1
|
Claes PA, Hanff DF, Weir A, Riedstra NS, Weinans H, Eygendaal D, Heerey J, Oei EH, van Klij P, Agricola R. The Association Between the Development of Cam Morphology During Skeletal Growth in High-Impact Athletes and the Presence of Cartilage Loss and Labral Damage in Adulthood: A Prospective Cohort Study With a 12-Year Follow-up. Am J Sports Med 2024; 52:2555-2564. [PMID: 39101608 PMCID: PMC11344970 DOI: 10.1177/03635465241256123] [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: 11/18/2023] [Accepted: 04/17/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Cam morphology develops during skeletal growth, but its influence on cartilage and the labrum in high-impact athletes later in life is unknown. PURPOSE To (1) explore the association between the presence and duration of cam morphology during adolescence and the cartilage and labral status 7 to 12 years later and (2) report the prevalence of cartilage loss and labral damage in a population of young male athletes (<32 years old) who played professional soccer during skeletal growth. STUDY DESIGN Cohort study (Prognosis); Level of evidence, 2. METHODS A total of 89 healthy male academy soccer players from the Dutch soccer club Feyenoord (aged 12-19 years) were included at baseline. At baseline and 2.5- and 5-year follow-ups, standardized supine anteroposterior pelvis and frog-leg lateral radiographs of each hip were obtained. At 12-year follow-up, magnetic resonance imaging of both hips was performed. Cam morphology was defined by a validated alpha angle ≥60° on radiographs at baseline or 2.5- or 5-year follow-up when the growth plates were closed. Hips with the presence of cam morphology at baseline or at 2.5-year follow-up were classified as having a "longer duration" of cam morphology. Hips with cam morphology only present since 5-year follow-up were classified as having a "shorter duration" of cam morphology. At 12-year follow-up, cartilage loss and labral abnormalities were assessed semiquantitatively. Associations were estimated using logistic regression, adjusted for age and body mass index. RESULTS Overall, 35 patients (70 hips) with a mean age of 28.0 ± 2.0 years and mean body mass index of 24.1 ± 1.8 participated at 12-year follow-up. Cam morphology was present in 56 of 70 hips (80%). The prevalence of cartilage loss was 52% in hips with cam morphology and 21% in hips without cam morphology (adjusted odds ratio, 4.52 [95% CI, 1.16-17.61]; P = .03). A labral abnormality was present in 77% of hips with cam morphology and in 64% of hips without cam morphology (adjusted odds ratio, 1.99 [95% CI, 0.59-6.73]; P = .27). The duration of cam morphology did not influence these associations. CONCLUSION The development of cam morphology during skeletal growth was associated with future magnetic resonance imaging findings consistent with cartilage loss in young adults but not with labral abnormalities.
Collapse
Affiliation(s)
- Paula A.M. Claes
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - David F. Hanff
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Adam Weir
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Sports Groin Pain Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Noortje S. Riedstra
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Harrie Weinans
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Denise Eygendaal
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Josh Heerey
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Edwin H.G. Oei
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Pim van Klij
- Department of Sports Medicine, Isala Clinics, Zwolle, the Netherlands
| | - Rintje Agricola
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
2
|
Kelly M, Secomb J. Associations Between Hip Pathology, Hip and Groin Pain, and Injuries in Hockey Athletes: A Clinical Commentary. Int J Sports Phys Ther 2024; 19:625-641. [PMID: 38707850 PMCID: PMC11065768 DOI: 10.26603/001c.116580] [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: 12/12/2023] [Accepted: 03/29/2024] [Indexed: 05/07/2024] Open
Abstract
Femoroacetabular impingement (FAI), particularly cam morphology, is highly prevalent among elite hockey athletes. Moreover, hip and groin pain has become a common issue in hockey, with approximately 50% of European professional athletes reported to experience a hip or groin problem during a season. While most athletes will not miss training or competition due to this, restricted competitive performance and increased risk of reduced physical and psychological well-being are likely. Recent research suggests that the development of cam morphology is related to the repetitive shear stresses experienced at the hip joint during adolescence from skating. This condition likely increases the potential for intra-articular and extra-articular injuries in these athletes later in their careers. Research also indicates that the hip joint mechanics during forward skating substantially increase the possibility of sustaining a labral tear compared to other sports. Such an injury can increase femoral head movement within the joint, potentially causing secondary damage to the iliofemoral ligament, ligamentum teres and joint capsule. These injuries and the high density of nociceptors in the affected structures may explain the high prevalence of hip and groin pain in hockey athletes. Compensatory adaptations, such as reduced hip strength, stability, and range-of-motion (ROM) likely increase the opportunity for core muscle injuries and hip flexor and adductor injuries. Specifically, the limited hip ROM associated with cam morphology appears to exacerbate the risk of these injuries as there will be an increase in pubic symphysis stress and transverse strain during rotational movements. It is hoped that this article will assist practitioners currently working with hockey athletes to develop evidence-informed monitoring strategies and training interventions, aimed at reducing the incidence and severity of hip and groin problems, ultimately enhancing athlete performance and well-being. Therefore, the purpose of this clinical commentary was to examine current evidence on common hip pathologies in hockey athletes, exploring potential associations between hip and groin pain and the biomechanics of hockey activities. Level of Evidence 5.
