Hip Instability in the Athlete

Parvaresh, Kevin C.; Rasio, Jonathan; Azua, Eric; Nho, Shane J.

doi:10.1016/j.csm.2020.11.005

Cited by 9 publications

(3 citation statements)

References 67 publications

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“…The diagnosis of hip microinstability remains poorly defined, with many features described, but no clear gold standard [7]. In broad terms, hip microinstability has been defined as supraphysiologic motion of the hip coupled with pain or dysfunction [3, 7, 22, 23, 26, 29]. Several authors have described pathologic findings at hip arthroscopy, including straight anterior and/or lateral labral‐chondral separation, central femoral head chondromalacia, inside‐out wear pattern of the acetabular articular cartilage and ligamentum teres tearing or hypertrophy as features of microinstability [23, 25, 26, 28, 31].…”

Section: Introductionmentioning

confidence: 99%

Female gender, decreased lateral center edge angle and a positive hyperextension–external rotation test are associated with ease of hip distractability at time of hip arthroscopy

Curtis

Pullen

Murray

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeTo identify factors associated with ease of hip distraction at the time of hip arthroscopy. MethodsA retrospective review of patients 17–50 years old undergoing hip arthroscopy with a single high‐volume hip arthroscopist was performed from 2014 to 2020. Demographics, clinical history, examination, and imaging findings were collected. Distractibility was quantified using turns of fine traction (1 turn = 4 mm axial distraction) with the patient paralyzed on a fracture table with a well‐padded perineal post Fine axial traction was applied after the patient’s perineum contacted the post. Demographic and clinical predictors of ease of distractibility were analyzed with simple linear regression models. Significant predictors were subsequently added to a multivariable linear regression model, estimating the effect of each variable. ResultsIn total, 453 patients were included, with an average age of 31.6 years (± 9.2) and 45.9% females. In univariate analysis, gender, race, BMI, range of motion, hyperextension–external rotation (HEER) test, the abduction–extension–external rotation test, and lateral center edge angle (LCEA) were associated with the number of fine traction turns required to distract the hip. On multivariable analysis, lower LCEA (p = 0.002), female gender (p < 0.001), and a positive HEER test (p = 0.045) were associated with decreased turns required for adequate hip distraction. ConclusionFemale gender, decreased LCEA, and a positive HEER test are associated with decreased axial traction required for adequate hip distraction at the time of hip arthroscopy. As ease of distractibility has been associated with hip microinstability, these findings may allow pre‐operative identification of hip instability patients and aid in pre‐operative counseling, risk stratification and capsular management planning. Level of evidenceIV. Clinical relevancePreoperative identification of risk factors for ease of hip distraction may raise pre‐surgical suspicion and, when coupled with other intraoperative findings, may aid in the diagnosis and management of hip microinstability.

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Section: Introductionmentioning

confidence: 99%

Female gender, decreased lateral center edge angle and a positive hyperextension–external rotation test are associated with ease of hip distractability at time of hip arthroscopy

Curtis

Pullen

Murray

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…Subjects classified in the Radiographic FAI group (displaying more than two subnormal 3D radiological hip parameters) had a significantly decreased acetabular anteversion, abduction, tilt and femoral anteversion. In addition, subjects in the Radiographic FAI group had a significantly increased VCE and acetabular coverage of the femoral head, thus increasing the risk of developing FAI [ 29 , 30 ]. Moreover, the results in our study regarding femoral anteversion and acetabular coverage are in accordance with those reported in the literature in subjects with asymptomatic FAI: Audenaert et al reported a decreased femoral anteversion and an overcoverage of the femoral head by the acetabulum which contribute to the risk of early collision between the proximal femur and the acetabulum.…”

Section: Discussionmentioning

confidence: 99%

“…If a value was found to be outside of the assumed normal range, the 3D radiological hip parameter was considered to be subnormal, and thus underlying asymptomatic femoro-acetabular impingement (FAI). Values of acetabular tilt, acetabular abduction, femoral head diameter and neck length were considered subnormal if they were inferior to the established interval of [Mean-1SD], since their decrease can be associated with FAI, based on hip geometry [29][30][31]. Values of acetabular coverage of the femoral head were considered subnormal if they were superior to the established interval of [Mean+1SD].…”

Section: Figure 2: Hip Radiological Parameters Based On 3d Reconstruc...mentioning

confidence: 99%

Differences in Kinematic Changes From Self-Selected to Fast Speed Gait in Asymptomatic Adults With Radiological Signs of Femoro-Acetabular Impingement

Yared,

Massaad,

Bakouny

et al. 2023

Cureus

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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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