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Grant TM, Saxby DJ, Pizzolato C, Savage T, Bennell K, Dickenson E, Eyles J, Foster N, Hall M, Hunter D, Lloyd D, Molnar R, Murphy N, O’Donnell J, Singh P, Spiers L, Tran P, Diamond LE. Squatting biomechanics following physiotherapist-led care or hip arthroscopy for femoroacetabular impingement syndrome: a secondary analysis from a randomised controlled trial. PeerJ 2024; 12:e17567. [PMID: 38938616 PMCID: PMC11210460 DOI: 10.7717/peerj.17567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/23/2024] [Indexed: 06/29/2024] Open
Abstract
Background Femoroacetabular impingement syndrome (FAIS) can cause hip pain and chondrolabral damage that may be managed non-operatively or surgically. Squatting motions require large degrees of hip flexion and underpin many daily and sporting tasks but may cause hip impingement and provoke pain. Differential effects of physiotherapist-led care and arthroscopy on biomechanics during squatting have not been examined previously. This study explored differences in 12-month changes in kinematics and moments during squatting between patients with FAIS treated with a physiotherapist-led intervention (Personalised Hip Therapy, PHT) and arthroscopy. Methods A subsample (n = 36) of participants with FAIS enrolled in a multi-centre, pragmatic, two-arm superiority randomised controlled trial underwent three-dimensional motion analysis during squatting at baseline and 12-months following random allocation to PHT (n = 17) or arthroscopy (n = 19). Changes in time-series and peak trunk, pelvis, and hip biomechanics, and squat velocity and maximum depth were explored between treatment groups. Results No significant differences in 12-month changes were detected between PHT and arthroscopy groups. Compared to baseline, the arthroscopy group squatted slower at follow-up (descent: mean difference -0.04 m∙s-1 (95%CI [-0.09 to 0.01]); ascent: -0.05 m∙s-1 [-0.11 to 0.01]%). No differences in squat depth were detected between or within groups. After adjusting for speed, trunk flexion was greater in both treatment groups at follow-up compared to baseline (descent: PHT 7.50° [-14.02 to -0.98]%; ascent: PHT 7.29° [-14.69 to 0.12]%, arthroscopy 16.32° [-32.95 to 0.30]%). Compared to baseline, both treatment groups exhibited reduced anterior pelvic tilt (descent: PHT 8.30° [0.21-16.39]%, arthroscopy -10.95° [-5.54 to 16.34]%; ascent: PHT -7.98° [-0.38 to 16.35]%, arthroscopy -10.82° [3.82-17.81]%), hip flexion (descent: PHT -11.86° [1.67-22.05]%, arthroscopy -16.78° [8.55-22.01]%; ascent: PHT -12.86° [1.30-24.42]%, arthroscopy -16.53° [6.72-26.35]%), and knee flexion (descent: PHT -6.62° [0.56- 12.67]%; ascent: PHT -8.24° [2.38-14.10]%, arthroscopy -8.00° [-0.02 to 16.03]%). Compared to baseline, the PHT group exhibited more plantarflexion during squat ascent at follow-up (-3.58° [-0.12 to 7.29]%). Compared to baseline, both groups exhibited lower external hip flexion moments at follow-up (descent: PHT -0.55 N∙m/BW∙HT[%] [0.05-1.05]%, arthroscopy -0.84 N∙m/BW∙HT[%] [0.06-1.61]%; ascent: PHT -0.464 N∙m/BW∙HT[%] [-0.002 to 0.93]%, arthroscopy -0.90 N∙m/BW∙HT[%] [0.13-1.67]%). Conclusion Exploratory data suggest at 12-months follow-up, neither PHT or hip arthroscopy are superior at eliciting changes in trunk, pelvis, or lower-limb biomechanics. Both treatments may induce changes in kinematics and moments, however the implications of these changes are unknown. Trial registration details Australia New Zealand Clinical Trials Registry reference: ACTRN12615001177549. Trial registered 2/11/2015.
