RESUMO
PURPOSE: The treatment of Rockwood type III and V acromioclavicular (AC) joint dislocations is controversial, and an individualized treatment algorithm is yet to be developed. The objective of this study was to investigate the association of demographical, clinical, patient-reported and radiological variables with the Western Ontario Shoulder Instability Index (WOSI) score and risk of surgery. METHODS: Inclusion criteria for this prospective cohort study were patients aged 18-60 with an acute AC joint dislocation with >25% increase in the coracoclavicular distance on bilateral Zanca radiographs. Patients were treated non-surgically with 3 months of home-based training and the option of delayed surgical intervention. The outcomes were the WOSI score and surgery yes/no. Demographical, clinical, patient-reported (WOSI and Shoulder Pain and Disability Index [SPADI]) and radiological variables were collected at baseline and 6 weeks after the injury and investigated for association with the outcomes at 3 months, 6 months and 1 year. RESULTS: Ninety-five patients with Rockwood type III/V AC joint dislocation were included. Pre-injury participation in overhead/collision sports was a risk factor for surgery with an odds ratio of 5 (p = 0.03). Reduced range of motion (ROM) at baseline was associated with reduced WOSI scores and increased risk of surgery. At 6 weeks, reduced ROM, increased SPADI and increased pain during cross-over were associated with the outcomes. Radiological measurements were not correlated with the result. At the 6 weeks follow-up, patients eventually requiring surgery could be detected with a sensitivity of 100% and a specificity of 94% based on a SPADI score of >30 and a ROM ≤ 140° in shoulder flexion or abduction. CONCLUSION: ROM was the only variable consistently associated with both WOSI and risk of surgery. Six weeks after the injury, it was possible to detect patients in need of surgery based on ROM and SPADI with a sensitivity of 100% and a specificity of 94%. LEVEL OF EVIDENCE: Level II.
Assuntos
Articulação Acromioclavicular , Medidas de Resultados Relatados pelo Paciente , Radiografia , Humanos , Adulto , Masculino , Feminino , Estudos Prospectivos , Articulação Acromioclavicular/lesões , Articulação Acromioclavicular/cirurgia , Articulação Acromioclavicular/diagnóstico por imagem , Pessoa de Meia-Idade , Adulto Jovem , Adolescente , Luxações Articulares/cirurgia , Luxações Articulares/diagnóstico por imagem , Resultado do Tratamento , Amplitude de Movimento ArticularRESUMO
PURPOSE: The treatment of Rockwood type III AC joint dislocations has been debated for decades. In 2014, the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) Upper Extremity Committee suggested a subclassification of the injury into type A, considered stable and best treated nonsurgically, and type B, considered unstable and best treated surgically. Type B is defined by the presence of scapular dyskinesis and overriding of the clavicle to the acromion on a modified lateral radiograph. The objective of the study was to investigate if this subclassification is clinically relevant. METHODS: This was a prospective cohort study. Inclusion criteria were patients aged 18-60 years with acute AC joint dislocation and a baseline Zanca radiograph with an increase in the CC distance of >25% compared to the uninjured side. All patients were treated nonsurgically with 3 months of home-based training and with the option of delayed surgical intervention. Patients were assessed at baseline and at follow-ups 6 weeks, 3 months, 6 months and 1 year after the injury. At the 6-week follow-up, patients were graded as stable and unstable according to the ISAKOS criteria. Outcomes were the Western Ontario Shoulder Instability Index (WOSI) and referral for surgery. RESULTS: At 6 weeks of follow-up, 20 patients were classified as stable type A and 69 were classified as unstable type B. The ISAKOS subclassification was not clinically relevant, but patients graded as stable had statistically significantly better WOSI scores at 6 months compared to the unstable group (p = 0.03) but not at 3 months or 1 year. Nine patients (9.5%), all from the unstable group, were referred for surgery. No patients from the stable group underwent surgery (n.s). CONCLUSION: The ISAKOS subclassification of Rockwood type III in a stable type A and an unstable type B is not clinically applicable. LEVEL OF EVIDENCE: Level II.
