Clinical presentation of femoroacetabular impingement

The purpose of this study was to identify subjective complaints and objective findings in patients treated for femoroacetabular impingement (FAI). Three hundred and one arthroscopic hip surgeries were performed to treat FAI. The most frequent presenting complaint was pain, with 85% of patients reporting moderate or marked pain. The most common location of pain was the groin (81%). The average modified Harris Hip score was 58.5(range 14–100). The average sports hip outcome score was 44.0 (range 0–100). The anterior impingement test was positive in 99% of the patients. Range of motion was reduced in the injured hip. Patients who had degenerative changes in the hip had a greater reduction in range of motion. The most common symptom reported in patients with FAI was groin pain. Patient showed decreased ability to perform activities of daily living and sports. Significant decreases in hip motion were observed in operative hips compared to non-operative hips. Research performed at the Steadman Hawkins Research Foundation, Vail, CO.     

Physical examination tests for the diagnosis of femoroacetabular impingement. A systematic review

Numerous clinical tests have been proposed to diagnose FAI, but little is known about their diagnostic accuracy.ObjectivesTo summarize and evaluate research on the accuracy of physical examination tests for diagnosis of FAI.MethodsA search of the PubMed, SPORTDiscus and CINAHL databases was performed. Studies were considered eligible if they compared the results of physical examination tests to those of a reference standard. Methodological quality and internal validity assessment was performed by two independent reviewers using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool.ResultsThe systematic search strategy revealed 298 potential articles, five of which articles met the inclusion criteria. After assessment using the QUADAS score, four of the five articles were of high quality. Clinical tests included were Impingement sign, IROP test (Internal Rotation Over Pressure), FABER test (Flexion–Abduction–External Rotation), Stinchfield/RSRL (Resisted Straight Leg Raise) test, Scour test, Maximal squat test, and the Anterior Impingement test. IROP test, impingement sign, and FABER test showed the most sensitive values to identify FAI.ConclusionsThe diagnostic accuracy of physical examination tests to assess FAI is limited due to its heterogenecity. There is a strong need for sound research of high methodological quality in this area.     

Return-to-play rates following arthroscopic treatment of femoroacetabular impingement in competitive baseball players

Objective: Femoroacetabular impingement (FAI) has been increasingly recognized in cutting sports including soccer, hockey and football. More recently, the prevalence among overhead athletes has also been recognized. The purpose of this study was to review impingement patterns, return-to-play rates and clinical outcome following arthroscopic treatment of FAI among high-level baseball players.

Methods: Between 2010 and 2014, 70 competitive baseball players (86 hips; age 22.4 ± 4.5 years) were identified. Demographics and return-to-play rates were recorded. Patient-reported outcome scores, including the Modified Harris Hip Score (mHHS), the Hip Outcome Score-Activity of Daily Living (HOS-ADL), the Sport-specific Subscale (HOS-SSS), and the International Hip Outcome Tool (iHOT-33), were collected pre-operatively at 6 months and 1year (n = 34, 49% of cohort).

Results: The cohort included professional (27.1%), college (57.1%), high-school (8.6%) and club-team athletes (7.1%). Infielder (37.5%), pitcher (22.9%) and catcher (16.7%) were the most common positions. Average follow-up was 16.8 months (range 12.1–34.2). There was no relationship between playing position and impingement pattern (p ≥ 0.459), or between symptom laterality and handedness, batting position or playing position (p ≥ 0.179). One patient required revision surgery (infection). Return to sport rate was 88%, at a mean of 8.6 ± 4.2 months, with 97.7% returning at/above their pre-injury level of play. There was significant improvement in all outcome measures: mHHS (60.1 ± 11.9 to 93 ± 9.5), HOS-ADL (71.3 ± 16.7 to 96.3 ± 3.6), HOS-SSS (51.3 ± 24.8 to 92.3 ± 8.2) and iHOT-33 (40.7 ± 19.9 to 85.9 ± 14) (p < 0.001).

Conclusion: Arthroscopic treatment of FAI in competitive baseball players resulted in high return-to-play rates at short-term follow-up, with significant improvements in clinical outcome scores.     

