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Machado JKS, Guimarães GHDS, Ferreira MDC, Nogueira JG. Relationship between Femoroacetabular Impingement and Pubalgia in Professional Soccer Players. Rev Bras Ortop 2023; 58:e862-e868. [PMID: 38077776 PMCID: PMC10708980 DOI: 10.1055/s-0043-1776772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/29/2023] [Indexed: 08/03/2024] Open
Abstract
Objective To analyze the relationship between pubalgia and femoroacetabular impingement (FAI) in professional athletes of a soccer club, defining the prevalence of these conditions in the sample studied. Methods It is an epidemiological, cross-sectional, and analytical study including 90 professional soccer players active from 2019 to 2021. We accessed the medical records of the subjects to retrieve information from the modified Pre-Competition Medical Assessment (PCMA) protocol, orthopedic physical examination, and anteroposterior pelvic radiographs to assess pubalgia and FAI, respectively. Inclusion criteria were athletes playing in the professional soccer club in the 2019 to 2021 season, who underwent a modified PCMA upon admission, and who signed an informed consent form. Results FAI was highly prevalent (85.6%) in the sample. This prevalence may occur because, in Brazil, people start playing sports early, not always in suitable fields, or with no proper equipment and supervision. In addition, the CAM-type impingement was the most frequent (62.2%). These injuries are related to high-intensity movements, including those associated with soccer. Furthermore, there is no dependency correlation between pubalgia and FAI. FAI was present in only 20% of athletes with pubalgia complaints. Conclusion There was a high prevalence of FAI in professional soccer players in the studied population (85.6%) but with no relationship between FAI and pubalgia.
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Affiliation(s)
- Jean Klay Santos Machado
- Coordenador do Serviço de Ortopedia e Traumatologia pelo Hospital Porto Dias, Belém Pará, Brasil
| | | | | | - Jaime Gomes Nogueira
- Residente em Ortopedia e Traumatologia pelo Hospital Porto Dias, Belém Pará, Brasil
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Noebauer-Huhmann IM, Koenig FRM, Chiari C, Schmaranzer F. [Femoroacetabular impingement in adolescents]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:749-757. [PMID: 37698653 PMCID: PMC10522737 DOI: 10.1007/s00117-023-01197-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 09/13/2023]
Abstract
Femoroacetabular impingement syndrome (FAIS) is caused by a repetitive mechanical conflict between the acetabulum and the proximal femur, occurring in flexion and internal rotation. In cam impingement, bony prominences of the femoral head-neck junction induce chondrolabral damage. The acetabular type of FAIS, termed pincer FAIS, may be either due to focal or global retroversion and/or acetabular overcoverage. Combinations of cam and pincer morphology are common. Pathological femoral torsion may aggravate or decrease the mechanical conflict in FAI but can also occur in isolation. Of note, a high percentage of adolescents with FAI-like shape changes remain asymptomatic. The diagnosis of FAIS is therefore made clinically, whereas imaging reveals the underlying morphology. X‑rays in two planes remain the primary imaging modality, the exact evaluation of the osseous deformities of the femur and chondrolabral damage is assessed by magnetic resonance imaging (MRI). Acetabular coverage and version are primarily assessed on radiographs. Evaluation of the entire circumference of the proximal femur warrants MRI which is further used in the assessment of chondrolabral lesions, and also bone marrow and adjacent soft tissue abnormalities. The MRI protocol should routinely include measurements of femoral torsion. Fluid-sensitive sequences should be acquired to rule out degenerative or inflammatory extra-articular changes.
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Affiliation(s)
- Iris-M Noebauer-Huhmann
- Universitätsklinik für Radiologie und Nuklearmedizin, Abteilung für Neuroradiologie und Muskuloskelettale Radiologie, Medizinische Universität Wien, Wien, Österreich.
| | - Felix R M Koenig
- Universitätsklinik für Radiologie und Nuklearmedizin, Abteilung für Neuroradiologie und Muskuloskelettale Radiologie, Medizinische Universität Wien, Wien, Österreich
| | - Catharina Chiari
- Universitätsklinik für Orthopädie und Unfallchirurgie, Klinische Abteilung für Orthopädie, Medizinische Universität Wien, Wien, Österreich
- Abteilung für Kinderorthopädie und Fußchirurgie, Orthopädisches Spital Speising, Wien, Österreich
| | - Florian Schmaranzer
- Universitätsklinik für Diagnostische‑, Interventionelle- und Pädiatrische Radiologie, Inselspital Bern, Universität Bern, Bern, Schweiz
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3
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Kopscik M, Crisman JL, Lomasney L, Smith S, Jadidi S. Sports Hernias: A Comprehensive Review for Clinicians. Cureus 2023; 15:e43283. [PMID: 37692688 PMCID: PMC10492628 DOI: 10.7759/cureus.43283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Sports hernias are a complex cause of chronic groin pain in athletes, posing diagnostic and treatment challenges for clinicians. This review article synthesizes current knowledge on sports hernias, exploring pathogenesis, diagnostic approaches, and management strategies. Despite the growing body of research, sports hernias continue to present a significant challenge, necessitating a multidisciplinary approach and further research to improve clinical outcomes. This comprehensive review aims to equip clinicians with an updated understanding of sports hernias, ensuring optimal patient care and informing future research.