Assuntos
Instabilidade Articular , Humanos , Adulto , Estudos Prospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto Jovem , Instabilidade Articular/classificação , Instabilidade Articular/cirurgia , Adolescente , Luxações Articulares/classificação , Luxações Articulares/cirurgia , Luxações Articulares/diagnóstico por imagem , Radiografia , Articulação Acromioclavicular/lesões , Articulação Acromioclavicular/cirurgia , Articulação Acromioclavicular/diagnóstico por imagemRESUMO
PURPOSE: To identify modifiable biomechanical and neuromuscular anterior cruciate ligament (ACL) injury risk factors for first-time ACL injury in adolescent female elite football and team handball players. METHODS: Adolescent female elite football and handball players with no previous ACL injury participated in the present study. At baseline, players were tested during side-cutting manoeuvres performed in a 3-dimensional motion analysis laboratory with concomitant electromyography (EMG) measurements. Maximal isometric lower limb muscle strength was assessed by handheld dynamometry. Players were prospectively followed for 2 years after baseline testing, and all magnetic resonance imaging (MRI) verified ACL injuries were registered. The effect of 16 risk factor candidates on the relative risk (RR) of ACL injury was estimated using Poisson regression analysis. RESULTS: Ninety players (age 16.9 ± 1.2 years) were included in the analyses. Nine first-time ACL injuries (injury incidence 10.0% (95% confidence interval (CI) 5.4-18.6%)) were registered during the 2-year follow-up period. Four risk factor candidates were significantly associated with the risk of ACL injury: (1) hip flexion angle at initial contact (IC) [RR 0.56, 95% confidence interval (CI) 0.34-0.92], (2) internal knee rotation angle at IC [RR 1.13, 95% CI 1.08-1.19], (3) semitendinosus EMG activity 50 ms prior to IC [RR: 0.62, 95% CI 0.43-0.89], and (4) external hip rotator strength [RR: 0.77, 95% CI 0.66-0.89]. CONCLUSION: Four distinct ACL injury risk factors related to the side-cutting manoeuvre were identified in a population of adolescent female elite football and team handball players with no previous ACL injury. As ACL injury typically occur during side-cutting, intervention programmes to modify these risk factors pose a promising strategy for ACL injury prevention in adolescent female elite football and team handball. LEVEL OF EVIDENCE: II.
Assuntos
Lesões do Ligamento Cruzado Anterior , Traumatismos em Atletas , Futebol Americano , Adolescente , Lesões do Ligamento Cruzado Anterior/epidemiologia , Atletas , Traumatismos em Atletas/epidemiologia , Feminino , Futebol Americano/lesões , Humanos , Estudos Prospectivos , Fatores de RiscoRESUMO
PURPOSE: Retraction of semitendinosus muscle has been reported after reconstruction of the anterior cruciate ligament with semitendinosus/gracilis-graft. However, very little data exist on the natural variation in side-to-side length symmetry. The purpose of this study was to investigate the side-to-side asymmetry of semitendinosus muscle length in individuals with ACL reconstruction (ACLR) using the semitendinosus/gracilis-graft compared to a group of healthy control subjects to establish the level of retraction that can confidently be ascribed the surgery. METHODS: Eleven subjects aged 30 (19-39) years, with previous unilateral ACLR with the combined semitendinosus/gracilis tendon graft were recruited. Average follow-up was 6.8 years (0.3-13.0) after reconstruction. Ten healthy subjects aged 30 years (23-36) with no previous knee surgery served as controls. Bilateral magnetic resonance imaging (MRI) scans were obtained of the thigh from 60 mm below the knee joint and 700 mm proximal to this point with a slice thickness of 5 mm with 5 mm inter-slice distance. Semitendinosus length was measured on both legs between the distal and proximal musculotendinous junction of the semitendinosus. Length difference between legs was calculated for all participants. Percentage of shortening was expressed relative to the healthy leg. RESULTS: Subjects who had undergone ACLR had on average 81 mm (25%) shortening of the semitendinosus on the reconstructed leg compared to the non-reconstructed side. The healthy subjects all had less than 10 mm difference between legs (< 3%). The side-to-side difference was significantly different between the reconstructed patients and the healthy subjects (p < 0.001). CONCLUSION: This study indicates that retraction larger than 10 mm is a consequence of the tendon harvest and not natural variation. It also supports that persistent retraction of the semitendinosus muscle occurs following harvest of the semitendinosus tendon for ACL graft. LEVEL OF EVIDENCE: Level IV.
Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Músculos Isquiossurais , Tendões dos Músculos Isquiotibiais , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Músculos Isquiossurais/diagnóstico por imagem , Músculos Isquiossurais/cirurgia , Tendões dos Músculos Isquiotibiais/cirurgia , Humanos , Tendões/transplanteRESUMO
Acute adductor injuries account for the majority of acute groin injuries; however, little is known about specific injury characteristics, which could be important for the understanding of etiology and management of these injuries. The study aim was to describe acute adductor injuries in athletes using magnetic resonance imaging (MRI). Male athletes with acute groin pain and an MRI confirmed acute adductor muscle injury were prospectively included. MRI was performed within 7 days of injury using a standardized protocol and a reliable assessment approach. 156 athletes presented with acute groin pain of which 71 athletes were included, median age 27 years (range 18-37). There were 46 isolated muscle injuries and 25 athletes with multiple adductor injuries. In total, 111 acute adductor muscle injuries were recorded; 62 adductor longus, 18 adductor brevis, 17 pectineus, 9 obturator externus, 4 gracilis, and 1 adductor magnus injury. Adductor longus injuries occurred at three main injury locations; proximal insertion (26%), intramuscular musculo-tendinous junction (MTJ) of the proximal tendon (26%) and the MTJ of the distal tendon (37%). Intramuscular tendon injury was seen in one case. At the proximal insertion, 12 of 16 injuries were complete avulsions. This study shows that acute adductor injuries generally occur in isolation from other muscle groups. Adductor longus is the most frequently injured muscle in isolation and in combination with other adductor muscle injuries. Three characteristic adductor longus injury locations were observed on MRI, with avulsion injuries accounting for three-quarters of injuries at the proximal insertion, and intramuscular tendon injury was uncommon.
Assuntos
Traumatismos em Atletas/diagnóstico por imagem , Virilha/lesões , Músculo Esquelético/lesões , Coxa da Perna/lesões , Adolescente , Adulto , Atletas , Virilha/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Músculo Esquelético/diagnóstico por imagem , Traumatismos dos Tendões/diagnóstico por imagem , Coxa da Perna/diagnóstico por imagem , Adulto JovemRESUMO
Hip flexor injuries account for one-third of acute groin injuries; however, little is known about specific injury characteristics. The aims of this study were to describe acute hip flexor injuries using magnetic resonance imaging (MRI) in athletes with acute groin pain and to compare specific muscle injuries with reported injury situations. Male athletes with acute groin pain were prospectively and consecutively included during three sports seasons. MRI was performed within 7 days of injury using a standardized protocol and a reliable assessment approach. All athletes with an MRI confirmed acute hip flexor muscle injury were included. A total of 156 athletes presented with acute groin pain of which 33 athletes were included, median age 26 years (range 18-35). There were 16 rectus femoris, 12 iliacus, 7 psoas major, 4 sartorius, and 1 tensor fascia latae injury. Rectus femoris injuries primarily occurred during kicking (10) and sprinting (4), whereas iliacus injuries most frequently occurred during change of direction (5). In 10 (63%) rectus femoris injuries, tendinous injury was observed. The iliacus and psoas major injuries were mainly observed at the musculotendinous junction (MTJ), and two included tendinous injury. We have illustrated specific injury locations within these muscles, which may be relevant for the clinical diagnosis and prognosis of these injuries. Most proximal rectus femoris injuries included tendinous injury. In contrast, distinct acute iliacus and psoas injuries predominantly occurred at the MTJ. Only the iliacus or psoas major were injured during change of direction, whereas rectus femoris injuries occurred primarily during kicking and sprinting.
