The management of symptomatic femoroacetabular impingement: what is the rationale for non-surgical treatment?

Casartelli, Nicola C.; Maffiuletti, Nicola A.; Bizzini, Mario; Kelly, Bryan T.; Naal, Florian D.; Leunig, Michael

doi:10.1136/bjsports-2015-095722

Cited by 26 publications

(32 citation statements)

References 7 publications

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“…The treatment targets for rehabilitation are wide-ranging and include improving sagittal and frontal plane hip range of motion, hip muscle strengthening and lumbopelvic dissociation 14 47 48 65. However, details of what should be incorporated in such a programme has not been well tested and it would appear that different physiotherapists are delivering different treatments 23…”

Section: Discussionmentioning

confidence: 99%

The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement

et al. 2016

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The 2016 Warwick Agreement on femoroacetabular impingement (FAI) syndrome was convened to build an international, multidisciplinary consensus on the diagnosis and management of patients with FAI syndrome. 22 panel members and 1 patient from 9 countries and 5 different specialties participated in a 1-day consensus meeting on 29 June 2016. Prior to the meeting, 6 questions were agreed on, and recent relevant systematic reviews and seminal literature were circulated. Panel members gave presentations on the topics of the agreed questions at Sports Hip 2016, an open meeting held in the UK on 27-29 June. Presentations were followed by open discussion. At the 1-day consensus meeting, panel members developed statements in response to each question through open discussion; members then scored their level of agreement with each response on a scale of 0-10. Substantial agreement (range 9.5-10) was reached for each of the 6 consensus questions, and the associated terminology was agreed on. The term 'femoroacetabular impingement syndrome' was introduced to reflect the central role of patients' symptoms in the disorder. To reach a diagnosis, patients should have appropriate symptoms, positive clinical signs and imaging findings. Suitable treatments are conservative care, rehabilitation, and arthroscopic or open surgery. Current understanding of prognosis and topics for future research were discussed. The 2016 Warwick Agreement on FAI syndrome is an international multidisciplinary agreement on the diagnosis, treatment principles and key terminology relating to FAI syndrome.

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Section: Discussionmentioning

confidence: 99%

The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement

et al. 2016

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“…Surgery to correct the bony alignment and repair or resect the damaged acetabular labrum has been advocated, with good outcomes reported postoperatively (Kemp et al, ; Kierkegaard et al, ) although recent research has indicated that function and participation in sport and physical activity is still reduced 1 year after surgery (Thorborg et al, ). More recently, conservative nonsurgical management approaches focusing on improving neuromuscular function around the hip have been proposed as an alternative (Casartelli et al, ; Casartelli et al, ; Casartelli et al, ; Pennock et al, ).…”

Section: Introductionmentioning

confidence: 99%

“…An imbalance among the muscles surrounding the hip joint may also result in altered loading of joint surfaces (Lewis et al, ) with injury and/or degeneration as a possible consequence. As dynamic hip joint instability is thought to be related to the pathomechanism of acetabular labral injury associated with FAI, conservative nonsurgical management focusing on improving hip neuromuscular function has been recently advocated (Casartelli et al, ; Casartelli et al, ). However, to design effective neuromuscular treatment protocols, it is first important to know what deficits in hip neuromuscular function are present in association with intra‐articular hip joint pathology.…”

Section: Introductionmentioning

confidence: 99%

Hip muscle atrophy in patients with acetabular labral joint pathology

et al. 2019

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Intra‐articular hip joint pathology is a source of hip and groin pain in active individuals and is thought to be a precursor to hip osteoarthritis. Limited evidence exists to guide appropriate physiotherapy management for these patients. Identification of which hip muscles are affected may help clinicians to develop effective exercise programs. A cross‐sectional observational study in a hospital setting was conducted to investigate the size of individual hip abductor, hip extensor, and hip external rotator muscles in patients with acetabular labral joint pathology compared with age and sex matched healthy subjects. Twelve participants (eight females, four males), aged 20–53 years, with a medical diagnosis of unilateral acetabular labral tear and 12 healthy participants were recruited. Magnetic resonance imaging was used to assess cross‐sectional areas of the gluteus minimus, gluteus medius, upper gluteus maximus, lower gluteus maximus, piriformis, and quadratus femoris muscles bilaterally. Gluteus medius muscle cross‐sectional area was significantly different between groups (P < 0.01, effect size = 0.92) with muscle size found to be smaller in the pathology group. No differences were found for the other hip muscles (P > 0.05). These findings suggest that hip muscles are not all affected equally by the presence of intra‐articular hip joint pathology. Atrophy of specific hip muscles, which are important in hip joint and pelvic stability, may alter hip joint function during gait and functional tasks. Clinicians treating patients with intra‐articular hip joint pathology may need to prescribe exercises targeting the specific muscles with demonstrated dysfunction. Clin. Anat. 33:538–544, 2020. © 2019 Wiley Periodicals, Inc.

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“…7 The fact that some hip muscles already show morphologic alterations (muscle atrophy) besides functional alterations (muscle weakness) in FAIS strengthens the clinical importance of hip muscle function recovery in the nonsurgical management of patients, as well as after hip surgery, by means of exercise therapy. 8 Progressive rehabilitation protocols including specific exercises (e.g., hip muscle strengthening and core stability exercises) that provide appropriate training stimuli and can induce neuromuscular adaptations, such as muscle strength improvements, should be implemented. Even though the study of Malloy et al 6 adds knowledge to the characterization of morphologic changes to the hip muscles in FAIS, further research is necessary to better define these alterations.…”

Section: See Related Article On Page 1445mentioning

confidence: 99%

Editorial Commentary: Do Patients With Femoroacetabular Impingement Syndrome Already Show Hip Muscle Atrophy?

Casartelli¹,

Sutter

Leunig³

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Muscle atrophy, fatty degeneration, and strength deficits of the hip abductors, flexors, and even external rotators are well-known clinical and radiologic findings in patients with advanced hip osteoarthritis. More recently, in the context of prearthritic hip diseases, the role of hip muscle function in femoroacetabular impingement syndrome (FAIS) has gained greater focus for hip surgeons. Several studies have shown that patients with FAIS present with activation deficits of the hip muscles, which may result in hip muscle weakness. Nevertheless, previous studies have yet to determine whether young and mainly active patients with FAIS already show hip muscle atrophy. Future research is required to further characterize hip muscle function in patients with FAIS. Of particular interest is the investigation of whether both qualitative (muscle fatty degeneration) and quantitative (muscle atrophy) morphologic alterations of the hip muscles are present in patients with FAIS, as well as whether these alterations are sex specific and/or related to the underlying hip morphology.

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The management of symptomatic femoroacetabular impingement: what is the rationale for non-surgical treatment?

Cited by 26 publications

References 7 publications

The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement

The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement

Hip muscle atrophy in patients with acetabular labral joint pathology

Editorial Commentary: Do Patients With Femoroacetabular Impingement Syndrome Already Show Hip Muscle Atrophy?

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