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Affiliation(s)
- Tamara M. Grant
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - David J. Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - Claudio Pizzolato
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - Trevor Savage
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
- Sydney Musculoskeletal Health, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Kim Bennell
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Edward Dickenson
- University of Warwick, Coventry, United Kingdom
- University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
| | - Jillian Eyles
- Sydney Musculoskeletal Health, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
- Department of Rheumatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Nadine Foster
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, United Kingdom
- STARS Education and Research Alliance, Surgical, Treatment and Rehabilitation Service, University of Queensland, Brisbane, Queensland, Australia
| | - Michelle Hall
- Sydney Musculoskeletal Health, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - David Hunter
- Sydney Musculoskeletal Health, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
- Department of Rheumatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - David Lloyd
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - Rob Molnar
- Department of Orthopaedic Surgery, St George Hospital, Sydney, New South Wales, Australia
- Sydney Orthopaedic and Reconstructive Surgery, Sydney, New South Wales, Australia
| | - Nicholas Murphy
- Sydney Musculoskeletal Health, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
- Department of Orthopaedic Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - John O’Donnell
- Hip Arthroscopy Australia, Richmond, Victoria, Australia
- Department of Orthopaedic Surgery, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Parminder Singh
- Hip Arthroscopy Australia, Richmond, Victoria, Australia
- Maroondah Hospital, Eastern Health, Melbourne, Victoria, Australia
| | - Libby Spiers
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
| | - Phong Tran
- Department of Orthopaedic Surgery, Western Health, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne, Melbourne, Victoria, Australia
| | - Laura E. Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
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Martin RL, Takla A, Disantis A, Kohlrieser D, Enseki K, Lifshitz L, Grant L, Bizzini M, Voight M, Ryan M, McGovern R, Tyler T, Steinfeld-Mass Y, Campbell A, Zhang Y. Evaluating Functional Performance Tests in those with Non-arthritic Intra-articular Hip Pain: An International Consensus Statement. Int J Sports Phys Ther 2023; 18:1346-1355. [PMID: 38050542 PMCID: PMC10693491 DOI: 10.26603/001c.89269] [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: 06/24/2023] [Accepted: 09/25/2023] [Indexed: 12/06/2023] Open
Abstract
Background Non-arthritic intra-articular hip pain, caused by various pathologies, leads to impairments in range of motion, strength, balance, and neuromuscular control. Although functional performance tests offer valuable insights in evaluating these patients, no clear consensus exists regarding the optimal tests for this patient population. Purpose This study aimed to establish expert consensus on the application and selection of functional performance tests in individuals presenting with non-arthritic intra-articular hip pain. Study Design A modified Delphi technique was used with fourteen physical therapy experts, all members of the International Society for Hip Arthroscopy (ISHA). The panelists participated in three rounds of questions and related discussions to reach full consensus on the application and selection of functional performance tests. Results The panel agreed that functional performance tests should be utilized at initial evaluation, re-evaluations, and discharge, as well as criterion for assessing readiness for returning to sports. Tests should be as part of a multimodal assessment of neuromuscular control, strength, range of motion, and balance, applied in a graded fashion depending on the patient's characteristics. Clinicians should select functional performance tests with objective scoring criteria and prioritize the use of tests with supporting psychometric evidence. A list of recommended functional performance tests with varying intensity levels is provided. Low-intensity functional performance tests encompass controlled speed in a single plane with no impact. Medium-intensity functional performance tests involve controlled speed in multiple planes with low impact. High-intensity functional performance tests include higher speeds in multiple planes with higher impact and agility requirements. Sport-specific movement tests should mimic the patient's particular activity or sport. Conclusion This international consensus statement provides recommendations for clinicians regarding selection and utilization of functional performance tests for those with non-arthritic intra-articular hip pain. These recommendations will encourage greater consistency and standardization among clinicians during a physical therapy assessment.
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Affiliation(s)
| | - Amir Takla
- Swinburne University of Technology
- Australian Sports Physiotherapy
- Hip Arthroscopy Australia
| | | | | | | | | | | | | | - Mike Voight
- Nashville Hip Institute at TOA
- School of Physical Therapy Belmont University
| | - Mark Ryan
- The Steadman Clinic Steadman Philippon Research Institute
| | | | | | | | - Ashley Campbell
- Nashville Hip Institute at TOA
- School of Physical Therapy Belmont University
| | - Yongni Zhang
- Duquesne University
- Duquesne - China Health Institute
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Stewart C, King MG, Kemp JL, Mentiplay BF, O'Brien MJ, Perraton Z, Lawrenson PR, Semciw AI. Hip muscle activity in people with hip-related pain compared to asymptomatic controls: A systematic review. J Electromyogr Kinesiol 2023; 71:102784. [PMID: 37331133 DOI: 10.1016/j.jelekin.2023.102784] [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: 08/04/2022] [Revised: 05/02/2023] [Accepted: 05/17/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Altered hip and thigh muscle activity have been observed across a spectrum of articular hip pathologies, including hip osteoarthritis, femoroacetabular impingement syndrome, and labral pathology. No systematic reviews have examined muscle activity associated with hip pathology and hip-related pain across the life span. A greater understanding of impairments in hip and thigh muscle activity during functional tasks may assist in the development of targeted treatment strategies. METHODS We conducted a systematic review using the PRISMA guidelines. A literature search was performed in five databases (MEDLINE, CINAHL, EMBASE, Sports Discuss, and PsychINFO). Studies were included that (i) investigated people with hip-related pain (femoroacetabular impingement syndrome, labral tears) or hip osteoarthritis; and (ii) reported on muscle activity using electromyography of hip and thigh muscles during functional tasks such as walking, stepping, squatting, or lunging. Two independent reviewers performed data extraction and assessed risk of bias using a modified version of the Downs and Black checklist. RESULTS Non-pooled data demonstrated a limited level of evidence. Overall, differences in muscle activity appeared to be more prevalent in people with more advanced hip pathology. CONCLUSIONS We found that impairments in muscle activity in those with intra-articular hip pathology measured using electromyography were variable but appeared to be greater in severe hip pathology (e.g., hip OA).