Assuntos
Traumatismos em Atletas/diagnóstico por imagem , Virilha/lesões , Lesões do Quadril/diagnóstico por imagem , Traumatismos dos Tendões/diagnóstico por imagem , Músculos Abdominais/diagnóstico por imagem , Músculos Abdominais/lesões , Adolescente , Adulto , Atletas , Virilha/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Músculos Psoas/diagnóstico por imagem , Músculos Psoas/lesões , Adulto JovemRESUMO
OBJECTIVE: The preseason Nordic Hamstring Protocol (NHP) reduces hamstring strain injuries in football players. Despite persisting injury rates, elite clubs are reluctant to apply the NHP often over concerns of negative impacts on performance. This pilot study investigated if sprint or jump-performance outcomes tended to increase or decrease following implementation of the NHP in elite male soccer-players. RESULTS: Nineteen male soccer players from the Danish 1st division were randomised to perform NHP (27 sessions) during pre-season, or to control group (CG). Sprint performance (30 m with 5 and 10 m split times) and countermovement jump (CMJ height) was measured before the mid-seasonal break and again after 10 weeks of performing the NHP at the end of pre-season. Dropouts were due to transfers and injuries unrelated to performing NHP (NHP = 0, CG = 5). Sprint performance on the short split distances improved for most players in the NHP (6 out of 9 improved, median changes for 5 m split: - 0.068 s; 10 m split: - 0.078 s), but not CG (2 out of 5 improved, median changes for 5 m split: + 0.1 s; 10 m split: CG: + 0.11 s), but both groups had small declines at 30 m sprint (NHP: 7 out of 9 declined, median changes: + 0.116 s; CG: 4 out of 5 declined, median changes: + 0.159 s). CMJ height mostly improved in both groups (NHP: 6 out of 9 improved, median changes: + 2.1 cm; CG: 4 out of 8 improved, median changes: + 0.55 cm). Performing the NHP in elite soccer players did therefore not seem to negatively affect sprint and vertical jump performance outcomes in the present study, while in fact showing some promise for the more explosive characteristics such as the short 5 and 10 m split-times and maximal CMJ height, which all are highly relevant performance parameters in elite football.
Assuntos
Desempenho Atlético/fisiologia , Músculos Isquiossurais/fisiologia , Treinamento Intervalado de Alta Intensidade/métodos , Treinamento Resistido/métodos , Corrida/fisiologia , Adulto , Exercício Físico , Teste de Esforço/estatística & dados numéricos , Humanos , Masculino , Força Muscular/fisiologia , Resistência Física , Projetos Piloto , Distribuição Aleatória , Futebol/fisiologiaRESUMO
BACKGROUND: Pain and loss of function are cardinal symptoms associated with Subacromial impingement syndrome (SIS), while the presence and magnitude of deficits in strength and range of motion (ROM) are largely undescribed in non-athletic patients with SIS. Moreover, the relevance of impairments in strength and ROM to patient-reported shoulder function is not well described, even though testing of strength is recommended in clinical guidelines. The purpose of this study was, first, to investigate impairments in glenohumeral and scapulothoracic strength and in abduction and internal rotation ROM in patients with SIS. Secondly, to investigate the influence of these impairments on patient-reported shoulder function. METHODS: Cross-sectional study based on a consecutive cohort of 157 patients referred to specialist examination and diagnosed with shoulder impingement (SIS) using predefined validated diagnostic criteria. Prior to specialist examination, questionnaires regarding shoulder function (Shoulder Pain And Disability Index, SPADI) demographics and kinesiophobia (TSK-11) were collected, and shoulder strength and ROM was measured by trained testers, with the patient reporting pain levels during testing and for the last week. Impairments in strength (abduction, external-rotation, (protraction and horizontal-extension) and ROM (abduction and internal rotation) were investigated in patients with unilateral shoulder pain, using one-sample t-tests. SPADI total score (SPADI) and SPADI function score (SPADI-F), were chosen as dependent variables in multiple regressions to investigate the influence of impairments on patient-reported shoulder function. Independent variables of interest were; strength in abduction and external rotation, abduction ROM, pain-during-tests, pain-last-week and kinesiophobia. RESULTS: Significant impairments were found for all impairment tests, but most pronounced for glenohumeral strength and abduction ROM (29-33% deficits), and less for scapulothoracic strength and internal rotation ROM (8-18% deficits). Pain variables influenced SPADI and SPADI-F score to a high degree (R2 = 23.4-31.6%, p < 0.001), while strength and ROM did not. CONCLUSION: Substantial strength and ROM impairments were found in patients with SIS. Only pain significantly influenced patient-reported function, while impairments did not. As SPADI score does not reflect the substantial strength and ROM impairments in external rotation and abduction observed in patients with SIS, supplemental assessment of these impairments seems important.
