independent factor related to GMed atrophy. CONCLUSIONS The degree of GMed atrophy is related to symptoms of LSS. Spine surgeons should be aware of the risk of GMed atrophy in patients with LSS with unilateral buttock pain.
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Affiliation(s)
- Fanli Chong
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Weijie Fan
- Department of Radiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Lanlan Liu
- Department of Radiology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yaqing Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Hui Lin
- Department of Gastroenterology, Clinical Research Center, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Bo Huang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China.
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13
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Rostron ZPJ, Zacharias A, Semciw AI, Kingsley M, Pizzari T, Woodley SJ, Green R. Comparison between a targeted exercise program and a sham intervention on gluteal muscle activity in people with hip osteoarthritis: Analysis of secondary outcomes from a randomised clinical trial. Gait Posture 2023; 100:33-40. [PMID: 36469965 DOI: 10.1016/j.gaitpost.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/23/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND People with hip osteoarthritis (OA) typically display altered gluteus minimus (GMin) and gluteus medius (GMed) activity during gait, in addition to reduced walking speed and stride length. It is unknown if current rehabilitation programs address changes in gluteal muscle activity in people with hip OA. RESEARCH QUESTION Can a targeted gluteal intervention restore normal gluteal muscle segment activity during gait in people with hip OA? METHODS This study presents secondary outcomes from a multi-site, double-blinded clinical trial in which participants with radiologically confirmed mild-moderate hip OA were randomised into a targeted gluteal or sham intervention for 12-weeks following baseline testing. Electromyography (EMG) outcomes were only conducted at a single site and data were collected from 22 participants. Intramuscular electrodes were inserted into two segments of GMin (anterior, posterior) and three segments of GMed (anterior, middle, posterior) to record average amplitude, peak amplitude and time to peak (TTP) during the first 60 % of the gait cycle (stance phase) at baseline and post-intervention. RESULTS Following the targeted gluteal intervention, posterior GMin displayed a decrease in average (P = 0.032, ES=1.04) and peak (P = 0.017, ES=1.17) muscle activity during late stance phase with a shift to an earlier TTP (P = 0.034, ES=1.02). There were no further significant changes between groups for other outcome measures. Similar trends for an earlier TTP were observed for the posterior segment of GMed following the targeted intervention (P = 0.095, ES=0.87). The earlier TTP in the posterior segments of both GMin and GMed post-intervention resembled patterns observed in a healthy young population. SIGNIFICANCE A targeted gluteal intervention can positively impact activity in posterior GMin during gait in people with hip OA when compared to a sham intervention.
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Affiliation(s)
- Zachary P J Rostron
- Department of Rural Clinical Sciences, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia.
| | - Anita Zacharias
- Department of Rural Clinical Sciences, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Adam I Semciw
- Department of Physiotherapy, Podiatry, and Pr osthetics and Orthotics, School of Allied Health La Trobe University, Bundoora, VIC, Australia; School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Michael Kingsley
- Department of Exercise Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand; Holsworth Research Initiative, College of Science, Health & Engineering, La Trobe University, Bendigo, VIC, Australia
| | - Tania Pizzari
- Department of Physiotherapy, Podiatry, and Pr osthetics and Orthotics, School of Allied Health La Trobe University, Bundoora, VIC, Australia
| | - Stephanie J Woodley
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Rodney Green
- Department of Rural Clinical Sciences, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
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Jiang QL, Li Y, Bai XW, Deng Y, Hong H, Li J, Cao Y, Peng XY. A novel computed tomography-based three-column MLP classification of intertrochanteric fracture. THE JOURNAL OF MEDICAL INVESTIGATION 2023; 70:524-529. [PMID: 37940544 DOI: 10.2152/jmi.70.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
OBJECTIVES The aim of the present study was to introduce a novel three-dimensional computed tomography (3DCT)-based three-column classification (named "MLP classification system") of intertrochanteric fractures and evaluate its reproducibility and reliability. METHODS From September 2020 to September 2022, a total of 258 consecutive patients (60 male, 198 female;mean age 81.3 years) with intertrochanteric fractures were included in this study. The fracture in each case was assessed using a novel three-dimensional computed tomography-based three-column classification. Two examiners tested the intra and inter-observer reliability of this new classification system using kappa variance. RESULTS The intertrochanteric region was divided into the medial column, lateral column, and posterior column. Intertrochanteric fractures were documented as M0/1/2L0/1/2/3P0/1/2/3. All fractures were classifiable into the new classification system. The intra-observer kappa values were 0.91 and 0.89, while the inter-observer kappa value was 0.82, both indicating almost perfect reliability. CONCLUSION This novel 3DCT-based MLP classification system for intertrochanteric fractures is comprehensive, and reproducible with good agreement. It is based on proximal femur biomechanic characteristics and traumatic mechanism, contributing to formulating more reasonable treatment protocols involving various late-model internal fixation devices. J. Med. Invest. 70 : 524-529, August, 2023.
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Affiliation(s)
- Qi-Long Jiang
- Department of Orthopaedic Surgery, Chongqing Orthopedic Hospital Of Traditional Chinese Medicine, Chongqing, China
| | - Yan Li
- Central Sterile Supply Department, Chonggang General Hospital, Chongqing, China
| | - Xin-Wen Bai
- Department of Orthopaedic Surgery, Chongqing Orthopedic Hospital Of Traditional Chinese Medicine, Chongqing, China
| | - Yu Deng
- Department of Orthopaedic Surgery, Chongqing Orthopedic Hospital Of Traditional Chinese Medicine, Chongqing, China
| | - Hao Hong
- Department of Orthopaedic Surgery, Chongqing Orthopedic Hospital Of Traditional Chinese Medicine, Chongqing, China
| | - Jun Li
- Department of Orthopaedic Surgery, Chongqing Orthopedic Hospital Of Traditional Chinese Medicine, Chongqing, China
| | - Yong Cao
- Department of emergency, Chongqing Orthopedic Hospital Of Traditional Chinese Medicine, Chongqing, China
| | - Xiao-Yu Peng
- Department of emergency, Chongqing Orthopedic Hospital Of Traditional Chinese Medicine, Chongqing, China
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15
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Carroll M, Ellis R, Kohut S, Garrett N, Fernández-de-Las-Peñas C. Associations Between Gluteus Medius Trigger Points With Hip Passive Range of Movement and Muscle Strength in Adults With Chronic Nonspecific Low Back Pain: A Cross-Sectional Study. J Manipulative Physiol Ther 2022; 45:641-651. [PMID: 37318387 DOI: 10.1016/j.jmpt.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 03/21/2023] [Accepted: 03/30/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate whether there is a relationship between gluteus medius trigger points with hip passive range of motion and hip muscle strength in people with chronic nonspecific low back pain (LBP). METHODS This was a cross-sectional, blinded study that took place in 2 rural communities in New Zealand. Assessments were carried out in physiotherapy clinics in these towns. A total of 42 participants over 18 years old experiencing chronic nonspecific LBP were recruited. After meeting inclusion criteria, participants completed the following 3 questionnaires: Numerical Pain Rating Scale, Oswestry Disability Index, and Tampa Scale of Kinesiophobia. The primary researcher (a physiotherapist) assessed each participant's bilateral hip passive range of movement (using an inclinometer) and muscle strength (using a dynamometer). Following this, a blinded trigger point assessor examined the gluteus medius muscles for the presence of active and latent trigger points. RESULTS General linear modeling using univariate analysis revealed that there was a positive association between hip strength and trigger point status (P =.03 left internal rotation, P =.04 right internal rotation, and P =.02 right abduction). Participants with no trigger points showed higher strength values (eg, right internal rotation standard error: 0.64), and those with trigger points showed lower strength. Overall, muscles exhibiting latent trigger points were the weakest (eg, right internal rotation standard error: 0.67). CONCLUSION The presence of active or latent gluteus medius trigger points was associated with hip weakness in adults with chronic nonspecific LBP. There was no association between gluteus medius trigger points and hip passive range of movement.
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Affiliation(s)
- Marianne Carroll
- Department of Physiotherapy, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.
| | - Richard Ellis
- Department of Physiotherapy, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand; Active Living and Rehabilitation, Health and Rehabilitation Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Susan Kohut
- Department of Physiotherapy, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand; Active Living and Rehabilitation, Health and Rehabilitation Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Nick Garrett
- Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Madrid, Spain
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16
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Billuart F, Lalevée M, Brunel H, Van Driessche S, Beldame J, Matsoukis J. MRI assessment of minimally invasive anterolateral approaches in total hip arthroplasty. Orthop Traumatol Surg Res 2022; 108:103356. [PMID: 35724839 DOI: 10.1016/j.otsr.2022.103356] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/10/2022] [Accepted: 01/31/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Total hip arthroplasty (THA) on a minimally invasive anterolateral (MIAL) approach frequently leads to gluteus minimus and gluteus medius lesions, and sometimes to tensor fasciae latae (TFL) denervation. We therefore developed compensatory strategies, which we assessed on pre- and post-operative MRI: 1) to assess gluteus minimus and gluteus medius fatty infiltration (FI), 2) to assess TFL FI, and 3) to assess FI in the other periarticular muscles. HYPOTHESIS The modified MIAL approach reduces the rate of gluteus minimus and gluteus medius lesion. MATERIALS AND METHODS A continuous prospective single-surgeon series of THA using a MIAL approach included 25 patients. Femoral implantation was performed with the hip in extension so as to distance the proximal femur from the gluteals, avoiding muscle trauma. The superior gluteal nerve branch in the space between the gluteus medius and TFL, running toward the TFL, was systematically released and protected. MRI was performed preoperatively and at 3 months and 1 year post-surgery. FI was analyzed according to the Goutallier classification in all periarticular muscles. RESULTS One patient lacked preoperative MRI and was excluded, leaving 24 patients, for 72 MRIs. In 10/24 patients (41.7%) the gluteus minimus and in 8/24 patients (33.3%) the anterior third of the gluteus medius showed ≥2 grade increase in FI between preoperative and 1-year MRI, with significant increases in both at 3 months (p<0.001) and 1 year (p<0.001). At least a 2 grade increase in FI at 1 year was seen in 1 patient (4.2%) in the TFL, in 2 (8.3%) in the piriformis, and in 1 (4.2%) in the obturator internus. There were no significant differences in FI between preoperative, 3-month or 1-year MRI in any other periarticular muscles. CONCLUSION Femoral implantation in hip extension did not reduce the rate of gluteal lesions, which remained frequent. In contrast, release of the superior gluteal nerve branch could be effective in conserving TFL innervation. Some rare lesions of the proximal part of the pelvi-trochanteric muscles were also observed. LEVEL OF EVIDENCE IV, Prospective case series.