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Affiliation(s)
- Christopher Stewart
- La Trobe University, School of Allied Health, Human Services, and Sport, Australia
| | - Matthew G King
- La Trobe University, School of Allied Health, Human Services, and Sport, Australia
| | - Joanne L Kemp
- La Trobe University, School of Allied Health, Human Services, and Sport, Australia; La Trobe Sports and Exercise Medicine Research Center, La Trobe University
| | - Benjamin F Mentiplay
- La Trobe University, School of Allied Health, Human Services, and Sport, Australia
| | - Michael Jm O'Brien
- La Trobe University, School of Allied Health, Human Services, and Sport, Australia
| | - Zuzana Perraton
- La Trobe University, School of Allied Health, Human Services, and Sport, Australia
| | - Peter R Lawrenson
- University of Queensland, School of Health and Rehabilitation Sciences, Australia
| | - Adam I Semciw
- La Trobe University, School of Allied Health, Human Services, and Sport, Australia.
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Cannon J, Kulig K, Weber AE, Powers CM. Gluteal activation during squatting reduces acetabular contact pressure in persons with femoroacetabular impingement syndrome: A patient-specific finite element analysis. Clin Biomech (Bristol, Avon) 2023; 101:105849. [PMID: 36549048 DOI: 10.1016/j.clinbiomech.2022.105849] [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: 02/27/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Femoroacetabular impingement syndrome is a motion-related clinical disorder resulting from abnormal hip joint morphology. Mechanical impingement, in which the aspherical femoral head (cam morphology) abuts with the acetabular rim, is created with simultaneous hip flexion, internal rotation, and adduction. Impaired function of the gluteal muscles may be contributory to femoroacetabular impingement syndrome progression. The purpose of this study was to assess the influence of gluteal muscle recruitment on acetabular contact pressure during squatting in persons with cam femoroacetabular impingement syndrome. METHODS Eight individuals (4 males, 4 females) with a diagnosis of cam femoroacetabular impingement syndrome underwent CT imaging of the pelvis and proximal femora, and a biomechanical assessment of squatting (kinematics, kinetics, and electromyography). Two maximal depth bodyweight squat conditions were evaluated: 1) non-cued squatting; and 2) cued gluteal activation squatting. Utilizing subject-specific electromyography-driven hip and finite element modeling approaches, hip muscle activation, kinematics, bone-on-bone contact forces, and peak acetabular contact pressure were compared between squat conditions. FINDINGS Modest increases in gluteus maximus (7% MVIC, P < 0.0001) and medius (6% MVIC, P = 0.009) activation were able to reduce hip internal rotation on average 5° (P = 0.024), and in doing so reduced acetabular contact pressure by 32% (P = 0.023). Reductions in acetabular contact pressure occurred despite no change in hip abduction and increased bone-on-bone contact forces occurring in the cued gluteal activation condition. INTERPRETATION Our findings highlight the importance of gluteal activation in minimizing mechanical impingement and provide a foundation for interventions aimed at preventing the development and progression of femoroacetabular impingement syndrome.
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Affiliation(s)
- Jordan Cannon
- Jacquelin Perry Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA; Comparative Neuromuscular Biomechanics Laboratory, Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kornelia Kulig
- Jacquelin Perry Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Alexander E Weber
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christopher M Powers
- Jacquelin Perry Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.
