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Chen KK, Osadebey EN, Shupe PG, Gregory BP. Hip Sideline Emergencies and Hip Injuries in Elite Athletes. Curr Rev Musculoskelet Med 2024; 17:402-414. [PMID: 39017861 PMCID: PMC11372013 DOI: 10.1007/s12178-024-09914-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2024] [Indexed: 07/18/2024]
Abstract
PURPOSE OF REVIEW Hip injuries in elite athletes are an increasingly recognized problem and range from chronic overuse injuries, such as adductor strains and labral tears, to acute traumatic injuries such as hip dislocations. In this article, we review common hip pathology experienced by elite athletes and sideline management of emergent hip injuries. RECENT FINDINGS Elite athletes are subject to unique physical and mental stresses and therefore must be evaluated and treated in a unique manner. Hip and groin injuries account for approximately 6% of sport injuries overall and 3-15% of all injuries in professional sports. Hip sideline emergencies were rare but can include hip dislocations, subluxations, and avulsion fractures. Hip and groin injuries represent an important subset of injuries which can greatly impact an athlete's ability to perform. Understanding the physiology and types of hip/groin injuries, which athletes are prone to injuries, the impact on recovery time, recurrence risk, and the potential need for surgery aid sports medicine physicians in decision-making.
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Affiliation(s)
- Kevin K Chen
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Emmanuel N Osadebey
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Paul G Shupe
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Bonnie P Gregory
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
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2
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Nickerson M, Herickhoff P. Femoroacetabular Impingement and Groin Injuries Among Soccer Players. Sports Med Arthrosc Rev 2024; 32:120-124. [PMID: 39087700 DOI: 10.1097/jsa.0000000000000394] [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: 08/02/2024]
Abstract
Groin injuries and femoroacetabular impingement are common among soccer players and can provide a challenge in diagnosis, as well as treatment. Nonoperative and operative measures are the 2 predominant treatments. This current review investigates the recent literature on groin and femoroacetabular impingement injuries in soccer players, as well as potential treatment modalities.
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Affiliation(s)
- Morgan Nickerson
- Department of Orthopedic Surgery, Penn State Health Milton S. Hershey Medical Center, State College, PA
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3
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Ganal İ, Çelen ZE. Midterm Functional Outcomes of Arthroscopically Treated Recalcitrant Osteitis Pubis in Competitive Soccer Players. Orthop J Sports Med 2023; 11:23259671231203677. [PMID: 37900866 PMCID: PMC10605685 DOI: 10.1177/23259671231203677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 08/10/2023] [Indexed: 10/31/2023] Open
Abstract
Background Outcomes after arthroscopic debridement for isolated osteitis pubis in athletes are unknown, and midterm results following this method have not been established. Purpose/Hypothesis To evaluate the safety and efficiency of arthroscopic treatment for recalcitrant osteitis pubis in competitive soccer players. It was hypothesized that this treatment modality would yield clinical improvement in functional and patient satisfaction scores compared with preoperative values. Study Design Case series; Level of evidence 4. Methods At a single center, 10 consecutive male soccer players (mean age, 23.6 ± 4.4 years; range, 19-32 years) with a mean follow-up period of 72.2 ± 13.4 months (range, 60-97 months) were evaluated. All patients presented with symptomatic osteitis pubis and failed to respond to nonoperative treatment. Arthroscopic pubic symphysiectomy was performed in the supine position, and penile manipulation was performed in all cases to mitigate risks associated with neurovascular structures and the root of the penis. Outcome measurements were time to return to sports, visual analog scale (VAS) for pain, Nirschl Phase Rating Scale (NPRS), Nonarthritic Hip Score (NAHS), modified Harris Hip Score (mHHS), and patient satisfaction. Preoperative and postoperative radiographs were also assessed. Results The mean time to return to sports was 4.6 ± 1.7 months (range, 3-8 months). The mean VAS pain score decreased from 9.3 ± 0.8 (range, 8-10) to 0.2 ± 0.4 (range, 0-1) (P = .005). The mean NPRS decreased from 6.6 ± 0.5 (range, 6-7) to 0.3 ± 0.5 (range, 0-1) (P = .004). The mean NAHS increased from 35.8 ± 16.7 (range, 14-72) to 98.2 ± 2.7 (range, 93-100) (P = .005). The mean mHHS increased from 47.4 ± 10.6 (range, 27-60) to 98.2 ± 4.5 (range, 86-100) (p = .005). The mean patient satisfaction was 9.7 ± 0.7 (range, 8-10). Scrotal swelling was observed in 4 patients, which was resolved 36 to 48 hours postoperatively. Conclusion Arthroscopic treatment of osteitis pubis may be an option for recalcitrant cases when nonoperative treatment fails. However, further studies are needed to determine whether this technique and the outcomes of this study can be reproduced.