Collapse
Affiliation(s)
- Matt Kelly
- Physiotherapy and BiomechanicsSport Science Rehab and Performance Centre
| | - Josh Secomb
- Applied Sports Science and Exercise Testing LaboratoryUniversity of Newcastle Australia
- Active Living Research ProgramHunter Medical Research Institute
| |
Collapse
|
3
|
Ren N, Zhang Z, Li Y, Zheng P, Cheng H, Luo D, Zhang J, Zhang H. Effect of hip dysplasia on the development of the femoral head growth plate. Front Pediatr 2023; 11:1247455. [PMID: 37908967 PMCID: PMC10613681 DOI: 10.3389/fped.2023.1247455] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/28/2023] [Indexed: 11/02/2023] Open
Abstract
Purpose The purpose of this study was to observe whether developmental dysplasia of the hip (DDH) affects the development of the femoral head growth plate and to analyze the risk factors. Methods We selected female patients aged between 11 and 20 years with unilateral DDH and unclosed femoral head growth plate (s). The selected patients underwent anteroposterior radiography of the hip joint to compare the degree of development of the femoral head growth plate on both sides and to identify risk factors that affect the development of the growth plate in the femoral head. Results We included 48 female patients with unilateral DDH, with an average age of 14 years (range: 11.1-18.5 years) and an average BMI of 20.4 kg/m² (range: 15.5 kg/m²-27.9 kg/m²). Among them, 23 patients had earlier development of the femoral head growth plate on the affected side than on the healthy side, while the degree of development of the femoral head growth plate in 25 patients was the same as that on the contralateral side. When the Tönnis angle was greater than 29.5°C and/or the Reimers migration index was greater than 48.5%, there was a statistically significant difference in the acceleration of femoral head growth plate development. Conclusion An abnormal relative position of the acetabulum-femoral head caused by DDH can accelerate closure of the femoral head growth plate in immature female patients. The risk factors are a Tönnis angle greater than 29.5°C and/or Reimers migration index greater than 48.5%.
Collapse
Affiliation(s)
- Ningtao Ren
- Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Zhendong Zhang
- Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Yong Li
- Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Ping Zheng
- Department of Orthopedics, Fuzhou No.2 General Hospital (Fuzhou No.2 Hospital), Fuzhou, China
| | - Hui Cheng
- Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Dianzhong Luo
- Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Jianli Zhang
- Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Hong Zhang
- Department of Orthopedics, Fourth Medical Center of PLA General Hospital, Beijing, China
| |
Collapse
|
4
|
Hucke L, Holder J, van Drongelen S, Stief F, Gámez AJ, Huß A, Wittek A. Influence of tension-band plates on the mechanical loading of the femoral growth plate during guided growth due to coronal plane deformities. Front Bioeng Biotechnol 2023; 11:1165963. [PMID: 37415789 PMCID: PMC10321528 DOI: 10.3389/fbioe.2023.1165963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/07/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction: Correction of knee malalignment by guided growth using a tension-band plate is a common therapy to prevent knee osteoarthritis among other things. This approach is based on the Hueter-Volkmann law stating that the length growth of bones is inhibited by compression and stimulated by tension. How the locally varying mechanical loading of the growth plate is influenced by the implant has not yet been investigated. This study combines load cases from the gait cycle with personalized geometry in order to investigate the mechanical influence of the tension-band plates. Methods: Personalized finite element models of four distal femoral epiphyses of three individuals, that had undergone guided growth, were generated. Load cases from the gait cycles and musculoskeletal modelling were simulated with and without implant. Morphological features of the growth plates were obtained from radiographs. 3D geometries were completed using non-individual Magnetic Resonance Images of age-matched individuals. Boundary conditions for the models were obtained from instrumented gait analyses. Results: The stress distribution in the growth plate was heterogenous and depended on the geometry. In the insertion region, the implants locally induced static stress and reduced the cyclic loading and unloading. Both factors that reduce the growth rate. On the contralateral side of the growth plate, increased tension stress was observed, which stimulates growth. Discussion: Personalized finite element models are able to estimate the changes of local static and cyclic loading of the growth plate induced by the implant. In future, this knowledge can help to better control growth modulation and avoid the return of the malalignment after the treatment. However, this requires models that are completely participant-specific in terms of load cases and 3D geometry.