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5
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Suits WH. Clinical Measures of Pelvic Tilt in Physical Therapy. Int J Sports Phys Ther 2021; 16:1366-1375. [PMID: 34631258 PMCID: PMC8486407 DOI: 10.26603/001c.27978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/19/2021] [Indexed: 01/18/2023] Open
Abstract
Pelvic tilt refers to the spatial position or motion of the pelvis about a frontal horizontal axis on the rest of the body in the sagittal plane. It is relevant for several musculoskeletal conditions commonly seen in physical therapist practice, particularly conditions affecting the hip and groin. Despite the relevance of pelvic tilt identified in biomechanical studies, and the historical precedence for assessing pelvic tilt, there is a lack of clarity regarding the utility of clinical measures that are practical in a rehabilitation setting. There are several options available to assess pelvic tilt which are discussed in detail in this commentary. All of these options come with potential benefits and considerable limitations. The purpose of this commentary is to provide an overview of the relevance of understanding pelvic tilt in the pathology and rehabilitation of conditions affecting the hip joint, with a focus applying evidence towards identifying clinical measures that may be useful in the rehabilitation setting and considerations that are needed with these measures. LEVEL OF EVIDENCE 5.
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6
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Catelli DS, Kowalski E, Beaulé PE, Lamontagne M. Muscle and Hip Contact Forces in Asymptomatic Men With Cam Morphology During Deep Squat. Front Sports Act Living 2021; 3:716626. [PMID: 34568821 PMCID: PMC8458768 DOI: 10.3389/fspor.2021.716626] [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] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/06/2021] [Indexed: 01/01/2023] Open
Abstract
Cam morphology is defined as an aspherical femoral head-neck junction that causes abnormal contact of the acetabular rim with the anterior hip. Imaging confirmation of the cam morphology, associated with clinical signs and pain in the hip or groin, is characterized as femoroacetabular impingement (FAI) syndrome. Although some individuals with cam morphology do not experience any symptoms, sparse studies have been done on these individuals. Understanding the way asymptomatic individuals generate muscle forces may help us to better explain the progression of the degenerative FAI process and discover better ways in preventing the onset or worsening of symptoms. The purpose of this study was to compare the muscle and hip contact forces of asymptomatic cam morphology (ACM) and FAI syndrome men compared to cam-free healthy controls during a deep squat task. This prospective study compared 39 participants, with 13 in each group (ACM, FAI, and control). Five deep squatting trials were performed at a self-selected pace while joint trajectories and ground reaction forces were recorded. A generic model was scaled for each participant, and inverse kinematics and inverse dynamics calculated joint angles and moments, respectively. Muscle and hip contact forces were estimated using static optimization. All variables were time normalized in percentage by the total squat cycle and both muscle forces and hip contact forces were normalized by body weight. Statistical non-parametric mapping analyses were used to compare the groups. The ACM group showed increased pelvic tilt and hip flexion angles compared to the FAI group during the descent and ascent phases of the squat cycle. Muscle forces were greater in the ACM and control groups, compared to the FAI group for the psoas and semimembranosus muscles. Biceps femoris muscle force was lower in the ACM group compared to the FAI group. The FAI group had lower posterior hip contact force compared to both the control and ACM groups. Muscle contraction strategy was different in the FAI group compared to the ACM and control groups, which caused different muscle force applications during hip extension. These results rebut the concept that mobility restrictions are solely caused by the presence of the cam morphology and propose evidence that symptoms and muscle contraction strategy can be the origin of the mobility restriction in male patients with FAI.
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Affiliation(s)
- Danilo S Catelli
- Human Movement Biomechanics Laboratory, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Erik Kowalski
- Human Movement Biomechanics Laboratory, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mario Lamontagne
- Human Movement Biomechanics Laboratory, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
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Quinn M, Levins J, Mojarrad M, O’Donnell R, DeFroda S, Haggerty E, Evangelista P, Tabaddor R. Association of tensor fascia lata hypertrophy and fatty infiltration in the presence of abductor tendon tears: a radiographic study. J Hip Preserv Surg 2021; 8:197-201. [PMID: 35145718 PMCID: PMC8826352 DOI: 10.1093/jhps/hnab058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 06/09/2021] [Accepted: 08/27/2021] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Hip abductor tendon tears of the gluteus medius and minimus are becoming a well-recognized source of pain and dysfunction, primarily in middle-age females. Like the rotator cuff, fatty infiltration (FI) can occur after tearing of these tendons. While the association of TFL hypertrophy after abductor tendon tears has been established, its association with FI has not been well studied. Our hypothesis is that hypertrophy of the TFL will be associated with FI of the abductors. All patients >18 years old undergoing primary surgical repair for a confirmed tears on MRI, without a history of prior hip surgery or osteoarthritis, were included. The following measurements were obtained from MRI: TFL cross-sectional area, TFL:sartorius volume ratio, and modified Goutallier grade of gluteus medius and minimus. Seventy patients met inclusion criteria and were divided in two groups, those with (n = 28) and those without FI (n = 42) of the abductors. The FI group was on average older (65 versus 58 years, P < 0.00016). TFL hypertrophy and TFL:sartorius volume ratio were significantly associated with FI (P= 0.00069). Following abductor tendon tear and subsequent FI, there exists significant TFL hypertrophy in patients without a prior history of hip surgery in our patient cohort.
