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Yared F, Massaad A, Bakouny Z, Otayek J, Bizdikian AJ, Ghanimeh J, Labaki C, Ghanem D, Ghanem I, Skalli W, Assi A. Differences in Kinematic Changes From Self-Selected to Fast Speed Gait in Asymptomatic Adults With Radiological Signs of Femoro-Acetabular Impingement. Cureus 2023; 15:e43733. [PMID: 37727201 PMCID: PMC10505836 DOI: 10.7759/cureus.43733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/21/2023] Open
Abstract
Femoro-acetabular impingement (FAI) may present as alterations in the skeletal morphology of the hip. Repercussions of FAI can be witnessed in self-selected speed walking as well as physical exercise such as running or fast speed walking. The aim of this study was to investigate changes in kinematics at different gait speeds in subjects presenting with radiological findings invoking FAI. One hundred thirty asymptomatic adults underwent biplanar X-rays with a calculation of 3D hip parameters: acetabular anteversion, abduction and tilt, vertical center edge angle (VCE), femoral anteversion, neck-shaft angle, acetabular coverage of the femoral head, femoral head diameter and neck length. Parameters were classified according to FAI clinical thresholds. Two groups were created: Control group (63 subjects having up to one subnormal hip parameter in favour of FAI) and Radiographic FAI group (67 subjects having ≥2 subnormal hip parameters that might cause FAI). All subjects underwent 3D gait analysis at self-selected and fast speed, from which kinematic parameters were generated. Arithmetic differences between fast and self-selected speed gait were considered as gait changes. Subjects in the Radiographic FAI group had decreased acetabular tilt (24 vs. 19˚), anteversion (19 vs. 16˚), abduction (55 vs. 53˚), femoral anteversion (18 vs. 14˚) and increased VCE (29 vs. 33˚, all p<0.05), compared to controls. Changes from self-selected to fast speed showed that subjects in the Radiographic FAI group had lower range of motion (ROM) pelvic rotation (7 vs. 4˚) and ROM hip flexion/extension (10 vs. 7˚), reduced hip extension (-4 vs. -2˚) and step length (16 vs. 13 cm; all p<0.05). The Radiographic FAI group had decreased acetabular abduction, anteversion and femoral anteversion in favour of FAI. When adapting from self-selected to fast speed gait, the Radiographic FAI group seemed to limit pelvic rotation and hip flexion/extension resulting in a decrease in step length. These kinematic limitations were previously reported in subjects with symptomatic FAI. Gait analysis could be considered as a functional diagnostic tool to assess FAI along with radiological assessment.
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Affiliation(s)
- Fares Yared
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Abir Massaad
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Ziad Bakouny
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Joeffroy Otayek
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Aren-Joe Bizdikian
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Joe Ghanimeh
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Chris Labaki
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Diane Ghanem
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, FRA
| | - Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN
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Johnson AH, Brennan JC, Stock LA, Levermore SB, Maley A, Turcotte JJ, Petre BM. Change in Postoperative Weightbearing Protocol Does Not Increase Postoperative Complications Following Hip Arthroscopy for Femoroacetabular Impingement Syndrome. Cureus 2023; 15:e40859. [PMID: 37489196 PMCID: PMC10363374 DOI: 10.7759/cureus.40859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 07/26/2023] Open
Abstract
Background Postoperative rehabilitation protocols, including weightbearing restrictions following hip arthroscopy (HA) for femoracetabular impingement syndrome (FAIS), vary widely among surgeons, from complete non-weightbearing to immediate weightbearing as tolerated; it is unclear if weightbearing restrictions affect short-term outcomes in patients undergoing HA. The purpose of this study is to evaluate patients undergoing hip arthroscopy for FAIS before and after a change in weightbearing protocol, from partial weightbearing with crutches for three weeks to weightbearing and weaning from crutches as tolerated, by examining postoperative outcomes. We hypothesize that the change in weightbearing protocol will have no significant effect on patient outcomes. Methods A retrospective review was conducted of 211 patients undergoing hip arthroscopy by a single high-volume