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Affiliation(s)
- Fabien Billuart
- Laboratoire d'analyse du mouvement, institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du Commerce, 75015 Paris, France; Université Paris-Saclay, UVSQ, Erphan, 78000 Versailles, France
| | - Matthieu Lalevée
- Centre hospitalier universitaire de Rouen, service de chirurgie orthopédique et traumatologique, 37, boulevard Gambetta, 76000 Rouen, France.
| | - Helena Brunel
- Laboratoire d'analyse du mouvement, institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du Commerce, 75015 Paris, France
| | | | - Julien Beldame
- Institut clinique du Pied-Paris, Ramsay santé, clinique blomet, 136, rue Blomet, 75015 Paris, France; Clinique Mégival, 1328, avenue de la Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - Jean Matsoukis
- Département de Chirurgie Orthopédique, Groupe Hospitalier du Havre, BP 24, 76083 Le Havre cedex, France
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17
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The relationship between gluteus medius and minimus muscle volumes and hip development in developmental dysplasia of the hip. J Orthop Sci 2022; 27:1078-1081. [PMID: 34362634 DOI: 10.1016/j.jos.2021.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/14/2021] [Accepted: 06/23/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Several studies in adult hips have revealed the role of the gluteus medius (Gmed) and gluteus minimus (Gmin) muscles in maintaining the stability and centripetal force of the hip joint. Hip centripetality in developmental dysplasia of the hip (DDH) patients contributes to subsequent healthy hip development later in life. The purpose of this study is to investigate the relationship between Gmed and Gmin volume and centripetality of the hip in infant DDH patients. METHODS We retrospectively enrolled 41 unilateral DDH patients (4 males, 37 females) who were treated by closed reduction from 2006 to 2016 and underwent magnetic resonance imaging at around 2 years old. Gmed, and Gmin volume was measured in magnetic resonance imaging. We defined both Gmin and Gmed together as hip abductor gluteus muscles (GMs; Gmed + Gmin). The muscle volume ratio of the affected side was calculated by dividing the GMs volume of the affected side by the contralateral side. Relationships between center-head distance discrepancy (CHDD) at 2 years old, and at 4-6 years old and GMs volume ratio were investigated by Pearson's correlation coefficient within the same patients. RESULTS Mean age of closed reduction was 0.8 years old and mean age at MRI was 2.2 years old with a mean follow-up period of 3.7 years. Mean GMs volume in the affected side, contralateral side, and muscle volume ratio were 25.3 cm3, 27.0 cm3, and 0.94, respectively. GMs volumes were significantly higher in the contralateral side (p < 0.001). GMs volume ratio at 2 years old significantly correlated with CHDD at 4-6 years old (p < 0.05). CONCLUSION GMs volume at 2 years old was found to be associated with later hip afferents. Promoting the healthy development of GMs by properly maintaining the infant's natural hip movement is important for the healthy hip development. LEVEL OF EVIDENCE Level III.
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18
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Tsuchida M, Shibata M, Iimura A, Oguchi T, Kim S, Nakao Y, Nakamura H. A macroscopic anatomical study of the appropriate palpation zone of the gluteus medius muscle. J Phys Ther Sci 2022; 34:554-560. [PMID: 35937621 PMCID: PMC9345755 DOI: 10.1589/jpts.34.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/18/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Few previous studies have delimitated the palpation zone of the gluteus medius
muscle with a focus on its fiber bundles. The purpose of this study was to clarify the
morphological characteristics of the gluteus medius muscle using an anatomical approach,
and to define its proper palpation zone. [Participants and Methods] In this study, we
evaluated thirteen halves of the pelvic region in seven formalin-fixed cadavers. We
identified the borders between the iliotibial band and gluteus medius muscle, and between
the gluteus medius and gluteus maximus muscles, on the iliac crest. Furthermore, we
quantified the border points of the gluteus medius’ fiber bundles and observed its
anatomical and morphological characteristics. [Results] We identified two fiber bundles in
the gluteus medius muscle, an anterior and a posterior fiber bundle, and detected that a
portion of the posterior fibers was located subcutaneously. [Conclusion] We propose that
the region where the posterior fibers of the gluteus medius muscle are located
subcutaneously is an appropriate zone for the palpation of this muscle.
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Affiliation(s)
- Masayuki Tsuchida
- Department of Rehabilitation, Shonan University of Medical Sciences: 16-48 Kamishinano-cho, Totsuka-ku, Yokohama-shi, Kanagawa 244-0806, Japan
| | - Masakazu Shibata
- Department of Rehabilitation, Shonan University of Medical Sciences: 16-48 Kamishinano-cho, Totsuka-ku, Yokohama-shi, Kanagawa 244-0806, Japan
| | - Akira Iimura
- Department of Anatomy, Kanagawa Dental University, Japan
| | - Takeshi Oguchi
- Department of Anatomy, Kanagawa Dental University, Japan
| | - SungHyek Kim
- Faculty of Health Science, Tokoha University, Japan
| | - Yoko Nakao
- Department of Rehabilitation, Shonan University of Medical Sciences: 16-48 Kamishinano-cho, Totsuka-ku, Yokohama-shi, Kanagawa 244-0806, Japan
| | - Hisashi Nakamura
- Department of Rehabilitation, Shonan University of Medical Sciences: 16-48 Kamishinano-cho, Totsuka-ku, Yokohama-shi, Kanagawa 244-0806, Japan
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19
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The role of hip abductor strength and ankle dorsiflexion range of motion on proximal, local and distal muscle activation during single-leg squat in patellofemoral pain women: an all-encompassing lower limb approach. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-022-00980-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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20
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Looney AM, Bodendorfer BM, Donaldson ST, Browning RB, Chahla JA, Nho SJ. Influence of Fatty Infiltration on Hip Abductor Repair Outcomes: A Systematic Review and Meta-analysis. Am J Sports Med 2022; 50:2568-2580. [PMID: 34495797 DOI: 10.1177/03635465211027911] [Citation(s) in RCA: 12] [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 Increasing evidence supports surgical intervention for hip abductor tears; however, the influence of fatty infiltration (FI) on outcomes after repair remains uncertain and has been addressed only in small case series. PURPOSE To clarify the relationship between FI and surgical outcomes for hip abductor tears. STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS A systematic review and meta-analysis was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. FI severity was assessed by Goutallier-Fuchs (G-F) grade. The relationship between FI and improvement in Harris Hip Score (HHS)/modified Harris Hip Score (mHHS) and visual analog scale (VAS) score for pain was examined with mixed-effects metaregression. Outcomes with open and endoscopic techniques were also compared. RESULTS A total of 4 studies (206 repairs in 201 patients) were eligible. High-grade FI was associated with significantly less improvement in HHS/mHHS than both no FI (6.761 less; 95% CI, 3.983-11.570; P = .002) and low-grade FI (7.776 less; 95% CI, 2.460-11.062; P < .001) but did not significantly influence VAS score (P > .05). Controlling for FI severity, we found no significant difference in HHS/mHHS improvement between open versus endoscopic repair (P > .05 at each level), but open repair resulted in significantly greater improvement in VAS score for every G-F grade (all P < .005). CONCLUSION Surgical intervention for symptomatic hip abductor tendon tears improved outcomes as reflected by change in HHS/mHHS; however, the presence of high-grade FI resulted in less improvement. FI severity did not influence VAS scores for pain. Although no differences were found between open and endoscopic repairs in terms of FI-adjusted improvement in HHS/mHHS, open repairs resulted in significantly greater pain relief at each FI level.
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Affiliation(s)
- Austin M Looney
- Department of Orthopaedic Surgery, Georgetown University Hospital, Washington, DC, USA.,The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Blake M Bodendorfer
- Department of Orthopaedic Surgery, Georgetown University Hospital, Washington, DC, USA.,Midwest Orthopaedics, Rush, Chicago, Illinois, USA
| | | | - Robert B Browning
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Shane J Nho
- Midwest Orthopaedics, Rush, Chicago, Illinois, USA
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21
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Pearce AN, Stambough JB, Mears SC, Barnes CL, Stronach BM. Diagnosis and Treatment Options of Abductor Insufficiency After Total Hip Replacement. Orthop Clin North Am 2022; 53:255-265. [PMID: 35725034 DOI: 10.1016/j.ocl.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Abductor insufficiency can cause abnormal gait, lateral hip pain, and abduction weakness in both native and prosthetic hips. In the setting of total hip arthroplasty (THA), abductor insufficiency may occur secondary to iatrogenic injury to the superior gluteal nerve or gluteus medius muscle, adverse local tissue reactions owing to metal-associated prosthetics, and osteolysis owing to bearing wear or infection. Surgical reconstruction of the abductor complex is indicated for patients with chronic tears who have pain, weakness, limp, and/or instability. This article reviews the pearls and pitfalls of surgical reconstruction options for abductor insufficiency following THA.