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Affiliation(s)
- Matthew Quinn
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI 02903, USA
| | - James Levins
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI 02903, USA
| | - Mohammadali Mojarrad
- Department of Radiology, Brown University, Warren Alpert School of Medicine, Providence, RI 02903, USA
| | - Ryan O’Donnell
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI 02903, USA
| | - Steven DeFroda
- Midwest Orthopaedics, Rush University, Chicago, IL 60612, USA
| | - Erin Haggerty
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI 02903, USA
| | - Peter Evangelista
- Department of Radiology, Brown University, Warren Alpert School of Medicine, Providence, RI 02903, USA
| | - Ramin Tabaddor
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI 02903, USA
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Wierks CH, Boersma JB, Pate MJ, Davis AT. Hip Strength Before and After Arthroscopic Femoroacetabular Impingement Surgery. Orthopedics 2021; 44:148-153. [PMID: 34039218 DOI: 10.3928/01477447-20210416-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Femoroacetabular impingement (FAI) and labral pathology are associated with pain, decreased function, and hip strength deficits. Existing data are in conflict regarding when hip strength normalizes following arthroscopic treatment of FAI. The objective of this study was to identify preoperative hip strength relative to the contralateral hip not undergoing surgery as well as when postoperative strength in 4 functional muscle groups normalizes following arthroscopic treatment of FAI. Ninety-eight individuals with radiographic evidence of FAI and labral pathology underwent arthroscopic labral repair. Pre-surgical hip strength testing was performed in the symptomatic "surgical hip" and the contralateral "non-surgical hip." Hip strength measurements were repeated at 8 and 16 weeks postoperatively. Significant preoperative hip strength deficits were noted in the surgical hip compared with the non-surgical hip in flexion, extension, and adduction. At 8 weeks postoperatively, hip strength in the surgical hip improved to being equivalent to that in the non-surgical hip in adduction and extension, remained equivalent to that of the non-surgical hip in abduction, and decreased in flexion relative to the non-surgical hip. At 16 weeks, hip strength remained equivalent in the surgical hip and the non-surgical hip in abduction and adduction, but the surgical hip exceeded the non-surgical hip in extension. While flexion strength improved between 8 and 16 weeks postoperatively for the surgical hip, it had not fully recovered to that of the non-surgical hip. Using a structured postoperative rehabilitation protocol, abduction strength was maintained at 8 weeks postoperatively, while adduction and extension strength had improved to those of the non-surgical hip. At 16 weeks postoperatively, hip abduction and adduction had strength equivalent to those of the non-surgical hip. Despite preoperative improvement, flexion of the surgical hip lagged behind that of the non-surgical hip 16 weeks postoperatively. [Orthopedics. 2021;44(3):148-153.].
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Catelli DS, Bedo BLS, Beaulé PE, Lamontagne M. Pre- and postoperative in silico biomechanics in individuals with cam morphology during stair tasks. Clin Biomech (Bristol, Avon) 2021; 86:105387. [PMID: 34044296 DOI: 10.1016/j.clinbiomech.2021.105387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 04/16/2021] [Accepted: 05/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Osteochondroplasty for cam femoroacetabular impingement is a common treatment to improve hip function and prevent joint degeneration. The purpose was to compare in-silico hip biomechanics during stair tasks in pre- and postoperative patients matched with healthy controls. METHODS Ten symptomatic cam femoroacetabular impingement patients performed stair ascent and descent pre- and 2 years postoperatively. Patients were age, and body-mass-index matched to controls. Full-body kinematics and kinetics were computed and, muscle and hip contact forces were estimated using musculoskeletal modeling and static optimization. Stance-phases were time-normalized and compared using statistical non-parametric mapping. FINDINGS Preoperatives showed lower hip abduction than controls during stairs ascent (76-100%, P = .007). Pre- and postoperative showed lower hip external rotation compared to controls on stair ascent (Pre-op vs controls: 71-100%, P = .005; Post-op vs controls: 72-100%, P = .01) and stair descent (Pre-op vs controls: 0-62%, P = .001; Post-op vs controls: 0-60%, P = .001). Postoperatives showed lower iliacus force compared to preoperative (1-3%, P = .012) and control (3-6%, P = .008), and higher gluteus maximus and piriformis forces compared to controls during stair descent. Lower postoperative anterior hip contact force (0-7%, P = .004) during descent, and superior (33-35%, P = .018) during ascent compared to controls were observed. Postoperative contact forces were medialized compared to preoperative (0-2%, P = .011) and controls (1-2%, P = .016). INTERPRETATION Forcing participants to adhere to standardized step length/rise minimized sagittal kinematic differences between conditions and groups. Persistent reduced hip external rotation postoperatively and minor muscle force adaptations led to reduced superior hip contact force during stair ascent and reduced anterior and more medialized contact forces during stair descent.
