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Day T, Pasic N, Churchill L, Bryant D, Degen R. A scoping review of postoperative return to sport criteria and protocols for patients with femoroacetabular impingement syndrome. PHYSICIAN SPORTSMED 2023; 51:97-106. [PMID: 34836488 DOI: 10.1080/00913847.2021.2011628] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To identify the objective criteria and guidelines utilized to determine if patients diagnosed with FAIS can safely return to sport following hip arthroscopy. METHODS The electronic databases MEDLINE Ovid, EMBASE Ovid, and CINAHL were searched to identify eligible studies. Details of study design, sample size, primary diagnosis, and return to sport protocol, duration, and rate were collected by two reviewers, independently. RESULTS Sixty-two studies were selected for full text review of which 14 were included in the final analysis. Of these, nine were clinical commentaries and five were retrospective cohort studies. Three types of rehabilitation guidelines are currently utilized postoperatively: 4-phase, 5-phase, and 6-phase protocols. Although all 14 studies recommend using various types of outcome measures to evaluate a patient's ability to return to sport, only eleven outlined the specific outcome criteria they must achieve to do so. The most utilized outcome measures are the hip outcome score, active and passive range of motion tests, gait analysis, single- and double-leg squat tests, and the Vail hip sports test. Criteria across all three types of protocols was variable, but they all evaluated the same international classification of disability and function constructs described by the World Health Organization: body function, body structure limitations, and activity capacity limitations. CONCLUSIONS There is no consensus on the optimal methods of evaluating a patient's readiness to return to sport after undergoing hip arthroscopy, with most criteria focused on expert opinion. Performance-based return to sport outcome criteria is not clearly defined, and validated outcome measures are not being used for FAIS patients post hip arthroscopy. Lastly, well-conducted prospective cohort studies using validated outcome measures and objective definitions of return to sport are needed to consistently identify signs that are prognostic of safe return to sport.
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Affiliation(s)
- Trevor Day
- Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, Ontario, Canada
| | - Nicholas Pasic
- Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Schulich School of Medicine & Dentistry, Department of Surgery, Western University, London, Ontario, Canada
| | - Laura Churchill
- Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, Ontario, Canada
| | - Dianne Bryant
- Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, Ontario, Canada
- Schulich School of Medicine & Dentistry, Department of Surgery, Western University, London, Ontario, Canada
- Faculty of Medicine, Michael G. DeGroote School of Medicine, Department of Health Research Methods, Evidence, and Impact (Formerly Clinical Epidemiology & Biostatistics), McMaster University, Hamilton, Ontario, Canada
| | - Ryan Degen
- Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Schulich School of Medicine & Dentistry, Department of Surgery, Western University, London, Ontario, Canada
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2
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Serbin PA, Youngman TR, Johnson BL, Wilson PL, Sucato D, Podeszwa D, Ellis HB. Radiographic Predictors of Reoperation in Adolescents Undergoing Hip Preservation Surgery for Femoroacetabular Impingement. Am J Sports Med 2023; 51:687-693. [PMID: 36856281 DOI: 10.1177/03635465221147062] [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] [Indexed: 03/02/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is a condition caused by repetitive abutment of a morphologically abnormal proximal femur and/or acetabulum that may result in chondral and labral pathology. An understanding of radiographic parameters associated with successful primary surgery has not been well established. PURPOSE To determine preoperative radiographic parameters that predict reoperation for FAI and correlate radiographic measurements with outcomes in these patients. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A prospectively collected institutional registry of adolescent patients (age, <19 years) who underwent surgery for FAI (arthroscopic/open) was reviewed. Preoperative standing anteroposterior pelvic radiographs were analyzed for femoroepiphyseal acetabular roof (FEAR) index, as well as lateral center-edge angle (LCEA) and alpha, Tönnis, and Sharp angles. Patient-reported outcomes (PROs) (modified Harris Hip Score, Hip disability and Osteoarthritis Outcome Score) were analyzed preoperatively and at 1- and 2-year followup. Radiographic indication of risk for reoperation was evaluated using receiver operating characteristic (ROC) analysis. Spearman correlation was calculated between radiographic measurements and PROs at 2 years postoperatively. RESULTS A total of 81 patients (91 hips) underwent primary surgery (57 surgical dislocations vs 34 arthroscopies) for FAI. The mean age at time of primary operation was 16.23 years (range, 10.4-19.6 years) (73.6% female). Eleven hips (12.1%) underwent reoperation at a mean of 20.6 months from primary surgery. The LCEA, FEAR index, Tönnis angle, and Sharp angle before index surgery were significantly different (P < .05) between patients who underwent reoperation and those who did not. ROC analysis indicated that LCEA <22°, FEAR index >-8.7°, Tönnis angle >6.0°, and Sharp angle >44° were predictors for increased risk of reoperation. Using the cutoff values from the ROC analysis in this series, 43% of patients with an LCEA ≤22° had a repeat procedure, while only 8% of those with an LCEA >22° had a repeat procedure. Similar trends were seen with the other aforementioned acetabular radiographic measurements (FEAR index, Tönnis angle, Sharp angle). Patients who did not require a reoperation demonstrated significant improvement in all PRO categories from their preoperative to 2-year postoperative visits (P < .0001). CONCLUSION In patients undergoing treatment for FAI, a reoperation was associated with radiographic signs of hip dysplasia, indicating that patients with a shallower acetabulum are at risk for a repeat operation.
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Affiliation(s)
- Philip A Serbin
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, Texas, USA.,Department of Orthopaedic Surgery, Texas Scottish Rite for Children, Dallas, Texas, USA
| | - Tyler R Youngman
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, Texas, USA.,Department of Orthopaedic Surgery, Texas Scottish Rite for Children, Dallas, Texas, USA
| | - Benjamin L Johnson
- Department of Orthopaedic Surgery, Texas Scottish Rite for Children, Dallas, Texas, USA
| | - Philip L Wilson
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, Texas, USA.,Department of Orthopaedic Surgery, Texas Scottish Rite for Children, Dallas, Texas, USA
| | - Dan Sucato
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, Texas, USA.,Department of Orthopaedic Surgery, Texas Scottish Rite for Children, Dallas, Texas, USA
| | - David Podeszwa
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, Texas, USA.,Department of Orthopaedic Surgery, Texas Scottish Rite for Children, Dallas, Texas, USA
| | - Henry B Ellis
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, Texas, USA.,Department of Orthopaedic Surgery, Texas Scottish Rite for Children, Dallas, Texas, USA
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Murphy NJ, Diamond LE, Bennell KL, Burns A, Dickenson E, Eyles J, Fary C, Grieve SM, Griffin DR, Kim YJ, Linklater JM, Lloyd DG, Molnar R, O'Connell RL, O'Donnell J, Randhawa S, J Singh P, Spiers L, Tran P, Wrigley T, Hunter DJ. Which hip morphology measures and patient factors are associated with age of onset and symptom severity in femoroacetabular impingement syndrome? Hip Int 2023; 33:102-111. [PMID: 34424780 DOI: 10.1177/11207000211038550] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Bony morphology is central to the pathomechanism of femoroacetabular impingement syndrome (FAIS), however isolated radiographic measures poorly predict symptom onset and severity. More comprehensive morphology measurement considered together with patient factors may better predict symptom presentation. This study aimed to determine the morphological parameter(s) and patient factor(s) associated with symptom age of onset and severity in FAIS. METHODS 99 participants (age 32.9 ± 10.5 years; body mass index (BMI 24.3 ± 3.1 kg/m2; 42% females) diagnosed with FAIS received standardised plain radiographs and magnetic resonance scans. Alpha angle in four radial planes (superior to anterior), acetabular version (AV), femoral torsion, lateral centre-edge, anterior centre-edge (ACEA) and femoral neck-shaft angles were measured. Age of symptom onset (age at presentation minus duration of symptoms), international Hip Outcome Tool-33 (iHOT-33) and modified UCLA activity scores were recorded. Backward stepwise regression assessed morphological parameters and patient factors (age, sex, BMI, symptom duration, annual income, private/public healthcare system accessed) to determine variables independently associated with onset age and iHOT-33 score. RESULTS Earlier symptom onset was associated with larger superoanterior alpha angle (p = 0.007), smaller AV (p = 0.023), lower BMI (p = 0.010) and public healthcare system access (p = 0.041) (r2 = 0.320). Worse iHOT-33 score was associated with smaller ACEA (p = 0.034), female sex (p = 0.040), worse modified UCLA activity score (p = 0.010) and public healthcare system access (p < 0.001) (r2 = 0.340). CONCLUSIONS Age of symptom onset was chiefly predicted by femoral and acetabular bony morphology measures, whereas symptom severity predominantly by patient factors. Factors measured explained a small amount of variance in the data; additional unmeasured factors may be more influential.
