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Douma MV, Casartelli NC, Sutter R, Leunig M, Maffiuletti NA. Sex-Specific Differences in Hip Muscle Cross-sectional Area and Fatty Infiltration in Patients With Femoroacetabular Impingement Syndrome. Orthop J Sports Med 2023; 11:23259671221147528. [PMID: 36743730 PMCID: PMC9893369 DOI: 10.1177/23259671221147528] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/11/2022] [Indexed: 01/27/2023] Open
Abstract
Background Patients with femoroacetabular impingement syndrome (FAIS) show sex-specific differences in hip muscle function, hip morphology, and symptoms. Possible differences in hip muscle characteristics between men and women with FAIS are unknown. Purpose To compare hip muscle cross-sectional area (CSA) and fatty infiltration between men and women with FAIS and investigate possible associations with patient-reported outcomes. Study Design Cohort study; Level of evidence, 3. Methods We retrospectively analyzed preoperative axial pelvic magnetic resonance imaging scans of 104 patients (54 women) who underwent hip surgery for FAIS. The main outcome measures were side-to-side percentage asymmetry in hip muscle CSA and involved-side fatty infiltration as measured with the Goutallier scale for a total of 10 hip muscles. Patient-reported outcomes included duration of hip symptoms, iHOT-12 (12-item International Hip Outcome Tool), and Hip Sports Activity Scale. Results Women showed larger hip abductor muscle CSA asymmetry than men (P = .018), particularly for the gluteus medius (P = .049), while men exhibited more fatty streaks (grade 1) in the gluteus medius (P = .015) than women. Duration of symptoms was associated only with fatty infiltration of obturator externus in men (r S = -0.55, P = .018). iHOT-12 was associated with CSA asymmetry of the gluteus minimus (r = -0.41, P = .011) and iliopsoas (r = -0.36, P = .028) in men and with piriformis fatty infiltration (r S = -0.56, P = .030) in women. The Hip Sports Activity Scale was associated with iliopsoas CSA asymmetry (r S = 0.32, P = .026) and with fatty infiltration of the tensor fasciae latae (r S = -0.45, P = .046) and obturator externus (r S = -0.50, P = .023) in women. Conclusion Patients with FAIS demonstrated few sex-specific quantitative and qualitative alterations of hip muscles. Women showed greater hip abductor muscle atrophy than men, particularly for the gluteus medius, while men showed a higher degree of fatty infiltration in this same muscle. The duration of hip symptoms was not associated with muscle atrophy. Patient-reported hip pain/function and sport activity level were only moderately associated with isolated muscular variables.
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Affiliation(s)
- Mirjam V Douma
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland.,Division of Physiotherapy, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Nicola C Casartelli
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland.,Laboratory of Exercise and Health, Swiss Federal Institute of Technology, Schwerzenbach, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Michael Leunig
- Department of Orthopaedic Surgery, Schulthess Clinic, Zurich, Switzerland
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Mid-term outcomes of exercise therapy for the non-surgical management of femoroacetabular impingement syndrome: are short-term effects persisting? Phys Ther Sport 2022; 55:168-175. [DOI: 10.1016/j.ptsp.2022.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022]
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Terrell SL, Olson GE, Lynch J. Therapeutic Exercise Approaches to Nonoperative and Postoperative Management of Femoroacetabular Impingement Syndrome. J Athl Train 2021; 56:31-45. [PMID: 33112956 DOI: 10.4085/1062-6050-0488.19] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Femoroacetabular impingement syndrome (FAIS) is characterized by premature contact of the femur and acetabulum during hip motion. Morphologic variations of FAIS present as either aspherical femoral deformity (cam femoroacetabular impingement) or overcoverage (pincer femoroacetabular impingement) or both. Patients with FAIS often describe discomfort with hip flexion, adduction, and internal rotation. The use of hip arthroscopy to treat FAIS has risen substantially over the last 15 years. Given that one practice domain of the athletic training profession involves injury prevention and wellness protection, optimal FAIS treatment and management strategies warrant discussion. Sports medicine professionals often help patients with FAIS explore nonoperative exercise strategies and direct rehabilitation exercises for those who pursue surgery. Both approaches demonstrate key pillars of exercise program design, which include postural control, core stabilization, hip strength and motor control, and mobility. The purpose of this article is 2-fold: to present an overview of FAIS, including common diagnostic strategies, and commonalities in therapeutic approaches between nonoperative and postoperative rehabilitation for the treatment and management of patients with FAIS.