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Affiliation(s)
| | - Bruno L S Bedo
- School of Human Kinetics, University of Ottawa, Ottawa, Canada; Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Canada
| | - Mario Lamontagne
- School of Human Kinetics, University of Ottawa, Ottawa, Canada; Department of Mechanical Engineering, University of Ottawa, Ottawa, Canada.
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Lindman I, Nikou S, Öhlin A, Senorski EH, Ayeni O, Karlsson J, Sansone M. Evaluation of outcome reporting trends for femoroacetabular impingement syndrome- a systematic review. J Exp Orthop 2021; 8:33. [PMID: 33893563 PMCID: PMC8065071 DOI: 10.1186/s40634-021-00351-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/08/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The aim of this systematic review was to evaluate the trends in the literature regarding surgical treatment for femoroacetabular impingement syndrome (FAIS) and to present which patient-reported outcome-measures (PROMs) and surgical approaches are included. METHODS This systematic review was conducted with the PRISMA guidelines. The literature search was performed on PubMed and Embase, covering studies from 1999 to 2020. Inclusion criteria were clinical studies with surgical treatment for FAIS, the use of PROMs as evaluation tool and studies in English. Exclusion criteria were studies with patients < 18 years, cohorts with < 8 patients, studies with primarily purpose to evaluate other diagnoses than FAIS and studies with radiographs as only outcomes without using PROMs. Data extracted were author, year, surgical intervention, type of study, level of evidence, demographics of included patients, and PROMs. RESULTS The initial search yielded 2,559 studies, of which 196 were included. There was an increase of 2,043% in the number of studies from the first to the last five years (2004-2008)-(2016-2020). There were 135 (69%) retrospective, 55 (28%) prospective and 6 (3%) Randomized Controlled Trials. Level of evidence ranged from I-IV where Level III was most common (44%). More than half of the studies (58%) originated from USA. Arthroscopic surgery was the most common surgical treatment (85%). Mean follow-up was 27.0 months (± 17 SD), (range 1.5-120 months). Between 1-10 PROMs were included, and the modified Harris Hip Score (mHHS) was most commonly used (61%). CONCLUSION There has been a continuous increase in the number of published studies regarding FAIS with the majority evaluating arthroscopic surgery. The mHHS remains being the most commonly used PROM.
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Affiliation(s)
- Ida Lindman
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden.
| | - Sarantos Nikou
- Department of Orthopaedic Surgery, South Älvsborg Hospital, 501 82, Borås, Sweden
| | - Axel Öhlin
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olufemi Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, L8N 3Z5, Canada
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
| | - Mikael Sansone
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
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Takla A, O'Donnell J, Voight M, Byrd T, Dienst M, Martin RR, Philippon MJ, Enseki K, Andrade T, Safran M, Christoforetti JJ, Martin H, Grant L, Campbell A, Ryan M, Tyler T, McGovern RP, Bizzini M, Kohlrieser D. The 2019 International Society of Hip Preservation (ISHA) physiotherapy agreement on assessment and treatment of femoroacetabular impingement syndrome (FAIS): an international consensus statement. J Hip Preserv Surg 2021; 7:631-642. [PMID: 34377507 PMCID: PMC8349584 DOI: 10.1093/jhps/hnaa043] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/30/2020] [Accepted: 08/15/2020] [Indexed: 12/11/2022] Open
Abstract
The 2019 International Society of Hip Preservation (ISHA) physiotherapy agreement on femoroacetabular impingement syndrome (FAIS) was intended to build an international physiotherapy consensus on the assessment, non-surgical physiotherapy treatment, pre-/post-operative management, and return to sport decisions for those patients with FAIS. The panel consisted of 11 physiotherapists and 8 orthopaedic surgeons. There is limited evidence regarding the use of physiotherapy in the overall management of those with FAIS. Therefore, a group of ISHA member physiotherapists, who treat large numbers of FAIS patients and have extensive experience in this area, constructed a consensus statement to guide physiotherapy-related decisions in the overall management of those with FAIS. The consensus was conducted using a modified Delphi technique. Six major topics were the focus of the consensus statement: (i) hip assessment, (ii) non-surgical physiotherapy management, (iii) pre-habilitation prior to hip arthroscopy, (iv) post-operative physiotherapy rehabilitation, (v) stages of post-operative rehabilitation and (vi) return to sports criteria/guidelines after surgery.