surgeon. The change in weightbearing was implemented in February 2022; previously, all patients were toe-touch weightbearing with crutches for the first three weeks postoperatively. Following this change, patients were allowed to weightbear as tolerated with crutches immediately and wean from crutches as tolerated. The patients were divided into two groups: 119 patients pre-implementation (January 2021 to January 2022) and 92 patients post-implementation (February 2022 to December 2022). The primary endpoint was any complication in the first six weeks postoperatively, divided into complications at two and six weeks, emergency department returns in the first 90 days, reoperations in the first 30 days, and pain at six weeks. We also compared patient-reported outcomes at six weeks. Results There were no significant differences in demographics between groups. There were no significant differences in postoperative outcomes between patients that had weightbearing restrictions and those that did not when looking at 30 day return to operating room (0 vs 0%, p=1.000), 90-day return to emergency department (8.4 vs. 13.0%, p=0.386), two-week complications (2.5 vs. 6.5%, p=0.279), six-week complications (1.7 vs. 1.1%, p=1.000), pain score at six weeks postoperatively (0.34 vs. 0.33, p=0.971), any pain at six weeks postoperatively 37.8 vs. 32.6%, p=0.523), and six-week Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF) score (36.0 vs. 34.5, p=0.330). Conclusion Patients undergoing HA after the discontinuation of a mandatory period of protected weightbearing did not experience any significant increase in complications or continued pain, and patient-reported outcomes were similar. Routine postoperative weightbearing restrictions may not be necessary for patients undergoing hip arthroscopy for femoroacetabular impingement syndrome. Further study is required to validate these findings and determine the optimal postoperative protocol for this patient population.
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Affiliation(s)
| | - Jane C Brennan
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA
| | - Laura A Stock
- Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA
| | | | - Alyssa Maley
- Orthopedic Surgery, Anne Arundel Medical Center, Annapolis, USA
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Johnson AH, Richardson E, Fowler B, West M, Turcotte JJ, Petre BM. Elimination of a Postoperative Brace Does Not Increase Complications Following Hip Arthroscopy. Cureus 2023; 15:e40321. [PMID: 37448381 PMCID: PMC10337986 DOI: 10.7759/cureus.40321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Background The practice of routine postoperative bracing to limit abduction and internal rotation, along with weight-bearing restrictions after hip arthroscopy (HA), varies significantly among surgeons. It is unclear whether the use of a postoperative brace improves short-term outcomes in patients undergoing HA. The purpose of this study was to determine the differences in patient outcomes before and after eliminating routine usage of a postoperative brace. Methods A retrospective review was conducted of 176 adult patients undergoing HA by a single, high-volume surgeon. The no-brace protocol was implemented in October 2020. The patients were divided into two groups: pre-implementation (January-October 2020) and post-implementation (October 2020-April 2021). Twenty-three patients that used a brace during the post-implementation period were excluded. All patients had weight-bearing restrictions with crutches for three weeks postoperatively. The primary endpoint was any complication in the first six weeks postoperatively. Results There were no significant differences in demographics between groups, although the body mass index in the brace group was higher (28.1 vs. 26.4 kg/m2, p = 0.066) and the rate of additional procedures performed was higher in the brace group (55.2% vs. 40.1%, p = 0.056). There was no significant difference in postoperative outcomes between groups when looking at 90-day emergency department visits (1.7% vs. 0%, p = 0.548), complications at two (1.7% vs. 1.7%, p = 1.000) and six weeks (0% vs. 1.7%, p = 0.341) postoperatively, all complications in the first six weeks (1.7% vs. 1.7%, p = 1.000), and continued pain at six weeks (10.3% vs. 16.7%, p = 0.238). Conclusion The brace and no-brace groups were similar demographically. Patients undergoing HA with no brace and crutches experienced no significant differences in pain or complications in comparison to those receiving a traditional bracing protocol. Routine use of a postoperative brace may not be necessary in this population.