Is hip muscle strength normalised in patients with femoroacetabular impingement syndrome one year after surgery?: Results from the HAFAI cohort

Objectives

Little is known about hip function after hip arthroscopic surgery in patients with femoroacetabular impingement syndrome. Hence, the aim of the study was (1) to investigate changes in hip muscle strength from before to one year after hip arthroscopic surgery, (2) to compare patients with a reference group.

High rate of return to tennis after hip arthroscopy for patients with femoroacetabular impingement syndrome

ObjectiveThe purpose of this study was to evaluate return to sport (RTS) outcomes in tennis athletes following hip arthroscopy for femoroacetabular impingement syndrome (FAIS). It was hypothesized that there would be a high rate of return to tennis after hip arthroscopy.Study designLevel IV, Retrospective Analysis.SettingOutpatient sports medicine clinic at a single institution.ParticipantsA total of 28 patients (60.8% female; mean age, 36.2 ± 9.2 years; mean BMI, 22.8 ± 2.1 kg/m²) with self reported tennis activity prior to hip arthroscopy.Main outcome measuresA postoperative return to sport and minimum two-year patient reported outcomes.ResultsThere was a high rate of return to tennis, with 78% of patients eventually returning to tennis. An additional 9% of patients had the necessary hip function to return, but did not return due to lack of interest or resources. The patients returned to tennis at an average of 8.0 ± 3.3 months after surgery. The majority of athletes (66.7%) were able to continue competing at the same or higher levels following surgery.ConclusionsPatients return to tennis 78% of the time at a mean of 8.0 ± 3.3 months following hip arthroscopy for FAIS.     

Rehabilitation after hip femoroacetabular impingement arthroscopy

Hip arthroscopic techniques to repair labral tears and address femoroacetabular impingement (FAI) are evolving. This article discusses the different phases of rehabilitation and the rehabilitation protocol. Although there is evidence to support arthroscopic procedures to address labral tears and FAI, there are few published evidence-based rehabilitation studies dedicated to postoperative rehabilitative care. It is thought that by following the restrictions set by the physician while performing early circumduction, using the minimal criteria to advance through each subsequent phase, and allowing patients to perform functional sport progressions throughout the rehabilitation athletes will be able to return to sport smoothly and effectively.     

股骨髋臼撞击症的影像学评估

股骨髋臼撞击症（FAI）是引起青年人髋关节运动障碍及髋部疼痛的主要原因之一,与股骨、髋臼解剖形态学异常密切相关,髋关节运动时异常撞击进而导致软骨损伤。X线摄影、CT定量测量及MRI等观察软骨的影像方法可进一步明确FAI的分型,有助于临床诊断治疗。就FAI的影像学典型表现及其定量测量方法予以综述。     

Pericapsular hip muscle activity in people with and without femoroacetabular impingement. A comparison in dynamic tasks

ObjectivesCompare anterior pericapsular muscle activity between individuals with and without femoroacetabular impingement syndrome (FAIS) during dynamic tasks, to investigate whether muscle activity is consistent with a role in retracting the capsule to prevent impingement and active restraint of the femoral head in walking.DesignCross-sectional.SettingUniversity-laboratory.ParticipantsThirteen athletes with FAIS and 13 pain-free controls.Main outcome measuresMuscle activity was recorded using fine-wire (Iliocapsularis, iliacus and anterior gluteus minimus) and surface (rectus femoris) electromyography (EMG), during three hip flexion tasks (active and assisted hip flexion; squatting) and four walking trials.ResultsIliocapsularis EMG amplitude was no different between active and assisted hip flexion tasks around 90° of hip flexion in FAIS. There was no difference in EMG between groups in squatting. The pattern of burst activity preceding peak hip extension in iliacus, iliocapsularis, and anterior gluteus minimus was similar in both groups during walking.ConclusionIn FAIS, similar activation of iliocapsularis during active and assisted hip flexion, despite reduced flexion torque demand in the latter, suggests a role in capsular retraction or enhanced hip joint protection. Pericapsular muscle activity in advance of peak hip extension during walking is consistent with a proposed contribution to femoral head control.     