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Affiliation(s)
- Amir Takla
- Swinburne University of Technology - Hawthorn Campus, Health Science, Hawthorn, VIC, Australia.,Australian Sports Physiotherapy - Ivanhoe, 3079, Australia.,Hip Arthroscopy Australia, Melbourne, Richmond, VIC 3121, Australia
| | - John O'Donnell
- Hip Arthroscopy Australia, Melbourne, Richmond, VIC 3121, Australia.,Orthopaedic, St Vincent's Melbourne, East Melbourne, VIC 3054, Australia
| | - Michael Voight
- Physical Therapy, Nashville Hip Institute, Nashville, TN 37203, USA.,Physical Therapy, Belmont University, Nashville, TN 37212-3757, USA
| | - Thomas Byrd
- Surgery, Nashville Sports Medicine Foundation, Nashville, TN, USA
| | - Michael Dienst
- OCM Orthopädische Chirurgie München, Steinerstr. 6, Munich, 81369, Germany
| | - Rob Roy Martin
- Physical Therapy, Duquesne University, Pittsburgh, PA 15282-0001, USA
| | - Marc J Philippon
- Steadman Philippon Research Institute, COOR, Vail, CO 81657-5242, USA
| | - Keelan Enseki
- University of Pittsburgh Medical Center, Rooney Sports Complex, Pittsburgh, PA, USA
| | - Tony Andrade
- Reading Orthopaedic Centre, Circle Reading Hospital, Reading RG2 0NE, UK.,Trauma and Orthopaedic Department, Royal Berkshire NHS Foundation Trust, Reading RG1 5AN, UK
| | - Marc Safran
- Orthopaedic Surgery, Stanford University, Redwood City, CA 94063, USA
| | | | - Hal Martin
- Hip Preservation Center, Baylor University Medical Center at Dallas, Dallas, TX 75246-2088, USA
| | | | - Ashley Campbell
- Physical Therapy, Belmont University, Nashville, TN 37212-3757, USA
| | - Mark Ryan
- University of Pittsburgh Medical Center, Rooney Sports Complex, Pittsburgh, PA, USA
| | - Tim Tyler
- Physiotherapy, Pro Sports Physical Therapy, New York, USA
| | - Ryan P McGovern
- Texas Health Sports Medicine, Sports Medicine Research, Allen, TX 15013, USA
| | - Mario Bizzini
- Physiotherapy, Schulthess Klinik, Zurich, Switzerland
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12
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Catelli DS, Ng KCG, Wesseling M, Kowalski E, Jonkers I, Beaulé PE, Lamontagne M. Hip Muscle Forces and Contact Loading During Squatting After Cam-Type FAI Surgery. J Bone Joint Surg Am 2020; 102:34-42. [PMID: 32870617 DOI: 10.2106/jbjs.20.00078] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The purpose of this study was to compare muscle forces and hip contact forces (HCFs) during squatting in patients with cam-type femoroacetabular impingement (cam-FAI) before and after hip corrective surgery and with healthy control participants. METHODS Ten symptomatic male patients with cam-FAI performed deep squatting preoperatively and at 2 years postoperatively. Patients were matched by age and body mass index to 10 male control participants. Full-body kinematics and kinetics were computed, and muscle forces and HCFs were estimated using a musculoskeletal model and static optimization. Normalized squat cycle (%SC) trials were compared using statistical nonparametric mapping (SnPM). RESULTS Postoperatively, patients with cam-FAI squatted down with higher anterior pelvic tilt, higher hip flexion, and greater hip extension moments than preoperatively. Preoperative patients demonstrated lower anterior pelvic tilt and lower hip flexion compared with the participants in the control group. Postoperative patients showed increased semimembranosus force compared with their preoperative values. Preoperative forces were lower than the control group for the adductor magnus, the psoas major, and the semimembranosus; however, the preoperative patients showed greater inferior gluteus maximus forces than the patients in the control group, whereas the postoperative patients did not differ from the control patients. Higher posterior, superior, and resultant HCF magnitudes were identified postoperatively in comparison with the preoperative values. Preoperative posterior HCF was lower than in the control group, whereas the postoperative posterior HCF did not differ from those in the control group. CONCLUSIONS Higher postoperative anterior pelvic tilt was associated with an indication of return to closer to normal pelvic motion, which resembled data from the control group. Lower preoperative anterior pelvic tilt was associated with muscle force imbalance, indicated by decreased semimembranosus and increased gluteus maximus forces. The overall increased postoperative muscle forces were associated with improved pelvic mobility and increased HCFs that were comparable with the control-group standards. CLINICAL RELEVANCE Muscle forces and HCFs may be indicative of postoperative joint health restoration and alleviated symptoms.