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Affiliation(s)
- Alexa N Pearce
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Box 531, Little Rock, AR 72205, USA
| | - Jeffrey B Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Box 531, Little Rock, AR 72205, USA
| | - Simon C Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Box 531, Little Rock, AR 72205, USA
| | - Charles Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Box 531, Little Rock, AR 72205, USA.
| | - Benjamin M Stronach
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Box 531, Little Rock, AR 72205, USA
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22
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Pumar Pérez M, Marsico S, Rodríguez Baeza A, Solano López A. Role of imaging techniques in the diagnosis of selective hypertrophy of the tensor fascia lata. RADIOLOGIA 2022; 64:368-374. [DOI: 10.1016/j.rxeng.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/21/2021] [Indexed: 11/29/2022]
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23
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Perraton Z, Lawrenson P, Mosler AB, Elliott JM, Weber KA, Flack NA, Cornwall J, Crawford RJ, Stewart C, Semciw AI. Towards defining muscular regions of interest from axial magnetic resonance imaging with anatomical cross-reference: a scoping review of lateral hip musculature. BMC Musculoskelet Disord 2022; 23:533. [PMID: 35658932 PMCID: PMC9166386 DOI: 10.1186/s12891-022-05439-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/09/2022] [Indexed: 12/03/2022] Open
Abstract
Background Measures of hip muscle morphology and composition (e.g., muscle size and fatty infiltration) are possible with magnetic resonance imaging (MRI). Standardised protocols or guidelines do not exist for evaluation of hip muscle characteristics, hindering reliable and valid inter-study analysis. This scoping review aimed to collate and synthesise MRI methods for measuring lateral hip muscle size and fatty infiltration to inform the future development of standardised protocols. Methods Five electronic databases (Medline, CINAHL, Embase, SportsDISCUS and AMED) were searched. Healthy or musculoskeletal pain populations that used MRI to assess lateral hip muscle size and fatty infiltration were included. Lateral hip muscles of interest included tensor fascia late (TFL), gluteus maximus, gluteus medius, and gluteus minimus. Data on MRI parameters, axial slice location, muscle size and fatty infiltrate measures were collected and analysed. Cross referencing for anatomical locations were made between MRI axial slice and E-12 anatomical plastinate sections. Results From 2684 identified publications, 78 studies contributed data on volume (n = 31), cross sectional area (CSA) (n = 24), and fatty infiltration (n = 40). Heterogeneity was observed for MRI parameters and anatomical boundaries scrutinizing hip muscle size and fatty infiltration. Seven single level axial slices were identified that provided consistent CSA measurement, including three for both gluteus maximus and TFL, and four for both gluteus medius and minimus. For assessment of fatty infiltration, six axial slice locations were identified including two for TFL, and four for each of the gluteal muscles. Conclusions Several consistent anatomical levels were identified for single axial MR slice to facilitate muscle size and fatty infiltration muscle measures at the hip, providing the basis for reliable and accurate data synthesis and improvements in the validity of future between studies analyses. This work establishes the platform for standardised methods for the MRI assessment of lateral hip musculature and will aid in the examination of musculoskeletal conditions around the hip joint. Further studies into whole muscle measures are required to further optimise methodological parameters for hip muscle assessment.
Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05439-x.
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Affiliation(s)
- Zuzana Perraton
- School of Allied Health, La Trobe University, Melbourne, Australia
| | - Peter Lawrenson
- School of Allied Health, La Trobe University, Melbourne, Australia.,School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.,Department of Anatomy, School of Biomedical Sciences, The University of Otago, Dunedin, New Zealand
| | - Andrea B Mosler
- School of Allied Health, La Trobe University, Melbourne, Australia
| | - James M Elliott
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.,Faculty of Medicine and Health and Northern Sydney Local Health District, The University of Sydney, The Kolling Institute, Sydney, Australia.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Kenneth A Weber
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA, USA
| | - Natasha Ams Flack
- Department of Anatomy, School of Biomedical Sciences, The University of Otago, Dunedin, New Zealand
| | - Jon Cornwall
- University of Otago, Centre for Early Learning in Medicine, Otago Medical School, Dunedin, New Zealand
| | | | | | - Adam I Semciw
- School of Allied Health, La Trobe University, Melbourne, Australia. .,Allied Health Research, Northern Health, Epping, VIC, Australia.
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24
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Maldonado DR, Youssefzadeh KA, Wydra F, Sherman B, Gerhardt MB. High Prevalence of Lumbosacral Pathology in Patients with Greater Trochanteric Pain Syndrome. Arthroscopy 2022; 38:1189-1192. [PMID: 34601010 DOI: 10.1016/j.arthro.2021.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To establish prevalence of lumbar and lumbosacral pathologies in patients with hip abductor tendon disorders. METHODS A retrospective review of patients' charts was conducted over a 5-year period, January 2013 to October 2018, using the S76 and M76 International Classification of Diseases Tenth Revision (ICD-10) codes. Patients with symptomatic and radiologically confirmed hip abductor tendon disorders (partial and full-thickness tear of the gluteus medius tear with or without gluteus minimus tearing) were included in the study. No exclusion criteria were applied. Patient medical history was examined for concurrent diagnoses of lumbar and lumbosacral pathologies (radiculopathy, lumbar stenosis, degenerative disc disease, and neurogenic claudication). RESULTS One-hundred and three patients with hip abductor tendon disorders were identified. Forty-seven (45.6%) patients had low-grade partial abductor tears, while 56 (54.4%) of patients had a high-grade partial or complete abductor tear. Fifty (48.5%) patients carried a concomitant lumbosacral diagnosis, with 20 (19.4%) patients being diagnosed with lumbar stenosis and 45 (43.7%) being diagnosed with degenerative disc disease. CONCLUSION Patients with hip abductor tendon disorders were associated with a high prevalence of underlying lumbar and lumbosacral pathologies. Nevertheless, a causal relationship between these conditions cannot be established. LEVEL OF EVIDENCE Level IV. Retrospective Case Series.
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Affiliation(s)
- David R Maldonado
- Cedars Sinai, Kerlan-Jobe Institute, Santa Monica Orthopaedic and Sports Medicine Group, Santa Monica, California, U.S.A
| | - Keon A Youssefzadeh
- Cedars Sinai, Kerlan-Jobe Institute, Santa Monica Orthopaedic and Sports Medicine Group, Santa Monica, California, U.S.A..
| | - Frank Wydra
- Cedars Sinai, Kerlan-Jobe Institute, Santa Monica Orthopaedic and Sports Medicine Group, Santa Monica, California, U.S.A
| | | | - Michael B Gerhardt
- Cedars Sinai, Kerlan-Jobe Institute, Santa Monica Orthopaedic and Sports Medicine Group, Santa Monica, California, U.S.A
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25
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Martins EC, Ruschel C, Roesler EM, Silvano GA, de Castro MP, Herzog W, de Brito Fontana H. Tensor fascia latae and gluteal muscles myoelectric responses to increasing levels of hip medial rotation torque. J Biomech 2022; 132:110944. [PMID: 35016091 DOI: 10.1016/j.jbiomech.2022.110944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/09/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
Abstract
Medial hip rotation is typically attributed to the tensor fascia latae (TFL) and lateral rotation, to the gluteus maximus. However, experimental studies in cadavers suggest that the TFL lacks a moment arm for medial rotation and that the gluteus maximus may act as hip medial rotator depending on the hip flexion angle. In order to address this contradictory thinking, we measured the myoelectric activity of TFL, gluteus medius and gluteus maximus (superior portion, GMaxS, and inferior portion, GMaxI) for increasing levels of medial rotation torque applied to the hip. To keep frontal and sagittal plane hip joint net torques constant during the experiments, the medial hip rotation torque was changed by displacing standard weights along an aluminum bar device, thereby producing pure medial hip rotation torques. The effect of increasing medial hip rotation torque was investigated for a fully extended hip (0°), and at 45° and 90° of flexion. We found an increase in the myoelectric activity of the TFL (∼90%↑, p = 0.002) at 90° of flexion and of the GMaxS (∼7%↑, p = 0.048) at the extended position with an increase in medial hip torque application (from 0 to 7.4 N.m.). For the GMed (regardless of hip position) and for the 45° position (regardless of muscle), no systematic changes across torque conditions were observed. In contrast to the common clinical assumption and current practice thinking, our results indicate that an increase in TFL activity is required to control for an increase in external torque towards hip medial rotation.