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Affiliation(s)
- İlker Ganal
- Department of Orthopaedics and Traumatology, Yalova Aktif Private Hospital, Yalova, Turkey
| | - Zekeriya Ersin Çelen
- Department of Orthopaedics and Traumatology, Yalova Training and Research Hospital, Yalova, Turkey
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Hirata K, Murata Y, Hatakeyama A, Takahashi M, Quinn PM, Uchida S. Biomechanical Analysis of Hip Braces after Hip Arthroscopic Surgery for Femoroacetabular Impingement Syndrome: An Observational Study. Biomimetics (Basel) 2023; 8:225. [PMID: 37366820 DOI: 10.3390/biomimetics8020225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/26/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Currently, hip braces are recommended and typically worn by femoroacetabular impingement (FAI) patients after hip arthroscopic surgery. However, there is currently a lack of literature regarding the biomechanical effectiveness of hip braces. The purpose of this study was to investigate the biomechanical effect of hip braces after hip arthroscopic surgery for FAI. Overall, 11 patients who underwent arthroscopic FAI correction and labral preservation surgery were included in the study. Standing-up and walking tasks in unbraced and braced conditions were performed at 3 weeks postoperatively. For the standing-up task, videotaped images of the hip's sagittal plane were recorded while patients stood from a seated position. After each motion, the hip flexion-extension angle was calculated. For the walking task, acceleration of the greater trochanter was measured using a triaxial accelerometer. For the standing-up motion, the mean peak hip flexion angle was found to be significantly lower in the braced condition than in the unbraced condition. Furthermore, the mean peak acceleration of the greater trochanter was significantly lower in the braced condition than in the unbraced condition. Patients undergoing arthroscopic FAI correction surgery would benefit from usage of a hip brace in terms of protecting repaired tissues during early postoperative recovery.
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Affiliation(s)
- Kai Hirata
- Research and Development Department, Nippon Sigmax Co., Ltd., Tokyo 160-0023, Japan
| | - Yoichi Murata
- Department of Orthopaedic Surgery, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu 808-0024, Japan
| | | | - Makoto Takahashi
- Department of Rehabilitation Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu 808-0024, Japan
| | - Patrick M Quinn
- Department of Orthopaedic Surgery, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu 808-0024, Japan
| | - Soshi Uchida
- Department of Orthopaedic Surgery, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu 808-0024, Japan
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Ceballos-Laita L, Hernando-Garijo I, Medrano-de-la-Fuente R, Mingo-Gómez MT, Carrasco-Uribarren A, Jiménez-del-Barrio S. Hip Range of Motion and Strength in Male Athletes with Stage 1 Osteitis Pubis: A Cross-Sectional and Correlational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12824. [PMID: 36232123 PMCID: PMC9564700 DOI: 10.3390/ijerph191912824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/01/2022] [Accepted: 10/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The objectives of this study were: (1) to determine whether athletes with stage 1 osteitis pubis (OP) present differences in hip range of motion (ROM) and muscle strength, between both sides and compared with healthy athletes; (2) to investigate the relationship between the internal rotation (IR) ROM and pain intensity and physical function. METHODS a cross-sectional and correlational study was designed, in which 30 athletes (15 athletes with stage 1 OP and 15 healthy athletes) were included. Pain intensity, physical function, hip ROM and hip muscle strength were assessed. RESULTS The ROM assessment reported significant differences between both groups in the IR, external rotation (ER) and adduction (ADD) ROM of the painful side (PS) (p < 0.05). The OP group showed differences between both sides in IR ER and ADD ROM (p < 0.05). No statistically significant differences were found between or within groups in the maximum isometric strength of the hip (p > 0.05). A strong negative correlation between pain intensity and IR ROM (r = -0.640) and a strong positive correlation between physical function and IR ROM (r = 0.563) were found in the OP group. CONCLUSIONS Male athletes with stage 1 OP present a hip IR, ER and ADD ROM limitation in the PS compared to non-PS and to healthy athletes. IR ROM is correlated to pain intensity and physical function in athletes with stage 1 OP.
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Affiliation(s)
- Luis Ceballos-Laita
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology and Physiotherapy, University of Valladolid, 42004 Soria, Spain
| | - Ignacio Hernando-Garijo
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology and Physiotherapy, University of Valladolid, 42004 Soria, Spain
| | - Ricardo Medrano-de-la-Fuente
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology and Physiotherapy, University of Valladolid, 42004 Soria, Spain
| | - María Teresa Mingo-Gómez
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology and Physiotherapy, University of Valladolid, 42004 Soria, Spain
| | | | - Sandra Jiménez-del-Barrio
- Clinical Research in Health Sciences Group, Department of Surgery, Ophthalmology and Physiotherapy, University of Valladolid, 42004 Soria, Spain
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Davey MS, Hurley ET, Davey MG, Fried JW, Hughes AJ, Youm T, McCarthy T. Criteria for Return to Play After Hip Arthroscopy in the Treatment of Femoroacetabular Impingement: A Systematic Review. Am J Sports Med 2022; 50:3417-3424. [PMID: 34591697 DOI: 10.1177/03635465211038959] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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 (FAI) is a common pathology in athletes that often requires operative management in the form of hip arthroscopy. PURPOSE To systematically review the rates and level of return to play (RTP) and the criteria used for RTP after hip arthroscopy for FAI in athletes. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of the literature, based on the PRISMA guidelines, was performed using PubMed, Embase, and Scopus databases. Studies reporting outcomes after the use of hip arthroscopy for FAI were included. Outcomes analyzed were RTP rate, RTP level, and criteria used for RTP. Statistical analysis was performed using SPSS software. RESULTS Our review found 130 studies, which included 14,069 patients (14,517 hips) and had a mean methodological quality of evidence (MQOE) of 40.4 (range, 5-67). The majority of patients were female (53.7%), the mean patient age was 30.4 years (range, 15-47 years), and the mean follow-up was 29.7 months (range, 6-75 months). A total of 81 studies reported RTP rates, with an overall RTP rate of 85.4% over a mean period of 6.6 months. Additionally, 49 studies reported the rate of RTP at preinjury level as 72.6%. Specific RTP criteria were reported in 97 studies (77.2%), with time being the most commonly reported item, which was reported in 80 studies (69.2%). A total of 45 studies (57.9%) advised RTP at 3 to 6 months after hip arthroscopy. CONCLUSION The overall rate of reported RTP was high after hip arthroscopy for FAI. However, more than one-fourth of athletes who returned to sports did not return at their preinjury level. Development of validated rehabilitation criteria for safe return to sports after hip arthroscopy for FAI could potentially improve clinical outcomes while also increasing rates of RTP at preinjury levels.