Collapse
Affiliation(s)
- Lucie Hucke
- Peronalized Biomedical Engineering Laboratory, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
- Department of Mechanical Engineering and Industrial Design, School of Engineering, University of Cádiz, Cádiz, Spain
| | - Jana Holder
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Stefan van Drongelen
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix Stief
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Antonio J. Gámez
- Department of Mechanical Engineering and Industrial Design, School of Engineering, University of Cádiz, Cádiz, Spain
| | - Armin Huß
- Peronalized Biomedical Engineering Laboratory, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
| | - Andreas Wittek
- Peronalized Biomedical Engineering Laboratory, Frankfurt University of Applied Sciences, Frankfurt am Main, Germany
| |
Collapse
|
5
|
Alonso G, Yawny A, Bertolino G. How do bones grow? A mathematical description of the mechanobiological behavior of the epiphyseal plate. Biomech Model Mechanobiol 2022; 21:1585-1601. [PMID: 35882677 DOI: 10.1007/s10237-022-01608-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: 11/10/2021] [Accepted: 06/24/2022] [Indexed: 11/29/2022]
Abstract
Growth modulation is an emerging method for the treatment of skeletal deformities originating in the long bones or the vertebral bodies. It requires the controlled application of mechanical loads to the affected bone, causing an alteration of the growth and ossification process occurring in a cartilaginous region called epiphyseal growth plate or physis. In order to avoid the possibility of under- or over-correction, quantification of the applied forces is necessary. Pursuing this goal, here we propose a phenomenological model of mechanobiological effects on the epiphyseal growth plate, based on the observed similarity between the mechanobiologically induced growth and viscoelastic material behavior. The model incorporates mechanical loading effects on growth direction, growth rate and ossification speed; it also allows to evaluate the occurrence of transient effects. Model consistency was tested against a rather large set of experiments existing in the literature. A generic simplified geometrical model of bones was established for this. Analytical solutions for growth and ossification evolution were obtained for different loading conditions, allowing to test the ability of the model to describe bone growth under various kinds of mechanical loading conditions. Model-predicted changes regarding epiphyseal growth plate thickness as well as longitudinal growth speed are consistent with experiments in which static tension or compression were applied to long bones. Results suggest that when the mechanical load is sinusoidally variable, conflicting data existing in the literature could be explained by a previously unconsidered effect of the the applied load initial phase. The model can accurately fit data regarding torsional loads effects on growth. Mechanobiological data for humans is very scarce. For this reason, when possible, the model parameters values were estimated, for the proposed generic geometry, after growth measurements in animal models available in the literature. Although it is not possible to assert their validity for humans, the proposed model along with the obtained parameters values give a rational foundation to be used in more advanced computational studies.
Collapse
Affiliation(s)
- Gastón Alonso
- División Física de Metales, CNEA, Centro Atómico Bariloche, Bariloche, 8400, Río Negro, Argentina. .,Instituto Balseiro, Universidad Nacional de Cuyo, Mendoza, Argentina.
| | - Alejandro Yawny
- División Física de Metales, CNEA, Centro Atómico Bariloche, Bariloche, 8400, Río Negro, Argentina.,CONICET, Buenos Aires, Argentina.,Instituto Balseiro, Universidad Nacional de Cuyo, Mendoza, Argentina
| | - Graciela Bertolino
- División Física de Metales, CNEA, Centro Atómico Bariloche, Bariloche, 8400, Río Negro, Argentina.,CONICET, Buenos Aires, Argentina.,Instituto Balseiro, Universidad Nacional de Cuyo, Mendoza, Argentina
| |
Collapse
|
6
|
Mancuso ME, Wilzman AR, Murdock KE, Troy KL. Effect of External Mechanical Stimuli on Human Bone: a narrative review. PROGRESS IN BIOMEDICAL ENGINEERING (BRISTOL, ENGLAND) 2022; 4:012006. [PMID: 36310606 PMCID: PMC9616042 DOI: 10.1088/2516-1091/ac41bc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Bone is a living composite material that has the capacity to adapt and respond to both internal and external stimuli. This capacity allows bone to adapt its structure to habitual loads and repair microdamage. Although human bone evolved to adapt to normal physiologic loading (for example from gravitational and muscle forces), these same biological pathways can potentially be activated through other types of external stimuli such as pulsed electromagnetic fields, mechanical vibration, and others. This review summarizes what is currently known about how human bone adapts to various types of external stimuli. We highlight how studies on sports-specific athletes and other exercise interventions have clarified the role of mechanical loading on bone structure. We also discuss clinical scenarios, such as spinal cord injury, where mechanical loading is drastically reduced, leading to rapid bone loss and permanent alterations to bone structure. Finally, we highlight areas of emerging research and unmet clinical need.