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Affiliation(s)
- Eduardo Campos Martins
- Biomechanics Laboratory, School of Sports, Federal University of Santa Catarina, Florianopolis, Santa Catarina CEP: 88040-900, Brazil
| | - Caroline Ruschel
- College of Health and Sport Science, Santa Catarina State, Florianópolis, Santa Catarina, Brazil
| | - Erik Mecca Roesler
- Biomechanics Laboratory, School of Sports, Federal University of Santa Catarina, Florianopolis, Santa Catarina CEP: 88040-900, Brazil
| | - Gessica Aline Silvano
- Biomechanics Laboratory, School of Sports, Federal University of Santa Catarina, Florianopolis, Santa Catarina CEP: 88040-900, Brazil
| | - Marcelo Peduzzi de Castro
- Labclin Neuromusculoskeletal Rehabilitation and Clinical Biomechanics Laboratory, Florianópolis, Santa Catarina CEP: 88015-310, Brazil
| | - Walter Herzog
- Biomechanics Laboratory, School of Sports, Federal University of Santa Catarina, Florianopolis, Santa Catarina CEP: 88040-900, Brazil
| | - Heiliane de Brito Fontana
- Biomechanics Laboratory, School of Sports, Federal University of Santa Catarina, Florianopolis, Santa Catarina CEP: 88040-900, Brazil; Department of Morphological Sciences, School of Biological Sciences, Federal University of Santa Catarina, Florianopolis, Santa Catarina CEP: 88040-900, Brazil.
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26
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Modelling gluteus medius tendon degeneration and repair in a large animal model. Arch Orthop Trauma Surg 2022; 142:1-12. [PMID: 32813126 DOI: 10.1007/s00402-020-03573-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Gluteus medius tendon tears often occur in the context of chronic tendinopathy and remain a difficult clinical problem. Surgical repair is challenging as it is often delayed and performed in degenerative tendons. No animal model currently exists to mimic the delayed repair of tendinopathic gluteus medius tears. The aims of this study were to develop a chronic model of gluteus medius tendinopathy and tear and then compare this model to an acute gluteus medius tear and repair. MATERIALS AND METHODS Six gluteus medius muscles were dissected and examined in mature sheep to confirm anatomical similarity to the human counterpart. Ten separate adult sheep underwent tendon detachment, followed by relook and histological sampling at 6 and 16 weeks to assess the extent of tendon degeneration. Six adult sheep underwent tendon repair at 6 weeks and were later assessed for healing of the tendon and compared to a further four adult sheep who underwent an acute tendon detachment and repair procedure. RESULTS The sheep gluteus medius muscle consisted of three compartments, the anterior, middle and posterior. All compartments inserted via the common tendon on the superolateral aspect of the greater trochanter. At both 6 and 16 weeks, there was significant tendinopathic changes on histology compared to controls as assessed by modified Movin's score (p = 0.018, p = 0.047) but no difference between the 6- and 16-week groups (p = 0.25). There were significant differences between delayed and acute repair in both histological appearance (p = 0.025) and biomechanical properties (p = 0.019), with acute repair superior in both. CONCLUSIONS Tendon detachment for 6 weeks is sufficient to produce histological changes similar to chronic tendinopathy and repair of this degenerative tendon results in significantly poorer healing when compared to an acute repair model. Animal models for gluteus medius tears should use a delayed repair model to improve clinical validity.
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27
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Su Y, Huang L, Liu H, Chen S, Peng L. The Effect of Exercise Intervention on Disability and Kinesiophobia in a Retired Athlete With Old Patella Fracture: A Case Report. Front Psychol 2021; 12:744433. [PMID: 34867625 PMCID: PMC8633896 DOI: 10.3389/fpsyg.2021.744433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/13/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives: To evaluate the effect of exercise intervention on disability, pain, and kinesiophobia in a retired athlete with old patella fracture. Methods: A 34-year-old retired football player with old patella fracture conducted the exercise intervention for 12 weeks, 1 h each time, three times a week. the retired football player completed the Lysholm Knee Score (LKS), Visual Analog Scale (VAS), and the Tampa Scale for Kinesiophobia (TSK) were measured at pre-intervention, mid-intervention, and post-intervention. Results: Based on the functional training perspective, the retired athlete was subjected to two stages of exercise intervention for a total of 12 weeks. The patient's LKS score increased from 76 to 95, and the pain level of various physical states was relieved. When walking, the VAS score was reduced from 3 to 1, and when running, the VAS score was reduced from 5 to 2. Jumping VAS score for actions was reduced from 6 to 3, and the VAS score for of daily life activities was reduced from 3 points to 2. The patient's TSK score from 50 to 37. Conclusion: A 12-week exercise intervention could improve knee joint function, relieve pain and relieve kinesiophobia.
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Affiliation(s)
- Yuqin Su
- College of Physical Education, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Li Huang
- College of Physical Education, Southwest University, Chongqing, China
| | - Haowei Liu
- College of Physical Education, Southwest University, Chongqing, China
- Key Lab of Physical Fitness Evaluation and Motor Function Monitoring, Southwest University, Chongqing, China
| | - Shifan Chen
- Electrical Engineering and Automation Department, College of Automation, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Li Peng
- College of Physical Education, Southwest University, Chongqing, China
- Key Lab of Physical Fitness Evaluation and Motor Function Monitoring, Southwest University, Chongqing, China
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28
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Tran V, De Martino E, Hides J, Cable G, Elliott JM, Hoggarth M, Zange J, Lindsay K, Debuse D, Winnard A, Beard D, Cook JA, Salomoni SE, Weber T, Scott J, Hodges PW, Caplan N. Gluteal Muscle Atrophy and Increased Intramuscular Lipid Concentration Are Not Mitigated by Daily Artificial Gravity Following 60-Day Head-Down Tilt Bed Rest. Front Physiol 2021; 12:745811. [PMID: 34867450 PMCID: PMC8634875 DOI: 10.3389/fphys.2021.745811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/13/2021] [Indexed: 11/27/2022] Open
Abstract
Exposure to spaceflight and head-down tilt (HDT) bed rest leads to decreases in the mass of the gluteal muscle. Preliminary results have suggested that interventions, such as artificial gravity (AG), can partially mitigate some of the physiological adaptations induced by HDT bed rest. However, its effect on the gluteal muscles is currently unknown. This study investigated the effects of daily AG on the gluteal muscles during 60-day HDT bed rest. Twenty-four healthy individuals participated in the study: eight received 30 min of continuous AG; eight received 6 × 5 min of AG, interspersed with rest periods; eight belonged to a control group. T1-weighted Dixon magnetic resonance imaging of the hip region was conducted at baseline and day 59 of HDT bed rest to establish changes in volumes and intramuscular lipid concentration (ILC). Results showed that, across groups, muscle volumes decreased by 9.2% for gluteus maximus (GMAX), 8.0% for gluteus medius (GMED), and 10.5% for gluteus minimus after 59-day HDT bed rest (all p < 0.005). The ILC increased by 1.3% for GMAX and 0.5% for GMED (both p < 0.05). Neither of the AG protocols mitigated deconditioning of the gluteal muscles. Whereas all gluteal muscles atrophied, the ratio of lipids to intramuscular water increased only in GMAX and GMED muscles. These changes could impair the function of the hip joint and increased the risk of falls. The deconditioning of the gluteal muscles in space may negatively impact the hip joint stability of astronauts when reexpose to terrestrial gravity.
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Affiliation(s)
- Vienna Tran
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Enrico De Martino
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Julie Hides
- School of Health Sciences and Social Work, Griffith University, Brisbane, QLD, Australia
| | - Gordon Cable
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - James M. Elliott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Faculty of Medicine and Health, The Kolling Research Institute Sydney, Northern Sydney Local Health District, The University of Sydney, Sydney, NSW, Australia
| | - Mark Hoggarth
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, United States
| | - Jochen Zange
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Kirsty Lindsay
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Dorothée Debuse
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Andrew Winnard
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - David Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Jonathan A. Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Sauro E. Salomoni
- NHMRC Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Tobias Weber
- Space Medicine Team (HRE-OM), European Astronaut Centre, Cologne, Germany
- KBR GmbH, Cologne, Germany
| | - Jonathan Scott
- Space Medicine Team (HRE-OM), European Astronaut Centre, Cologne, Germany
- KBR GmbH, Cologne, Germany
| | - Paul W. Hodges
- NHMRC Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Nick Caplan
- Aerospace Medicine and Rehabilitation Laboratory, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
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Tibrewala R, Pedoia V, Lee J, Kinnunen C, Popovic T, Zhang AL, Link TM, Souza RB, Majumdar S. Automatic hip abductor muscle fat fraction estimation and association with early OA cartilage degeneration biomarkers. J Orthop Res 2021; 39:2376-2387. [PMID: 33368579 DOI: 10.1002/jor.24974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 08/19/2020] [Accepted: 12/21/2020] [Indexed: 02/04/2023]
Abstract
The aim of this study was to develop an automatic segmentation method for hip abductor muscles and find their fat fraction associations with early stage hip osteoarthritis (OA) cartilage degeneration biomarkers. This Institutional Review Board approved, Health Insurance Portability and Accountability Act compliant prospective study recruited 61 patients with evidence of hip OA or Femoroacetabular Impingement (FAI). Magnetic resonance (MR) images were acquired for cartilage segmentation, T1ρ and T2 relaxation times computation and grading of cartilage lesion scores. A 3D V-Net (Dice loss, Adam optimizer, learning rate = 1e-4 , batch size = 3) was trained to segment the three muscles (gluteus medius, gluteus minimus, and tensor fascia latae). The V-Net performance was measured using Dice, distance maps between manual and automatic masks, and Bland-Altman plots of the fat fractions and volumes. Associations between muscle fat fraction and T1ρ , T2 relaxation times values were found using voxel based relaxometry (VBR). A p < 0.05 was considered significant. The V-Net had a Dice of 0.90, 0.88, and 0.91 (GMed, GMin, and TFL). The VBR results found associations of fat fraction of all three muscles in early stage OA and FAI patients with T1ρ , T2 relaxation times. Using an automatic, validated segmentation model, the associations derived between OA biomarkers and muscle fat fractions provide insight into early changes that occur in OA, and show that hip abductor muscle fat is associated with markers of cartilage degeneration.