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Affiliation(s)
- Danilo S Catelli
- School of Human Kinetics (D.S.C., E.K., and M.L.), Division of Orthopaedic Surgery (P.E.B.), and Department of Mechanical Engineering (M.L.), University of Ottawa, Ottawa, Ontario, Canada
| | - K C Geoffrey Ng
- MSk Lab, Department of Surgery & Cancer, Imperial College London, London, United Kingdom
| | | | - Erik Kowalski
- School of Human Kinetics (D.S.C., E.K., and M.L.), Division of Orthopaedic Surgery (P.E.B.), and Department of Mechanical Engineering (M.L.), University of Ottawa, Ottawa, Ontario, Canada
| | - Ilse Jonkers
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Paul E Beaulé
- School of Human Kinetics (D.S.C., E.K., and M.L.), Division of Orthopaedic Surgery (P.E.B.), and Department of Mechanical Engineering (M.L.), University of Ottawa, Ottawa, Ontario, Canada
| | - Mario Lamontagne
- School of Human Kinetics (D.S.C., E.K., and M.L.), Division of Orthopaedic Surgery (P.E.B.), and Department of Mechanical Engineering (M.L.), University of Ottawa, Ottawa, Ontario, Canada
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13
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Cvetanovich GL, Farkas GJ, Beck EC, Malloy P, Jan K, Espinoza-Orias A, Nho SJ. Squat and gait biomechanics 6 months following hip arthroscopy for femoroacetabular impingement syndrome. J Hip Preserv Surg 2020; 7:27-37. [PMID: 32382426 PMCID: PMC7195932 DOI: 10.1093/jhps/hnaa004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 12/27/2019] [Accepted: 01/09/2020] [Indexed: 01/17/2023] Open
Abstract
The purpose of this study was to (i) assess whether squat and gait biomechanical measures improve in patients with femoroacetabular impingement syndrome (FAIS) 6 months after surgery compared to pre-operative measures and (ii) compare biomechanical properties to controls without FAIS. In this prospective study, biomechanical data during a double leg squat task and gait for 15 FAIS patients and 9 controls were collected using three-dimensional motion analysis. Data were collected in the FAIS group at two-time points, pre-operatively and 6-month post-operatively following arthroscopic hip surgery, and at a single time point for the healthy controls. Independent sample's t-test were used to compare the FAIS group to the controls, and paired samples t-test were used to determine within-group differences before and after hip arthroscopy in the FAIS group. The results indicated that there were significant within-group increases for sagittal plane moment rate during the double leg squat task (P = 0.009) between the pre-operative and post-operative time points for the FAIS group. Between-group differences showed that FAIS patients pre-operatively exhibit slower squat velocities during the descent (P = 0.005) and ascent phase (P = 0.012) of a double leg squat when compared healthy controls. Reduced hip external rotation moments during gait (P = 0.02) were also found between FAIS patients pre-operatively and controls. In conclusion, alterations in hip biomechanics are present before surgery for FAIS when compared to healthy controls, and joint mechanics change 6 months after surgery. However, the biomechanical differences during a double leg squat and gait were minimal.
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Affiliation(s)
- Gregory L Cvetanovich
- Department of Orthopedic Surgery, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Gary J Farkas
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, CA, USA
| | - Edward C Beck
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 West Harrison St, Suite 300, Chicago, IL 60612, USA
| | - Philip Malloy
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 West Harrison St, Suite 300, Chicago, IL 60612, USA
| | - Kyleen Jan
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 West Harrison St, Suite 300, Chicago, IL 60612, USA
| | - Alejandro Espinoza-Orias
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 West Harrison St, Suite 300, Chicago, IL 60612, USA
| | - Shane J Nho
- Department of Orthopedic Surgery, Rush University Medical Center, 1611 West Harrison St, Suite 300, Chicago, IL 60612, USA
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