Assuntos
Avaliação da Deficiência , Força Muscular/fisiologia , Escápula/fisiopatologia , Síndrome de Colisão do Ombro/fisiopatologia , Articulação do Ombro/fisiopatologia , Dor de Ombro/fisiopatologia , Adulto , Idoso , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Escápula/patologia , Autorrelato , Síndrome de Colisão do Ombro/diagnóstico , Síndrome de Colisão do Ombro/epidemiologia , Articulação do Ombro/patologia , Dor de Ombro/diagnóstico , Dor de Ombro/epidemiologiaRESUMO
PURPOSE: Determine which examination findings are key clinical descriptors of femoroacetabular impingement syndrome (FAIS) through use of an international, multi-disciplinary expert panel. METHODS: A three-round Delphi survey utilizing an international, multi-disciplinary expert panel operationally defined from international publications and presentations was utilized. RESULTS: All six domains (subjective examination, patient-reported outcome measures, physical examination, special tests, physical performance measures, and diagnostic imaging) had at least one descriptor with 75% consensus agreement for diagnosis and assessment of FAIS. Diagnostic imaging was the domain with the highest level of agreement. Domains such as patient-reported outcome measures (PRO's) and physical examination were identified as non-diagnostic measures (rather as assessments of disease impact). CONCLUSION: Although it also had the greatest level of variability in description of examination domains, diagnostic imaging continues to be the preeminent diagnostic measure for FAIS. No single domain should be utilized as the sole diagnostic or assessment parameter for FAIS. While not all investigated domains provide diagnostic capability for FAIS, those that do not are able to serve purpose as a measure of disease impact (e.g., impairments and activity limitations). The clinical relevance of this Delphi survey is the understanding that a comprehensive assessment measuring both diagnostic capability and disease impact most accurately reflects the patient with FAIS. LEVEL OF EVIDENCE: V.
Assuntos
Impacto Femoroacetabular/diagnóstico , Adulto , Técnica Delphi , Feminino , Impacto Femoroacetabular/diagnóstico por imagem , Humanos , Medidas de Resultados Relatados pelo Paciente , Exame Físico , Inquéritos e QuestionáriosRESUMO
The purpose of this retrospective cohort study was to (a) describe the clinical presentation of femoroacetabular impingement (FAI) and hip labral pathology; (b) describe the accuracy of patient history and physical tests for FAI and labral pathology as confirmed by hip arthroscopy. Patients (18-65 years) were included if they were referred to a physical therapist to gather pre-operative data and were then diagnosed during arthroscopy. Results of pre-operative patient history and physical tests were collected and compared to arthroscopy. Data of 77 active patients (mean age: 37 years) were included. Groin as main location of pain, the Anterior Impingement test (AIT), Flexion-Abduction-External Rotation (FABER) test, and Fitzgerald test had a high sensitivity (range 0.72-0.91). Sensitivity increased when combining these tests (0.97) as either groin as main location of pain and a positive FABER test or a positive AIT and a positive FABER test were the shortest most sensitive combinations. The results of this study point out that in clinical practice absence of groin as main location of pain combined with a negative FABER test or the combination of a negative AIT and a negative FABER test are suggested to rule out the diagnosis of symptomatic FAI and/or labral pathology.