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Affiliation(s)
| | | | - Brook Fowler
- Clinical Research, Anne Arundel Medical Center, Annapolis, USA
| | - Michaline West
- Clinical Research, Anne Arundel Medical Center, Annapolis, USA
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Anzillotti G, Iacomella A, Grancagnolo M, Bertolino EM, Marcacci M, Sconza C, Kon E, Di Matteo B. Conservative vs. Surgical Management for Femoro-Acetabular Impingement: A Systematic Review of Clinical Evidence. J Clin Med 2022; 11:5852. [PMID: 36233719 DOI: 10.3390/jcm11195852] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/19/2022] Open
Abstract
Femoro-acetabular impingement (FAI) syndrome is one of the most studied conditions in sports medicine. Surgical or conservative approaches can be proposed for treating FAI, although the best standard of care is not established yet. Our aim is to provide a comprehensive review of the best treatment for FAI syndrome evaluating differences in outcomes between surgical and non-operative management. A literature search was carried out on the PubMed, EMBASE, Scopus, and PEDro databases, using the following keywords: "femoroacetabular impingement", "FAI", in association with "surgery", "arthroscopy", "surgical" and "conservative", "physiotherapy", "physical therapy", "rehabilitation", "exercise". Only Level I RCTs were included. Four articles were selected for this systematic review. Our analysis showed different therapeutic protocols, follow-up periods, and outcomes; however, three out of the four studies included favored surgery. Our study demonstrates beneficial effects for both arthroscopic treatment and a proper regimen of physical therapy, nevertheless a surgical approach seemed to offer superior short-term results when compared to conservative care only. Further trials with larger sample sizes and longer follow-ups are needed to assess the definitive approach to the FAI condition.
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Wirries N, Heinrich G, Derksen A, Budde S, Floerkemeier T, Windhagen H. Is a Femoro-Acetabular Impingement Type Cam Predictable after Slipped Capital Femoral Epiphysis? Children (Basel) 2021; 8:children8110992. [PMID: 34828705 PMCID: PMC8623557 DOI: 10.3390/children8110992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
(1) Background: Previous studies have proven a high incidence of a femoro-acetabular impingement (FAI) type cam in patients sustaining a slipped capital femoral epiphysis (SCFE). Thus, the current study analyzed, if a cam deformity is predictable after SCFE treatment; (2) Methods: 113 cases of SCFE were treated between 1 January 2005 and 31 December 2017. The radiological assessment included the slip angle after surgery (referenced to the femoral neck (epiphyseal tilt) and shaft axis as Southwick angle) and the last available lateral center edge angle (LCEA), the acetabular- and alpha angle. A correlation was performed between these parameters and the last alpha angle to predict a FAI type cam; (3) Results: After a mean follow-up of 4.3 years (±1.9; 2.0-11.2), 48.5% of the patients showed a FAI type cam and 43.2% a dysplasia on the affected side. The correlation between the epiphyseal tilt and alpha angle was statically significant (p = 0.017) with a medium effect size of 0.28; (4) Conclusions: The postoperative posterior epiphyseal tilt was predictive factor to determine the alpha angle. However, the cut-off value of the slip angle was 16.8° for a later occurrence of a FAI type cam indicating a small range of acceptable deviations from the anatomical position for SCFE reconstruction.