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Affiliation(s)
- Martin S Davey
- Sports Surgery Clinic, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eoghan T Hurley
- Sports Surgery Clinic, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland.,NYU Langone, New York, New York, USA
| | | | | | - Andrew J Hughes
- Sports Surgery Clinic, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
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7
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The minimal clinically important difference for the nonarthritic hip score at 2-years following hip arthroscopy. Knee Surg Sports Traumatol Arthrosc 2022; 30:2419-2423. [PMID: 34738159 DOI: 10.1007/s00167-021-06756-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 09/27/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to determine and establish the MCID for the NAHS at 2 years in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS). METHODS Patients that underwent primary hip arthroscopy for FAIS between 2010 and 2016 were analyzed for eligibility. Data were collected from a single surgeon's hip arthroscopy database. MCID was calculated for the NAHS utilizing a distribution-based method. RESULTS The study included 298 patients (184 females) with an average age of 40.4 ± 13.0 years and average body mass index (BMI) of 25.7 ± 4.2 kg/m2. At baseline, the cohort's average NAHS score was 48.7 ± 13.6 and demonstrated an improvement of 36.5 ± 17.0 for NAHS at follow-up. This resulted in MCID values of + 8.5 for NAHS. CONCLUSION This is the first study to report the MCID (+ 8.5) for NAHS following primary hip arthroscopy, and as such, is a valuable contribution to future hip arthroscopy research. LEVEL OF EVIDENCE IV.
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8
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Budde S, Ezechieli M. [Management of FAIS in professional soccer athletes and return to sports]. DER ORTHOPADE 2022; 51:466-471. [PMID: 35482052 DOI: 10.1007/s00132-022-04257-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 10/18/2022]
Abstract
The prevalence of femoroacetabular impingement syndrome in professional soccer athletes is high. Professional training and treatment conditions ensure an effective conservative therapy focusing on dynamic stability, motion control, muscle balance and core stability. In the case of persistent limitations, indication for surgery has to be considered carefully. The probability is high that return to a professional level of soccer is feasible. However, the period of rehabilitation is long, leading to a potential conflict area between economic and medical interests. Good communication and intensive patient education are essential.
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Affiliation(s)
- Stefan Budde
- Klinik für Unfallchirurgie und Orthopädie, Evangelisches Klinikum Bethel, Universitätsklinikum OWL der Universität Bielefeld, Burgsteig 13, 33617, Bielefeld, Deutschland.
| | - Marco Ezechieli
- Vincenz Krankenhaus Paderborn, Standort Salzkotten, Salzkotten, Deutschland
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Athanasiou V, Ampariotou A, Lianou I, Sinos G, Kouzelis A, Gliatis J. Osteitis Pubis in Athletes: A Literature Review of Current Surgical Treatment. Cureus 2022; 14:e22976. [PMID: 35464551 PMCID: PMC9001088 DOI: 10.7759/cureus.22976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 11/05/2022] Open
Abstract
Osteitis pubis (OP) is a self-limiting, noninfectious inflammatory disease of the pubic symphysis and the surrounding soft tissues that usually improves with activity modification and targeted conservative treatment. Surgical treatment is required for a limited number of patients. This study aims to investigate the current literature on the surgical treatment of OP in athletes. A systematic review was conducted on two databases (MEDLINE/PubMed and Google Scholar) from 2000 to 2021. The inclusion criteria were adult patients with athletic OP who underwent surgical treatment and studies published in English. The exclusion criteria included pregnancy, infection OP, or postoperative complications related to other surgical interventions, such as urological or gynecological complications. Fifty-one surgically treated cases have been reported in eight studies, which included short-term, mid-term, and long-term studies ranging from one patient to 23 patients. The surgical treatment methods were as follows: (a) pubic symphysis arthrodesis, (b) open or endoscopic pubic symphysectomy, (c) wedge resection of the pubic symphysis, and (d) polypropylene mesh placed into the preperitoneal retropubic space endoscopically. The main indication for surgical intervention was failure of conservative measures and long-lasting pain, disability, and inability to participate in athletic activities. Wedge resection of the pubic symphysis has been the less preferred surgical treatment in the recently published literature. The most common surgical method of treatment of OP in athletes, which entailed the existence of posterior stability of the sacroiliac joint, in the current literature is open pubic symphysis curettage. Recently, there has been a tendency for pubic symphysis curettage to be performed endoscopically.
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Nakayama K, Utsunomiya H, Murata Y, Takada S, Tsukamoto M, Sakai A, Uchida S. Cleft Sign and Bone Marrow Edema of the Pubic Symphysis Are Associated With Sports and Bony Morphology in Patients With Femoroacetabular Impingement and Labral Tears. Orthop J Sports Med 2022; 10:23259671211068477. [PMID: 35141338 PMCID: PMC8819768 DOI: 10.1177/23259671211068477] [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: 08/20/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The cleft sign (CS) and bone marrow edema (BME) are considered magnetic
resonance imaging (MRI) findings signifying a pubic pathology, which is
associated with groin pain; however, their relationship with bony morphology
related to femoroacetabular impingement (FAI) has not been established. Purpose: To investigate the prevalence of CS and BME in symptomatic patients with
acetabular labral tears and assess their possible association with bone
morphology and sport-specific activities. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study enrolled 418 patients (469 hips) undergoing hip arthroscopic
surgery for labral tears. Also included were patients with labral tears in
the setting of either hip dysplasia or borderline hip dysplasia who were
undergoing endoscopic shelf acetabuloplasty combined with hip arthroscopic
labral repair, cam osteoplasty, and capsular plication. All patients were
screened for superior CS (SCS), inferior CS (ICS), and BME of the
ipsilateral side of the pubis using 3-T MRI. We measured the following
angles: lateral center edge (LCE), Sharp, Tönnis, vertical-central-anterior,
and alpha. Then, we evaluated the relationship between patient
characteristics and abnormal findings on MRI scans (preoperatively vs 1 year
postoperatively). Results: An overall 397 hips were included: 200 in men and 197 in women (mean ± SD
age, 35.3 ± 16.0 years). There were hips in 214 athletes (53.9%) and hips in
183 nonathletes (46.1%). MRI findings revealed SCS, ICS, and BME in 18
(4.5%), 13 (3.3%), and 34 hips (8.6%), respectively. Abnormal MRI findings
at the pubis were seen more often in athletes than nonathletes (23.8% vs
3.3%), and contact sports athletes had the most frequent abnormalities.