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Affiliation(s)
- Nicholas J Murphy
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, St Leonards, NSW, Australia.,Department of Orthopaedic Surgery, John Hunter Hospital, Australia
| | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, School of Allied Health Sciences, Griffith University, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia
| | | | - Edward Dickenson
- Warwick Medical School, University of Warwick, Coventry, UK and University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jillian Eyles
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, St Leonards, NSW, Australia.,Department of Rheumatology, Royal North Shore Hospital, Australia
| | - Camdon Fary
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Melbourne, Australia
| | - Stuart M Grieve
- Sydney Translational Imaging Laboratory, Charles Perkins Centre, University of Sydney, Camperdown, Australia.,Department of Radiology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Damian R Griffin
- Warwick Medical School, University of Warwick, Coventry, UK and University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Young Jo Kim
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, USA
| | - James M Linklater
- Department of Musculoskeletal Imaging, Castlereagh Sports Imaging Centre, St Leonards, Australia
| | - David G Lloyd
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, School of Allied Health Sciences, Griffith University, Australia
| | - Robert Molnar
- Sydney Orthopaedic Trauma and Reconstructive Surgery, Sydney, Australia
| | - Rachel L O'Connell
- Department of Rheumatology, Royal North Shore Hospital, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - John O'Donnell
- Hip Arthroscopy Australia, Richmond, Australia.,St Vincent's Private Hospital, East Melbourne, Australia
| | - Sunny Randhawa
- Macquarie University Hospital, Macquarie University, Sydney, Australia
| | - Parminder J Singh
- Hip Arthroscopy Australia, Richmond, Australia.,Maroondah Hospital, Eastern Health, Davey Drive, Ringwood East, Melbourne, Australia
| | - Libby Spiers
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia
| | - Phong Tran
- Department of Orthopaedic Surgery, Western Health, Melbourne, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Melbourne, Australia
| | - Tim Wrigley
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia
| | - David J Hunter
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, St Leonards, NSW, Australia.,Department of Rheumatology, Royal North Shore Hospital, Australia
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Outcomes in Pediatric Hip FAI Surgery: a Scoping Review. Curr Rev Musculoskelet Med 2022; 15:362-368. [PMID: 35917094 DOI: 10.1007/s12178-022-09771-6] [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: 06/01/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE OF REVIEW Femoracetabular impingement (FAI) is a common source of hip pain in children and adolescents. While nonoperative therapies and open surgical procedures can be effective, hip arthroscopy is a minimally invasive treatment option with substantial benefit. The purpose of this paper is to evaluate the current role of hip arthroscopy in treating FAI within the pediatric population. This article examines its efficacy through a review of hip arthroscopy outcomes in the contemporary orthopaedic literature. RECENT FINDINGS Morphologic changes in the acetabulum and proximal femur seen in FAI can be attributed to a multitude of etiologies-including idiopathic FAI, Legg-Calve-Perthes, and slipped capital femoral epiphysis. In general, arthroscopic treatment of FAI secondary to these conditions leads to statistically significant improvements in pain and patient-reported outcomes in the short and long term. In the pediatric athlete, repetitive stress on the hip perpetuates FAI and can drastically hinder performance. Hip arthroscopy allows for a high rate of return to sport with minimal morbidity in this population. Overall, pediatric hip arthroscopy is effective in treating FAI secondary to a wide variety of conditions. Despite its clinical benefits, patients and their families should be counseled regarding alternative treatments, potential complications, and return to play.
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5
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Šarčević Z, Tepavčević A. Association between femoroacetabular impingement syndrome and limited lateral hip rotation in young athletes: A case-control study. J Child Orthop 2022; 16:191-197. [PMID: 35800651 PMCID: PMC9254021 DOI: 10.1177/18632521221106377] [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: 03/10/2022] [Accepted: 05/10/2022] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Hip pain is very common in athletes. One of the main disorders causing hip pain is femoroacetabular impingement syndrome. This study aimed to identify a new etiological risk factor for femoroacetabular impingement in the hip. METHODS This case-control study included 88 young athletes, 34 with pains in the hip (supposedly with femoroacetabular impingement) and 54 controls. Femoroacetabular impingement was diagnosed with a flexion, adduction, internal, and rotation test and a particular type of hip pain during sports activities. The medial (internal) and lateral (external) hip ranges of rotation have been measured with an inclinometer. The data were analyzed using a t-test, the Wilcoxon test, the Mann-Whitney U test, and logistic regression. RESULTS There is a statistically significant difference in the external hip rotation range between the athletes with hip pain and controls. Logistic regression analysis showed that external hip range of motion is significantly associated with femoroacetabular impingement. CONCLUSION Limited external hip range of motion was found to be significantly associated with the diagnosis of femoroacetabular impingement in young athletes. A biomechanical explanation of the hypothesis that limited external hip rotation can predict femoroacetabular impingement is given. Based on our results, the hip's lateral range of motion screening can be advised within the regular screening of young athletes. Kinesiotherapeutic procedures for stretching the muscles of the medial hip rotors can be advised to prevent the lateral hip rotation restriction and lower the risk of femoroacetabular impingement in case the limited rotation is due to muscular restriction. LEVEL OF EVIDENCE level III-case-control study.
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Affiliation(s)
- Zoran Šarčević
- Sports Medicine Centre, Novi Sad
Health Care Centre, Novi Sad, Serbia
- Faculty of Medicine, University
of Novi Sad, Novi Sad, Serbia
- Zoran Šarčević, Sports Medicine
Centre, Novi Sad Health Care Centre, Branka Radicevica 51, Novi Sad
21000, Serbia.
| | - Andreja Tepavčević
- Faculty of Sciences, University
of Novi Sad, Novi Sad, Serbia
- Mathematical Institute SANU,
Belgrade, Serbia
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6
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Fukase N, Murata Y, Pierpoint LA, Soares RW, Arner JW, Ruzbarsky JJ, Quinn PM, Philippon MJ. Outcomes and Survivorship at a Median of 8.9 Years Following Hip Arthroscopy in Adolescents with Femoroacetabular Impingement: A Matched Comparative Study with Adults. J Bone Joint Surg Am 2022; 104:902-909. [PMID: 35255011 DOI: 10.2106/jbjs.21.00852] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Because of the unique theoretical surgical risks, including osteonecrosis, acute iatrogenic slipped capital femoral epiphysis, and epiphyseal injury, the optimal treatment strategy for femoroacetabular impingement (FAI) in growing adolescents has yet to be established. The aim of this study was to compare the clinical outcomes of primary arthroscopic treatment of FAI in growing adolescents with a matched adult group. METHODS Patients with FAI who underwent arthroscopic treatment with a minimum follow-up of 2 years were included. Patients with previous ipsilateral hip surgery, an Outerbridge grade of ≥3, a preoperative Tönnis grade of ≥2, or evidence of dysplasia (lateral center-edge angle of <25°) were excluded. Eligible patients who were ≤19 years old and whose proximal femoral physis had not yet closed were matched to adult (20 to 40-year-old) counterparts in a 1:1 ratio by sex, body mass index, and time of surgery. For the adolescents, cam resection was performed with a physeal-sparing approach. Outcome scores, including the modified Harris hip score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and HOS-Sports-Specific Subscale (HOS-SSS), were prospectively collected. RESULTS Of the 196 eligible adolescents, 157 (80%) were pair-matched to adult controls, with a median postoperative follow-up of 8.9 and 6.6 years, respectively. Fourteen (9%) of the adolescents required revision hip arthroscopy compared with 18 adults (11%) (p = 0.46). No patient in the adolescent group had conversion to a total hip arthroplasty (THA), while 3 in the adult group had a THA (p = 0.25). For adolescents without subsequent hip surgery, the median mHHS improved from 59 preoperatively to 96 postoperatively; the HOS-ADL, from 71 to 98; and the HOS-SSS, from 44 to 94 (p < 0.001), which were significantly higher postoperative scores than those of the matched adults (p < 0.05) despite similar or inferior baseline scores. No complications were found during the office visit or at the final follow-up. CONCLUSIONS Hip arthroscopy performed with a physeal-sparing approach for FAI in growing adolescents is safe and effective and yields superior clinical outcomes compared with those in a matched adult group. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Naomasa Fukase
- Steadman Philippon Research Institute, Vail, Colorado.,Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoichi Murata
- Department of Orthopaedic Surgery, Wakamatsu Hospital of University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | - Rui W Soares
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Justin W Arner
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | - Marc J Philippon
- Steadman Philippon Research Institute, Vail, Colorado.,The Steadman Clinic, Vail, Colorado
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7
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Safran MR, Foard SJ, Robell K, Pullen WM. Incidence of Symptomatic Femoroacetabular Impingement: A 4-Year Study at a National Collegiate Athletic Association Division I Institution. Orthop J Sports Med 2022; 10:23259671221084979. [PMID: 35434170 PMCID: PMC9008859 DOI: 10.1177/23259671221084979] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Femoroacetabular impingement (FAI) is an increasingly recognized
cause of hip pain in young athletes. Although there are multiple
studies that describe the radiographic prevalence of FAI in
athletes, its true incidence within this population is
unknown. Purpose: To report on the overall and sport-specific incidence of
symptomatic FAI in National Collegiate Athletic Association
(NCAA) Division I athletes. Return-to-sport times were reported
for patients treated operatively. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review was conducted to identify all reported hip
injuries within a large, multisport NCAA Division I institution.