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Affiliation(s)
- Sara Lynn Terrell
- Department of Exercise Science, Florida Southern College, Lakeland.,School of Nursing and Health Sciences, Florida Southern College, Lakeland
| | - Gayle E Olson
- Department of Athletics, Florida Southern College, Lakeland
| | - James Lynch
- School of Nursing and Health Sciences, Florida Southern College, Lakeland
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Hoit G, Whelan DB, Dwyer T, Ajrawat P, Chahal J. Physiotherapy as an Initial Treatment Option for Femoroacetabular Impingement: A Systematic Review of the Literature and Meta-analysis of 5 Randomized Controlled Trials. Am J Sports Med 2020; 48:2042-2050. [PMID: 31774704 DOI: 10.1177/0363546519882668] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement is a common and debilitating source of hip pain in young adults. Although physiotherapy is used as a mainstay of nonoperative care for femoroacetabular impingement, the evidence regarding different physiotherapy practices is poorly understood. PURPOSE To collect and synthesize the best available evidence and arrive at a summary estimate of treatment effect for the utility of physiotherapy in the management of femoroacetabular impingement. STUDY DESIGN Meta-analysis. METHODS A systematic review was performed on February 2, 2019, of PubMed, EMBASE, and Cochrane Library databases using "femoroacetabular impingement OR hip pain" and "physiotherapy OR nonoperative management" and their synonyms as search terms. Central treatment themes were identified across protocols, and pooled analyses were conducted to assess for differences in patient-reported outcome measures across these themes. RESULTS A total of 5 randomized controlled trials met our inclusion criteria. The studies included 124 patients with a mean age of 35 years, of whom 24% were male. The average follow-up was 9.4 weeks (range, 6-12 weeks), and the follow-up rate across all participants was 86%. Among these 5 studies, 4 studies used a physiotherapy protocol that focused on core strengthening versus no core strengthening, 4 studies compared active strengthening versus passive modalities, and 3 studies compared supervised versus unsupervised physiotherapy. Pooled analysis across all studies demonstrated improved outcomes in the treatment groups compared with the controls (standardized mean difference [SMD], 0.76; 95% CI, 0.38-1.13; P < .0001). Core strengthening (SMD, 0.82; 95% CI, 0.39-1.26; P = .0002), active physiotherapy (SMD, 0.70; 95% CI, 0.29-1.10; P = .0008), and supervised physiotherapy (SMD, 0.58; 95% CI, 0.14-1.03; P = .01) were found to result in statistically significant improvements in functional outcomes compared with no core strengthening, passive modalities, and unsupervised care, respectively. CONCLUSION Supervised physiotherapy programs focusing on active strengthening and core strengthening are more effective than unsupervised, passive, and non-core focused programs. Future studies with longer term follow-up and validated femoroacetabular impingement specific outcome measures are required to determine prognostic factors for success with nonoperative care as well as to determine the ideal patient profile and structured rehabilitation protocol.
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Affiliation(s)
- Graeme Hoit
- University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, Ontario, Canada
| | - Daniel B Whelan
- University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, Ontario, Canada.,St Michael's Hospital, Toronto, Ontario, Canada
| | - Tim Dwyer
- University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Prabjit Ajrawat
- University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, Ontario, Canada
| | - Jaskarndip Chahal
- University of Toronto Orthopaedic Sports Medicine (UTOSM), Women's College Hospital, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada
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Mendis MD, Wilson SJ, Hayes DA, Hides JA. Hip muscle atrophy in patients with acetabular labral joint pathology. Clin Anat 2020; 33:538-544. [DOI: 10.1002/ca.23429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/30/2019] [Indexed: 12/15/2022]
Affiliation(s)
- M. Dilani Mendis
- School of Allied Health SciencesGriffith University Brisbane Queensland Australia
- Physiotherapy DepartmentMater Health Services South Brisbane Queensland Australia
| | - Stephen J. Wilson
- School of Information Technology and Electrical EngineeringThe University of Queensland Brisbane Queensland Australia
| | - David A. Hayes
- Brisbane Orthopaedic & Sports Medicine Centre Brisbane Queensland Australia
| | - Julie A. Hides
- School of Allied Health SciencesGriffith University Brisbane Queensland Australia
- Mater Back Stability Research ClinicMater Health Services South Brisbane Queensland Australia
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Hip muscle strength asymmetries and their associations with hip morphology and symptoms are sex-specific in patients with femoroacetabular impingement syndrome. Phys Ther Sport 2020; 42:131-138. [DOI: 10.1016/j.ptsp.2020.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 01/19/2023]