There was no SCS in patients with an LCE angle <22°. SCS was more
frequently seen in those who had an alpha angle ≥71°. More than 60% of
abnormal findings at the pubis diminished after arthroscopic surgery that
included FAI correction and labral repair. Conclusion: In patients with labral tears, CS and BME were seen more frequently in
athletes versus nonathletes, especially contact athletes with FAI-related
bony abnormalities. More than 60% of abnormal MRI pubis findings resolved
after arthroscopic treatment of FAI.
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Affiliation(s)
- Keisuke Nakayama
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hajime Utsunomiya
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoichi Murata
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shinichiro Takada
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Manabu Tsukamoto
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Soshi Uchida
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
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Shimodaira H, Hatakeyama A, Suzuki H, Takada S, Murata Y, Sakai A, Uchida S. The prevalence and risk factors of pubic bone marrow edema in femoroacetabular impingement and hip dysplasia. J Hip Preserv Surg 2021; 8:318-324. [PMID: 35505801 PMCID: PMC9052425 DOI: 10.1093/jhps/hnab081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/28/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
Femoroacetabular impingement syndrome (FAIS) has been associated with osteitis pubis; however, it is still unclear whether hip dysplasia is associated with osteitis pubis. This study aimed to investigate (i) the incidence of pubic bone marrow edema (BME) on magnetic resonance imaging in symptomatic patients with FAIS, borderline developmental dysplasia of the hip (BDDH) and developmental dysplasia of the hip (DDH) undergoing hip arthroscopic surgery with labral preservation and (ii) the demographic and radiographic factors associated with pubic BME. A total of 259 symptomatic patients undergoing hip arthroscopic surgery between July 2016 and April 2019 were retrospectively reviewed and divided into three groups: FAIS (180 patients), BDDH (29 patients) and DDH (50 patients). Diffuse changes in the pubic bone adjacent to the pubic symphysis were labeled pubic BME, and the prevalence of their occurrence was examined. Multivariate logistic regression analysis was performed to identify factors involved in pubic BME, and odds ratios (ORs) for relevant factors were calculated. There was no significant difference in the prevalence of pubic BME among the three groups (20 [11.1%] of 180 FAIS patients, 6 [20.6%] of 29 BDDH patients and 7 [14%] of 50 DDH patients, P = 0.325). Multivariate logistic regression analysis showed that acetabular coverage was not associated with pubic BME, whereas younger age and greater alpha angle were still independent associated factors [age ≤26 years (OR, 65.7) and alpha angle ≥73.5° (OR, 4.79)]. Determining the possible association of osteitis pubis with cam impingement in dysplastic hips may provide insights toward a more accurate understanding of its pathophysiology.
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Affiliation(s)
- Hiroki Shimodaira
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu, Fukuoka 808-0024, Japan
| | - Akihisa Hatakeyama
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu, Fukuoka 808-0024, Japan
| | - Hitoshi Suzuki
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu, Fukuoka 808-0024, Japan
| | - Shinichiro Takada
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu, Fukuoka 808-0024, Japan
| | - Yoichi Murata
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu, Fukuoka 808-0024, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu, Fukuoka 808-0024, Japan
| | - Soshi Uchida
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu, Fukuoka 808-0024, Japan
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12
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Hatem M, Martin RL, Bharam S. Surgical Outcomes of Inguinal-, Pubic-, and Adductor-Related Chronic Pain in Athletes: A Systematic Review Based on Surgical Technique. Orthop J Sports Med 2021; 9:23259671211023116. [PMID: 34541009 PMCID: PMC8442511 DOI: 10.1177/23259671211023116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Controversies remain regarding the surgical treatment of inguinal-, pubic-, and adductor-related chronic groin pain (CGP) in athletes. Purpose: To investigate the outcomes of surgery for CGP in athletes based on surgical technique and anatomic area addressed. Study Design: Systematic review; Level of evidence, 4. Methods: The PubMed and Embase databases were searched for articles reporting surgical treatment of inguinal-, pubic-, or adductor-related CGP in athletes. Inclusion criteria were level 1 to 4 evidence, mean patient age >15 years, and results presented as return-to-sport, pain, or functional outcomes. Quality assessment was performed with the CONSORT (Consolidated Standards of Reporting Trials) statement or MINORS (Methodological Index for Non-randomized Studies) criteria. Techniques were grouped as inguinal, adductor origin, pubic symphysis, combined inguinal and adductor, combined pubic symphysis and adductor, or mixed. Results: Overall, 47 studies published between 1991 and 2020 were included. There were 2737 patients (94% male) with a mean age at surgery of 27.8 years (range, 12-65 years). The mean duration of symptoms was 13.1 months (range, 0.3-144 months). The most frequent sport involved was soccer (71%), followed by rugby (7%), Australian football (5%), and ice hockey (4%). Of the 47 articles reviewed, 44 were classified as level 4 evidence, 1 study was classified as level 3, and 2 randomized controlled trials were classified as level 1b. The quality of the observational studies improved modestly with time, with a mean MINORS score of 6 for articles published between 1991 and 2000, 6.53 for articles published from 2001 to 2010, and 6.9 for articles published from 2011 to 2020. Return to play at preinjury or higher level was observed in 92% (95% CI, 88%-95%) of the athletes after surgery to the inguinal area, 75% (95% CI, 57%-89%) after surgery to the adductor origin, 84% (95% CI, 47%-100%) after surgery to the pubic symphysis, and 89% (95% CI, 70%-99%) after combined surgery in the inguinal and adductor origin. Conclusion: Return to play at preinjury or higher level was more likely after surgery for inguinal-related CGP (92%) versus adductor-related CGP (75%). However, the majority of studies reviewed were methodologically of low quality owing to the lack of comparison groups.