Assuntos
Artroscopia , Impacto Femoroacetabular/diagnóstico , Articulação do Quadril/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Adulto , Estudos de Coortes , Feminino , Impacto Femoroacetabular/fisiopatologia , Impacto Femoroacetabular/cirurgia , Articulação do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Exame Físico , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto JovemRESUMO
BACKGROUND: No simple clinical measure exits to evaluate groin pain and its severity in athletes. The aim was to investigate the validity, reliability and responsiveness of a five-second hip-adduction squeeze test for football players designed to assess sports-related hip and groin function, pain and severity. METHODS: Construct validity was assessed in 667 subelite male football players with a mean age (±SD) of 24±4 in the beginning of the season. Responsiveness and reliability were evaluated during the season in 52 and 10 players, respectively. Players answered the Copenhagen Hip and Groin Outcome Score (HAGOS) and performed the Copenhagen five-second squeeze assessed on a Numerical Pain Rating Scale (NRS) ranging from 0 to 10. RESULTS: As hypothesised higher pain scores during the Copenhagen five-second squeeze correlated significantly (Spearman's rho=-0.61, p<0.01) with a lesser HAGOS (Sport) Score. The change scores in the Copenhagen five-second squeeze also correlated significantly (Spearman's rho=-0.51, p<0.01), with HAGOS (Sport) change scores in the responsiveness analysis, and test-retest reliability (concordance correlation coefficient) was 0.90. Moreover, significant (p<0.01) between-group differences existed for HAGOS (Sport) Scores in players reporting groin pain intensity at one of the 3 different pain levels: NRS (0-2), NRS (3-5) and NRS (6-10). The NRS (6-10) group had the lowest median (IQR) HAGOS (Sport) Score of 47 (31-61). CONCLUSIONS: The Copenhagen five-second squeeze is a valid indicator of sports-related hip and groin function in football players. Players reporting groin pain intensity as 6 of 10 or more in the Copenhagen five-second squeeze experience substantially impaired sports-related hip and groin function.
Assuntos
Traumatismos em Atletas/diagnóstico , Virilha/fisiopatologia , Quadril/fisiopatologia , Medição da Dor/métodos , Exame Físico/métodos , Adulto , Atletas , Humanos , Masculino , Dor/fisiopatologia , Reprodutibilidade dos Testes , Futebol , Adulto JovemRESUMO
The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub-elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1-4) were included. Players completed in the beginning of the new season (July-Sept 2011) a self-reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45-52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26-36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub-elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.
Assuntos
Atletas/estatística & dados numéricos , Virilha , Lesões do Quadril/epidemiologia , Dor Musculoesquelética/epidemiologia , Futebol/lesões , Adulto , Estudos de Coortes , Estudos Transversais , Dinamarca/epidemiologia , Quadril , Lesões do Quadril/fisiopatologia , Humanos , Masculino , Dor Musculoesquelética/fisiopatologia , Prevalência , Índice de Gravidade de Doença , Adulto JovemRESUMO
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.Author note The Warwick Agreement on femoroacetabular impingement syndrome has been endorsed by the following 25 clinical societies: American Medical Society for Sports Medicine (AMSSM), Association of Chartered Physiotherapists in Sports and Exercise Medicine (ACPSEM), Australasian College of Sports and Exercise Physicians (ACSEP), Austian Sports Physiotherapists, British Association of Sports and Exercise Medicine (BASEM), British Association of Sport Rehabilitators and Trainers (BASRaT), Canadian Academy of Sport and Exercise Medicine (CASEM), Danish Society of Sports Physical Therapy (DSSF), European College of Sports and Exercise Physicians (ECOSEP), European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA), Finnish Sports Physiotherapist Association (SUFT), German-Austrian-Swiss Society for Orthopaedic Traumatologic Sports Medicine (GOTS), International Federation of Sports Physical Therapy (IFSPT), International Society for Hip Arthroscopy (ISHA), Groupo di Interesse Specialistico dell'A.I.F.I., Norwegian Association of Sports Medicine and Physical Activity (NIMF), Norwegian Sports Physiotherapy Association (FFI), Society of Sports Therapists (SST), South African Sports Medicine Association (SASMA), Sports Medicine Australia (SMA), Sports Doctors Australia (SDrA), Sports Physiotherapy New Zealand (SPNZ), Swedish Society of Exercise and Sports Medicine (SFAIM), Swiss Society of Sports Medicine (SGMS/SGSM), Swiss Sports Physiotherapy Association (SSPA).
