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Silvestri MA, Cleather DJ, Patterson S, Legg HS. Femoroacetabular Impingement in Ice Hockey Athletes. J Strength Cond Res 2023; 37:2106-2117. [PMID: 37639646 DOI: 10.1519/jsc.0000000000004531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
ABSTRACT Femoroacetabular impingement (FAI) in ice hockey is a concern for many athletes. The biomechanics of skating and the injury mechanism, prevalence, identification, and treatment protocols currently available for FAI in ice hockey athletes are important for all coaches and practitioners to understand. This article discusses the underlying anatomical issues and biomechanical considerations surrounding FAI. Furthermore, this article describes the interventions that can be used when encountering FAI and well-established protocols to aid in the return to play. Finally, prevention strategies that can aid in injury prevention are discussed.
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Affiliation(s)
- Michael A Silvestri
- Faculty of Sport, Allied Health and Performance Sciences, St. Mary's University, Twickenham, London, United Kingdom
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Lindman I, Öhlin A, Desai N, Samuelsson K, Ayeni OR, Hamrin Senorski E, Sansone M. Five-Year Outcomes After Arthroscopic Surgery for Femoroacetabular Impingement Syndrome in Elite Athletes. Am J Sports Med 2020; 48:1416-1422. [PMID: 32195598 PMCID: PMC7227125 DOI: 10.1177/0363546520908840] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement syndrome (FAIS) is a common cause of hip pain and disability in athletes. Arthroscopic treatment for FAIS is well-established; however, the long-term results in elite athletes are limited. PURPOSE To evaluate outcomes 5 years after arthroscopic treatment for FAIS in elite athletes. STUDY DESIGN Case series; Level of evidence, 4. METHODS Elite athletes undergoing arthroscopic treatment for FAIS with a minimum 5-year follow-up were included. They were prospectively followed up with patient-reported outcome measures. An elite athlete was defined as having a Hip Sports Activity Scale (HSAS) level of 7 or 8 before the onset of symptoms. Preoperatively and 5 years after surgery, all athletes completed a web-based questionnaire, including the Copenhagen Hip and Groin Outcome Score (comprising 6 subscales), the EQ-5D and EQ-VAS (European Quality of Life-5 Dimensions Questionnaire and European Quality of Life-Visual Analog Scale), iHOT-12 (International Hip Outcome Tool), a visual analog scale for hip function, and the HSAS. Moreover, patients reported their overall satisfaction with their hip function. Preoperative measurements were compared with the 5-year follow-up. RESULTS A total of 64 elite athletes (52 men, 12 women) with a mean ± SD age of 24 ± 6 years were included. On average, patients reported a statistically significant and clinically relevant improvement from preoperative patient-reported outcome measures to the 5-year follow-up (P < .0003), Copenhagen Hip and Groin Outcome Score subscales (symptoms, 51.7 vs 71.9; pain, 61.0 vs 81.1; function of daily living, 67.1 vs 83.6; function in sports and recreation, 40.0 vs 71.5; participation in physical activity, 25.0 vs 67.4; hip and groin-related quality of life, 34.4 vs 68.0), EQ-5D (0.60 vs 0.83), EQ-VAS (66.1 vs 76.7), and iHOT-12 (40.0 vs 68.8). At the 5-year follow-up, 90.5% reported satisfaction with their overall hip function. In total, 54% still participated in competitive sports (HSAS, 5-8) at follow-up, while 77% had decreased their level. Older patients and patients with longer duration of symptoms reported a significantly lower level of sports activity (HSAS, 0-4; P < .009). CONCLUSION Arthroscopic treatment for FAIS in elite athletes results in a statistically significant and clinically relevant improvement regarding symptoms, hip function, quality of life, and pain 5 years after surgery. Approximately half of the cohort was still in competitive sports at follow-up, yet 77% had decreased their level of sports. Nine of 10 patients were satisfied with their surgery.