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Affiliation(s)
- Radhika Tibrewala
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Jinhee Lee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Carla Kinnunen
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Tijana Popovic
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Alan L Zhang
- Department of Orthopedics, University of California at San Francisco, San Francisco, San Francisco, California, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Richard B Souza
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA.,Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, California, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
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30
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Pumar Pérez M, Marsico S, Rodríguez Baeza A, Solano López A. Role of imaging techniques in the diagnosis of selective hypertrophy of the tensor fascia lata. RADIOLOGIA 2021; 64:S0033-8338(21)00117-X. [PMID: 34384599 DOI: 10.1016/j.rx.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 11/25/2022]
Abstract
The tensor fascia lata is a muscular structure that forms part of the lateral portion of the pelvis and proximal thigh. Because conditions affecting this muscle have not been widely reported and are relatively unknown, hypertrophy and pseudo-hypertrophy of the tensor fascia lata, although relatively common imaging findings, often go undiagnosed; instead, radiologists perform the differential diagnosis with more complex and more dangerous conditions. This article aims to review the anatomic and functional characteristics of the tensor fascia lata, going into detail about the radiological description of this muscle and pathological conditions that can affect it, as well as reviewing the relevant literature.
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Affiliation(s)
| | | | - Alfonso Rodríguez Baeza
- Departamento de Ciencias Morfológicas. Universitat Autònoma de Barcelona. Bellaterra, Barcelona, España
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Lee DH, Jeon HJ. The effect of the use of smartphone while walking on the electromyography activity of the lower extremity in young students. J Exerc Rehabil 2021; 17:138-144. [PMID: 34012940 PMCID: PMC8103187 DOI: 10.12965/jer.2142166.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/26/2021] [Indexed: 11/22/2022] Open
Abstract
The study aims to determine the effects of smartphone use on the muscle activity of the lower extremity when walking. Twenty-three healthy young students were asked to perform a 10-m walk test between normal walking without using a smartphone and walking while two-handed texting on a smartphone. The electromyography activities of the lower extremity were quantified. To quantitatively assess the cervical flexion range of smartphone users, the cervical flexion angle was measured using a digital goniometer. The study results indicated that the use of a smartphone while walking could lessen muscle activity on the tibialis anterior, gastrocnemius, rectus femoris, gluteus maximus, and gluteus medius than that of normal walking without using a smartphone. The walking speeds were reduced in walking while using a smartphone compared with normal walking without using a smartphone. The cervical flexion angle was greater when walking while using a smartphone compared to that of normal walking without using a smartphone. These results suggest that frequently using a smartphone while walking could be a potential risk for musculoskeletal problems.
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Affiliation(s)
- Dae-Hee Lee
- Department of Physical Therapy, U1 University, Yeongdong, Korea
| | - Hye-Joo Jeon
- Department of Physical Therapy, U1 University, Yeongdong, Korea
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32
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Cregg AC, Foley RCA, Livingston LA, La Delfa NJ. A biomechanical evaluation of different footrest heights during standing computer work. ERGONOMICS 2021; 64:342-353. [PMID: 33021134 DOI: 10.1080/00140139.2020.1832261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 09/28/2020] [Indexed: 06/11/2023]
Abstract
Working at a standing desk is a popular strategy to help reduce low back pain development during prolonged computer work. The purpose of this study was to examine how muscle activity, joint kinematics, weight distribution, balance and low back discomfort were affected by utilising footrests at different heights while working at a standing desk. Sixteen individuals performed a computer task at a standing workstation under four conditions: flat ground stance, and standing with one leg elevated on a low (10 cm), medium (20 cm), or high (30 cm) footrest. Footrest usage altered lumbo-pelvic and bilateral hip joint angles, muscle activity, weight distribution, and range of sway in the elevated limb. Additionally, footrest height altered lumbo-pelvic and hip joint position in the elevated limb. Discomfort increased with time across all conditions. Results suggest that intermittent utilisation of a footrest should be considered to promote changes in posture and muscle activity during prolonged computer use. Practitioner summary: This laboratory study showed that utilising a footrest between the heights of 10-30 cm during standing computer work may be beneficial to promote changes in posture and muscle activity over time. However, we recommend exercising caution while maintaining any standing position beyond 10 min of consecutive use. Abbreviations: LBP: low back pain; PD: pain developer; NPD: non-pain developer; GMe: gluteus medius; TFL: tensor fascia lata; LES: lumbar erector spinae; COP: centre of pressure; NDI: northern digital incorporated; CV: coefficient of variation; WHQ: waterloo handedness questionnaire; WFQ: waterloo footedness questionnaire; VAS: visual analogue scale; OBDI: Oswestry back disability index; IBS: International Society of Biomechanics; sEMG: surface electromyography; MVIC: maximum voluntary isometric contraction; RMS: root mean square; A/P: anterior/posterior; M/L: medial/lateral; % MVE: percentage of maximum voluntary excitation; ROM: range of motion; MCID: minimum clinically important difference.
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Affiliation(s)
- Andrew C Cregg
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Ryan C A Foley
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
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Ranker A, Oergel M, Aschoff HH, Jaiman A, Krettek C, Schiller J, Liodakis E. Preoperative femoral abduction angle correlates with initial postoperative lateral hip pain after transcutaneous osseointegrated prosthetic system (TOPS) in transfemoral amputees. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1225-1233. [PMID: 33471264 DOI: 10.1007/s00590-021-02872-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/08/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To analyse whether a preoperative femoral abduction angle (FAA) correlates with postoperative initial lateral hip pain (LHP) in above-knee amputees (AKA) treated with transcutaneous osseointegrated prosthetic system (TOPS). METHODS Pre- and postoperative long-leg radiographs of eighteen unilateral AKA (mean age 51.55y ± 12.16) were retrospectively measured. FAA was measured on both sides. Pain intensity of LHP was measured by numeric rating scale (NRS) preoperatively and every week for four weeks from the first day of weight loading. Pearson's r was calculated for correlation. Furthermore, odds ratio for LHP ≥ 5/10 NRS and relative FAA > 13° was calculated. RESULTS FAA significantly decreased in the postoperative period (pre/post. 15.33° ± 4.22; p < 0.001). Median LHP was 0/10 NRS (min.0, max.3) preoperatively and 4/10 NRS (min.2, max. 7, p < 0.001) postoperatively after first loading. Interestingly, it decreased within four weeks to a median of 0.5/10 NRS (min.0, max. 3) without intervention. A strong correlation was seen on the amputated side between preoperative FAA and LHP after loading (r = 0.835, p < 0.001), as well as the relative FAA to LHP after loading (r = 0.732, p < 0.001) and between the gap of pre- to postoperative FAA and LHP. Odds ratio for LHP ≥ 5/10 and relative FAA > 13° was 6.4 (95%CI = 0.55; 74.89). CONCLUSION The preoperative FAA strongly correlates with postoperative LHP. Surgeons should be aware of high risk of LHP that can limit prosthetic training. High preoperative FAAs should be realised in the decision meeting of TOPS implantation and pre-rehabilitative reduction of the FAA should be taken into consideration.
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Affiliation(s)
- Alexander Ranker
- Department of Rehabilitation Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. .,Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Marcus Oergel
- Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Horst-Heinrich Aschoff
- Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Ashish Jaiman
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Christian Krettek
- Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jörg Schiller
- Department of Rehabilitation Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Emmanouil Liodakis
- Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Pathogenesis and contemporary diagnoses for lateral hip pain: a scoping review. Knee Surg Sports Traumatol Arthrosc 2021; 29:2408-2416. [PMID: 33341914 PMCID: PMC8298339 DOI: 10.1007/s00167-020-06354-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/26/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE Recent advances in diagnostic imaging techniques and soft tissue endoscopy now allow for precise diagnosis and management of extra-articular hip pathology. The aim of this scoping review is to present an evidence-based update of the relevant literature focussing only on the pathoanatomy, clinical assessment and the diagnosis of pathology in the peritrochanteric space. METHODS A literature search was performed on PubMed to include articles which reported on the anatomy and diagnosis of greater trochanteric pain syndrome, trochanteric bursitis, gluteus medius tears and external snapping hip syndrome. RESULTS A total of 542 studies were identified, of which 49 articles were included for full text analysis for the scoping review. Peritrochanteric space pathology can be broadly classified into (1) greater trochanteric pain syndrome (GTPS), (2) abductor tears and (3) external snapping hip syndrome. Anatomically, gluteus medius, gluteus minimus and tensor fascia lata work in conjunction to abduct and internally rotate the hip. The anterolateral part of the gluteus medius tendon is more prone to tears due to a thin tendinous portion. Increased acetabular anteversion has also been shown to be associated with gluteal and trochanteric bursitis. In terms of clinical examination, tests which were found to be most useful for assisting in the diagnoses of lateral hip pain were the single-leg stance, resisted external derotation of the hip, hip lag sign and the Trendelenburg's test. Dynamic ultrasound along with guided injections and MRI scan do assist in differentiating the pathology and confirming the diagnosis in patients presenting with lateral hip pain. Finally, the assessment of baseline psychological impairment is essential in this group of patients to ensure outcomes are optimised. CONCLUSION Lateral hip pain used to be a poorly defined entity, but advances in imaging and interest in sports medicine have led to a better understanding of the pathology, presentation and management of this cohort of patients. A thorough appreciation of the anatomy of the abductor musculature, specific clinical signs and imaging findings will lead to an appropriate diagnosis being made and management plan instituted. LEVEL OF EVIDENCE IV.