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Affiliation(s)
- Munif Hatem
- Hip Preservation Center-Baylor Scott and White Research Institute, Dallas, Texas, USA
| | | | - Srino Bharam
- New York Hip Preservation and Groin Center at Lenox Hill Hospital of Northwell Health, New York, New York, USA
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Matsuda DK. Editorial Commentary: Managing Hip Pain, Athletic Pubalgia, Sports Hernia, Core Muscle Injury, and Inguinal Disruption Requires Diagnostic and Therapeutic Expertise. Arthroscopy 2021; 37:2391-2392. [PMID: 34226017 DOI: 10.1016/j.arthro.2021.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 02/02/2023]
Abstract
Pubalgia means pubic pain. This is different from core muscle injury (implying muscular pathology) or inguinal disruption (different anatomic region). Athletic pubalgia includes a myriad of pathologic conditions involving the pubic symphysis, adductors, rectus abdominis, posterior inguinal wall, and/or related nerves. Moreover, growing evidence supports a link between femoroacetabular impingement (FAI) and pubalgic conditions. Constrained hip range of motion in flexion causing obligatory transitory, even ballistic, posterior tilting of the hemipelvis may produce pathologic transfer stress to not only the pubic symphysis but the sacroiliac joint, lumbar spine, and proximal hamstrings, manifesting in diverse, often-painful, conditions. In select cases of pubalgia, patients may have clinical improvement with concurrent or even isolated treatment addressing FAI. Unlike atypical posterior hip pain from FAI, which may be referred pain that might respond favorably, albeit temporarily, to an intra-articular injection, secondary pubic pain from a transfer stress pathomechanism might not be expected to benefit from such. And, it's not always FAI. Some patients who do not respond to nonoperative management may not require arthroscopic surgery and might benefit from open or laparoscopic mesh hernia repair, adductor tenotomy, primary tissue (hernia) repair, rectus abdominis repair, or even endoscopic surgery for osteitis pubis and/or pubalgia. And, finally, these may be combined with FAI surgical treatment. Refinement of definitions, pathologic conditions, technical advances, and collaboration with general surgeons will best help us treat our patients.
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Carton P, Filan D. Arthroscopic Correction of Femoroacetabular Impingement for Concomitant Inguinal Disruption in Athletes With Dual Pathology. Am J Sports Med 2021; 49:1741-1749. [PMID: 33914654 DOI: 10.1177/03635465211007144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Inguinal disruption and femoroacetabular impingement (FAI) are well-recognized sources of groin pain in athletes; however, the relationship between inguinal disruption and FAI remains unclear. In cases of dual pathology, where both entities coexist, there is no definitive consensus regarding which pathology should be prioritized for treatment in the first instance. PURPOSE (1) To examine the 2-year effectiveness and clinical outcome in athletes presenting with dual pathology in which the FAI component alone was treated with arthroscopic deformity correction. (2) To compare 2-year patient-reported outcome measures between athletes undergoing only hip arthroscopy (HA) and athletes undergoing groin repair and HA. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS All patients undergoing HA for the treatment of FAI with concomitant clinical signs of inguinal disruption at initial consultation were between 2010 and 2016 were included in this study. Inclusion criteria were male sex, age <40 years, and involvement in competitive sporting activity. Athletes with previous HA on the symptomatic side, Tönnis grade >1, or lateral center-edge angle <25° were excluded. Revision HA or subsequent groin surgery was documented. Outcome evaluation consisted of validated patient-reported outcome measures (modified Harris Hip Score; University of California, Los Angeles Activity Scale; 36-Item Short Form Health Survey; Western Ontario and McMaster Universities Osteoarthritis Index) completed preoperatively and a minimum 2 years postoperatively. The minimal clinically important difference was assessed by using a distribution-based technique (SD, 0.5) and an anchor-based technique (percentage of possible improvement). Level of satisfaction and return to play were assessed. RESULTS A total of 113 cases of dual pathology were included in 91 patients with a mean ± SD age of 26.3 ± 5.1 years. The index surgical procedure was HA for 104 cases (92%) and groin repair for 9 (8%). For patients undergoing HA as the index procedure, 98.1% (102/104 cases) were successfully followed up to establish survivorship. In 89.2% (91/102 cases), no additional groin surgery was required. In 11 cases (10.8%), additional groin surgery was required for persisting inguinal-related groin pain. At 2 years after the operation, there was no difference for any patient-reported outcome measure (P > .099), improvement from baseline (P > .070), or proportion of cases achieving the minimal clinically important difference (P > .120) between the HA-only group and the group undergoing HA and groin repair at any stage. There was also no difference between groups in terms of return-to-play rate (P = .509) or levels of satisfaction (pain, P = .204; performance, P = .345). CONCLUSION In patients with dual pathology, treatment of the FAI component alone using arthroscopic hip surgery results in a successful outcome without need for groin repair in 89.2% of cases. No statistical difference in clinical outcome 2 years after surgery was observed between athletes undergoing 1 procedure (HA alone) and those undergoing 2 procedures (HA and groin repair at any stage).