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Affiliation(s)
- Michael Kopscik
- Family & Community Medicine, AnMed Health Medical Center, Anderson, USA
| | - Joseph L Crisman
- Family & Community Medicine, Loyola University Medical Center, Chicago, USA
| | - Laurie Lomasney
- Musculoskeletal Imaging, Interventional Radiology, Diagnostic Radiology, Loyola University Medical Center, Chicago, USA
| | - Sean Smith
- Musculoskeletal Radiology, Superior Sports Radiology, Greenville, USA
| | - Shaheen Jadidi
- Sports Medicine, Edward-Elmhurst Health/NorthShore University HealthSystem, Chicago, USA
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4
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Mullen S, Hadley M, Vopat B, Wolf M. Core Muscle Injury Producing Groin Pain in the Athlete: Diagnosis and Treatment. J Am Acad Orthop Surg 2023; 31:549-556. [PMID: 36977185 DOI: 10.5435/jaaos-d-22-00739] [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: 08/13/2022] [Accepted: 02/27/2023] [Indexed: 03/30/2023] Open
Abstract
Groin pain is a common cause of pain in the athlete and may be the result of a variety of causes. Musculoskeletal groin injuries are often associated with muscle strain, particularly the adductor and abdominal muscles, termed "core muscle injury" (CMI). Since the early 1960s, there have been a growing number of articles intending to identify, define, prevent, and treat this condition; to date, however, the lack of a universal definition and treatment approach has complicated the narrative around CMI. This article intends to review the recent literature surrounding CMI, identifying common defining characteristics, as well as delineating treatment protocols that benefit the injured patient populations. Emphasis is placed on the clinical outcomes of different treatment methodologies and failure rates.
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Affiliation(s)
- Scott Mullen
- From the Department of Orthopedic Surgery and Sports Medicine, The University of Kansas Health System, Kansas City, KS (Mullen, Hadley and Vopat) and the Department of Orthopaedic Surgery and Rehabilitation Atrium Health Wake Forest Baptist, Winston-Salem, NC (Wolf)
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5
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Gowd AK, Beck EC, Trammell AP, Edge C, Stubbs AJ. Evaluation of additional causes of hip pain in patients with femoroacetabular impingement syndrome. Front Surg 2022; 9:697488. [PMID: 36034352 PMCID: PMC9399470 DOI: 10.3389/fsurg.2022.697488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Femoroacetabular impingement syndrome (FAIS) is an increasingly prevalent pathology in young and active patients, that has contributing factors from both abnormal hip morphology as well as abnormal hip motion. Disease progression can be detrimental to patient quality of life in the short term, from limitations on sport and activity, as well as the long term through early onset of hip arthritis. However, several concurrent or contributing pathologies may exist that exacerbate hip pain and are not addressed by arthroscopic intervention of cam and pincer morphologies. Lumbopelvic stiffness, for instance, places increased stress on the hip to achieve necessary flexion. Pathology at the pubic symphysis and sacroiliac joint may exist concurrently to FAIS through aberrant muscle forces. Additionally, both femoral and acetabular retro- or anteversion may contribute to impingement not associated with traditional cam/pincer lesions. Finally, microinstability of the hip from either osseous or capsuloligamentous pathology is increasingly being recognized as a source of hip pain. The present review investigates the pathophysiology and evaluation of alternate causes of hip pain in FAIS that must be evaluated to optimize patient outcomes.
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Shimodaira H, Hatakeyama A, Suzuki H, Takada S, Murata Y, Sakai A, Uchida S. The prevalence and risk factors of pubic bone marrow edema in femoroacetabular impingement and hip dysplasia. J Hip Preserv Surg 2021; 8:318-324. [PMID: 35505801 PMCID: PMC9052425 DOI: 10.1093/jhps/hnab081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/28/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
Femoroacetabular impingement syndrome (FAIS) has been associated with osteitis pubis; however, it is still unclear whether hip dysplasia is associated with osteitis pubis. This study aimed to investigate (i) the incidence of pubic bone marrow edema (BME) on magnetic resonance imaging in symptomatic patients with FAIS, borderline developmental dysplasia of the hip (BDDH) and developmental dysplasia of the hip (DDH) undergoing hip arthroscopic surgery with labral preservation and (ii) the demographic and radiographic factors associated with pubic BME. A total of 259 symptomatic patients undergoing hip arthroscopic surgery between July 2016 and April 2019 were retrospectively reviewed and divided into three groups: FAIS (180 patients), BDDH (29 patients) and DDH (50 patients). Diffuse changes in the pubic bone adjacent to the pubic symphysis were labeled pubic BME, and the prevalence of their occurrence was examined. Multivariate logistic regression analysis was performed to identify factors involved in pubic BME, and odds ratios (ORs) for relevant factors were calculated. There was no significant difference in the prevalence of pubic BME among the three groups (20 [11.1%] of 180 FAIS patients, 6 [20.6%] of 29 BDDH patients and 7 [14%] of 50 DDH patients, P = 0.325). Multivariate logistic regression analysis showed that acetabular coverage was not associated with pubic BME, whereas younger age and greater alpha angle were still independent associated factors [age ≤26 years (OR, 65.7) and alpha angle ≥73.5° (OR, 4.79)]. Determining the possible association of osteitis pubis with cam impingement in dysplastic hips may provide insights toward a more accurate understanding of its pathophysiology.
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Affiliation(s)
- Hiroki Shimodaira
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu, Fukuoka 808-0024, Japan
| | - Akihisa Hatakeyama
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu, Fukuoka 808-0024, Japan
| | - Hitoshi Suzuki
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu, Fukuoka 808-0024, Japan
| | - Shinichiro Takada
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu, Fukuoka 808-0024, Japan
| | - Yoichi Murata
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu, Fukuoka 808-0024, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu, Fukuoka 808-0024, Japan
| | - Soshi Uchida
- Department of Orthopaedic Surgery and Sports Medicine, Wakamatsu Hospital of University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu-ku, Kitakyushu, Fukuoka 808-0024, Japan
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Outcomes and rate of return to play in elite athletes following arthroscopic surgery of the hip. INTERNATIONAL ORTHOPAEDICS 2021; 45:2507-2517. [PMID: 34148120 PMCID: PMC8514359 DOI: 10.1007/s00264-021-05077-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/10/2021] [Indexed: 11/18/2022]
Abstract
Background The tremendous physical demands of elite performance increase the risk of elite athletes sustaining various orthopaedic injuries. Hip pain is common in high-level athletes representing up to 6% of all athletic injuries. Expedient diagnosis and effective treatment are paramount for their future sporting careers and to prevent subsequent joint degeneration. Purpose This systematic review aimed to evaluate the outcome and the rate of return to play (RTP) following arthroscopic procedures in the hip (osteoplasty, chondroplasty, labral repair and/or debridement, capsulotomy, capsulorrhaphy or any soft tissue procedure) in elite athletes. Elite athletes were defined as those who represented their country in international contests or were competing professionally for the purpose of this study. Methods A computer-based systematic search, following the PRISMA Guidelines, was performed on CENTRAL, PUBMED, EMBASE, SCOPUS, EBSCO, Google Scholar and Web of Science from inception until January 1, 2020, identifying studies that looked at return to sports post-hip arthroscopy in elite athletes. Weighted means were calculated for the RTP rate and duration and for patient-reported outcome measures (PROMs). Results After eligibility screening, 22 articles were included with a total of 999 male and seven female patients, 1146 hips and a mean age of 28.4 ± 3.2 years. The mean follow-up period was 35.8 ± 13.4 months and 15.9 ± 9.6% of athletes had undergone bilateral procedures. Overall, 93.9% (95% CI: 90.5, 96.6, P < 0.0001) of patients demonstrated RTP after 6.8 ± 2.1 months post-surgery and all PROMs improved post-operatively. During follow-up, 9.6% (95% CI: 5.2, 15.2, P = 0.025) patients needed further intervention. Conclusion A high percentage of elite athletes return to the same level of competition after hip arthroscopy, with a low rate of further interventions. Hip arthroscopy appears to be an efficacious treatment for hip and/or groin pain, caused by pathologies such as FAI or labral tears, in elite athletes in the shorter term. Long term outcomes need further evaluation.