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Kim DW, Park HK, Lee YJ. Comparison of the effects of the knee flexion and extension during side-lying hip abduction on the activity and onset time of the gluteus medius and quadratus lumborum. ISOKINET EXERC SCI 2020. [DOI: 10.3233/ies-192194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: An increase in the compensatory action of the quadratus lumborum (QL) during side-lying hip abduction (SHA) can lead to lateral movement impairment of the pelvis. OBJECTIVE: To compare the effects of knee flexion (KF) and knee extension (KE) during SHA at abduction angles of 25∘, 35∘, and 45∘ on the activity and onset time of the gluteus medius (GM) and QL. METHODS: Thirty healthy men were recruited and randomly divided into two groups: those with SHA with KF and those with SHA with KE. The subjects performed SHA at three angles of abduction in a random order. Surface electromyography was used to record the muscle activities of the GM and QL. RESULTS: The QL activity decreased significantly more in the KE group than in the KF group at each of the three angles of abduction during SHA. The GM/QL activity ratio increased significantly in the KE compared to the KF group. In addition, in the KE group, the onset of the GM activity was significantly earlier than that of the QL activity. On the other hand, in the KF group, the onset of the GM activity occurred later than that of the QL activity. CONCLUSIONS: These findings indicate that KE is more effective than KF in selectively activating the GM during SHA by reducing the QL activity and firing the GM earlier than the QL.
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Affiliation(s)
- Dong-Woo Kim
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Gyeongsan-si, Gyeongsangbuk-do, Korea
| | - Han-Kyu Park
- Department of Physical Therapy, Dongju College, Saha-gu, Busan, Korea
| | - Yang-Jin Lee
- Department of Physical Therapy, Kyungbuk College, Yeongju-si, Gyeongsangbuk-do, Korea
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Abstract
Hip abductor tendon tear is a difficult problem to manage. The hip abductor mechanism is made up of the gluteus medius and minimus muscles, both of which contribute to stabilising the pelvis through the gait cycle. Tears of these tendons are likely due to iatrogenic injury during arthroplasty and chronic degenerative tendinopathy. Ultrasound and magnetic resonance imaging have provided limited clues regarding the pattern of disease and further work is required to clarify both the macro and microscopic pattern of disease. While surgery has been attempted over the last 2 decades, the outcomes are variable and the lack of high-quality studies have limited the uptake of surgical repair. Hip abductor tendon tears share many features with rotator cuff tears, hence, innovations in surgical techniques, materials and biologics may apply to both pathologies.
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Affiliation(s)
- Mark F Zhu
- The University of Auckland, Auckland, New Zealand.,Auckland City Hospital, Auckland, New Zealand
| | | | | | - Simon W Young
- The University of Auckland, Auckland, New Zealand.,North Shore Hospital, Auckland, New Zealand
| | - Jacob T Munro
- The University of Auckland, Auckland, New Zealand.,Auckland City Hospital, Auckland, New Zealand
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Morphometric analysis of all 24 hip muscles: A cadaveric study of 18 hip specimens with proposal of a new classification of muscles. Surg Radiol Anat 2020; 43:63-72. [PMID: 32734344 DOI: 10.1007/s00276-020-02539-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE There are few papers investigating the morphometry of hip muscles and reporting either a single muscle or a group of synergistic muscles. With the development of hip joint simulation, hip arthroplasty implants, and gait analysis, a set of biometric data covering all the muscles that act on the hip joint is needed. METHODS Using a rigorous dissection process on 18 cadaveric hips, measurements of all 24 hip muscles and bone parameters were conducted. We measured the following: (a) total femur, femoral shaft, and neck lengths, (b) total muscle lengths, (c) intra-muscular and extra-muscular (free) tendon lengths, (d) bone angles, (e) muscle pennation, sagittal, and frontal angles, (f) muscle weight, (g) muscle volume, (h) muscle cross-sectional area, and (i) and bending moment. Data on more than 12,000 morphometric or anatomical parameters were collected. Correlation values between bone variables, muscle variables, and in-between muscle variables were computed. Based on their compliance, muscles were classified using the ratio of belly length over the sum of intra-muscular and free tendons. RESULTS Values of the neck, shaft, and total femur lengths were highly correlated in relation to each other. The long muscles and the pelvitrochanteric muscles were highly correlated with femoral bone lengths. The proximal and distal intra-muscular tendon lengths were correlated to the total muscle length for all long muscles, independently of free tendon (extra-muscular) or muscle belly lengths. A very significant correlation was found between muscle weight variations among specimens. Three groups of muscles were identified based on their compliance. CONCLUSION This is the first comprehensive anatomical morphometric study which includes all the 24 muscles acting on the hip joint. It generates a unique anatomical dataset comprising all necessary data for musculoskeletal modeling and arthroplasty implants of the hip joint. A new muscle classification was proposed based on compliance where muscles of the same group would exhibit similar compliance and functional anatomy.
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Ismailidis P, Kvarda P, Vach W, Appenzeller-Herzog C, Mündermann A. Abductor muscle strength deficit in patients after total hip arthroplasty for hip osteoarthritis: a protocol for a systematic review and meta-analysis. BMJ Open 2020; 10:e035413. [PMID: 32690507 PMCID: PMC7371135 DOI: 10.1136/bmjopen-2019-035413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/05/2020] [Accepted: 06/07/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Conservation of abductor muscle strength is directly associated with physical function after total hip replacement (THA). Although many studies have tried to explore and quantify a potential abductor muscle strength deficit after THA as well as identify possible causes and treatment options, this topic has not been addressed systematically. METHODS AND ANALYSIS Human-based studies reporting measurements of hip abductor strength will be included in this review. Studies reporting on hip abductor strength measured manually or isometric measurements at an abduction angle other than 0° will not be considered. No restriction will be placed on study design, publication date operative approach, prosthesis design, age and sex of the patients or severity of OA. Data sources will be Embase via embase.com, Medline ALL via Ovid and the Cochrane Central Register of Controlled Trials. The preliminary search was conducted on 5 May 2019. Data regarding absolute values or torque ratio of hip abductor torque between sides as well as patient demographic data, surgical approaches and rehabilitation protocols will be extracted. The assessment of quality and risk of bias will be performed with the modified Newcastle-Ottawa Scale. The screening, data extraction and quality assessment will be performed by two reviewers independently. Where necessary, a third review author will make a final judgement. Narrative synthesis as well as tabular presentation of the extracted data will be included. Whenever possible, metaregression and subgroup specific meta-analyses will be used to investigate the influence of time since THA and type of measurement (isokinetic or isometric) on the different outcomes. In case of sufficient information, these analyses will be extended to include characteristics such as age, sex, surgical approach or rehabilitation programme. ETHICS AND DISSEMINATION No ethics approval is required. The results will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42020153185.
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Affiliation(s)
- Petros Ismailidis
- Department of Orthopaedics and Traumatology, University Hospital of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Peter Kvarda
- Department of Orthopaedics and Traumatology, University Hospital of Basel, Basel, Switzerland
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Basel-Landschaft, Switzerland
| | - Werner Vach
- Department of Orthopaedics and Traumatology, University Hospital of Basel, Basel, Switzerland
| | | | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
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Patellofemoral Pain Syndrome and Pain Severity Is Associated With Asymmetry of Gluteus Medius Muscle Activation Measured Via Ultrasound. Am J Phys Med Rehabil 2020; 99:595-601. [DOI: 10.1097/phm.0000000000001367] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Comparison of Protonics™ Knee Brace With Sport Cord on Knee Pain and Function in Patients With Patellofemoral Pain Syndrome: A Randomized Controlled Trial. J Sport Rehabil 2020; 29:547-554. [PMID: 31034316 DOI: 10.1123/jsr.2018-0171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 02/18/2019] [Accepted: 03/10/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Protonics™ knee brace has been suggested as an intervention for patients with patellofemoral pain syndrome. However, the effectiveness of this knee brace compared with traditional conservative methods knee rehabilitation is lacking. OBJECTIVE To compare the effect of Protonics™ knee brace versus sport cord on knee pain and function in patients with patellofemoral pain syndrome. DESIGN Randomized controlled trial. SETTING Loma Linda University. PARTICIPANTS There were 41 subjects with patellofemoral pain with a mean age of 28.8 (5.0) years and body mass index of 25.6 (4.7) kg/m2 participated in the study. INTERVENTION Subjects were randomized to 1 of 2 treatment groups, the Protonics™ knee brace (n = 21) or the sport cord (n = 20) to complete a series of resistance exercises over the course of 4 weeks. MAIN OUTCOME MEASURES Both groups were evaluated according to the following clinical outcomes: anterior pelvic tilt, hip internal/external rotation, and iliotibial band flexibility. The following functional outcomes were also assessed: Global Rating of Change Scale, the Kujala score, the Numeric Pain Rating Scale, and the lateral step-down test. RESULTS Both groups showed significant improvement in the outcome measures. However, the Protonics™ knee brace was more effective than the sport cord for the Global Rating of Change Scale over time (immediate 1.0 [2.1] vs post 2 wk 3.0 [2.2] vs 4 wk 4.6 [2.3] in the Protonics™ brace compared with 0.0 [2.1] vs 1.3 [2.2] vs 3.0 [2.3] in the sport cord, P < .01), suggesting greater satisfaction. CONCLUSIONS Both study groups had significant improvements in the clinical and functional symptoms of patellofemoral pain. The Protonics™ knee brace group was significantly more satisfied with their outcome. However, the sport cord may be a more feasible and cost-effective method that yields similar results in patients with patellofemoral pain syndrome.