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Affiliation(s)
- Patrick Carton
- The Hip and Groin Clinic, UPMC Whitfield, Waterford, Ireland
| | - David Filan
- The Hip and Groin Clinic, UPMC Whitfield, Waterford, Ireland
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Weber AE, Bolia IK, Mayfield CK, Ihn H, Kang HP, Bedi A, Nho SJ, Philippon MJ. Can We Identify Why Athletes Fail to Return to Sport After Hip Arthroscopy for Femoroacetabular Impingement Syndrome? A Systematic Review and Meta-analysis. Am J Sports Med 2021; 49:1651-1658. [PMID: 33017544 DOI: 10.1177/0363546520956292] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND No previous systematic review has focused on the athletes who fail to return to sport after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). PURPOSE To review the literature on the athletes who fail to return to sport after hip arthroscopy for FAIS to determine the rate of nonreturning athletes and explore the reasons for their inability to return to sport after arthroscopic FAI surgery. STUDY DESIGN Systematic review and meta-analysis. METHODS Three electronic databases were searched for eligible articles. Two reviewers independently screened the titles, abstracts, and full-text articles using prespecified criteria. Eligible articles were those that clearly stated the rate of athletes who did not return to sport after hip arthroscopy for FAIS. Data collected were the rate of patients who did not return to sport, the level of competition (high level, recreational, or mixed), the type of sport, comments on patients who did not return to sport, the rate of subsequent hip surgeries (total hip replacement or revision hip arthroscopy) in nonreturning athletes, and the reported reason for not returning to sport. A random-effects model was used for meta-analysis. RESULTS Twenty studies were eligible for inclusion, and 1093 athletes were analyzed. The weighted rate of athletes who did not return to sport after hip arthroscopy for FAIS was 12.1% (95% CI, 7.7-17.4). Only 2 studies (2/20;10%) reported the age of the athletes who did not return, while sex was reported in 3 studies (3/20;15%). The estimated proportion of athletes who did not return to sport because of hip-related issues was significantly greater than the percentage of athletes who did not return for reasons unrelated to their hip (74.3% vs 22.3%; P < .0001). Persistent hip pain was the most commonly reported factor (52/110 patients; 47.2%) associated with failure to return to sport. Whether the nonreturning athletes underwent any subsequent hip procedure after hip arthroscopy for FAIS was reported in only 4 out of 20 studies (20%). There was evidence of publication bias and study heterogeneity. CONCLUSION The estimated rate of athletes who did not return to sport after hip arthroscopy for FAIS was 12%, with the majority of athletes being unable to return because of persistent hip pain. There is a severe lack of evidence on the athlete characteristics and clinical course of the nonreturning athletes, and the rate of subsequent hip procedures is unknown. The outcomes and reasons for athletes not returning to sport should be reported in detail to improve patient care.
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Affiliation(s)
- Alexander E Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Cory K Mayfield
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Hansel Ihn
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Hyunwoo P Kang
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Shane Jay Nho
- Midwest Orthopaedics at Rush, Chicago, Illinois, USA
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Saito M, Niga S, Nihei T, Uomizu M, Ikezawa Y, Tsukada S. The cleft sign may be an independent factor of magnetic resonance imaging findings associated with a delayed return-to-play time in athletes with groin pain. Knee Surg Sports Traumatol Arthrosc 2021; 29:1474-1482. [PMID: 33452578 DOI: 10.1007/s00167-020-06410-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 12/07/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the prevalence of magnetic resonance imaging (MRI) findings and define prognostic factors of the return-to-play time in young athletes with groin pain. METHODS A total of 1091 consecutive athletes were retrospectively screened; 651 athletes, aged 16-40 years, with pain in the groin regions were assessed using MRI. Of these athletes, 356 were included for analysing the time to return-to-play. Univariate and multiple linear regression analyses were used to determine the associations between the time to return-to-play (primary outcome variable) and the following variables: age, sex, body mass index, type of sports, Hip Sports Activity Scale, clear trauma history, and 12 MRI findings. RESULTS Four MRI findings, including cleft sign, pubic bone marrow oedema of both the superior and inferior ramus, and central disc protrusion of the pubic symphysis, appeared together in more than 44% of the cases. The median time to return-to-play was 24.7 weeks for athletes with a cleft sign on MRI, which was significantly longer than the 11.9 weeks for athletes without the sign. The median time to return-to-play was 20.8 weeks for athletes with BMI > 24, which was significantly longer than the 13.6 weeks for athletes with BMI ≦ 24. In multiple linear regression analysis of 356 athletes, in whom hip-related groin pain was excluded, and who were followed-up until the return-to-play, the body mass index and cleft sign were the independent factors associated with a delayed return-to-play. In contrast, iliopsoas muscle strain and other muscle injuries were associated with a shorter return-to-play. CONCLUSIONS Multiple MRI findings were present in almost half of all cases. Body mass index and the cleft sign were independently associated with a delayed return-to-play time in young athletes suffering from groin pain. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Masayoshi Saito
- Department of Orthopaedic Surgery, St. Luke's International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Sadao Niga
- JIN Orthopaedic & Sports Clinic, 3-10-7 Suzuya, Chuo-ku, Saitama, Saitama, 338-0013, Japan.