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Affiliation(s)
- Ida Lindman
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden,Ida Lindman, MD, Department of Orthopaedics, University of Gothenburg, Hedasg 12B, Gothenburg 413 45, Sweden ()
| | - Axel Öhlin
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Neel Desai
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Olufemi R. Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - Eric Hamrin Senorski
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Mikael Sansone
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden,Orthocenter/IFK-Kliniken, Gothenburg, Sweden
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Larson CM, Ross JR, Kuhn AW, Fuller D, Rowley DM, Giveans MR, Stone RM, Bedi A. Radiographic Hip Anatomy Correlates With Range of Motion and Symptoms in National Hockey League Players. Am J Sports Med 2017; 45:1633-1639. [PMID: 28298064 DOI: 10.1177/0363546517692542] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip disorders in athletes have been increasingly recognized. PURPOSE To characterize radiographic hip anatomy for National Hockey League (NHL) players and correlate it with hip range of motion and hip symptoms and/or surgery. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Fifty-nine professional hockey players (118 hips) with 1 NHL organization (mean age, 24.2 years; range, 18-36) prospectively underwent history and physician examination by 2 independent orthopaedic surgeons. Current or previous groin and/or hip pain or surgery was noted. Anteroposterior (AP) pelvis and bilateral Dunn lateral radiographs were obtained for all players with assessment of hip morphology by 2 blinded independent orthopaedic surgeons. RESULTS Good to very good reliability of radiographic assessments was noted (intraclass correlation coefficients = 0.749-0.958). Sixty-four percent of athletes had a positive crossover sign, while 86% and 60% had a positive posterior wall sign and a prominent ischial spine sign, respectively. Twenty-one percent of hips demonstrated dysplastic acetabular features (lateral center edge angle <25°). Eighty-five percent and 89% of hips demonstrated cam-type morphology based on alpha angle (>50° Dunn lateral) and head-neck offset, respectively. Good to very good reliability was noted for ROM assessments (intraclass correlation coefficient >0.69). Mean hip flexion was 107.4º ± 6.7º, and mean hip internal rotation was 26.1º ± 6.6º. Thirty-one percent of hips had a history of hip-related pain and/or surgery. Higher AP, Dunn lateral, and maximal alpha angles correlated with decreased hip internal rotation ( P = .004). Greater AP alpha angle correlated with decreased hip extension/abduction ( P = .025), and greater Dunn lateral and maximal alpha angle correlated with decreased hip flexion/abduction ( P = .001). A positive posterior wall sign correlated with increased straight hip abduction, while other radiographic acetabular parameters were not predictive of range of motion. Only decreased hip external rotation and total arc of motion correlated with an increased risk for current or prior hip symptoms or surgery ( P < .001). CONCLUSION Hip anatomy in NHL players is characterized by highly prevalent cam-type morphology (>85%) and acetabular retroversion (>60%). In addition, acetabular dysplasia (21%) was relatively common. Greater cam-type morphology correlated with decreased hip range of motion, and a positive crossover sign correlated with increased hip abduction. Decreased hip external rotation and total arc of motion were predictive of hip-related pain and/or surgery.