The effectiveness of hip arthroscopic surgery for the treatment of femoroacetabular impingement syndrome: A systematic review and meta-analysis

ObjectiveTo determine the effectiveness of hip arthroscopic surgery for the treatment of femoroacetabular impingement syndrome (FAI).DesignSystematic review with meta-analysis.Data sourcesWe performed electronic database searches in MEDLINE, Embase, SPORTDiscus, CINAHL, Cochrane Central Register for Controlled Trials (CENTRAL), Web of Science, Scopus, the WHO International Clinical Trials Registry Platform and ClinicalTrials.gov from their inception to July 10th 2019.Eligibility criteria for selecting studiesWe included randomised controlled trials (RCTs) comparing hip arthroscopic surgery to a placebo/sham surgery and other non-operative comparators (e.g. no intervention, physiotherapy, etc.). Two authors independently selected studies, rated risk of bias, extracted data, and judged overall certainty of evidence using GRADE. Hip-specific quality of life (QoL) at 12 months was the primary outcome.ResultsWe identified three RCTs (n = 650 participants). There is high certainty evidence from three RCTs (n = 574 participants) that hip arthroscopic surgery provided superior outcomes compared to non-operative care for hip-specific QoL at 12 months (mean difference (MD): 11.02 points, 95% CI 4.83–17.21). Low quality evidence suggests that arthroscopic surgery provided similar outcomes to non-operative care for hip-specific QoL at 24 months (MD: 6.3, 95% CI ?6.1 to 18.7).ConclusionHip arthroscopic surgery for FAI provides superior outcomes compared to non-operative care at 12 months, but not at 24 months. Placebo trials are needed to establish the efficacy of hip arthroscopic surgery.     

Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression

Femoroacetabular impingement (FAI) occurs when an osseous abnormality of the proximal femur (cam) or acetabulum (pincer) triggers damage to the acetabular labrum and articular cartilage in the hip. Although the precise etiology of FAI is not well understood, both types of FAI are common in athletes presenting with hip pain, loss of range-of-motion, and disability in athletics. An open surgical approach to decompressing FAI has shown good clinical outcomes; however, this highly invasive approach inherently may delay or preclude a high level athlete’s return to play. The purpose of this study was to define associated pathologies and determine if an arthroscopic approach to treating FAI can allow professional athletes to return to high-level sport. Hip arthroscopy for the treatment of FAI allows professional athletes to return to professional sport. Between October 2000 and September 2005, 45 professional athletes underwent hip arthroscopy for the decompression of FAI. Operative and return-to-play data were obtained from patient records. Average time to follow-up was 1.6 years (range: 6 months to 5.5 years). Forty two (93%) athletes returned to professional competition following arthroscopic decompression of FAI. Three athletes did not return to play; however, all had diffuse osteoarthritis at the time of arthroscopy. Thirty-five athletes (78%) remain active in professional sport at an average follow-up of 1.6 years. Arthroscopic treatment of FAI allows professional athletes to return to professional sport.     

Femoroacetabular impingement

Femoroacetabular impingement (FAI) is a pathomechanical concept describing the early and painful contact of morphological changes of the hip joint, both on the acetabular, and femoral head sides. These can lead clinically to symptoms of hip and groin pain, and a limited range of motion with labral, chondral and bony lesions.     

Hip muscle strength asymmetries and their associations with hip morphology and symptoms are sex-specific in patients with femoroacetabular impingement syndrome