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Affiliation(s)
- Nils Wirries
- Department of Orthopaedic Surgery at Diakovere Annastift, Hannover Medical School, 30625 Hannover, Germany; (N.W.); (G.H.); (A.D.); (S.B.)
| | - Gesche Heinrich
- Department of Orthopaedic Surgery at Diakovere Annastift, Hannover Medical School, 30625 Hannover, Germany; (N.W.); (G.H.); (A.D.); (S.B.)
| | - Alexander Derksen
- Department of Orthopaedic Surgery at Diakovere Annastift, Hannover Medical School, 30625 Hannover, Germany; (N.W.); (G.H.); (A.D.); (S.B.)
| | - Stefan Budde
- Department of Orthopaedic Surgery at Diakovere Annastift, Hannover Medical School, 30625 Hannover, Germany; (N.W.); (G.H.); (A.D.); (S.B.)
| | | | - Henning Windhagen
- Department of Orthopaedic Surgery at Diakovere Annastift, Hannover Medical School, 30625 Hannover, Germany; (N.W.); (G.H.); (A.D.); (S.B.)
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Abstract
Aims Our retrospective analysis reports the outcome of patients operated for slipped capital femoral epiphysis using the modified Dunn procedure. Results, complications, and the need for revision surgery are compared with the recent literature. Methods We retrospectively evaluated 17 patients (18 hips) who underwent the modified Dunn procedure for the treatment of slipped capital femoral epiphysis. Outcome measurement included standardized scores. Clinical assessment included ambulation, leg length discrepancy, and hip mobility. Radiographically, the quality of epiphyseal reduction was evaluated using the Southwick and Alpha-angles. Avascular necrosis, heterotopic ossifications, and osteoarthritis were documented at follow-up. Results At a mean follow-up of more than nine years, the mean modified Harris Hip score was 88.7 points, the Hip Disability and Osteoarthritis Outcome Score (HOOS) 87.4 , the Merle d’Aubigné Score 16.5 points, and the UCLA Activity Score 8.4. One patient developed a partial avascular necrosis of the femoral head, and one patient already had an avascular necrosis at the time of delayed diagnosis. Two hips developed osteoarthritic signs at 14 and 16 years after the index operation. Six patients needed a total of nine revision surgeries. One operation was needed for postoperative hip subluxation, one for secondary displacement and implant failure, two for late femoroacetabular impingement, one for femoroacetabular impingement of the opposite hip, and four for implant removal. Conclusion Our series shows good results and is comparable to previous published studies. The modified Dunn procedure allows the anatomic repositioning of the slipped epiphysis. Long-term results with subjective and objective hip function are superior, avascular necrosis and development of osteoarthritis inferior to other reported treatment modalities. Nevertheless, the procedure is technically demanding and revision surgery for secondary femoroacetabular impingement and implant removal are frequent. Cite this article: 2020;1-4:80–87.
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Affiliation(s)
- Caroline Passaplan
- Department of Orthopaedic Surgery, Balgrist University Hospital, Zürich, Switzerland.,Department of Orthopaedic Surgery, HFR - Cantonal Hospital, Fribourg, Switzerland
| | | | - Emanuel Gautier
- Department of Orthopaedic Surgery, HFR - Cantonal Hospital, Fribourg, Switzerland
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Abstract
Classical indications for hip preserving surgery are: femoro-acetabular impingement (FAI) (intra- and extra-articular), hip dysplasia, slipped capital femoral epiphysis, residual deformities after Perthes disease, avascular necrosis of the femoral head. Pre-operative evaluation of the pathomorphology is crucial for surgical planning including radiographs as the basic modality and magnetic resonance imaging (MRI) and/or computed tomography (CT) to evaluate further intra-articular lesions and osseous deformities. Two main mechanisms of intra-articular impingement have been described:
(1) Inclusion type FAI (‘cam type’). (2) Impaction type FAI (‘pincer type’).
Either arthroscopic or open treatment can be performed depending on the severity of deformity. Slipped capital femoral epiphysis often results in a cam-like deformity of the hip. In acute cases a subcapital re-alignment (modified Dunn procedure) of the femoral epiphysis is an effective therapy. Perthes disease can lead to complex femoro-acetabular deformity which predisposes to impingement with/without joint incongruency and requires a comprehensive diagnostic workup for surgical planning. Developmental dysplasia of the hip results in a static overload of the acetabular rim and early osteoarthritis. Surgical correction by means of periacetabular osteotomy offers good long-term results.