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8
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Kraeutler MJ, Kurowicki J, Dávila Castrodad IM, Milman E, Talishinskiy T, Scillia AJ. Use of Preoperative Magnetic Resonance Imaging to Predict Clinical Outcomes After Core Muscle Injury Repair. Orthop J Sports Med 2021; 9:2325967121995806. [PMID: 33889646 PMCID: PMC8033399 DOI: 10.1177/2325967121995806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 11/29/2020] [Indexed: 11/15/2022] Open
Abstract
Background Core muscle injury (CMI), often referred to as a sports hernia or athletic pubalgia, is a common cause of groin pain in athletes. Imaging modalities used to assist in the diagnosis of CMI include ultrasound (US) and magnetic resonance imaging (MRI). Purpose To determine if preoperative MRI findings predict clinical outcomes after surgery for CMI. Study Design Cohort study; Level of evidence, 3. Methods A retrospective cohort study was performed on a consecutive series of patients who were operatively treated for CMI by a single surgeon. CMI was diagnosed based on history, physical examination, and a positive US. In addition, all patients underwent a preoperative MRI. Patients were divided into 2 groups based on whether the MRI was interpreted as positive or negative for CMI. All patients underwent mini-open CMI repair. Patient-reported outcomes (PROs) were collected both pre- and postoperatively and included a visual analog scale (VAS) for pain, the University of California, Los Angeles (UCLA) activity score, and the modified Harris Hip Score. Results A total of 39 hips were included in this study, of which 17 had a positive MRI interpretation for CMI (44%) and 22 had a negative MRI interpretation (56%). Mean age at the time of surgery was 35 years (range, 17-56 years), and mean follow-up was 21 months (range, 12-35 months). No significant difference was found between groups in mean age or time to follow-up. Patients in both groups demonstrated significant improvement from preoperative to most recent follow-up in terms of the UCLA activity score (P < .05). VAS scores significantly improved for patients with a positive MRI interpretation (P = .001) but not for those with a negative MRI interpretation (P = .094). No significant difference on any PROs was found between groups at the most recent follow-up. Conclusion Successful clinical outcomes can be expected in patients undergoing surgery for CMI diagnosed based on history, physical examination, and US. Patients with a preoperative MRI consistent with CMI may experience greater improvement in pain postoperatively, although MRI does not predict postoperative activity level in these patients.
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Affiliation(s)
- Matthew J Kraeutler
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Jennifer Kurowicki
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, USA
| | | | - Edward Milman
- Department of Radiology, St. Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Toghrul Talishinskiy
- Department of Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, USA
| | - Anthony J Scillia
- Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, USA.,New Jersey Orthopaedic Institute, Wayne, New Jersey, USA
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Abstract
Core muscle injury is a common but difficult problem to treat. Although it can affect all individuals, it is most commonly seen in male athletes in cutting, twisting, pivoting, and explosive sports. Owing to the high association of femoroacetabular impingement, we believe these individuals are best treated with a multidisciplinary approach involving both orthopedic and general surgeons. Conservative treatment should be the first step in management. When conservative means are unsuccessful, operative intervention to correct all the pathologic issues around the pubis can have extremely high success rates.
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Affiliation(s)
- Timothy J Mulry
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medicine School, Worcester, MA, USA
| | - Paul E Rodenhouse
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medicine School, Worcester, MA, USA. https://twitter.com/PaulRodenhouse
| | - Brian D Busconi
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medicine School, Worcester, MA, USA.
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Short SM, MacDonald CW, Strack D. Hip and Groin Injury Prevention in Elite Athletes and Team Sport - Current Challenges and Opportunities. Int J Sports Phys Ther 2021; 16:270-281. [PMID: 33604155 PMCID: PMC7872466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/21/2020] [Indexed: 11/12/2023] Open
Abstract
Hip and groin injury (HAGI) has been reported as a source of significant time loss in elite sport. Field and court-based sports such as basketball, football, hockey, soccer, among others, require explosive multiplanar movement in single stance and high-speed change of direction. Often situations arise where sub-optimal pre-season training has occurred or congested in-season competition minimizes physiologic recovery periods between bouts of physical activity, both of which could magnify concomitant existing risk factors and increase injury risk. Identification and management of HAGI can be challenging as numerous structures within the region can be drivers of pain and injury, especially when considering the likelihood of concurrent pathology and injury reoccurrence. Focused prevention strategies have been suggested, but their practical clinical implementation has not been heavily investigated across the sporting spectrum. The purpose of this commentary is to review the historical and current state of HAGI, while focusing on applying evidence and clinical experience towards the development of future risk reduction strategies. Level of evidence: 5.