ObjectivesTo investigate sex-specific differences in hip muscle strength asymmetries, and associations between hip abductor and flexor strength asymmetries, hip morphology and symptoms in patients with femoroacetabular impingement syndrome (FAIS).DesignCross-sectional study.SettingClinical setting.ParticipantsThirty-four patients with FAIS (21 women, 13 men).Main outcome measuresSide-to-side strength asymmetries of hip adductor, abductor, internal and external rotator, flexor and extensor muscles were assessed using dynamometry, while hip pain during contractions was evaluated with a visual analogue scale. Hip morphology was assessed on anteroposterior pelvic radiographs and magnetic resonance arthrography images. Hip symptoms were evaluated using the Oxford Hip Score (OHS).ResultsWomen presented larger hip flexor strength asymmetries than men. In women, hip abductor asymmetries correlated with the OHS and with hip pain during muscle contraction. Hip flexor asymmetries correlated with the alpha angle in men.ConclusionPatients with FAIS demonstrated sex-specific hip muscle strength asymmetries and associations with the underlying hip symptoms and morphology. Women showed larger hip flexor strength asymmetries than men, and their hip abductor strength asymmetries were associated with hip symptoms. In contrast, hip flexor strength asymmetries in men were associated with the severity of the underlying cam morphology.     

髋关节撞击综合征影像表现的初步探讨

目的 探讨髋关节撞击综合征(FAI)的影像表现.方法 回顾性分析经手术证实的9例FAI患者的影像资料,9例患者均行髋关节正侧位X线检查及患髋MR检查,其中1例还接受了患髋关节MR关节造影检查,探讨其影像特征性改变.结果 9例患者X线表现均出现股骨头颈交界处骨性突起或髋臼过度覆盖.MR检查显示9例患者均出现不同程度的髋臼盂唇损伤,均出现在前上盂唇,ⅠA期损伤2例,ⅠB期损伤3例,ⅡA期损伤2例,ⅡB期损伤2例;1例患髋关节MR造影检查显示髋臼前上盂唇内线样裂隙,可见对比剂进入裂隙.2例的股骨头负重区软骨下骨内出现硬化囊变区,手术证实相应部位出现直径2 cm大小的软骨剥脱.结论 MRI可以显示FAI患者髋臼盂唇及关节软骨损伤,有助于早期诊断FAI.     

Effects of a hip brace on biomechanics and pain in people with femoroacetabular impingement

Objectives

This study evaluates whether hip bracing in patients with femoroacetabular impingement (FAI) (a) immediately reduces range of hip internal rotation, flexion, adduction, and pain during functional tasks; and (b) improves patient-reported outcomes when worn daily over 4 weeks.

MR Arthrography versus conventional MRI in evaluation of labral and chondral lesions in different types of femoroacetabular impingement

Objective

To detect the value of MR Arthrography over MRI in evaluation of labral and chondral lesions in all types of FAI, and to correlate the findings with arthroscopy as a gold standard.

股骨髋臼撞击综合征非手术治疗与关节镜手术治疗效果比较的Meta分析

 目的 采用Meta分析对股骨髋臼撞击综合征患者采取关节镜手术治疗和非手术治疗的临床效果进行比较,为临床治疗股骨髋臼撞击综合征提供循证证据。方法 检索 PubMed、Embase、 Cochrane 图书馆、中国知网、万方知网等数据库中比较非手术和关节镜手术治疗股骨髋臼撞击综合征的临床随机对照研究,经过严格的质量评价后使用 RevMan 5.3软件进行Meta 分析。临床指标为iHOT-33评分、HOS-ADL评分。结果 共纳入3篇文献,Meta 分析结果显示,HOS-ADL评分关节镜手术治疗组高于非手术治疗组,差异有统计学意义(MD＝7.80,95%CI:2.95～12.656,P＜0.05),两组iHOT-33评分差异无统计学意义(MD＝2.35,95%CI:-12.62～17.33,P＞0.05)。结论 Meta分析结果表明,髋关节镜手术治疗股骨髋臼撞击综合征能够取得较高的HOS-ADL评分,而iHOT-33评分两种治疗方法的差异无统计学意义。     

Trunk,pelvis and lower limb walking biomechanics are similarly altered in those with femoroacetabular impingement syndrome regardless of cam morphology size