Hip injuries were stratified into FAI, general pain/dysfunction,
musculotendinous, ligament, bursitis, bone stress, contusion,
and other. FAI was diagnosed based on history, physical
examinations, imaging, and symptomatic relief after a diagnostic
injection. Descriptive statistics were used to calculate the
overall and sport-specific incidence, and chi-square analysis
was performed to identify contingency data. Results: In a 3-year period, a total of 5319 musculoskeletal injuries
occurred in 1072 athletes. There were 491 (9.2%) hip injuries
that occurred in 288 athletes, of which 40 injuries were FAI.
The overall incidence of symptomatic FAI was 3.0% of the total
population, 3.7% of all injured athletes, and 13.9% of athletic
hip injuries. There were no statistically significant
differences in FAI rates among male and female athletes overall
or among male and female athletes within similar sports. Of the
19 athletes who were treated nonoperatively, 2 failed to return
to play: 1 secondary to multiple musculoskeletal injuries and 1
related to cardiac issues. There were 21 hips in 20 patients
that were treated operatively, with 1 athlete failing to return
to sport. Return to play occurred at a mean of 202 days (range,
81-360 days) after hip arthroscopic surgery. Conclusion: In this large, multisport NCAA Division I cohort, the overall
incidence of symptomatic FAI was 3.0% and represented 13.9% of
hip injuries. The successful management of FAI with return to
play was achieved by both nonoperative and operative treatment
methods. The relatively low incidence of symptomatic FAI,
despite reports of a high prevalence of FAI morphology in
athletes, serves to emphasize the importance of clinical
evaluations in treating patients with FAI.
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Affiliation(s)
- Marc R. Safran
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | | | | | - W. Michael Pullen
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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8
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Mahmoud SSS, Takla A, Meyer D, Griffin D, O’Donnell J. Arthroscopic hip surgery offers better early patient-reported outcome measures than targeted physiotherapy programs for the treatment of femoroacetabular impingement syndrome: a systematic review and meta-analysis of randomized controlled trials. J Hip Preserv Surg 2022; 9:107-118. [PMID: 35854801 PMCID: PMC9291355 DOI: 10.1093/jhps/hnac012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/01/2021] [Accepted: 02/10/2022] [Indexed: 02/04/2023] Open
Abstract
Targeted physiotherapy programs (TPP), and surgery, using either open surgical hip dislocation or hip arthroscopy (HA), are the treatment modalities available for femoroacetabular impingement syndrome (FAIS). Randomized controlled trials have recently been performed to compare these treatment options. This review was performed to provide a focused synthesis of the available evidence regarding the relative value of treatment options. A systematic search was performed of Medline, Embase, Cochrane Library and ClinicalTrials.gov databases. Inclusion criteria were randomized controlled trials comparing treatment methods. The Cochrane Risk of Bias assessment tool (RoB2) was used to assess the selected studies. A meta-analysis was performed between homogenous studies. Four trials were identified including 749 patients (392 males). The mean ages of the cohorts ranged between 30.1 and 36.2 years old. Three hundred thirty-five patients underwent HA by 46 surgeons among all trials. Fifty-two patients crossed over from the TPP to the HA group. One of the trials was found to have a high risk of bias, while the other three were between low risk and some concerns. The iHOT-33 was the most commonly used patient-reported outcome measure followed by the HOS ADL and EQ-5D-5L. Others scores were also identified. Scores from two trials could be pooled together for meta-analysis. Apart from SF-12 and GRC, all other scores have shown significantly better outcomes with HA in comparison to TPP at 8- and 12-months follow-up points. HA offers better patient-reported outcomes than TPP for management of FAIS at 8- and 12-months follow-up.
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Affiliation(s)
- Samer S S Mahmoud
- Hip Arthroscopy Australia, 21 Erin Street, Richmond, VIC 3121, Australia
| | - Amir Takla
- Department of Health Professions, Faculty of Health, Arts and Design, Sports & Musculoskeletal Physiotherapist, Australian Sports Physiotherapy, Swinburne University of Technology, Hip Arthroscopy Australia, 21 Erin Street, Richmond, VIC 3121, Australia
| | - Denny Meyer
- Department of Health Sciences and Biostatistics, School of Health, Swinburne University of Technology, PO Box 218, Hawthorn, VIC 3122, Australia
| | - Damian Griffin
- Department of Orthopaedic Surgery, University of Warwick, University Hospitals of Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - John O’Donnell
- Department of Orthopaedics, Swinburne University of Technology, PO Box 218, Hawthorn, VIC 3122, Australia
- Hip Arthroscopy Australia, 21 Erin Street, Richmond, VIC 3121, Australia
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9
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Chiari C, Lutschounig MC, Nöbauer-Huhmann I, Windhager R. [Femoroacetabular impingement syndrome in adolescents-How to adivse? How to treat?]. DER ORTHOPADE 2022; 51:211-218. [PMID: 35166900 PMCID: PMC8894180 DOI: 10.1007/s00132-022-04214-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 12/01/2022]
Abstract
Hintergrund Das Femoroazetabuläre Impingement-Syndrom (FAIS) ist eine relevante Ursache für Leistenschmerzen beim Jugendlichen. Insbesondere sind Sportler betroffen. Ziel der Arbeit Die Arbeit soll einen evidenzbasierten Hintergrund für Beratung und Therapie des FAIS beim Adoleszenten bieten. Material und Methoden Anhand der aktuellen Literatur wurde eine Übersicht zu Prävalenz und Pathogenese, Abklärung und Diagnostik sowie therapeutischen Empfehlung des FAIS beim Adoleszenten erarbeitet. Ergebnisse und Diskussion Das FAIS beim Jugendlichen betrifft vor allem sportlich aktive Patienten. Bestimmte Sportarten begünstigen die Entstehung eines FAIS. Cam-Impingement, Pincer-Impingement und kombiniertes FAIS sind die häufigsten Entitäten in dieser Altersgruppe. Die Cam-Morphologie entsteht kurz vor Schluss der proximalen Femurwachstumsfuge. Beim Cam-Impingement muss die Epiphyseolysis capitis femoris (ECF) von der primären Cam-Morphologie unterschieden werden. Die ECF verlangt eine rasche operative Versorgung mit Stabilisierung der Epiphyse, während das primäre Cam-Impingement elektiv abgeklärt werden kann und ein konservativer Behandlungsversuch sinnvoll ist. Schäden an Labrum und Knorpel werden regelhaft beobachtet. Eine systematische radiologische Abklärung mittels Projektionsröntgen und MRT ist obligat, um einen adäquaten Therapieplan zu entwickeln. Bei jugendlichen Patienten mit FAIS sollte immer ein konservativer Therapieversuch erfolgen. Ist dieser nicht erfolgreich, ist die operative Sanierung mit Hüftarthroskopie indiziert. Die postoperativen Ergebnisse zeigen bei Jugendlichen sehr gute Erfolge mit rascher Besserung der Beschwerden, geringen Komplikationen und einer hohen „Return-to-sport“-Rate.