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Varada S, Moy MP, Wu F, Rasiej MJ, Jaramillo D, Wong TT. The prevalence of athletic pubalgia imaging findings on MRI in patients with femoroacetabular impingement. Skeletal Radiol 2020; 49:1249-1258. [PMID: 32144449 DOI: 10.1007/s00256-020-03405-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/22/2020] [Accepted: 02/25/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the prevalence of athletic pubalgia imaging findings on MRI in patients with femoroacetabular impingement and assess for correlative risk factors. MATERIALS AND METHODS A retrospective search identified 156 hips with femoroacetabular impingement and a control group of 113 without femoroacetabular impingement that had an MRI performed between January 1, 2015, and January 1, 2018. Two fellowship-trained musculoskeletal radiologists reviewed studies for the presence of acute osteitis pubis, chronic osteitis pubis, adductor tendinosis, and tendon tear; rectus abdominis tendinosis and tendon tear; and aponeurotic plate tear. Findings were correlated with various clinical and imaging risk factors. Univariate and multivariate statistical analyses were performed. RESULTS Imaging findings of adductor tendinosis (p = 0.02) and chronic osteitis pubis (p = 0.01) were more prevalent in FAI patients than controls. Univariate analyses in FAI patients showed that an alpha angle ≥ 60° had a higher prevalence of aponeurotic plate tears (p = 0.02) and adductor tendinosis (p = 0.049). Multivariate analyses showed that an alpha angle ≥ 60° had a higher prevalence of chronic osteitis pubis (OR = 2.27, p = 0.031), sports participation had a higher prevalence of adductor tendon tears (OR = 4.69, p = 0.013) and chronic osteitis pubis (OR = 2.61, p = 0.0058), and males had a higher prevalence of acute osteitis pubis (OR = 5.17, p = 0.032). CONCLUSION Sports participation, alpha angle ≥ 60°, and male sex predict a higher prevalence of athletic pubalgia imaging findings in patients with femoroacetabular impingement.
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Affiliation(s)
- Sowmya Varada
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital Columbia University Medical Center, 622 West 168th Street, MC-28, New York, NY, 10032, USA.
| | - Matthew P Moy
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital Columbia University Medical Center, 622 West 168th Street, MC-28, New York, NY, 10032, USA
| | - Fangbai Wu
- Department of Radiology, Division of Musculoskeletal Imaging, University of North Carolina at Chapel Hill, 101 Manning Dr. Chapel Hill, Chapell Hill, NC, 27514, USA
| | - Michael J Rasiej
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital Columbia University Medical Center, 622 West 168th Street, MC-28, New York, NY, 10032, USA
| | - Diego Jaramillo
- Department of Radiology, Division of Pediatric Radiology, NewYork-Presbyterian Hospital Columbia University Medical Center, 630 West 168th Street, MC-28, New York, NY, 10032, USA
| | - Tony T Wong
- Department of Radiology, Division of Musculoskeletal Radiology, NewYork-Presbyterian Hospital Columbia University Medical Center, 622 West 168th Street, MC-28, New York, NY, 10032, USA
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[Diagnostic algorithm "FAI and sports hernia" : Results of the consensus meeting for groin pain in athletes]. DER ORTHOPADE 2020; 49:211-217. [PMID: 31515590 DOI: 10.1007/s00132-019-03775-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
As a result of the complexity and diversity of diseases in the region of the groin, differentiation of the various soft-tissue and bone pathologies remains a challenge for differential diagnosis in routine clinical practice. In the case of athletes with pain localized in the area of the groin, femoroacetabular impingement (FAI) and athlete's groin must be considered as important causes of the groin pain, whereby the common occurrence of double pathologies further complicates diagnosis. Despite the importance of groin pain and its differential diagnoses in everyday clinical practice, there has been a lack of recognized recommendations for diagnostic procedure to date. To this end, a consensus meeting was held in February 2017, in which a group composed equally of groin and hip surgeons took part. With the formulation of recommendations and the establishment of a practicable diagnostic path, colleagues that are involved in treating such patients should be sensitized to this issue and the quality of the diagnosis of groin pain improved in routine clinical practice.
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Gerhardt M, Christiansen J, Sherman B, Miranda A, Hutchinson W, Chahla J. Outcomes following surgical management of inguinal-related groin pain in athletes: a case series. J Hip Preserv Surg 2020; 7:103-108. [PMID: 32382436 PMCID: PMC7195923 DOI: 10.1093/jhps/hnz068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 12/19/2019] [Accepted: 12/24/2019] [Indexed: 12/18/2022] Open
Abstract
To determine the outcomes of a limited surgical intervention, consisting of neurolysis, inguinal wall repair and/or adductor debridement of adhesions based on intraoperative findings. Retrospective case series. Outpatient orthopedic/general surgery clinic. Fifty-one athletes treated surgically for inguinal-related groin pain from 2009 to 2015. Limited surgical intervention, consisting of neurolysis, inguinal wall repair and/or adductor debridement based on intra-operative findings. Ability to return to sport at the same level, time to return to play. Fifty-one athletes were included in the study with an average follow-up of 4.42 years (range 2.02–7.01). The average age was 24.2 years (range 16–49) and consisted of 94.0% males and 6.0% females. Nerve entrapment was demonstrated in 96.2% of cases with involvement of the ilioinguinal in 92.5%, the iliohypogastric in 30.8% and the genitofemoral in 13.2%. Attenuation of the posterior inguinal wall was present and repaired in 79.3% of cases. Scar tissue was present around the adductor origin and required debridement in 56.7% of cases. Forty-nine (96.1%) athletes returned to sport at the same level of play at an average of 5.9 weeks. Two athletes required a revision surgery. High rates of return to sport were achieved after surgery for inguinal-related groin pain that addresses the varying pathology and associated nerve entrapment.