| | - Tadahiro Nihei
- JIN Orthopaedic & Sports Clinic, 3-10-7 Suzuya, Chuo-ku, Saitama, Saitama, 338-0013, Japan
| | - Mari Uomizu
- Department of Orthopaedic Surgery, Nerima General Hospital, 1-24-1 Asahigaoka, Nerima-ku, Tokyo, 176-8530, Japan
| | - Yuji Ikezawa
- JIN Orthopaedic & Sports Clinic, 3-10-7 Suzuya, Chuo-ku, Saitama, Saitama, 338-0013, Japan
| | - Sachiyuki Tsukada
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, 3-2-1 Higashihara, Mito, Ibaraki, 310-0035, Japan
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Bolia IK, Ihn H, Kang HP, Mayfield CK, Briggs KK, Bedi A, Jay Nho S, Philippon MJ, Weber AE. Cutting, Impingement, Contact, Endurance, Flexibility, and Asymmetric/Overhead Sports: Is There a Difference in Return-to-Sport Rate After Arthroscopic Femoroacetabular Impingement Surgery? A Systematic Review and Meta-analysis. Am J Sports Med 2021; 49:1363-1371. [PMID: 32909823 DOI: 10.1177/0363546520950441] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous studies have established a classification of sports based on hip mechanics: cutting, impingement, contact, endurance, flexibility, and asymmetric/overhead. No previous review has compared the outcomes of hip arthroscopy for femoroacetabular impingement syndrome (FAIS) using this classification. PURPOSE To determine whether the rate of return to sport differs among cutting, impingement, contact, endurance, flexibility, and asymmetric/overhead athletes who undergo hip arthroscopy for FAIS. We also aimed to identify differences in patient characteristics, intraoperative procedures performed, and time to return to play among the 6 sport categories. STUDY DESIGN Systematic review and meta-analysis. METHODS Three electronic databases were searched for eligible articles. Two reviewers independently screened the titles, abstract, and full-text articles using prespecified criteria. Eligible articles were those that reported the rate of return to sport (defined by the number of hips) after hip arthroscopy for FAIS in athletes of all levels. Data collected were patient age, sex, body mass index, type of sport, rate and time to return to sport, and intraoperative procedures performed. A mixed effects model was used for meta-analysis. RESULTS A total of 29 articles and 1426 hip arthroscopy cases were analyzed with 185 cutting, 258 impingement, 304 contact, 207 endurance, 116 flexibility, and 356 asymmetric/overhead athletes. The mean age was similar among the 6 subgroups (P = .532), but the proportion of female athletes was significantly higher in flexibility, endurance, and asymmetric/overhead sports as compared with impingement and contact athletes. Flexibility athletes had the highest rate of return to sport after hip arthroscopy for FAIS (94.8%), whereas contact athletes had the lowest rate (88%). The longest mean ± SD time (8.5 ± 1.9 months) to return to sport was reported in cutting sports, while endurance athletes returned faster than the rest (5.4 ± 2.6 months). The difference in rate and time to return to sport, as well as the intraoperative procedure performed, did not reach statistical significance among the 6 subgroups. There was evidence of publication bias and study heterogeneity, and the mean Methodological Index for Non-randomized Studies score was 13 ± 2.6. CONCLUSION Flexibility athletes had the highest rate of return to sport after hip arthroscopy for FAIS, while endurance athletes returned the fastest. The difference in rate and time to return to sport and intraoperative procedures performed did not reach statistical significance among the 6 subgroups. These results are limited by the evidence of publication bias and should be interpreted with caution. Laboratory-based studies are necessary to validate the classification of sports based on hip mechanics.
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Affiliation(s)
- Ioanna K Bolia
- Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Hansel Ihn
- Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Hyunwoo P Kang
- Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Cory K Mayfield
- Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
| | - Karen K Briggs
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Shane Jay Nho
- Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | | | - Alexander E Weber
- Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California, USA
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Marom N, Dooley MS, Burger JA, Chang B, Coleman SH, Ranawat AS, Kelly BT, Nawabi DH. Characteristics of Soccer Players Undergoing Primary Hip Arthroscopy for Femoroacetabular Impingement: A Sex- and Competitive Level-Specific Analysis. Am J Sports Med 2020; 48:3255-3264. [PMID: 32966110 DOI: 10.1177/0363546520958697] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Radiographic features of femoroacetabular impingement (FAI) are prevalent in kicking athletes, especially soccer players. However, there remains a paucity of data on the characteristics of symptomatic soccer players with an established diagnosis of FAI. PURPOSE To report on patient demographics, injury, and clinical and radiographic characteristics in a large cohort of soccer players who underwent primary hip arthroscopy for FAI and to perform a sex- and competition level-specific analysis of these data. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS An institutional hip preservation registry containing 3318 consecutive primary hip arthroscopies for FAI performed between March 2010 and January 2016 was retrospectively reviewed for patients identified as soccer players. Patient demographics, injury characteristics, and clinical and radiographic findings were recorded, and sex- and competition level-specific differences were analyzed. RESULTS A total of 421 hips (336 soccer players) were identified, including 257 (61.0%) men and 164 (39.0%) women. Of these, 105 (24.9%) were reported as highly competitive, 194 (46.1%) as competitive, 75 (17.8%) as recreational, and 47 (11.2%) did not report a level. The majority of the 336 soccer players (231 hips; 55%) reported chronic hip pain lasting >6 months with no acute injury at the initial visit. Alpha angle, coronal center-edge angle, and femoral version on computed tomography scan measured 64.5°± 12°, 32.3°± 9°, and 13.7°± 10° (mean ± SD), respectively. There were 230 (55%) hips with a type 2 anterior inferior iliac spine (AIIS), 78 (18.5%) with a type 1 AIIS, and 19 (4.5%) with a type 3 AIIS. When compared with male athletes, female athletes had more hip internal rotation on physical examination (14.9° vs 8°; P < .001), lower alpha angles (57.5° vs 68.5°; P < .001), and lower-grade AIIS morphology (P = .003). Acute injury as the reason for hip symptoms was most likely in the highly competitive group (P < .001). CONCLUSION Female soccer players were more likely to have less severe clinical and radiographic findings than were male soccer players. Acute injury as the cause of hip symptoms was more common in highly competitive players. CLINICAL RELEVANCE Focusing on soccer players with an established FAI diagnosis, the findings of this study suggest that there are sex- and competition level-based differences in the presentation, physical examination, and imaging characteristics among the players. These findings can better guide clinicians in the diagnostic evaluation of symptomatic soccer players with FAI and in tailoring treatment recommendations to specific cohorts.