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Affiliation(s)
- Catharina Chiari
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - Marie-Christine Lutschounig
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Iris Nöbauer-Huhmann
- Universitätsklinik für Radiologie und Nuklearmedizin, Abteilung für Neuroradiologie/Muskuloskelettale Radiologie, Medizinische Universität Wien, Wien, Österreich
| | - Reinhard Windhager
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
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10
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Weinhandl JT, Irmischer BS, Bennett HJ. The effects of sex and landing task on hip mechanics. Comput Methods Biomech Biomed Engin 2021; 24:1819-1827. [PMID: 34665980 DOI: 10.1080/10255842.2021.1921163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Prevalence of femoroacetabular impingement syndrome is common in cutting sports. A first step to understanding the relationship between cutting sports and the development of femoroacetabular impingement is to investigate hip joint contact forces during such tasks. The purpose of this study was to explore sex and task differences in hip joint contact forces, estimated through musculoskeletal modeling, during single-leg drop landings and land-and-cuts. Kinematics and ground reaction forces were obtained from 38 adults performing drop landings and land-and-cut tasks. Simulations were performed in OpenSim to estimate lower extremity muscle forces and hip joint contact forces. Statistical parametric mapping was used to compare hip joint force waveforms between sex and task. There were no sex differences in hip joint forces, but landing trials were characterized by increased hip joint forces compared to land-and-cut trials. The hip joint force estimates obtained the current study could be used in future finite element models that incorporate bone growth models to understand the development of femoroacetabular impingement and design possible compensatory exercises.
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Affiliation(s)
- Joshua T Weinhandl
- Department of Kinesiology, Recreation, & Sports Studies, The University of Tennessee, Knoxville, TN, USA
| | - Bobbie S Irmischer
- School of Computer Science and Mathematics, University of Central Missouri, Warrensburg, MO, USA
| | - Hunter J Bennett
- Department of Human Movement Sciences, Old Dominion University, Norfolk, VA, USA
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11
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Carsen S, Grammatopoulos G, Zaltz I, Ward L, Smit K, Beaulé PE. The Effects of Physical Activity on Physeal and Skeletal Development. JBJS Rev 2021; 9:01874474-202110000-00002. [PMID: 34637401 DOI: 10.2106/jbjs.rvw.21.00060] [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: 11/14/2022]
Abstract
» There is increasing evidence in the literature regarding the important health impact of and risk factors for injury in youth sport. » Increasing pediatric and adolescent activity intensity, such as is seen in earlier single-sport focus and specialization, may be associated with morphological changes in the growing skeleton. » Chronic subacute injury to the developing physes in the active child can lead to stress on the growth plate and surrounding tissues that induces developmental morphological changes in the joint. » There is evidence to suggest that frequent participation in sports that place particular stress across the physes of the proximal humerus, the proximal femur, and the distal radius can be associated with an increased risk of inducing developmental and morphological changes that could lead to future joint dysfunction and premature degeneration. » Additional research is necessary to better define the pathoetiology of activity-mediated morphological changes, as well as to create and validate parameters for safe involvement in competitive physical activities.
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Affiliation(s)
- Sasha Carsen
- Division of Orthopaedic Surgery, CHEO (the Children's Hospital of Eastern Ontario), Ottawa, Ontario, Canada
| | | | - Ira Zaltz
- Department of Orthopedic Surgery, Beaumont Health, Royal Oak, Michigan
| | - Leanne Ward
- Division of Endocrinology, CHEO (the Children's Hospital of Eastern Ontario), Ottawa, Ontario, Canada
| | - Kevin Smit
- Division of Orthopaedic Surgery, CHEO (the Children's Hospital of Eastern Ontario), Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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12
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Terrell SL, Lynch J. Training Load Monitoring and Improved Movement Literacy-Overlooked Strategies for Femoroacetabular Impingement Syndrome Injury Incidence in Youth Athletes. Curr Sports Med Rep 2021; 20:503-505. [PMID: 34622811 DOI: 10.1249/jsr.0000000000000886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Sara Lynn Terrell
- Exercise Science Program, School of Nursing and Health Sciences, Florida Southern College, Lakeland, FL
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13
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Hoch A, Schenk P, Jentzsch T, Rahm S, Zingg PO. FAI morphology increases the risk for osteoarthritis in young people with a minimum follow-up of 25 years. Arch Orthop Trauma Surg 2021; 141:1175-1181. [PMID: 32601879 DOI: 10.1007/s00402-020-03522-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/21/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The mechanical conflict in symptomatic femoroacetabular impingement can lead to early osteoarthritis. However, radiographic impingement morphology is often seen in asymptomatic individuals. Long-term observation regarding the risk of developing osteoarthritis in these individuals is lacking. Our study addressed the following questions: Does femoroacetabular impingement morphology increase the risk for development of osteoarthritis after at least 25 years? If yes, which radiographic parameter is the most predictive? Does the level of activity influence the risk for development of osteoarthritis? Are PROM influenced by the grade of osteoarthritis in this population? METHODS We investigated 51 (32 male, 19 female) patients for whom AP pelvis and Dunn view radiographs were available with a minimum follow-up of 25 years. Alpha angle in AP pelvis and Dunn view radiographs, femoral torsion in Dunn view, lateral center edge angle, cross-over sign, posterior wall sign and prominence of ischial spine sign in AP pelvis radiographs were determined. On the follow-up radiographs, osteoarthritis was graded. Tegner Score for the time of the index radiograph was evaluated. Harris Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index were assessed at latest follow-up. RESULTS The mean follow-up was 43 years (range 25-58). Cam impingement morphology showed to increase the risk for development of osteoarthritis: Alpha angles of ≥ 55° on AP pelvis and Dunn view radiographs were associated risk factors and showed an OR of 1.05 (p = 0.002) and 1.10 (p = 0.001), respectively. Abnormal femoral torsion and acetabular retroversion were not risk factors for osteoarthritis. Tegner Score at index presentation, HHS and WOMAC Score did not correlate with the grade of osteoarthritis. CONCLUSION This study showed that cam impingement morphology in young patients raises the risk for development of hip osteoarthritis by 5-10% in a long-term follow-up with a minimum of 25 years, thus its contribution was small.
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Affiliation(s)
- Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Pascal Schenk
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Thorsten Jentzsch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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14
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Wojtys EM. New Epidemic? Sports Health 2021; 13:322-323. [PMID: 34187246 DOI: 10.1177/19417381211021067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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15
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Collis RW, McCullough AB, Ng C, Prather H, Colditz GA, Clohisy JC, Cheng AL. Rate of Surgery and Baseline Characteristics Associated With Surgery Progression in Young Athletes With Prearthritic Hip Disorders. Orthop J Sports Med 2020; 8:2325967120969863. [PMID: 33294476 PMCID: PMC7705795 DOI: 10.1177/2325967120969863] [Citation(s) in RCA: 4] [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: 07/27/2020] [Accepted: 05/08/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Prearthritic hip disorders (PAHD), such as femoroacetabular impingement
(FAI), acetabular dysplasia, and acetabular labral tears, are a common cause
of pain and dysfunction in adolescent and young adult athletes, and optimal
patient-specific treatment has not been defined. Operative management is
often recommended, but conservative management may be a reasonable approach
for some athletes. Purpose: To identify (1) the relative rate of progression to surgery in self-reported
competitive athletes versus nonathletes with PAHD and (2) baseline
demographic, pain, and functional differences between athletes who proceeded
versus those who did not proceed to surgery within 1 year of evaluation. Study Design: Cohort study; Level of evidence, 3. Methods: An electronic medical record review was performed of middle school, high
school, and college patients who were evaluated for PAHD at a single
tertiary-care academic medical center between June 22, 2015, and May 1,
2018. Extracted variables included patients’ self-reported athlete status,
decision to choose surgery within 1 year of evaluation, and baseline
self-reported pain and functional scores on Patient-Reported Outcomes
Measurement Information System (PROMIS) domains, the Hip disability and
Osteoarthritis Outcome Score (HOOS), and the modified Harris Hip Score. Results: Of 260 eligible patients (289 hips), 203 patients (78%; 227 hips) were
athletes. Athletes were no more likely to choose surgery than nonathletes
(130/227 hips [57%] vs 36/62 hips [58%]; relative risk [RR], 0.99 [95% CI,
0.78-1.25]). Among athletes, those who proceeded to surgery over
conservative care were more likely to be female (81% vs 69%; RR, 1.34 [95%
CI, 0.98-1.83]) and had more known imaging abnormalities (FAI: 82% vs 69%,
RR, 1.47 [95% CI, 1.09-1.99]; dysplasia: 48% vs 27%, RR, 1.44 [95% CI,
1.16-1.79]; mixed deformity: 30% vs 10%, RR, 2.91 [95% CI, 1.53-5.54]; known
labral tear: 84% vs 40%, RR, 2.79 [95% CI, 2.06-3.76]). Athletes who chose
surgery also reported worse baseline hip-specific symptoms on all HOOS
subscales (mean difference, 10.8-17.7; P < .01 for
all). Conclusion: Similar to nonathletes, just over half of athletes with PAHD chose surgical
management within 1 year of evaluation. Many competitive athletes with PAHD
continued with conservative management and deferred surgery, but more
structural hip pathology and worse hip-related baseline physical impairment
were associated with the choice to pursue surgery.