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Affiliation(s)
- Michael Gerhardt
- Cedars-Sinai Kerlan-Jobe Institute, 2020 Santa Monica Blvd. Suite 400, Santa Monica, CA 90404, USA
| | - Josh Christiansen
- Cedars-Sinai Kerlan-Jobe Institute, 2020 Santa Monica Blvd. Suite 400, Santa Monica, CA 90404, USA
| | - Benjamin Sherman
- Riverside University Health System, Department of Orthopedic Surgery, 26520 Cactus Ave. Suite B2042, Moreno Valley, CA 92555, USA
| | - Alejandro Miranda
- Cedars-Sinai Kerlan-Jobe Institute, 2020 Santa Monica Blvd. Suite 400, Santa Monica, CA 90404, USA
| | - William Hutchinson
- Pacific Coast Hernia Center, 2001 Santa Monica Blvd. Suite 890, Santa Monica, CA 90404, USA
| | - Jorge Chahla
- Rush University Medical Center, Midwest Orthopaedics, 1611 W. Harrison Ave. Suite 300, Chicago, IL 60612, USA
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14
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High insertion of conjoint tendon is associated with inguinal-related groin pain: a MRI study. Eur Radiol 2019; 30:1517-1524. [DOI: 10.1007/s00330-019-06466-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/20/2019] [Accepted: 09/19/2019] [Indexed: 10/25/2022]
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Krishnamoorthy VP, Kunze KN, Beck EC, Cancienne JM, O'Keefe LS, Ayeni OR, Nho SJ. Radiographic Prevalence of Symphysis Pubis Abnormalities and Clinical Outcomes in Patients With Femoroacetabular Impingement Syndrome. Am J Sports Med 2019; 47:1467-1472. [PMID: 30995415 DOI: 10.1177/0363546519837203] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The decreased hip range of motion seen in femoroacetabular impingement syndrome (FAIS) may lead to compensatory increased motion at the symphysis pubis (SP) with resultant increased stress on the joint, which can subsequently lead to osteitis pubis. PURPOSE To quantify the prevalence of SP abnormalities in patients with FAIS through the use of imaging modalities and to compare outcomes based on the presence of SP abnormalities. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Radiographs and magnetic resonance imaging (MRI) scans of 1009 consecutive patients who underwent primary hip arthroscopy for FAIS from January 2012 to January 2016 were identified. Exclusion criteria were patients undergoing revision or bilateral surgery, patients with dysplasia, and patients with less than 2-year follow-up. On radiographs, SP joints were reviewed for joint surface erosions, subchondral sclerosis and cysts, and ankylosis. MRI scans were reviewed for marrow edema in the subarticular pubic bone, subchondral sclerosis and cysts, joint surface erosions, and ankylosis. Patients with SP abnormalities were matched 1:2 to patients without SP abnormalities by age and body mass index. Outcomes included the Hip Outcome Score-Activities of Daily Living (HOS-ADL), HOS-Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), International Hip Outcome Tool-12 (iHOT-12), and visual analog scales (VAS) for pain and satisfaction. RESULTS 830 patients were included; 23 (2.8%) demonstrated SP abnormalities. Of the 726 (72%) MRI scans reviewed, 15 (1.8%) showed bone marrow edema, subchondral sclerosis, erosions, or ankylosis. After matching, patients without SP abnormalities had significantly greater HOS-ADL (95.7 vs 83.0; P = .008), HOS-SS (91.6 vs 61.9; P = .003), iHOT-12 (89.5 vs 74.6; P = .046), and VAS satisfaction (91.3 vs 58.8; P = .004) scores, in addition to less postoperative pain (6.3 vs 23.5; P < .001). No significant differences were found in the mHHS (92.5 vs 82.2; P = .08). Patients without SP abnormalities had higher odds of achieving the minimal clinically important difference for the HOS-ADL (odds ratio [OR], 4.5; 95% CI, 1.3-14.1; P = .010), the HOS-SS (OR, 7.2; 95% CI, 1.8-18.5; P = .006), and the mHHS (OR, 14.5; 95% CI, 1.8-24.7; P = .013). CONCLUSION A low prevalence (1.8%-2.6%) of SP joint abnormality is seen on imaging in patients with FAIS. These patients may demonstrate significantly inferior clinical outcomes and persistent postoperative pain after FAIS treatment.
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Affiliation(s)
- Vignesh P Krishnamoorthy
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Kyle N Kunze
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Edward C Beck
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Jourdan M Cancienne
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Lauren S O'Keefe
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
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Tummala SV, Chhabra A, Makovicka JL, Patel KA, Hartigan DE. Hip and Groin Injuries Among Collegiate Male Soccer Players: The 10-Year Epidemiology, Incidence, and Prevention. Orthopedics 2018; 41:e831-e836. [PMID: 30321437 DOI: 10.3928/01477447-20181010-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/14/2018] [Indexed: 02/03/2023]
Abstract
The physical and demanding style of play in soccer places these athletes at an elevated risk for hip and groin injuries. Several studies have examined hip and groin injuries in professional and youth soccer in European countries, but few have involved American counterparts. Hip injury data were analyzed retrospectively from the National Collegiate Athletic Association Injury Surveillance Program for the 2004 to 2014 academic years for collegiate men's soccer. This study found that hip and groin injuries among collegiate male soccer players were most often new injuries (87.8%; n=527) that were noncontact in nature (77.3%; n=464) and resulted in time loss of less than 7 days (67.5%; n=405). Hip injuries were significantly more likely during the pre-season (5.72 per 1000 athlete exposures) relative to in-season (injury proportion ratio, 1.64; 95% confidence interval, 1.39-1.94) and post-season (injury proportion ratio, 1.69; 95% confidence interval, 1.18-2.41). Further, they were more likely in competition relative to practice (injury proportion ratio, 2.33; 95% confidence interval, 1.98-2.74). The most common injuries were adductor strains (46.5%; n=279) followed by hip flexor strains (27.3%; n=164) and hip contusions (10.8%; n=65). Among these injuries, adductor (73.1%; n=204) and hip flexor (59.8%; n=98) strains were more commonly noncontact related and occurred in practice, whereas hip contusions were due to contact and during competition. The study of the complex and lingering nature of hip and groin injuries in soccer players is critical because these injuries not only are prevalent but also have multifactorial risks associated with coexisting pathologies that make them difficult to prevent and treat effectively. [Orthopedics. 2018; 41(6):e831-e836.].