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Hapa O, Işın Y, Toklong M, Hüsemoğlu B, Edizer M, Havitçioğlu H. Bare area on the trochanter and its correlations to gluteal tendon insertion dimensions. J Hip Preserv Surg 2020; 7:38-42. [PMID: 32382427 PMCID: PMC7195920 DOI: 10.1093/jhps/hnaa001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 01/02/2020] [Accepted: 01/09/2020] [Indexed: 01/08/2023] Open
Abstract
Gluteus medius and minimus tears have recently been reported to be very common and the main etiology of lateral sided hip pain. The purpose of this study was to determine whether there is any correlation between the dimensions of the tendon insertions and bare areas (BA) and various bony landmarks. Twenty-seven hemipelvises from adult male hips were included. The bony landmarks [anterior tip (Ta), posterior tip of trochanter, vastus tubercle (VT) and center of BA] were marked. The longitudinal lengths and widths (maximum) of posterosuperior (PS), lateral facets (LF), minimus insertion (Min) and BA and the distance between posterior (Tp) and Ta and between anterior/posterior tips and the VT or center of BA were measured using a digital caliper. A correlation analysis was performed between variables. There was a correlation between LFlength and Minlength (r = 0.4, P = 0.01) and between Ta-BA and PS + LF (r = 0.5, P = 0.003) or Minlength (r = 0.4, P = 0.016). LFwidth was negatively correlated with BAwidth (r = -0.4, P = 0.002). Tp-BA was negatively correlated with BAwidth (r = -0.4, P = 0.01). LFwidth was correlated with Tp-BA, and this nearly reached statistical significance (r = 0.3, P = 0.05). BA can be used intraoperatively as landmarks to estimate the width of the LF and also to determine the length of the longitudinal insertion of the gluteus medius and minimus tendons.
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Affiliation(s)
| | | | | | | | - Mete Edizer
- Department of Anatomy, Dokuz Eylül University, 35340, İzmir, Turkey
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Georgoulis G, Sindou M. Muscle responses to radicular stimulation during lumbo-sacral dorsal rhizotomy for spastic diplegia: Insights to myotome innervation. Clin Neurophysiol 2020; 131:1075-1086. [PMID: 32199396 DOI: 10.1016/j.clinph.2020.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/07/2019] [Accepted: 02/03/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Most of knowledge on muscle radicular innervation was from explorations in root/spinal cord pathologies. Direct and individual access to each of the lumbar-sacral -ventral and dorsal- nerve roots during dorsal rhizotomy for spastic diplegia allows precise study of the corresponding muscle innervation. Authors report the lumbo-sacral segmental myotomal organization obtained from recordings of muscle responses to root stimulation in a 20-children prospective series. METHODS Seven key-muscles in each lower limb and anal sphincter were Electromyography (EMG)-recorded and clinically observed by physiotherapist during L2-to-S2 dorsal rhizotomy. Ventral roots (VR), for topographical mapping, and dorsal roots (DR), for segmental excitability testing, were stimulated, just above threshold for eliciting muscular response. RESULTS In 70% of the muscles studied, VR innervation was pluri-radicular, from 2-to-4 roots, with 1 or 2 roots being dominant at each level. Overlapping was important. Muscle responses to DR stimulation were 1.75 times more extended compared to VR stimulation. Inter-individual variability was important. CONCLUSIONS Accuracy of root identification and stimulation with the used method brings some more precise information to radicular functional anatomy. SIGNIFICANCE Those neurophysiological findings plead for performing Intra-Operative Neuromonitoring when dealing with surgery in the lumbar-sacral roots.
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Affiliation(s)
- George Georgoulis
- Department of Neurosurgery, General Hospital of Athens "G. Gennimatas", Mesogeion Avenue 154, 11527 Athens, Greece; Medical School, University of Athens, Mikras Asias 75, 11527 Athens, Greece.
| | - Marc Sindou
- University of Lyon, Lyon, France; Clinique Bretéché, Nantes, France
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Elbuluk AM, Coxe FR, Schimizzi GV, Ranawat AS, Bostrom MP, Sierra RJ, Sculco PK. Abductor Deficiency-Induced Recurrent Instability After Total Hip Arthroplasty. JBJS Rev 2020; 8:e0164. [DOI: 10.2106/jbjs.rvw.18.00164] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Rehabilitation Exercises for the Gluteus Minimus Muscle Segments: An Electromyography Study. J Sport Rehabil 2019; 28:544-551. [PMID: 29584533 DOI: 10.1123/jsr.2017-0262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 02/02/2018] [Accepted: 03/06/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT The gluteus minimus (GMin) muscle consists of 2 uniquely oriented segments that have potential for independent function and have different responses to pathology and aging. For healthy young adults, it is unknown that which rehabilitation exercises specifically target the individual segments. OBJECTIVE To quantify segmental GMin activity for 6 common lower-limb rehabilitation exercises in healthy young adults and determine if significant differences exist in segmental activity levels between the exercises. METHOD Six common lower-limb rehabilitation exercises were performed by 10 healthy young adults with fine-wire electromyography (EMG) electrodes inserted into the anterior and posterior segments of the GMin muscle. MAIN OUTCOME MEASURES Electromyography signals were recorded, and median normalized exercise activity levels were reported and compared for each GMin segment across the 6 exercises. RESULTS High activity levels were generated in the anterior segment by the resisted hip abduction-extension exercise (51% maximum voluntary isometric contraction [MVIC]), whereas for the posterior segment, high activity levels were produced by the single-leg bridge (49% MVIC), the side-lie hip abduction (43% MVIC), the resisted hip abduction-extension exercise (43% MVIC), and the single-leg squat (40% MVIC). There were significant differences (P < .05) in the median electromyography activity levels for the anterior GMin segment but not for the posterior GMin segment across some of the exercises with large effect sizes. CONCLUSION Targeted rehabilitation exercises graded by exercise intensity can be prescribed specifically for the anterior and posterior GMin segments to aid in restoration of hip function following injury or aging.
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Kahlenberg CA, Nwachukwu BU, Jahandar H, Meyers KN, Ranawat AS, Ranawat AS. Single- Versus Double-Row Repair of Hip Abductor Tears: A Biomechanical Matched Cadaver Study. Arthroscopy 2019; 35:818-823. [PMID: 30733037 DOI: 10.1016/j.arthro.2018.10.146] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 10/05/2018] [Accepted: 10/29/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The purposes of this study were (1) to evaluate the percentage of gluteus medius and minimus tendon footprint restoration that can be achieved with fixation using single-row repair versus double-row repair and (2) to evaluate the yield load of a repair of the gluteus medius and minimus tendon using single-row versus double-row repair techniques. METHODS Twelve human fresh-frozen cadaveric hip specimens (6 matched pairs, 4 female, mean age 47.5 ± 14.5 years) were tested. Specimens were excluded if they had any prior hip surgery or injury, if any abnormality of the tendon was noted on dissection, or if they had a body mass index <20 or >35 or a T-score <2.0 on dual-energy x-ray absorptiometry scanning. Matched pairs were randomized to receive either double-row repair with 2 standard suture anchors and 2 knotless anchor devices or a single-row repair with suture anchors only. The percentage of the footprint area covered after repair was determined using a computer-assisted digitization algorithm. With a mechanical testing system, each repaired specimen was tested for mechanical strength first with cyclic loading and then load to failure testing. RESULTS Footprint coverage of the lateral facet was significantly greater for double-row repair (mean 76.6%) compared with single-row repair (mean 50.3%) (P = .03). There was no significant difference between single- and double-row repair for posterior-superior or anterior facet coverage. Mechanical testing showed a higher mean yield load for double-row anchor repair (197.6 ± 61.7 N vs 163.5 ± 35.4 N for single-row repair), but this did not reach statistical significance (P = .15). The predominant mode of failure was suture pullout through the musculotendinous unit (9/12 specimens: 5 double-row and 4 single-row). CONCLUSIONS For hip abductor tears, double-row suture repair yields improved footprint coverage compared with single-row repair. Although it did not reach statistical significance, there was a higher mean yield load in the double-row group. CLINICAL RELEVANCE Double-row suture fixation technique for hip abductor tears maximizes strength and footprint coverage of the repair.