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Affiliation(s)
- Christopher M Larson
- Minnesota Orthopedic Sports Medicine Institute, Twin Cities Orthopedics, Edina, Minnesota, USA
| | - James R Ross
- Boca Care Orthopedics, Boca Raton Regional Hospital, Boca Raton, Florida, USA.,College of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
| | - Andrew W Kuhn
- Department of Orthopaedic Surgery-MedSport, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Donnie Fuller
- Minnesota Wild Hockey Club, National Hockey League, St Paul, Minnesota, USA
| | - David M Rowley
- Fairview/MOSMI Orthopedic Fellowship Program, Minneapolis, Minnesota, USA
| | - M Russell Giveans
- Minnesota Orthopedic Sports Medicine Institute, Twin Cities Orthopedics, Edina, Minnesota, USA
| | - Rebecca M Stone
- Minnesota Orthopedic Sports Medicine Institute, Twin Cities Orthopedics, Edina, Minnesota, USA
| | - Asheesh Bedi
- Department of Orthopaedic Surgery-MedSport, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Return to Play Following Open Treatment of Femoroacetabular Impingement in Adolescent Athletes. J Am Acad Orthop Surg 2016; 24:872-879. [PMID: 27855130 DOI: 10.5435/jaaos-d-16-00110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION After treatment of femoroacetabular impingement (FAI) in adolescent competitive athletes, the rate, timing, and level of return to play have not been well reported. METHODS Adolescent athletes who underwent open FAI treatment were assessed at a minimum 1-year follow-up. Patients completed a self-reported questionnaire centered on the time and level of return to play. Pain and functional outcomes were assessed using the modified Harris Hip Score (mHHS) and the Hip Disability and Osteoarthritis Outcome Score (HOOS). RESULTS Among the 24 athletes included, 21 (87.5%) (95% confidence interval [CI], 67.6% to 97.3%) successfully returned to play after open FAI treatment. The median time to return to play was 7 months (95% CI, 6 to 10 months). Of the 21 who returned to play, 19 (90%) returned at a level that was equivalent to or greater than their level of play before surgery. Three athletes (12.5%) did not return to play and indicated that failure to return to play was unrelated to their hip. There was significant improvement in the mHHS (P < 0.0001), HOOS (P < 0.0001), α angle (P < 0.0001), and offset (P < 0.0001). DISCUSSION Most adolescent athletes can expect to return to the same or better level of sports participation during the first year after open treatment of FAI.
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Kuhn AW, Noonan BC, Kelly BT, Larson CM, Bedi A. The Hip in Ice Hockey: A Current Concepts Review. Arthroscopy 2016; 32:1928-38. [PMID: 27318779 DOI: 10.1016/j.arthro.2016.04.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/18/2016] [Accepted: 04/25/2016] [Indexed: 02/02/2023]
Abstract
Ice hockey is a fast, physical sport with unique associated biomechanical demands often placing the hip in forced and repetitive supraphysiological ranges of motion. Ice hockey players commonly endure and are sidelined by nebulous groin injury or hip pain. Underlying causes can be chronic or acute and extra-articular, intra-articular, or "hip-mimicking." This article serves to review common hip-related injuries in ice hockey. For each, we define the particular condition; comment on risk factors and preventive strategies; discuss key historical, physical examination, and imaging findings; and finally, suggest nonoperative and/or operative treatment plans.
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Affiliation(s)
- Andrew W Kuhn
- MedSport and Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A
| | | | - Bryan T Kelly
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, U.S.A
| | | | - Asheesh Bedi
- MedSport and Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A..
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Ng KCG, Lamontagne M, Beaulé PE. Differences in anatomical parameters between the affected and unaffected hip in patients with bilateral cam-type deformities. Clin Biomech (Bristol, Avon) 2016; 33:13-19. [PMID: 26895447 DOI: 10.1016/j.clinbiomech.2016.01.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 12/16/2015] [Accepted: 01/25/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND It is still unclear why many individuals with bilateral cam deformities demonstrate only unilateral symptoms of femoroacetabular impingement, thus symptoms may be attributed to additional anatomical parameters. The purpose was to examine patients with bilateral cam deformities, with unilateral symptoms, and compare anatomical hip joint parameters between their affected (symptomatic) hip and their contralateral, unaffected (asymptomatic) hip. METHODS Twenty participants (n=20) with unilateral symptoms, but bilateral cam deformities, underwent CT imaging to measure their affected and unaffected hip's: axial and radial alpha angles, femoral head-neck offset, femoral neck-shaft angle, medial proximal femoral angle, femoral torsion, acetabular version, center-edge angle; and a physical examination (hip flexion, straight-leg raise, internal rotation, external rotation) to ascertain clinical signs. FINDINGS The affected hips demonstrated limited motions during physical examination, compared with unaffected hips (effect size=0.550 to 0.955). The affected hips had significantly lower femoral neck-shaft angles (mean 125° (SD 3)) and lower medial proximal femoral angles (mean 79° (SD 4)), compared with the unaffected hips (mean 127° (SD 3), P=0.001, effect size=0.922; and mean 81° (SD 4), P=0.011, effect size=0.632; respectively). There were no differences in cam deformity parameters (axial and radial alpha angles, femoral head-neck offset), femoral torsion, acetabular version, and center-edge angle, between affected and unaffected hips. INTERPRETATION A decreased femoral neck-shaft angle or medial proximal femoral angle can be implemented as a diagnostic predictor, to determine which hip may be at a greater risk of developing early symptoms.