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Rager O, Picarra M, Astrinakis E, Garibotto V, Amzalag G. Incidental 18F-FDG Uptake of the Pubic Ramus and Abdominal Muscles due to Athletic Pubalgia During Acute Prostatitis. Mol Imaging Radionucl Ther 2018; 27:133-135. [PMID: 30317850 PMCID: PMC6191733 DOI: 10.4274/mirt.19484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
A 23-year-old African native male patient presented with fever, lumbalgia and dysuria after returning from a trip to Togo. His physical examination revealed pain over the pubic symphysis and rectal tenderness on digital exam. The C-reactive protein (CRP) level was elevated along with positive blood and urinary cultures for methicillin-resistant Staphylococcus aureus. An magnetic resonance imaging that has been performed to rule out arthritis/osteomyelitis in the pubis revealed edema of the symphysis. An 18F-FDG positron emission tomography/computed tomography supported the diagnosis of prostate infection and showed a focal uptake of the pubic symphysis, with diffuse hyper-metabolism of the insertions of the rectus abdominis and longus adductor muscles, corresponding to athletic pubalgia. Fever and CRP responded rapidly to antibiotherapy.
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Affiliation(s)
- Olivier Rager
- University Hospital of Geneva, Clinic of Nuclear Medicine, Geneva, Switzerland
| | - Marlise Picarra
- University Hospital of Geneva, Clinic of Radiology, Geneva, Switzerland
| | | | - Valentina Garibotto
- University Hospital of Geneva, Clinic of Nuclear Medicine, Geneva, Switzerland
| | - Gaël Amzalag
- University Hospital of Geneva, Clinic of Nuclear Medicine, Geneva, Switzerland
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de Sa D, Lian J, Sheean AJ, Inman K, Drain N, Ayeni O, Mauro C. A Systematic Summary of Systematic Reviews on the Topic of Hip Arthroscopic Surgery. Orthop J Sports Med 2018; 6:2325967118796222. [PMID: 30320142 PMCID: PMC6154262 DOI: 10.1177/2325967118796222] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is a rapidly growing body of literature on the topic of hip arthroscopic surgery. PURPOSE To provide an overall summary of systematic reviews published on the indications, complications, techniques, outcomes, and information related to hip arthroscopic surgery. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of all hip arthroscopic surgery-related systematic reviews published between January 2000 and May 2018 was performed using PubMed, MEDLINE, and the Cochrane Library. Narrative reviews and non-English articles were excluded. RESULTS A total of 837 articles were found, of which 85 met the inclusion criteria. Included articles were summarized and divided into 6 major categories based on the subject of the review: femoroacetabular impingement (FAI), non-FAI indications, surgical technique, outcomes, complications, and miscellaneous. CONCLUSION A summary of systematic reviews on hip arthroscopic surgery can provide surgeons with a single source for the most current synopsis of the available literature. As the prevalence of orthopaedic surgeons performing hip arthroscopic surgery increases, updated evidence-based guidelines must likewise be advanced and understood to ensure optimal patient management.
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Affiliation(s)
- Darren de Sa
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jayson Lian
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Albert Einstein College of Medicine, New York, New York, USA
| | - Andrew J Sheean
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kathleen Inman
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nicholas Drain
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Olufemi Ayeni
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Craig Mauro
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Ramazzina I, Bernazzoli B, Braghieri V, Costantino C. Groin pain in athletes and non-interventional rehabilitative treatment: a systematic review. J Sports Med Phys Fitness 2018; 59:1001-1010. [PMID: 30160087 DOI: 10.23736/s0022-4707.18.08879-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Groin pain is a common complaint both in high-performance and recreational athletes. Diagnosis is based on the patient's history and physical examination. Imaging assessments are often considered to exclude other pathologies. To date there is no strong evidence to support conservative or surgical treatment options. The purpose of this study is to shed light on the more effective non-interventional rehabilitative treatments for the management of groin pain in athletes and, if possible, provide guidelines useful for clinical practice. EVIDENCE ACQUISITION The following electronic databases were searched: PubMed, Physiotherapy Evidence Database (PEDro), Scopus, Web of Science, Google and Google Scholar. Databases were investigated from January 1997 until March 2017. EVIDENCE SYNTHESIS The results reported in the randomized clinical trial studies highlight that active treatment is better than passive treatment to improve clinical signs of groin pain. Comparing the active strategy with multi-modal treatment the latter allows a faster return to sport activity. Although the evidence remains poor, all the included literature highlights that an integrated strategy which combines active and passive treatment, the assessment of perceived pain, a return to running program and specific-sport exercises is an effective strategy for management of groin pain in athletes. CONCLUSIONS Although we shed some light on common key aspects able to improve the typical signs of groin pain, on the basis of available data we were unable to provide practice guidelines. Further studies are necessary to set the best treatment algorithm for the management of groin pain in athletes.
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Affiliation(s)
- Ileana Ramazzina
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Benedetta Bernazzoli
- Graduate School of Physical Medicine and Rehabilitation, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Cosimo Costantino
- Department of Medicine and Surgery, University of Parma, Parma, Italy - .,Graduate School of Physical Medicine and Rehabilitation, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Bou Antoun M, Reboul G, Ronot M, Crombe A, Poussange N, Pesquer L. Imaging of inguinal-related groin pain in athletes. Br J Radiol 2018; 91:20170856. [PMID: 29947268 DOI: 10.1259/bjr.20170856] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Inguinal canal-related groin pain is common in athletes and may involve numerous structures such as the conjoint tendon and the transversalis fascia. Ultrasound is the only dynamic tool that shows the passage of preperitoneal fat at the level of the Hesselbach triangle and allows excluding true inguinal hernias. Fascia transversalis bulging and inguinal ring dilatation may also be described. MRI assesses injuries of rectus abdominis and adductor longus enthesis and osteitis symphysis but its accuracy for the diagnosis of inguinal-related groin pain remains debated.