Cite this article: EFORT Open Rev 2020;5:630-640. DOI: 10.1302/2058-5241.5.190074
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Affiliation(s)
- Markus S Hanke
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology, University Hospital of Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Simon D Steppacher
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Till D Lerch
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Klaus A Siebenrock
- Department of Orthopaedic and Trauma Surgery, Inselspital, University of Bern, Bern, Switzerland
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Grammatopoulos G, Speirs AD, Ng KCG, Riviere C, Rakhra KS, Lamontagne M, Beaule PE. Acetabular and spino-pelvic morphologies are different in subjects with symptomatic cam femoro-acetabular impingement. J Orthop Res 2018; 36:1840-1848. [PMID: 29323746 DOI: 10.1002/jor.23856] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/08/2018] [Indexed: 02/04/2023]
Abstract
Acetabular and spino-pelvic (SP) morphological parameters are important determinants of hip joint dynamics. This prospective study aimed to determine whether acetabular and SP morphological differences exist between hips with and without cam morphology and between symptomatic and asymptomatic hips with cam morphology. A cohort of 67 patients/hips was studied. Hips were either asymptomatic with no cam (Controls, n = 18), symptomatic with cam (n = 26) or asymptomatic with cam (n = 23). CT-based quantitative assessments of femoral, acetabular, pelvic, and spino-pelvic parameters were performed. Measurements were compared between controls and those with a cam deformity, as well as between the three groups. Morphological parameters that were independent predictors of a symptomatic cam were determined using a regression analysis. Hips with cam deformity had slightly smaller subtended angles superior-anteriorly (87° vs. 84°, p = 0.04) and greater pelvic incidence (53° vs. 48°, p = 0.003) compared to controls. Symptomatic cams had greater acetabular version (p < 0.01), greater subtended angles superiorly and superior-posteriorly (p = 0.01), higher pelvic incidence (p = 0.02), greater alpha angles and lower femoral neck-shaft angles compared to asymptomatic cams (p < 0.01) and controls (p < 0.01). The four predictors of symptomatic cam included antero-superior alpha angle, femoral neck-shaft angle, acetabular depth, and pelvic incidence. In conclusion, this study illustrates that symptomatic hips had a greater amount of supero-posterior coverage; which would be the contact area between a radial cam and the acetabulum, when the hip is flexed to 90°. Furthermore, individuals with symptomatic cam morphology had greater PI. Acetabular- and SP parameters should be part of the radiological assessment of femoro-acetabular impingement. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1840-1848, 2018.
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Affiliation(s)
| | - Andrew D Speirs
- Carleton University, 1125 Colonel By Dr, Ottawa, Ontario, K1S 5B6
| | - K C Geoffrey Ng
- Department of Mechanical Engineering, Imperial College London, London, SW7 2AZ, United Kingdom
| | - Charles Riviere
- MSK Lab, Charing Cross Campus, Laboratory Block, Imperial College London, London, W6 8RP, United Kingdom
| | - Kawan S Rakhra
- The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6
| | - Mario Lamontagne
- Faculty of Health Sciences, Human Movement Biomechanics Laboratory, University of Ottawa, 200 Lees Avenue (E 020), Ottawa, Ontario, K1N 6N5
| | - Paul E Beaule
- The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6
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Abstract
Hip arthroscopy is an evolving surgical technique that has recently increased in popularity. Although femoroacetabular impingement was an important launch pad for this technique, extra-articular pathology has been described through hip endoscopy. Good clinical results in the medium term will allow improvements in this technique and increase its indications.