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Affiliation(s)
- Cynthia A Kahlenberg
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A..
| | - Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Hamidreza Jahandar
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, U.S.A
| | - Kathleen N Meyers
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, U.S.A
| | - Amar S Ranawat
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
| | - Anil S Ranawat
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A
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Belzile EL, Hébert M, Janelle N, Lechasseur B, Dessery Y, Ayeni OR, Corbeil P. Capsular plication in the non-deformity hip: impact on post-operative joint stability. J Exp Orthop 2019; 6:3. [PMID: 30694409 PMCID: PMC6890890 DOI: 10.1186/s40634-019-0172-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 01/17/2019] [Indexed: 11/10/2022] Open
Abstract
Purpose and hypothesis The aim of this study was to evaluate the hip joint range of motion after different capsular plication. The study hypothesis proposed that capsular plication after hip arthroscopy may reduce hip external rotation and thus prevent the hip joint instability created by arthroscopic capsulotomies. Methods Six fresh frozen human cadavers were studied in the intact state (5 males, 1 females) for a total of 12 non-deformity hips tested. They were fixed to the operating room table using a custom-made apparatus. Three Steinman pins were inserted, the first into ASIS, a parallel pin into the distal femur proximal to inter-epicondylar axis and the third pin into the lateral epicondyle. Simulation of arthroscopic capsulotomies was done progressively with simulation of three capsular plication techniques. The first plication technique consisted of a primary plication shift of the antero-lateral capsule. The distal-medial arm of the iliofemoral ligament was shifted toward the proximal-lateral arm. The second plication technique consisted in adding a longitudinal arm to the capsulotomy, between the lateral arm and the medial arm of the iliofemoral ligament, to create a T-shaped capsulotomy. The resulting two triangular capsular flaps were overlaid onto each other by approximately 5 mm, plicated fully and tighly sutured in a double-breast manner. The third plication technique, called redrapping, consisted in excising the inferior capsular triangular flap (previously made in the second technique), and suturing the latero-anterior superior capsular flap to the medial arm of the iliofemoral ligament, superimposing the capsular edges for closure. External rotation of the hip at 0°, 15° and 30° of flexion were obtained after the capsulotomy and each capsular plication technique to quantify the increase in hip stability after plication. Data were assessed using a two-way repeated measure analysis of variance (ANOVAs) and Student’s T-test when necessary to determine if the change in external rotation was significantly different. Results After capsulotomy, external rotation averaged 26.3°, 29.1° and 31.1° at 0°, 15° and 30° of flexion. With the primary plication shift, external rotation averaged 24.9°, 30.3° and 34.0°. With the two-triangle technique, external rotation averaged 26.1°, 31.9° and 33.3°. With the re-draping technique, external rotation averaged 25.8°, 30.9° and 32.0°. A significant relationship was found between «Plication Technique» and «Angle of flexion» factors for the measured angle of external rotation (P = 0.04). A decomposition of the interaction showed that external rotation decreased at 0° of hip flexion and increased as the hip flexion angle increased. The only significant difference found corresponded to the two triangles technique at 15° flexion (mean difference compared to the non-repaired state = 2.8° ± 3.8° or 8.8% increase in external rotation; P = 0.03). Conclusions Different techniques of capsular plication result in a non-significant increase in hip external rotation when compared to unrepaired capsulotomies. Therefore, special attention should be paid at the time of capsular plication, which could be disadvantageous when done overzealously aiming to increase postoperative stability.
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Affiliation(s)
- Etienne L Belzile
- CHU de Quebec-Université Laval, 11 cote du Palais, Quebec city, QC, Canada. .,Department of Surgery, Division of Orthopaedic Surgery, Faculty of Medicine, Université Laval, 1401 18e rue, Quebec city, QC, G1J 1Z4, Canada.
| | - Mathieu Hébert
- Department of Surgery, Division of Orthopaedic Surgery, Faculty of Medicine, Université Laval, 1401 18e rue, Quebec city, QC, G1J 1Z4, Canada
| | - Nicolas Janelle
- Department of Kinesiology, Faculty of Medicine, Université Laval, Quebec city, QC, Canada
| | - Benoit Lechasseur
- Department of Surgery, Division of Orthopaedic Surgery, Faculty of Medicine, Université Laval, 1401 18e rue, Quebec city, QC, G1J 1Z4, Canada
| | - Yoann Dessery
- Department of Kinesiology, Faculty of Medicine, Université Laval, Quebec city, QC, Canada.,Unité de recherche sur le vieillissement, Centre de recherche FRSQ du CHA universitaire de Québec, Quebec city, QC, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Philippe Corbeil
- Department of Kinesiology, Faculty of Medicine, Université Laval, Quebec city, QC, Canada.,Unité de recherche sur le vieillissement, Centre de recherche FRSQ du CHA universitaire de Québec, Quebec city, QC, Canada
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47
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Frigotto MF, Cardoso CA, Santos RRD, Rodrigues R. Gluteus Medius and Tensor Fascia Latae muscle activation levels during multi-joint strengthening exercises. MOTRIZ: REVISTA DE EDUCACAO FISICA 2019. [DOI: 10.1590/s1980-6574201900030011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | - Rodrigo Rodrigues
- Centro Universitário da Serra Gaúcha, Brasil; Faculdades Integradas de Taquara, Brazil
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48
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Gluteus Minimus and Gluteus Medius Muscle Activity During Common Rehabilitation Exercises in Healthy Postmenopausal Women. J Orthop Sports Phys Ther 2017; 47:914-922. [PMID: 29034801 DOI: 10.2519/jospt.2017.7229] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Controlled laboratory study, cross-sectional. Background The gluteus medius (GMed) and gluteus minimus (GMin) provide dynamic stability of the hip joint and pelvis. These muscles are susceptible to atrophy and injury in individuals during menopause, aging, and disease. Numerous studies have reported on the ability of exercises to elicit high levels of GMed activity; however, few studies have differentiated between the portions of the GMed, and none have examined the GMin. Objectives To quantify and rank the level of muscle activity of the 2 segments of the GMin (anterior and posterior fibers) and 3 segments of the GMed (anterior, middle, and posterior fibers) during 4 isometric and 3 dynamic exercises in a group of healthy, postmenopausal women. Methods Intramuscular electrodes were inserted into each segment of the GMed and GMin in 10 healthy, postmenopausal women. Participants completed 7 gluteal rehabilitation exercises, and average normalized muscle activity was used to rank the exercises from highest to lowest. Results The isometric standing hip hitch with contralateral hip swing was the highest-ranked exercise for all muscle segments except the anterior GMin, where it was ranked second. The highest-ranked dynamic exercise for all muscle segments was the dip test. Conclusion The hip hitch and its variations maximally activate the GMed and GMin muscle segments, and may be useful in hip muscle rehabilitation in postmenopausal women. J Orthop Sports Phys Ther 2017;47(12):914-922. Epub 15 Oct 2017. doi:10.2519/jospt.2017.7229.
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49
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Foucher KC. Sex-specific hip osteoarthritis-associated gait abnormalities: Alterations in dynamic hip abductor function differ in men and women. Clin Biomech (Bristol, Avon) 2017; 48:24-29. [PMID: 28708989 DOI: 10.1016/j.clinbiomech.2017.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 06/09/2017] [Accepted: 07/03/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hip osteoarthritis results in abnormal gait mechanics, but it is not known whether abnormalities are the same in men and women. The hypothesis tested was that gait abnormalities are different in men and women with hip osteoarthritis vs. sex-specific asymptomatic groups. METHODS 150 subjects with mild through severe radiographic hip osteoarthritis and 159 asymptomatic subjects were identified from an Institutional Review Board-approved motion analysis data repository. Sagittal plane hip range of motion and peak external moments about the hip, in all three planes, averaged from normal speed walking trials, were compared for men and women, with and without hip osteoarthritis using analysis of variance. FINDINGS There were significant sex by group interactions for the external peak hip adduction and external rotation moments (P=0.009-0.045). Although asymptomatic women had peak adduction and external rotation moments that were respectively 12% higher and 23% lower than asymptomatic men (P=0.026-0.037), these variables did not differ between men and women with hip osteoarthritis (P≥0.684). The osteoarthritis vs. asymptomatic group difference in the peak hip adduction moment was 45% larger in women than in men. The osteoarthritis vs. asymptomatic group difference in the peak hip external rotation moment was 55% larger for men than for women (P<0.001). Sex did not influence the association between radiographic severity and gait variables. INTERPRETATION Normal sex differences in gait were not seen in hip osteoarthritis. Sex-specific adaptations may reflect different aspects of hip abductor function. Men and women with hip osteoarthritis may require different interventions to improve function.
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Affiliation(s)
- Kharma C Foucher
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, USA.
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50
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Awwad DH, Buckley JD, Thomson RL, O'Connor M, Carbone TA, Chehade MJ. Testing the Hip Abductor Muscle Strength of Older Persons Using a Handheld Dynamometer. Geriatr Orthop Surg Rehabil 2017; 8:166-172. [PMID: 28835874 PMCID: PMC5557201 DOI: 10.1177/2151458517722608] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/01/2017] [Accepted: 06/14/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the reliability of a clinically applicable method of dynamometry to assess and monitor hip abductor muscle strength in older persons. DESIGN Bilateral isometric hip abductor muscle strength measured with a handheld dynamometer, patients supine with the contralateral hip positioned directly against a wall for stabilization. Reliability determined by comparing intra-assessor and inter-assessor results and comparison to a criterion standard (stabilized dynamometer with patients in the standing position). SETTING UniSA Nutritional Physiology Research Centre. PARTICIPANTS Twenty-one patients older than 65 years were recruited from the Royal Adelaide Hospital. MAIN OUTCOME MEASURES Intraclass correlation coefficients (ICCs), bias, and limits of agreement calculated to determine reliability. RESULTS Intra-assessor and inter-assessor ICCs were high (0.94 and 0.92-0.94, respectively). There was no intra-assessor bias and narrow limits of agreement (±2.4%). There was a small inter-assessor bias but narrow limits of agreement (0.6%-0.9% and ± 2.3%, respectively). There was a wide variation comparing results to the criterion standard (±5.0%-5.2% limits of agreement), highlighting problems attributed to difficulties that the test population had with the standing position used in the criterion standard test. CONCLUSIONS Testing older persons' hip abductor muscle strength while in the supine position with optimal pelvic stabilization using a handheld dynamometer is highly reliable. While further studies must be done to assess patients with specific pathologies, this test has potential application to monitor and evaluate the effects of surgical interventions and/or rehabilitation protocols for a variety of conditions affecting hip abductor function such as hip fractures and arthritis.
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Affiliation(s)
- Daniel H Awwad
- Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, South Australia, Australia
| | - Jonathan D Buckley
- Nutritional Physiology Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Rebecca L Thomson
- Nutritional Physiology Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Matthew O'Connor
- Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, South Australia, Australia
| | - Tania A Carbone
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Mellick J Chehade
- Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, South Australia, Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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