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Affiliation(s)
- Myriame Bou Antoun
- 1 Department of radiology, HEGP hospital, Assistance publique-hôpitaux de paris (AP-HP), University Paris Descartes , Paris , France
| | - Gilles Reboul
- 2 Hernia center, Clinique du sport, Bordeaux-Mérignac , Mérignac , France
| | - Maxime Ronot
- 3 Department of radiology, Beaujon hospital, Assistance publique- hôpitaux de Paris (AP-HP), University of Paris VII , Paris , France
| | - Amandine Crombe
- 4 MSK Imaging Department, Clinique du sport, Bordeaux-Mérignac , Merignac , France
| | - Nicolas Poussange
- 4 MSK Imaging Department, Clinique du sport, Bordeaux-Mérignac , Merignac , France
| | - Lionel Pesquer
- 4 MSK Imaging Department, Clinique du sport, Bordeaux-Mérignac , Merignac , France
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Short S, Short G, Strack D, Anloague P, Brewster B. A COMBINED TREATMENT APPROACH EMPHASIZING IMPAIRMENT-BASED MANUAL THERAPY AND EXERCISE FOR HIP-RELATED COMPENSATORY INJURY IN ELITE ATHLETES: A CASE SERIES. Int J Sports Phys Ther 2017; 12:994-1010. [PMID: 29158960 PMCID: PMC5675375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND/PURPOSE Athletes experiencing hip, groin, and low back pain often exhibit similar clinical characteristics. Individuals with hip, groin and low back pain may have the presence of multiple concurrent pathoanatomical diagnoses. Regardless, similar regional characteristics and dysfunction may contribute to the patient's chief complaint, potentially creating a sub-group of individuals that may be defined by lumbopelvic and hip mobility limitations, motor control impairments, and other shared clinical findings. The purpose of this case series is to describe the conservative management of elite athletes, within the identified aforementioned sub-group, that emphasized regional manual therapy interventions, and therapeutic exercise designed to improve lumbopelvic and hip mobility, stability and motor control. CASE DESCRIPTIONS Five elite athletes were clinically diagnosed by a physical therapist with primary pathologies including adductor-related groin pain (ARGP), femoral acetabular impingement (FAI) with acetabular labral lesion and acute, mechanical low back pain (LBP). Similar subjective, objective findings and overall clinical profiles were identified among all subjects. Common findings aside from the chief complaint included, but were not limited to, decreased hip range of motion (ROM), impaired lumbopelvic motor control and strength, lumbar hypomobility in at least one segment, and a positive hip flexion-adduction-internal rotation (FADIR) special test. A three-phase impairment-based physical therapy program was implemented to resolve the primary complaints and return the subjects to their desired level of function. Acute phase rehabilitation consisted of manual therapy and fundamental motor control exercises. Progression to the sub-acute and terminal phases was based on improved subjective pain reports and progress with functional impairments. As the subjects progress through the rehabilitation phases, the delivery of physical therapy interventions were defined by decreased manual therapies and an increased emphasis and priority on graded exercise. OUTCOMES Significant reductions in reported pain (>2 points Numeric Pain Rating Scale), improved reported function via functional outcome measures (Hip and Groin Outcome Score), and continued participation in sport occurred in all five cases without the need for surgical intervention. DISCUSSION The athletes described in this case series make up a common clinical sub-group defined by hip and lumbopelvic mobility restrictions, lumbopelvic and lower extremity motor control impairments and potentially other shared clinical findings. Despite differences in pathoanatomic findings, similar objective findings were identified and similar treatment plans were applied, potentially affecting the movement system as a whole. Subjects were conservatively managed allowing continued participation in sport within their competitive seasons. CONCLUSION Comprehensive conservative treatment of the athletes with shared impairments, as described in this case series, may be of clinical importance when managing athletes with hip, groin, and low back pain. LEVEL OF EVIDENCE Therapy, Level 4, Case Series.
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Affiliation(s)
- Steve Short
- Regis University Orthopaedic Manual Physical Therapy Fellowship, Denver, CO, USA
| | | | - Donald Strack
- Regis University Orthopaedic Manual Physical Therapy Fellowship, Denver, CO, USA
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22
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Bisciotti GN, Di Marzo F, Auci A, Parra F, Cassaghi G, Corsini A, Petrera M, Volpi P, Vuckovic Z, Panascì M, Zini R. Cam morphology and inguinal pathologies: is there a possible connection? J Orthop Traumatol 2017; 18:439-450. [PMID: 28921307 PMCID: PMC5685988 DOI: 10.1007/s10195-017-0470-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/22/2017] [Indexed: 02/03/2023] Open
Abstract
Background To analyse the prevalences of the cam and pincer morphologies in a cohort of patients with groin pain syndrome caused by inguinal pathologies. Materials and methods Forty-four patients (40 men and 4 women) who suffered from groin pain syndrome were enrolled in the study. All the patients were radiographically and clinically evaluated following a standardised protocol established by the First Groin Pain Syndrome Italian Consensus Conference on Terminology, Clinical Evaluation and Imaging Assessment in Groin Pain in Athlete. Subsequently, all of the subjects underwent a laparoscopic repair of the posterior inguinal wall. Results The study demonstrated an association between the cam morphology and inguinal pathologies in 88.6% of the cases (39 subjects). This relationship may be explained by noting that the cam morphology leads to biomechanical stress at the posterior inguinal wall level. Conclusions Athletic subjects who present the cam morphology may be considered a population at risk of developing inguinal pathologies. Level of evidence Level IV, Observational cross-sectional study.