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Affiliation(s)
- K C Geoffrey Ng
- Department of Mechanical Engineering, University of Ottawa, Ottawa, ON, Canada.
| | - Mario Lamontagne
- Department of Mechanical Engineering, University of Ottawa, Ottawa, ON, Canada; School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada.
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, ON, Canada.
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Schröder JH, Bizzini M, Fickert S, Hölmich P, Krüger J, Kopf S. „Return to sports“ nach femoroazetabulärer Impingement-Operation. ARTHROSKOPIE 2016. [DOI: 10.1007/s00142-015-0060-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tijssen M, van Cingel R, de Visser E, Nijhuis-van der Sanden M. A clinical observational study on patient-reported outcomes, hip functional performance and return to sports activities in hip arthroscopy patients. Phys Ther Sport 2015; 20:45-55. [PMID: 27325539 DOI: 10.1016/j.ptsp.2015.12.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 12/11/2015] [Accepted: 12/21/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To describe data of short- and midterm results of hip arthroscopy patients based on patient-reported hip function, hip functional performance and return to sports activities. DESIGN Observational cohort study. SETTING Sports medical center. PARTICIPANTS 37 recreational athletes (21 men) at least six months after finishing rehabilitation for hip arthroscopy. MAIN OUTCOME MEASURES International Hip Outcome Tool 33 (IHOT-33), Pain Visual Analogue Scale (VAS), Global Perceived Effect Scale (GPE), sports questionnaires and hip functional performance tests. RESULTS At a mean follow-up time of 2.3 years, 81% of participants reported improvement on the GPE and 84% returned to sports activities. The mean IHOT-33 score was 69.3; the mean VAS score was 35.0. Range of motion (ROM) and strength were within the 90% Limb Symmetry Index (LSI) limit, except for hip internal rotation ROM. A full recovery of hip functional performance, as measured with balance and hop tests, was established based on the 90% LSI limit. CONCLUSIONS The overall short- and midterm results of these follow-up data show good recovery of hip arthroscopy patients on patient-reported outcomes, functional performance and return to sports activities. The functional performance tests used in this study seem adequate for measuring recovery in hip arthroscopy patients.
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Affiliation(s)
- Marsha Tijssen
- Sports Medical Center Papendal, Papendallaan 7, 6816 VD Arnhem, The Netherlands; Radboud University Medical Center, Scientific Institute for Health Sciences, IQ Healthcare, P.O. Box 9101, 114 IQ, 6500 HB Nijmegen, The Netherlands.
| | - Robert van Cingel
- Sports Medical Center Papendal, Papendallaan 7, 6816 VD Arnhem, The Netherlands; HAN University of Applied Sciences, Research Group Musculoskeletal Rehabilitation, P.O. Box 6960, 6503 GL Nijmegen, The Netherlands.
| | - Enrico de Visser
- Rijnstate Hospital Arnhem, Department Orthopedic Surgery, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands.
| | - Maria Nijhuis-van der Sanden
- Radboud University Medical Center, Scientific Institute for Health Sciences, IQ Healthcare, P.O. Box 9101, 114 IQ, 6500 HB Nijmegen, The Netherlands.
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