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Affiliation(s)
- Reid W Collis
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Andrea B McCullough
- Division of Physical Medicine and Rehabilitation, Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Chris Ng
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Heidi Prather
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - John C Clohisy
- Division of Adult Reconstruction and Hip Preservation, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Abby L Cheng
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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16
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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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17
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Ejnisman L, Ricioli Júnior W, Queiroz MC, Vicente JRN, Croci AT, Polesello GC. Femoroacetabular Impingement and Acetabular Labral Tears - Part 1: Pathophysiology and Biomechanics. Rev Bras Ortop 2020; 55:518-522. [PMID: 33093713 PMCID: PMC7575372 DOI: 10.1055/s-0040-1702964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 11/12/2019] [Indexed: 11/02/2022] Open
Abstract
Femoroacetabular impingement (FAI) is an important cause of hip pain, and the main etiology of hip osteoarthritis in the young population. Femoroacetabular impingement is characterized by subtle alterations in the anatomy of the acetabulum and proximal femur, which can lead to labrum tearing. The acetabular labrum is essential to the stability of the hip joint. Three types of FAI were described: cam (anespherical femoral head), pincer (acetabular overcoverage) and mixed (characteristics of both cam and pincer). The etiology of FAI is related to genetic and environmental characteristics. Knowledge of this condition is essential to adequately treat patients presenting with hip pain.
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Affiliation(s)
- Leandro Ejnisman
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Walter Ricioli Júnior
- Grupo de Quadril, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Marcelo Cavalheiro Queiroz
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Jose Ricardo Negreiros Vicente
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Alberto Tesconi Croci
- Grupo de Quadril, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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18
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Karuc J, Mišigoj-Duraković M, Marković G, Hadžić V, Duncan MJ, Podnar H, Sorić M. Movement quality in adolescence depends on the level and type of physical activity. Phys Ther Sport 2020; 46:194-203. [PMID: 32971341 DOI: 10.1016/j.ptsp.2020.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/03/2020] [Accepted: 09/05/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES This study examined the relationship between functional movement and physical activity (PA) levels in adolescents. DESIGN Cross-sectional study. SETTING This research is a part of the CRO-PALS longitudinal study conducted in a random sample of adolescents in Zagreb at the Faculty of Kinesiology, University of Zagreb, Croatia. PARTICIPANTS Seven hundred and twenty-five adolescents aged between 16 and 17 years were included. MAIN OUTCOME MEASURE Total Functional Movement Screen score (total FMS score). RESULTS After adjusting for age, body fat and SES, both VPA and MVPA showed minor but significant effects on total FMS score among girls (β = 0.011, p = 0.001, β = 0.005, p = 0.006, respectively), but not in boys (β = 0.004, p = 0.158; β = 0.000, p = 0.780). Regarding PA type, volleyball and dance improved total FMS score (β = 1.003, p = 0.071; β = 0.972, p = 0.043, respectively), while football was associated with lower FMS score (β = -0.569, p = 0.118). CONCLUSION Results suggest that the PA level is positively associated with the functional movement in adolescent girls, but not in boys, where the type of PA moderates these associations. Therefore, functional movement patterns incorporated into physical education curriculum could be beneficial to the musculoskeletal health of the children.
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Affiliation(s)
- Josip Karuc
- Physical Activity Measurement and Surveillance Laboratory, Department of Sport and Exercise Medicine, Faculty of Kinesiology, University of Zagreb, Horvaćanski zavoj 1510000, Zagreb, Croatia.
| | - Marjeta Mišigoj-Duraković
- Physical Activity Measurement and Surveillance Laboratory, Department of Sport and Exercise Medicine, Faculty of Kinesiology, University of Zagreb, Horvaćanski zavoj 1510000, Zagreb, Croatia
| | - Goran Marković
- Department of Kinesiology of Sport, Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Vedran Hadžić
- Department of Sport and Exercise Medicine, Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Michael J Duncan
- School of Life Sciences, Coventry University, Coventry, United Kingdom
| | - Hrvoje Podnar
- Department of General and Applied Kinesiology, Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Maroje Sorić
- Physical Activity Measurement and Surveillance Laboratory, Department of Sport and Exercise Medicine, Faculty of Kinesiology, University of Zagreb, Horvaćanski zavoj 1510000, Zagreb, Croatia
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19
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Shin J, Adeyemi TF, Hobson T, Peters CL, Maak TG. The Bipolar Hip: How Acetabular and Femoral Pathomorphology Affects Hip Motion in Femoral Acetabular Impingement Syndrome. Arthroscopy 2020; 36:1864-1871. [PMID: 32169663 DOI: 10.1016/j.arthro.2020.02.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 02/21/2020] [Accepted: 02/28/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the individual and combined contributions of acetabular and femoral morphology to hip range of motion (ROM) in patients with femoroacetabular impingement syndrome (FAIS) by use of computed tomography measurements and hip ROM evaluated on physical examination. METHODS A retrospective chart and radiographic analysis of patients presenting with hip pain suggestive of FAIS was performed. The femoral neck-shaft angle, femoral version, magnitude and clock-face location of the alpha angle, midcoronal center-edge angle (CEA), midsagittal CEA, acetabular version, and McKibbin index were measured on computed tomography scans. Univariate and multivariate linear regression analyses determined which measurements correlated with hip ROM, including hip flexion as well as hip internal and external rotation with the hip in 90° of flexion. RESULTS Two hundred hips that met the inclusion and exclusion criteria during the eligibility period were included in the analysis. The mean age was 31.9 ±10.0 years, there were 145 female patients (72%), and the mean body mass index was 25.2 ± 5.0. Multivariate linear regression analysis showed that the midsagittal CEA was the only measurement correlating with flexion (q = .031) whereas the femoral neck-shaft angle and McKibbin index were the only significant variables that correlated with external rotation (q = .031 and q < .001, respectively). Finally, the McKibbin index and maximum alpha angle were the only variables that correlated with internal rotation (q < .001 and q = .034, respectively). CONCLUSIONS Multivariate analysis showed that combined acetabular and femoral version significantly correlated with internal and external rotation whereas femoral version in isolation did not. Increased cam morphology remained a significant contributor to reduced internal rotation but did not affect hip flexion. These data suggest that hip ROM is affected by both femoral pathomorphology and acetabular pathomorphology and that careful evaluation of both should be conducted prior to corrective osteoplasty or osteotomy. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Jessica Shin
- Department of Orthopaedic Surgery, University of Utah Orthopedic Center, University of Utah, Salt Lake City, Utah, U.S.A
| | - Temitope F Adeyemi
- Department of Orthopaedic Surgery, University of Utah Orthopedic Center, University of Utah, Salt Lake City, Utah, U.S.A
| | - Taylor Hobson
- Department of Orthopaedic Surgery, University of Utah Orthopedic Center, University of Utah, Salt Lake City, Utah, U.S.A
| | - Christopher L Peters
- Department of Orthopaedic Surgery, University of Utah Orthopedic Center, University of Utah, Salt Lake City, Utah, U.S.A
| | - Travis G Maak
- Department of Orthopaedic Surgery, University of Utah Orthopedic Center, University of Utah, Salt Lake City, Utah, U.S.A..