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Casartelli NC, Bizzini M, Maffiuletti NA, Sutter R, Pfirrmann CW, Leunig M, Naal FD. Exercise Therapy for the Management of Femoroacetabular Impingement Syndrome: Preliminary Results of Clinical Responsiveness. Arthritis Care Res (Hoboken) 2019; 71:1074-1083. [PMID: 30133164 DOI: 10.1002/acr.23728] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/14/2018] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To investigate the responsiveness to exercise therapy of patients with femoroacetabular impingement syndrome (FAIS), and to investigate differences in hip function, strength, and morphology between responders versus nonresponders. METHODS Patients with FAIS underwent 12 weeks of semi-standardized and progressive exercise therapy. A good therapy outcome (responders) versus a poor therapy outcome (nonresponders) was determined at week 18 with the Global Treatment Outcome questionnaire for hip pain. Hip function was evaluated using the Hip Outcome Score (HOS) activities of daily living (ADL) and Sport at baseline, and at weeks 6, 12, and 18. Hip muscle strength and dynamic pelvic control were evaluated using dynamometry and video analysis, respectively, at baseline, week 12, and week 18. Hip morphology was evaluated with imaging at baseline. RESULTS Thirty-one patients (mean age 24 years) were included. Sixteen patients (52%) were responsive and 15 patients (48%) were not responsive to exercise therapy. Only responders improved HOS ADL and HOS Sport by 10 points (95% confidence interval [95% CI] 7, 14; P < 0.001) and by 20 points (95% CI 15, 25; P < 0.001), respectively, and hip abductor strength by 0.27 Nm/kg (95% CI 0.18, 0.36; P < 0.001). The prevalence of patients showing good dynamic pelvic control only increased in responders (44%; P = 0.029). The prevalence of severe cam morphology was higher in nonresponders than in responders (40% versus 6%; P = 0.037). CONCLUSION Half of patients with FAIS benefit from exercise therapy in the short term. Responsiveness to hip abductor strength and dynamic pelvic control improvements is associated with a good therapy outcome, whereas the presence of severe cam morphology is associated with a poor therapy outcome.
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Affiliation(s)
- Nicola C Casartelli
- Schulthess Clinic and Laboratory of Exercise and Health, Swiss Federal Institute of Technology, Zurich, Switzerland
| | | | | | - Reto Sutter
- Orthopaedic University Hospital Balgrist and University of Zurich, Zurich, Switzerland
| | - Christian W Pfirrmann
- Orthopaedic University Hospital Balgrist and University of Zurich, Zurich, Switzerland
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Catelli DS, Kowalski E, Beaulé PE, Lamontagne M. Increased pelvic mobility and altered hip muscles contraction patterns: two-year follow-up cam-FAIS corrective surgery. J Hip Preserv Surg 2019; 6:140-148. [PMID: 31660199 PMCID: PMC6662956 DOI: 10.1093/jhps/hnz019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 04/11/2019] [Accepted: 05/05/2019] [Indexed: 12/11/2022] Open
Abstract
Femoroacetabular impingement syndrome (FAIS) surgery can produce improvements in function and patient satisfaction; however, data on muscle assessment and kinematics of high mobility tasks of post-operative patients is limited. The purpose of this study was to evaluate kinematics and muscle activity during a deep squat task, as well as muscle strength in a 2-year follow-up FAIS corrective surgery. Eleven cam morphology patients underwent motion and electromyography capture while performing a squat task prior and 2-years after osteochondroplasty and were BMI-, age- and sex-matched to 11 healthy control (CTRL) participants. Isometric muscle strength, flexibility and patient-reported outcome measures (PROMs) were also evaluated. Post-operative FAIS was significantly weaker during hip flexion (23%) and hip flexion-with-abduction (25%) movements when compared with CTRL, no improvements in squat depth were observed. However, post-operative FAIS increased the pelvic range of motion during the squat descent (P = 0.016) and ascent (P = 0.047). They had greater peak activity for the semitendinosus and total muscle activity for the gluteus medius, but decreased peak activity for the glutei and rectus femoris during squat descent; greater total muscle activity for the tensor fascia latae was observed during squat ascent (P = 0.005). Although not improving squat depth, post-operative patients increased pelvic ROM and showed positive PROMs. The muscle weakness associated with hip flexion and flexion-with-abduction observed at the follow-up can be associated with the alterations in the muscle activity and neuromuscular patterns. Rehabilitation programs should focus on increasing pelvis and hip muscles flexibility and strength.
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Affiliation(s)
- Danilo S Catelli
- School of Human Kinetics, University of Ottawa, Ottawa, ON, 200 Lees Ave (E020), Canada.,Ministry of Education of Brazil, CAPES Foundation, Brasilia, DF, Brazil
| | - Erik Kowalski
- School of Human Kinetics, University of Ottawa, Ottawa, ON, 200 Lees Ave (E020), Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, 501 Smyth Road (028A), Canada
| | - Mario Lamontagne
- School of Human Kinetics, University of Ottawa, Ottawa, ON, 200 Lees Ave (E020), Canada.,Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, 501 Smyth Road (028A), Canada.,Department of Mechanical Engineering, University of Ottawa, Ottawa, ON, 800 King Edward Ave, Canada
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