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Affiliation(s)
- Niv Marom
- Sports Medicine Institute and Hip Preservation Service, Hospital for Special Surgery, New York, New York, USA
| | - Matthew S Dooley
- Sports Medicine Institute and Hip Preservation Service, Hospital for Special Surgery, New York, New York, USA
| | - Joost A Burger
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Brenda Chang
- Biostatistics Core, Hospital for Special Surgery, New York, New York, USA
| | - Struan H Coleman
- Sports Medicine Institute and Hip Preservation Service, Hospital for Special Surgery, New York, New York, USA
| | - Anil S Ranawat
- Sports Medicine Institute and Hip Preservation Service, Hospital for Special Surgery, New York, New York, USA
| | - Bryan T Kelly
- Sports Medicine Institute and Hip Preservation Service, Hospital for Special Surgery, New York, New York, USA
| | - Danyal H Nawabi
- Sports Medicine Institute and Hip Preservation Service, Hospital for Special Surgery, New York, New York, USA
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Varada S, Moy MP, Wu F, Rasiej MJ, Jaramillo D, Wong TT. The prevalence of athletic pubalgia imaging findings on MRI in patients with femoroacetabular impingement. Skeletal Radiol 2020; 49:1249-1258. [PMID: 32144449 DOI: 10.1007/s00256-020-03405-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/22/2020] [Accepted: 02/25/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the prevalence of athletic pubalgia imaging findings on MRI in patients with femoroacetabular impingement and assess for correlative risk factors. MATERIALS AND METHODS A retrospective search identified 156 hips with femoroacetabular impingement and a control group of 113 without femoroacetabular impingement that had an MRI performed between January 1, 2015, and January 1, 2018. Two fellowship-trained musculoskeletal radiologists reviewed studies for the presence of acute osteitis pubis, chronic osteitis pubis, adductor tendinosis, and tendon tear; rectus abdominis tendinosis and tendon tear; and aponeurotic plate tear. Findings were correlated with various clinical and imaging risk factors. Univariate and multivariate statistical analyses were performed. RESULTS Imaging findings of adductor tendinosis (p = 0.02) and chronic osteitis pubis (p = 0.01) were more prevalent in FAI patients than controls. Univariate analyses in FAI patients showed that an alpha angle ≥ 60° had a higher prevalence of aponeurotic plate tears (p = 0.02) and adductor tendinosis (p = 0.049). Multivariate analyses showed that an alpha angle ≥ 60° had a higher prevalence of chronic osteitis pubis (OR = 2.27, p = 0.031), sports participation had a higher prevalence of adductor tendon tears (OR = 4.69, p = 0.013) and chronic osteitis pubis (OR = 2.61, p = 0.0058), and males had a higher prevalence of acute osteitis pubis (OR = 5.17, p = 0.032). CONCLUSION Sports participation, alpha angle ≥ 60°, and male sex predict a higher prevalence of athletic pubalgia imaging findings in patients with femoroacetabular impingement.
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Affiliation(s)
- Sowmya Varada
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital Columbia University Medical Center, 622 West 168th Street, MC-28, New York, NY, 10032, USA.
| | - Matthew P Moy
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital Columbia University Medical Center, 622 West 168th Street, MC-28, New York, NY, 10032, USA
| | - Fangbai Wu
- Department of Radiology, Division of Musculoskeletal Imaging, University of North Carolina at Chapel Hill, 101 Manning Dr. Chapel Hill, Chapell Hill, NC, 27514, USA
| | - Michael J Rasiej
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital Columbia University Medical Center, 622 West 168th Street, MC-28, New York, NY, 10032, USA
| | - Diego Jaramillo
- Department of Radiology, Division of Pediatric Radiology, NewYork-Presbyterian Hospital Columbia University Medical Center, 630 West 168th Street, MC-28, New York, NY, 10032, USA
| | - Tony T Wong
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital Columbia University Medical Center, 622 West 168th Street, MC-28, New York, NY, 10032, USA
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20
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Landgraeber S, Dienst M. [Footballer's hip]. DER ORTHOPADE 2019; 48:1013-1018. [PMID: 31729559 DOI: 10.1007/s00132-019-03844-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although complaints and injuries in the knee and ankle joints are very prevalent in football, the hip has so far been given very little attention. Complaints in this area are often attributed to pathological changes in the inguinal region. However, intraarticular differential diagnoses are often not taken into consideration. This article gives an overview of possible hip pathology in footballers, as well as its diagnosis and treatment.
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Affiliation(s)
- S Landgraeber
- Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum des Saarlandes, Kirrberger Straße 100, 66421, Homburg, Deutschland.
| | - M Dienst
- Orthopädische Chirurgie München, OCM Gemeinschaftspraxis GbR, OCM Klinik GmbH, Steinerstraße 6, 81369, München, Deutschland
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