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Affiliation(s)
- G N Bisciotti
- Qatar Orthopaedic and Sport Medicine Hospital, FIFA Center of Excellence, Doha, Qatar
| | - F Di Marzo
- Ospedale Unico della Versilia, Asl Nordovest, Lido di Camaiore, Lucca, Italy
| | - A Auci
- UOS angiografia e radiologia interventistica, Ospedale delle Apuane, Massa-Carrara, Italy
| | - F Parra
- Centro Studi Kinemove Rehabilitation Centers, Pontremoli and La Spezia, Italy
| | - G Cassaghi
- Centro Studi Kinemove Rehabilitation Centers, Pontremoli and La Spezia, Italy
| | - A Corsini
- FC Internazionale Medical Staff, Milan, Italy.
| | - M Petrera
- University of Ottawa, Ottawa, Canada
| | - P Volpi
- FC Internazionale Medical Staff, Milan, Italy.,Department of Knee Orthopaedic and Sport and Traumatology Unit, Humanitas Research Hospital, Rozzano, Italy
| | - Z Vuckovic
- Qatar Orthopaedic and Sport Medicine Hospital, FIFA Center of Excellence, Doha, Qatar
| | - M Panascì
- Ospedale San Carlo di Nancy-GVM Care and Research, Rome, Italy
| | - R Zini
- Maria Cecilia Hospital-GVM Care and Research, Cotignola, Italy
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23
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Rivière C, Hardijzer A, Lazennec JY, Beaulé P, Muirhead-Allwood S, Cobb J. Spine-hip relations add understandings to the pathophysiology of femoro-acetabular impingement: A systematic review. Orthop Traumatol Surg Res 2017; 103:549-557. [PMID: 28373141 DOI: 10.1016/j.otsr.2017.03.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 02/21/2017] [Accepted: 03/07/2017] [Indexed: 02/02/2023]
Abstract
UNLABELLED Relationship between hip pathoanatomy and symptomatic FAI has been reported to be weak. This is explained by the reciprocal interaction between proximal femur and acetabular anatomies, but potentially also by the individual spine-hip relations (SHR). The key-answer for a complete understanding of the pathophysiology of FAI might lie in the comprehension of the SHRs, which have not yet been fully addressed. Therefore we conducted a systematic review to answer the subsequent questions: Is there any evidence of a relationship between FAI and (1) sagittal pelvic kinematics, (2) pelvic incidence, and (3) types of SHRs? A systematic review of the existing literature utilizing PubMed and Google search engines was performed in December 2016. Only studies published in peer-reviewed journals over the last ten years in either English or French were reviewed. We identified 90 reports, of which 9 met our eligibility criteria. Review of literature shows Caucasian FAI patients have a pelvis with higher anterior tilt, lesser sagittal mobility, and lower pelvic incidence compared to healthy patients. We found no study having assessed the relationship between SHR and FAI. In order to help further investigations at answering questions 3 and 4, we have developed a classification for SHRs. The classification according spino-pelvic parameters allows identifying patient at risk regarding FAI occurrence. Higher anterior pelvic tilt in standing, sitting and squatting positions and lower pelvic incidence have been found to correlate with symptomatic FAI. Because defining the individual SHR might increase the understanding of the pathophysiology of hip impingement, we have developed a classification for SHRs. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.
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Affiliation(s)
- C Rivière
- The MSK Lab, Charing Cross Campus, laboratory Block, London W6 8RP Imperial College, London, United Kingdom.
| | - A Hardijzer
- The MSK Lab, Charing Cross Campus, laboratory Block, London W6 8RP Imperial College, London, United Kingdom
| | - J-Y Lazennec
- Service de chirurgie orthopédique, université Pierre-et-Marie-Curie, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - P Beaulé
- Division of orthopaedic surgery, university of Ottawa, the Ottawa hospital, general campus, 501, Smyth road, W1638, K1H 8L6 Ottawa, Ontario, Canada
| | - S Muirhead-Allwood
- London hip unit, 30, Devonshire street, W1G 6PU Marylebone, London, United Kingdom
| | - J Cobb
- The MSK Lab, Charing Cross Campus, laboratory Block, London W6 8RP Imperial College, London, United Kingdom
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25
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Abstract
The femoroacetabular impingement (FAI) is as condition recently characterized that results from the abnormal anatomic and functional relation between the proximal femur and the acetabular border, associated with repetitive movements, which lead labrum and acetabular cartilage injuries. Such alterations result from anatomical variations such as acetabular retroversion or decrease of the femoroacetabular offset. In addition, FAI may result from acquired conditions as malunited femoral neck fractures, or retroverted acetabulum after pelvic osteotomies. These anomalies lead to pathological femoroacetabular contact, which in turn create impact and shear forces during hip movements. As a result, there is early labrum injury and acetabulum cartilage degeneration. The diagnosis is based on the typical clinical findings and images. Treatment is based on the correction of the anatomic anomalies, labrum debridement or repair, and degenerate articular cartilage removal. However, the natural evolution of the condition, as well as the outcome from long-term treatment, demand a better understanding, mainly in the asymptomatic individuals.
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Choi HR, Elattar O, Dills VD, Busconi B. Return to Play After Sports Hernia Surgery. Clin Sports Med 2016; 35:621-36. [DOI: 10.1016/j.csm.2016.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
PURPOSE OF REVIEW The present review discusses the etiology, clinical presentation, and management of femoroacetabular impingement (FAI) in the pediatric population, including etiologic and diagnostic controversies, management options, and outcomes. RECENT FINDINGS New evidence demonstrates conflicting results regarding how and when primary FAI develops in relation to skeletal maturity. Recent studies also discuss the effects of sex, race, and sports on FAI development and radiographic considerations in the pediatric population. Recent literature demonstrates good to excellent outcomes in the operative management of FAI in children and adolescents. SUMMARY FAI is a source of pediatric hip pain and can occur primarily or secondarily. It is characterized by anterior hip pain, made worse with flexion activities, decreased hip internal rotation, and a positive impingement sign. Pathologic values for radiographic measures of FAI are not clearly defined in the pediatric population. As FAI is a risk factor for osteoarthritis, early intervention in specific patients may be indicated. Hip arthroscopy, surgical hip dislocation, or combined mini-open and arthroscopic approaches are utilized, with good to excellent short, and mid-term functional results. Further study is required in the pediatric population to identify potential preventive strategies, to delineate the pathologic radiographic values of FAI, to define specific indications for operative management, and to examine long-term outcomes to determine optimal management.
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