Cite this article: EFORT Open Rev 2017;2:58-65. DOI: 10.1302/2058-5241.2.150041
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Affiliation(s)
- Oliver Marin-Peña
- Orthopedic Surgery and Traumatology, University Hospital Infanta Leonor, Madrid, Spain
| | | | | | | | - Pablo Sierra
- Madrid. University Hospital Torrejon, Madrid, Spain
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10
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Abstract
BACKGROUND Abnormal morphology of the anterior inferior iliac spine (AIIS) and the subspine region of the acetabular rim are increasingly being recognised as a source of symptomatic extra-articular hip impingement. This review article aims to highlight important differences in the pathogenesis, clinical presentation and management of extra-articular hip impingement from both the AIIS and subspine bony regions, and the outcome following surgical intervention. METHODS A literature review was undertaken to examine the supporting evidence for AIIS and subspine hip impingement. A narrative account of the Author's professional experience in this area, including operative technique for arthroscopic correction, is also presented. RESULTS Abnormal morphology of the AIIS and subspine region has been classified using cadaveric, radiological and arthroscopic means; the clinical presentation and operative treatment has been documented in several case series studies. Dual pathology is often present - recognition and treatment of both intra- and extra-articular components are necessary for good postoperative outcome. CONCLUSIONS AIIS and sub-spine hip impingement should be considered as distinct pathological entities, which may also co-exist. Symptom relief can be expected following arthroscopic deformity correction with the treatment of concomitant intra-articular pathology. Failure to recognise and treat the extra-articular component may affect postoperative outcome. LEVEL OF EVIDENCE V.
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Affiliation(s)
| | - David Filan
- The Hip and Groin Clinic, Waterford, Ireland
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Abstract
BACKGROUND Great advances in knowledge and understanding of the biomechanics of the hip, both in arthroscopic procedures and imaging techniques, have expanded and improved the diagnosis of pathologies of the young adult hip. The anatomy of the hip joint is complex due to its morphology and orientation. The inter-pretation of the images requires deep knowledge of the osseous and soft tissue anatomy: muscles, tendons, ligaments, vessels and nerves. There are multiple imaging tools. Diagnostic techniques have different utilities and often are complementary. METHODS In this article the various diagnostic imaging techniques for evaluation of hip pathologies are discussed, their indications and usefulness, with emphasis on those resolved arthroscopically. CONCLUSION Young adult hip disorders are increasingly diagnosed and treated as arthroscopic procedures improved. Radiology is a fundamental contribution in the diagnostic process. Plain radiography (X-ray) is always the initial examination. LEVEL OF EVIDENCE V.
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Wolfinger CR, Davenport TE. PHYSICAL THERAPY MANAGEMENT OF ICE HOCKEY ATHLETES: FROM THE RINK TO THE CLINIC AND BACK. Int J Sports Phys Ther 2016; 11:482-495. [PMID: 27274432 PMCID: PMC4886814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND The increasing number of athletes playing hockey compels rehabilitation professionals working in orthopedic and sports settings to understand the unique functional demands of ice hockey and the patterns of injuries they may promote. PURPOSE The purpose of this clinical perspective is to: (1) discuss the functional implications of different positions and age levels on injury prevalence within the sport; (2) summarize the seven most common injuries sustained by ice hockey athletes; and (3) present a conceptual model for the clinical management and prevention of these injuries by rehabilitation professionals. METHODS A narrative review and synthesis was conducted of currently available literature on prevalence, etiology, rehabilitative intervention, prognosis, and prevention of ice hockey injuries. RESULTS Research evidence is available to support the prevalence of injuries sustained while participating in ice hockey, as well as the most effective clinical treatment protocols to treat them. Most of the existing protocols are based on clinical and sports experience with incorporation of scientific data. CONCLUSION This clinical commentary reviews the current concepts of ice hockey injury care and prevention, based on scientific information regarding the incidence, mechanism, rehabilitation protocols, prognosis, and prevention of injuries. Science-based, patient-centered reasoning is integral to provide the highest quality of rehabilitative and preventative care for ice hockey athletes by physical therapists. LEVEL OF EVIDENCE 5.
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Affiliation(s)
| | - Todd E. Davenport
- Department of Physical Therapy, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, California, USA
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