Collapse
|
7
|
Yadav P, Fernández MP, Gutierrez-Farewik EM. Influence of loading direction due to physical activity on proximal femoral growth tendency. Med Eng Phys 2021; 90:83-91. [PMID: 33781483 DOI: 10.1016/j.medengphy.2021.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 01/20/2021] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
Longitudinal bone growth is regulated by mechanical forces arising from physical activity, whose directions and magnitudes depend on activity kinematics and intensity. This study aims to investigate the influence of common physical activities on proximal femoral morphological tendency due to growth at the femoral head growth plate. A subject-specific femur model based on magnetic resonance images of one able-bodied 6-year old child was developed, and the directions of hip contact force were described as load samples at a constant magnitude. Finite element analysis was performed to predict growth rate and growth direction, and expected changes in neck-shaft angle and femoral anteversion were computed corresponding to circa 4 months of growth. For most loading conditions, neck-shaft angle and femoral anteversion decreased during growth, corresponding to the femur's natural course during normal growth. The largest reduction in neck-shaft angle and femoral anteversion was approximately 0.25° and 0.15°. Our results suggest that most common physical activities induce the expected morphological changes in normal growth in able-bodied children. Understanding the influence of contact forces during less common activities on proximal femoral development might provide improved guidelines and treatment planning for children who have or are at risk of developing a femoral deformity.
Collapse
Affiliation(s)
- Priti Yadav
- KTH MoveAbility Lab, Department of Engineering Mechanics, School of Engineering Sciences, KTH Royal Institute of Technology, Osquars Backe 18, 10044 Stockholm, Sweden; KTH BioMEx Center, Royal Institute of Technology, Stockholm, Sweden
| | - Marta Peña Fernández
- KTH MoveAbility Lab, Department of Engineering Mechanics, School of Engineering Sciences, KTH Royal Institute of Technology, Osquars Backe 18, 10044 Stockholm, Sweden; KTH BioMEx Center, Royal Institute of Technology, Stockholm, Sweden
| | - Elena M Gutierrez-Farewik
- KTH MoveAbility Lab, Department of Engineering Mechanics, School of Engineering Sciences, KTH Royal Institute of Technology, Osquars Backe 18, 10044 Stockholm, Sweden; KTH BioMEx Center, Royal Institute of Technology, Stockholm, Sweden; Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
8
|
Horenstein RE, Goudeau YR, Lewis CL, Shefelbine SJ. Using Magneto-Inertial Measurement Units to Pervasively Measure Hip Joint Motion during Sports. SENSORS 2020; 20:s20174970. [PMID: 32887517 PMCID: PMC7506643 DOI: 10.3390/s20174970] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/26/2020] [Accepted: 08/31/2020] [Indexed: 01/08/2023]
Abstract
The use of wireless sensors to measure motion in non-laboratory settings continues to grow in popularity. Thus far, most validated systems have been applied to measurements in controlled settings and/or for prescribed motions. The aim of this study was to characterize adolescent hip joint motion of elite-level athletes (soccer players) during practice and recreationally active peers (controls) in after-school activities using a magneto-inertial measurement unit (MIMU) system. Opal wireless sensors (APDM Inc., Portland OR, USA) were placed at the sacrum and laterally on each thigh (three sensors total). Hip joint motion was characterized by hip acceleration and hip orientation for one hour of activity on a sports field. Our methods and analysis techniques can be applied to other joints and activities. We also provide recommendations in order to guide future work using MIMUs to pervasively assess joint motions of clinical relevance.
Collapse
Affiliation(s)
- Rachel E. Horenstein
- Department of Mechanical & Industrial Engineering, Northeastern University, Boston, MA 02115, USA; (R.E.H.); (Y.R.G.)
| | - Yohann R. Goudeau
- Department of Mechanical & Industrial Engineering, Northeastern University, Boston, MA 02115, USA; (R.E.H.); (Y.R.G.)
| | - Cara L. Lewis
- Department of Physical Therapy & Athletic Training, Boston University, Boston, MA 02215, USA;
| | - Sandra J. Shefelbine
- Department of Mechanical & Industrial Engineering, Northeastern University, Boston, MA 02115, USA; (R.E.H.); (Y.R.G.)
- Department of Bioengineering, Northeastern University, Boston, MA 02115, USA
- Correspondence:
| |
Collapse
|