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French HP, Deasy M, Gallagher R, O'Grady A, Doyle F. Prevalence of Hip or Groin Pain in Adolescents: A Systematic Review and Meta-Analysis. Pain Pract 2020; 20:792-811. [PMID: 32362057 DOI: 10.1111/papr.12907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 04/01/2020] [Accepted: 04/26/2020] [Indexed: 12/25/2022]
Abstract
Musculoskeletal pain is a common cause of pain in adolescence and can be an important predictor of future pain. The prevalence of hip or groin pain that could potentially affect different adolescent populations has not yet been systematically reviewed. This systematic review aimed to determine the prevalence of hip or groin pain in this population. Five electronic databases were searched until January 2019 for eligible studies that included males and females 13 to 19 years of age. Study selection, data extraction, and risk of bias assessments were completed by 2 independent researchers. Based on inclusion criteria, 8 population-based, 8 clinical, and 4 sports populations were included. Studies were conducted in Europe, North America, and Australia. The prevalence was dichotomized into "0 to 3 months" and "3 months and above." Meta-analyses were performed to estimate the prevalence from 0 to 3 months, and individual estimates were reported for studies of 3 months and above. The overall prevalence of hip or groin pain in all adolescents from 0 to 3 months was 12% (95% confidence interval [CI] 6%, 23%) based on 10 studies, and was 7% (95% CI 6%, 10%) based on 7 population studies. Caution should be applied to these estimates due to substantial study heterogeneity. The pain prevalence in cerebral palsy from 0 to 3 months based on 4 studies was 13% (95% CI 10%, 15%). Individual prevalence estimates were 6% and 31% in obese and 4% in hypermobility populations, respectively, and ranged from 6% to 100% in 4 sports studies. The validity of these estimates is compromised by poor methodological quality.
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Affiliation(s)
| | - Margaret Deasy
- Physiotherapy Department, Sports Surgery Clinic, Santry, Dublin, Ireland
| | | | | | - Frank Doyle
- Royal College of Surgeons in Ireland, Dublin, Ireland
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21
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Chen SL, Maldonado DR, Go CC, Kyin C, Lall AC, Domb BG. Outcomes of Hip Arthroscopic Surgery in Adolescents With a Subanalysis on Return to Sport: A Systematic Review. Am J Sports Med 2020; 48:1526-1534. [PMID: 31539278 DOI: 10.1177/0363546519875131] [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 There is a plethora of literature on outcomes after hip arthroscopic surgery in the adult population; however, outcomes in the adolescent population have not been as widely reported. Additionally, as adolescents represent a very active population, it is imperative to understand their athletic activity and return to sport after hip arthroscopic surgery. PURPOSE To analyze patient-reported outcomes (PROs) after hip arthroscopic surgery in adolescents (aged 10-19 years) and present a return-to-sport analysis in the athletic adolescent subgroup. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS The PubMed, Embase, and Cochrane databases were searched according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify articles that reported PROs after hip arthroscopic surgery in adolescents. The standardized mean difference was calculated to compare the effect size of hip arthroscopic surgery on various PROs. For the athletic subgroup, a return-to-sport summary was also provided. RESULTS Ten studies, with 618 adolescent hips and a collective study period of December 2004 to February 2015, were included in this systematic review. Across all studies, the mean age was 15.8 years (range, 11.0-19.9 years), and female patients composed approximately 56.7% of the entire cohort. The mean follow-up was 34.5 months (range, 12-120 months). The modified Harris Hip Score (mHHS) was reported in 9 studies, and at latest follow-up, scores were excellent in 4 studies (range, 90-95) and good in the remaining 5 studies (range, 82.1-89.6). All adolescents also showed significant improvement on the Non-Arthritic Hip Score (NAHS), the Hip Outcome Score-Activities of Daily Living (HOS-ADL), the HOS-Sport-Specific Subscale (HOS-SSS), the physical component of the 12-Item Short Form Health Survey (SF-12P), a visual analog scale for pain (VAS), and both versions of the International Hip Outcome Tool (iHOT-12 and iHOT-33) at latest follow-up (P < .05). Further, mean improvements reported in all studies surpassed reported values of the minimal clinically important difference and patient acceptable symptomatic state for the mHHS, HOS-ADL, HOS-SSS, and iHOT-33. Finally, the collective return-to-sport rate among athletic adolescents was 84.9%. CONCLUSION In the setting of labral tears and femoroacetabular impingement, hip arthroscopic surgery can safely be performed in adolescents and leads to significant functional improvement. Furthermore, athletic adolescents return to sport at high levels after hip arthroscopic surgery.
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Affiliation(s)
- Sarah L Chen
- American Hip Institute, Des Plaines, Illinois, USA.,Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Cynthia Kyin
- American Hip Institute, Des Plaines, Illinois, USA
| | - Ajay C Lall
- American Hip Institute, Des Plaines, Illinois, USA
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Salas C, Sintes P, Joan J, Urbano D, Sospedra J, Caparros T. Conservative management of femoroacetabular impingement (FAI) in professional basketball. APUNTS SPORTS MEDICINE 2020. [DOI: 10.1016/j.apunsm.2020.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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23
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Falotico GG, Arliani GG, Yamada AF, Fernandes ADRC, Ejnisman B, Cohen M. Professional soccer is associated with radiographic cam and pincer hip morphology. Knee Surg Sports Traumatol Arthrosc 2019; 27:3142-3148. [PMID: 29876863 DOI: 10.1007/s00167-018-5008-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 06/01/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE Femoroacetabular impingement (FAI) syndrome is characterized by a triad: symptoms, clinical signs and imaging findings. Some individuals, especially athletes, have only imaging alterations. The objective of this study was to evaluate the prevalence of cam and pincer morphology in professional soccer players compared with a control group of non-athletes and to investigate the association between the age at which players start playing competitive soccer more than three times per week and duration of the soccer career with the prevalence of these radiographic findings. METHODS The prevalence of cam and pincer morphology in sixty professional adult male soccer players and thirty-two male controls was determined using pelvic anteroposterior radiography. Data were recorded for all hips and correlated with the age at which the players started competitive soccer practice and with the duration of their soccer career. RESULTS The prevalence of morphological FAI in the soccer players was 92.5% versus 28.1% in the controls (p < 0.001). The duration of the soccer career was positively correlated with the alpha angle (p = 0.033) and negatively correlated with the retroversion index (p = 0.009). The age at which competitive play began was inversely correlated with the alpha angle (p < 0.001). CONCLUSION The study showed a high prevalence of cam and pincer morphology in Brazilian professional soccer players compared with controls. The duration of the soccer career was associated with an increased alpha angle and a decreased retroversion index, and the age at which competitive soccer participation began was negatively associated with alpha angle values. Finally, this manuscript provides data about the association between greater exposure to soccer and cam and pincer morphological changes in the hip; specifically, cam morphology was more common in patients who began participating in sports at earlier ages. This information serves as an alert for coaches of youth teams to manage the training load in youth athletes. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Guilherme Guadagnini Falotico
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, Borges Lagoa, 783-5° floor, São Paulo, SP, Brazil.
| | - Gustavo Gonçalves Arliani
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, Borges Lagoa, 783-5° floor, São Paulo, SP, Brazil
| | - André Fukunishi Yamada
- Departamento de Diagnóstico por Imagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Benno Ejnisman
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, Borges Lagoa, 783-5° floor, São Paulo, SP, Brazil
| | - Moises Cohen
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, Borges Lagoa, 783-5° floor, São Paulo, SP, Brazil
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25
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O'Brien LK, Schallmo MS, Stubbs AJ. Return to Sport Following Femoroacetabular Impingement Syndrome. OPER TECHN SPORT MED 2019. [DOI: 10.1053/j.otsm.2019.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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26
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Garcia AS, Gobetti M, Tatei AY, Falótico GG, Arliani GG, Puertas EB. Prevalence of Radiographic Signs of Femoroacetabular Impingement in Asymptomatic Patients and Non-Athletes. Rev Bras Ortop 2019; 54:60-63. [PMID: 31363244 PMCID: PMC6424806 DOI: 10.1016/j.rbo.2017.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/06/2017] [Indexed: 11/15/2022] Open
Abstract
Objective Femoroacetabular impingement has been described as an anatomical variation of the proximal femur and/or acetabular rim, impinging the hip joint. A portion of the population asymptomatic in the hip may present radiographic changes from femoroacetabular impingement. The aim of the present study was to evaluate the prevalence of these signs in asymptomatic and sedentary males. Methods This was a clinical, observational, primary, cross-sectional, controlled study. A total of 32 male volunteers aged between 18 and 40 years, asymptomatic in the hip and sedentary, were selected from a university hospital orthopedic emergency room. All patients underwent standard anteroposterior pelvic radiographs. The measurements of the alpha angle, the retroversion index, the ischial spine signal, and the posterior wall sign were analyzed. Results
The mean age was 29 years (18-40 years old). The prevalence of radiographic signs of femoroacetabular impingement using an alpha angle of 67
o
was of 53.1%; with an alpha angle of 82
o
, it was of 31.2%. The mean alpha angle was 67
o
(52.4-88.2
o
), with 35.9% of the hips classified as borderline and 6.3% as pathological. The mean alpha angle for the right side was 67.5
o
(52.5-88.2
o
), and, for the left, it was 66.6
o
(53.1-86.9
o
). The mean retroversion index was 0.048 (right side: 0.044; left side: 0.052). The spine signal was positive in 15.6%, and the posterior wall sign, in 20.3% of the cases.