BackgroundStudies of walking in those with femoroacetabular impingement syndrome have found altered pelvis and hip biomechanics. But a whole body, time-contiuous, assessment of biomechanical parameters has not been reported. Additionally, larger cam morphology has been associated with more pain, faster progression to end-stage osteoarthritis and increased cartilage damage but differences in walking biomechanics between large compared to small cam morphologies have not been assessed.Research questionAre trunk, pelvis and lower limb biomechanics different between healthy pain-free controls and individuals with FAI syndrome and are those biomechanics different between those with larger, compared to smaller, cam morphologies?MethodsTwenty four pain-free controls were compared against 41 participants with FAI syndrome who were stratified into two groups according to their maximum alpha angle. Participants underwent three-dimensional motion capture during walking. Trunk, pelvis, and lower limb biomechanics were compared between groups using statistical parametric mapping corrected for walking speed and pain.ResultsCompared to pain-free controls, participants with FAI syndrome walked with more trunk anterior tilt (mean difference 7.6°, p < 0.001) as well as less pelvic rise (3°, p < 0.001), hip abduction (-4.6°, p < 0.05) and external rotation (-6.5°, p < 0.05). They also had lower hip flexion (-0.06Nm⋅kg⁻¹, p < 0.05), abduction (-0.07Nm⋅kg⁻¹, p < 0.05) and ankle plantarflexion moments (-0.19Nm⋅kg⁻¹, p < 0.001). These biomechanical differences occurred throughout the gait cycle. There were no differences in walking biomechanics according to cam morphology size.SignificanceResults do not support the hypothesis that larger cam morphology is associated with larger differences in walking biomechanics but did demonstrate general differences in trunk, pelvis and lower limb biomechanics between those with FAI sydrome and pain-free controls. Altered external biomechanics are likely the result of complex sensory-motor strategy resulting from pain inhibition or impingement avoidance. Future studies should examine internal loading in those with FAI sydnrome.     

髋关节镜下治疗股骨髋臼撞击综合征的疗效及X线指标分析

目的探讨髋关节镜下治疗股骨髋臼撞击综合征的临床效果,观察X线指标。方法收集2016年2月到2017年2月34例骨髋臼撞击综合征患者为对象,患者均行常规辅助检查和X线片确诊,于髋关节镜下行关节清理和股骨头成形术,比较患者术前和术后1周髋关节Harris功能评分水平及视觉模糊疼痛评分量表(VAS)水平。结果34例患者术前和术后12个月的髋关节ROM测量和VAS评分比较差异有统计学意义(P<0.05)。结论髋关节镜下治疗股骨髋臼撞击综合征,能取得理想的临床效果,促进股骨头颈部弧度的恢复,并且有效缓解患者疼痛,改善关节活动度,具有积极的推广价值。     

Imaging findings of femoroacetabular impingement syndrome

Femoroacetabular impingement syndrome (FAI) is a pathologic entity which can lead to chronic symptoms of pain, reduced range of motion in flexion and internal rotation, and has been shown to correlate with degenerative arthritis of the hip. History, physical examination, and supportive radiographic findings such as evidence of articular cartilage damage, acetabular labral tearing, and early-onset degenerative changes can help physicians diagnose this entity. Several pathologic changes of the femur and acetabulum are known to predispose patients to develop FAI and recognition of these findings can ultimately lead to therapeutic interventions. The two basic mechanisms of impingement—cam impingement and pincer impingement—are based on the type of anatomic anomaly contributing to the impingement process. These changes can be found on conventional radiography, MR imaging, and CT examinations. However, the radiographic findings of this entity are not widely discussed and recognized by physicians. In this paper, we will introduce these risk factors, the proposed supportive imaging criteria, and the ultimate interventions that can help alleviate patients symptoms.     

Conservative management of femoroacetabular impingement (FAI) in the long distance runner

Femoroacetabular impingement (FAI) is one cause of anterior hip pain that may occur in a long distance runner. By definition FAI is due to bony abutment of the femoral neck and the acetabulum. This occurs primarily with end-ranges of hip flexion and adduction. An understanding of running mechanics and performing a thorough examination will help the clinician provide an appropriate intervention for these athletes. A course of conservative treatment that includes patient education, manual therapy and strengthening should be tried prior to surgical management.