Conclusion This study showed that the prevalence of radiographic signs in a population of asymptomatic and sedentary adult men was high (31.2%). New studies are required to explian the actual clinical significance of this finding.
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Affiliation(s)
- André Sousa Garcia
- Escola Paulista de Medicina (EPM), Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil
| | - Murilo Gobetti
- Escola Paulista de Medicina (EPM), Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil
| | - Anderson Yutaka Tatei
- Escola Paulista de Medicina (EPM), Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil
| | - Guilherme Guadagnini Falótico
- Escola Paulista de Medicina (EPM), Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil
| | - Gustavo Gonçalves Arliani
- Escola Paulista de Medicina (EPM), Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil
| | - Eduardo Barros Puertas
- Escola Paulista de Medicina (EPM), Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil
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Vap AR. Editorial Commentary: Femoroacetabular Impingement and Open Physes-To Operate or Not to Operate? Is That the Only Question? Arthroscopy 2019; 35:1826-1827. [PMID: 31159967 DOI: 10.1016/j.arthro.2019.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/02/2019] [Indexed: 02/02/2023]
Abstract
Our clinical understanding, diagnosis, and treatment of femoroacetabular impingement (FAI) have improved tremendously over the past 2 decades. However, we still have major questions to answer when it comes to the exact etiology of FAI and the role played by intense adolescent athletic activity in the development of FAI. In a society in which there is increasing sports specialization in young people and also rising rates of overuse injuries, the balance between surgical intervention and early preventive measures has yet to be clearly defined. Although we may be able to "safely" treat FAI surgically and provide clinical improvement for these patients, the question remains: Are we addressing with surgery a condition that could be prevented with earlier precautionary measures? It is our responsibility to answer that question for our patients.
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Larson CM, McGaver RS, Collette NR, Giveans MR, Ross JR, Bedi A, Nepple JJ. Arthroscopic Surgery for Femoroacetabular Impingement in Skeletally Immature Athletes: Radiographic and Clinical Analysis. Arthroscopy 2019; 35:1819-1825. [PMID: 31072717 DOI: 10.1016/j.arthro.2019.01.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 01/11/2019] [Accepted: 01/11/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate radiographic and clinical outcomes after arthroscopic femoroacetabular impingement (FAI) correction in symptomatic adolescent athletes with open physes. METHODS We retrospectively reviewed radiographic and clinical outcomes in patients treated with a non-physeal-sparing arthroscopic approach for symptomatic FAI with open physes and a minimum 1-year follow-up. Specific plain radiographic and computed tomography parameters were determined, and preoperative and postoperative outcomes were prospectively evaluated with modified Harris Hip Score (mHHS), 12-Item Veterans-Rand, and pain on a visual analog scale. RESULTS Thirty-seven hips (28 patients; 75% male) with a mean age of 15.9 years (range, 12.8-18.3 years) had imaging studies consistent with open femoral neck and iliac crest physes. The ischial tuberosity and greater trochanteric physes were open in 95% and 54% of the hips, respectively. All patients participated in organized athletics, and 50% were in multiple sports year-round. Mean follow-up was 39.8 months post-arthroscopic FAI correction. There was a mean 27.7-point improvement in the mHHS (P < .001), a 4.8-point decrease in the visual analog scale for pain (P < .001), and a 15.2-point improvement in the 12-Item Veterans-Rand physical component (P < .001). Ninety-three percent of patients returned to their preinjury level of sports participation without limitations. Thirty (81.1%) patients demonstrated improvements in mHHS greater than the minimally clinically important difference (of mHHS 8 points). Two patients could not reach minimally clinically important difference because of a preoperative mHHS of > 92. There were no postoperative physeal growth arrests, growth disturbances, physeal instability, or avascular necrosis. CONCLUSIONS A non-physeal-sparing arthroscopic approach for FAI in adolescents with open physes is safe and effective with no evidence of clinically relevant complication of growth arrest-related deformity or physeal instability in patients with a minimum of 1 year (mean, 39.8 months) of follow-up after surgery. Young, highly athletic adolescent patients with larger FAI deformities demonstrated greater outcomes improvement after arthroscopy. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
| | | | | | | | - James R Ross
- BocaCare Orthopedics, Deerfield Beach, Florida, U.S.A
| | - Asheesh Bedi
- University of Michigan MedSport, Department of Orthopedics, University of Michigan, Ann Arbor, Michigan, U.S.A
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Knapik DM, Gaudiani MA, Camilleri BE, Nho SJ, Voos JE, Salata MJ. Reported Prevalence of Radiographic Cam Deformity Based on Sport: A Systematic Review of the Current Literature. Orthop J Sports Med 2019; 7:2325967119830873. [PMID: 30915376 PMCID: PMC6429661 DOI: 10.1177/2325967119830873] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Repetitive loading and shear stress across the proximal femur account for the high prevalence of cam deformity in athletes. Purpose To systematically review the literature to identify the reported number, age, mean alpha angle measurements, and differences between male and female athletes with radiographic cam deformity based on sport. Study Design Systematic review; Level of evidence, 4. Methods A systematic review was conducted of studies in the literature between January 1990 and March 2018 that reported on athletes with radiographic cam deformity based on sport. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed, and PubMed, Biosis Previews, SPORTDiscus, PEDro, and EMBASE databases were used. Inclusion criteria included studies documenting radiographic cam deformity based on alpha angle measurements categorized according to the athlete's primary sport and according to sex. Exclusion criteria were (1) studies not documenting primary sport, (2) studies not reporting total number of athletes with radiographic cam deformity, and (3) studies not separating cam deformity based on sex or using alpha angle measurements. Statistical analysis was used to compare mean reported age and alpha angle measurements between males and females. Results A total of 28 studies consisting of 1160 male and 53 female athletes with radiographic cam deformity were identified. Cam lesions were most commonly reported in soccer athletes among both males and females, followed by hockey and American football. Male athletes had significantly higher mean alpha angle measurements (59.9° ± 5.5°) compared with female athletes (48.3° ± 6.9°) (P = .001). No significant difference in age was appreciated between males (21.1 ± 4.0 years) and females (21.7 ± 3.0 years) (P = .62). Conclusion Radiographic cam deformity is most commonly reported in athletes participating in soccer and hockey. Males possessed significantly greater mean alpha angle measurements compared with females, whereas no significant difference in mean age at the time of diagnosis was appreciated between sexes.
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Affiliation(s)
- Derrick M Knapik
- University Hospitals Sports Medicine Institute, Cleveland, Ohio, USA.,Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - Michael A Gaudiani
- Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | | | - Shane J Nho
- Midwest Orthopaedics at Rush University, Chicago, Illinois, USA
| | - James E Voos
- University Hospitals Sports Medicine Institute, Cleveland, Ohio, USA.,Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - Michael J Salata
- University Hospitals Sports Medicine Institute, Cleveland, Ohio, USA.,Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
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Abstract
Subacute, nontraumatic hip pain is often a diagnostic challenge. Femoroacetabular impingement (FAI) is a common cause of atraumatic hip pain that is poorly understood. FAI is a result of abnormal morphologic changes in either the femoral head or the acetabulum. FAI is more prevalent in people who perform activities requiring repetitive hip flexion, but it remains common in the general population. Evaluation begins with physical examination maneuvers to rule out additional hip pathology and provocation tests to reproduce hip pain. Diagnosis is often made by radiography or magnetic resonance imaging. Initial treatment is generally more conservative, featuring activity modification and physical therapy, whereas more aggressive treatment requires operative management.
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Affiliation(s)
- Evan D Sheppard
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Connor R Read
- Department of Orthopaedic Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN
| | - Brad W Wills
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - A Reed Estes
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL
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Kraeutler MJ, Chadayammuri V, Garabekyan T, Mei-Dan O. Femoral Version Abnormalities Significantly Outweigh Effect of Cam Impingement on Hip Internal Rotation. J Bone Joint Surg Am 2018; 100:205-210. [PMID: 29406341 DOI: 10.2106/jbjs.17.00376] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the effects of femoral version, cam-type femoroacetabular impingement (FAI), and the combination of the 2 on the passive hip range of motion (ROM). METHODS We prospectively analyzed a consecutive cohort of 220 patients (440 hips) who presented with unilateral or bilateral hip pain. The passive hip ROM was measured bilaterally with the patient in prone, supine, and lateral positions. Femoral version was measured and the presence of cam-type deformity was determined on preoperative computed tomography (CT) scans. Diagnostic findings of cam-type FAI included an alpha angle of >50° on CT radial sequences of the head-neck junction and a femoral head-neck offset ratio of <0.18 on both radiographs and CT. RESULTS Multivariate linear regression analysis confirmed that femoral version, as compared with the presence of a cam lesion, was a stronger independent predictor of internal rotation ROM. Conversely, the presence of a cam lesion resulted in a significant decrease in the passive hip flexion ROM (p < 0.001) with no additional effects due to the degree of femoral version. The passive hip internal rotation ROM in neutral flexion/extension and with the hip in 90° of flexion were maximized in patients with femoral anteversion and decreased significantly with each incremental decrease in femoral version (p < 0.001). CONCLUSIONS Abnormalities in femoral version significantly outweigh the effect of cam-type impingement on the passive hip internal rotation ROM. In contrast, the presence of a cam lesion significantly decreases the hip flexion ROM, irrespective of the degree of femoral version. These findings help to inform surgical decision-making for patients with cam-type FAI or femoral version abnormalities. CLINICAL RELEVANCE It is common clinical practice to ascribe loss of hip internal rotation to the presence of a cam lesion and to assume that arthroscopic femoral osteoplasty will substantially improve internal rotation postoperatively. Our study shows that the cam lesion is more intimately tied to hip flexion than to hip internal rotation. This result directly impacts the clinical assessment of a patient presenting with radiographic findings of FAI.
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Affiliation(s)
- Matthew J Kraeutler
- Department of Orthopaedics, Seton Hall-Hackensack Meridian School of Medicine, South Orange, New Jersey
| | - Vivek Chadayammuri
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut
| | | | - Omer Mei-Dan
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
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CLINICAL MEASURES OF HIP RANGE OF MOTION DO NOT CORRELATE WITH THE DEGREE OF CAM MORPHOLOGY IN SEMI-ELITE AUSTRALIAN FOOTBALLERS: A CROSS-SECTIONAL STUDY. Int J Sports Phys Ther 2017; 12:1078-1086. [PMID: 29234559 DOI: 10.26603/ijspt20171078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Clinical testing to determine the presence of a cam morphology is becoming more common however the correlation between hip range of motion and the degree of cam morphology remains controversial in the literature. The prevalence of a cam morphology in athletes has been reported as higher than in the general population but the prevalence of cam morphology has not been reported in Australian Football (AF). Purpose The purpose of this study was to determine the correlation between hip range of motion and hip alpha angle and report the proportion of players with a cam morphology in a sample of AF players. Design Cross-sectional Study. Methods Twenty-one semi-elite AF players (42 hips) from the Peel Thunder Football Club were included in this study. A hip Flexion Internal Rotation (IR) test and a modified maximal squat test using the difference in depth of squat in hip internal and external rotation were used. These measures were then compared to alpha angles on 90 degree Dunn view x-rays. Results Four of the 42 hips (9.5%) had a cam morphology (alpha angle > 60 degrees). There was no significant correlation between alpha angle and ROM in a Flexion IR test or the difference in modified maximal squat test depth within this sample of players. Conclusions The proportion of cam morphology seems to be lower in this sample than the previously reported prevalence in other sports. The lack of correlations between hip range and hip alpha angle in players means that screening hips using clinical measures to detect cam morphology associated with poor hip range of motion may be inaccurate. Level of Evidence Level 3a.
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Degen RM, Mayer SW, Fields KG, Coleman SH, Kelly BT, Nawabi DH. Functional Outcomes and Cam Recurrence After Arthroscopic Treatment of Femoroacetabular Impingement in Adolescents. Arthroscopy 2017; 33:1361-1369. [PMID: 28412058 DOI: 10.1016/j.arthro.2017.01.044] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/21/2017] [Accepted: 01/23/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the functional outcomes after arthroscopic treatment of femoroacetabular impingement (FAI) in adolescent patients and non-adolescent patients, and to report on the rate of cam recurrence within 2 years after femoral osteoplasty in a limited sample of the adolescent group. METHODS From 2010 to 2014, patients younger than 18 years with symptomatic FAI (alpha angle >50°) who underwent hip arthroscopy with minimum 2-year follow-up or reoperation were identified. A group of non-adolescent patients with identical inclusion criteria, except age of 18 years or older, was also identified for comparison. In addition, a separate group of adolescent patients with 2-year postoperative radiographs was reviewed for cam recurrence. Demographic data, operative data, and radiographic and clinical outcomes (modified Harris Hip Score [mHHS], Hip Outcome Score-Activities of Daily Living [HOS-ADL], Hip Outcome Score-Sport-Specific Subscale [HOS-SSS], and International Hip Outcome Tool 33 [iHOT-33] score) were collected. RESULTS We identified 34 adolescent patients (38 hips) with an average age of 16 years (range, 13-17 years). The mean clinical follow-up period was 36.1 ± 11.6 months (range, 24.1-71.7 months) and 29.6 ± 2.4 months (range, 27.9-31.3 months) without and with reoperation, respectively. A control group of 296 non-adolescent patients (306 hips), with a mean age of 31 years (range, 18-59 years), was identified as our non-adolescent group. The mean clinical follow-up period was 34.1 ± 11 months (range, 24.0-77.4 months) and 15.1 ± 9.1 months (range, 3.6-34.6 months) without and with reoperation, respectively. Significant improvement was noted in adolescents in the changes in outcome scores (mHHS, 22.2 [95% confidence interval (CI), 15.4-29.0]; HOS-ADL, 18.6 [95% CI, 11.9-25.2]; HOS-SSS, 33.5 [95% CI, 24.5-42.5]; and iHOT-33 score, 30.5 [95% CI, 21.8-39.2]; P < .001). Similar improvements were observed in non-adolescents (mHHS, 21.0 [95% CI, 19.0-23.0]; HOS-ADL, 16.6 [95% CI, 14.6-18.6]; HOS-SSS, 30.1 [95% CI, 26.6-33.6]; and iHOT-33 score, 34.9 [95% CI, 31.5-38.3]; P < .001). There was no evidence of a difference in follow-up survey scores between groups (P > .203). Revision surgery was required in 2 adolescent hips (5.3% [95% CI, 1.5%-17.3%]) and 19 non-adolescent hips (6.2% [95% CI, 4.0%-9.5%]). Minimum 2-year radiographs were available for review in 24 adolescent patients (30 hips). The alpha angle (mean ± standard deviation) was reduced from 55.4° ± 12.1° preoperatively to 38.7° ± 4.9° at 6 weeks postoperatively (mean difference, -16.4° [95% CI, -19.8° to -12.9°]; P < .001). At 2 years, the alpha angle remained at 39.2° ± 11.2°, which did not differ from 6-week measurements (mean difference, 0.5° [95% CI, -2.9° to 3.9°]; P = .784). There were no cases of cam recurrence (0% [95% CI, 0%-11.4%]). CONCLUSIONS Significant improvement in clinical outcomes can be anticipated after arthroscopic treatment of FAI in adolescents. From a limited sample of our adolescent population, the risk of cam recurrence appears low; however, further follow-up is needed to ensure this does not represent a biased sample of the initial population. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Ryan M Degen
- Center for Hip Preservation, Hospital for Special Surgery, New York, New York, U.S.A..
| | - Stephanie W Mayer
- Center for Hip Preservation, Hospital for Special Surgery, New York, New York, U.S.A
| | - Kara G Fields
- Center for Hip Preservation, Hospital for Special Surgery, New York, New York, U.S.A
| | - Struan H Coleman
- Center for Hip Preservation, Hospital for Special Surgery, New York, New York, U.S.A
| | - Bryan T Kelly
- Center for Hip Preservation, Hospital for Special Surgery, New York, New York, U.S.A
| | - Danyal H Nawabi
- Center for Hip Preservation, Hospital for Special Surgery, New York, New York, U.S.A
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