Assuntos
Impacto Femoroacetabular/diagnóstico , Impacto Femoroacetabular/terapia , Acetábulo/fisiopatologia , Congressos como Assunto , Consenso , Articulação do Quadril/fisiopatologia , Humanos , SociedadesRESUMO
Knee injuries are common in adolescent female football. Self-reported previous knee injury and low Knee injury and Osteoarthritis Outcome Score (KOOS) are proposed to predict future knee injuries, but evidence regarding this in adolescent female football is scarce. The aim of this study was to investigate self-reported previous knee injury and low KOOS subscale score as risk factors for future knee injuries in adolescent female football. A sample of 326 adolescent female football players, aged 15-18, without knee injury at baseline, were included. Data on self-reported previous knee injury and KOOS questionnaires were collected at baseline. Time-loss knee injuries and football exposures were reported weekly by answers to standardized text-message questions, followed by injury telephone interviews. A priori, self-reported previous knee injury and low KOOS subscale scores (< 80 points) were chosen as independent variables in the risk factor analyses. The study showed that self-reported previous knee injury significantly increased the risk of time-loss knee injury [relative risk (RR): 3.65, 95% confidence (CI) 1.73-7.68; P < 0.001]. Risk of time-loss knee injury was also significantly increased in players with low KOOS subscale scores (< 80 points) in Activities of Daily Living (RR: 5.0), Sport/Recreational (RR: 2.2) and Quality of Life (RR: 3.0) (P < 0.05). In conclusion, self-reported previous knee injury and low scores in three KOOS subscales significantly increase the risk of future time-loss knee injury in adolescent female football.
Assuntos
Traumatismos do Joelho/fisiopatologia , Articulação do Joelho/fisiopatologia , Futebol/lesões , Inquéritos e Questionários , Adolescente , Feminino , Humanos , Recidiva , Fatores de Risco , AutorrelatoRESUMO
Hip adductor injuries are frequent in football, and players with low adductor strength appear to be at increased risk of injury. High adductor muscle activity has been shown in the Copenhagen Adduction exercise (CA); however, an associated strength gain has not been investigated. This study aims to examine the eccentric hip adduction strength (EHAD) gain using the CA in-season. Two U-19 sub-elite football teams, including 24 football players, were randomized to either an 8-week supervised progressive training program in addition to the usual training (intervention) or to continue training as usual (control). EHAD, eccentric hip abduction strength (EHAB), and side-bridge endurance were measured using reliable test procedures at baseline and follow-up by a blinded tester. There was a significant interaction between group and time on EHAD, EHAB, and EHAD/EHAB ratio (P < 0.025). The intervention group demonstrated a 35.7% increase in EHAD (P < 0.001); a 20.3% increase in EHAB (P = 0.003), and 12.3% increase in EHAD/EHAB ratio (P = 0.019). No significant within-group differences were found in the control group (P > 0.335). Compliance was 91.25%, and median muscle soreness ranged from 0 to 2. The CA implemented in-season with an 8-week progressive training program elicited a large significant increase in EHAD, EHAB, and EHAD/EHAB ratio.
Assuntos
Atletas , Contração Muscular , Força Muscular , Músculo Esquelético , Treinamento Resistido/métodos , Futebol , Adolescente , Traumatismos em Atletas , Dinamarca , Quadril , Lesões do Quadril , Humanos , Masculino , Método Simples-Cego , Adulto JovemRESUMO
The mainstay of patellofemoral pain (PFP) treatment is exercise therapy, often in combination with adjunct treatments such as patient education, orthoses, patella taping and stretching, making the intervention multimodal in nature. The vast majority of randomised controlled trials among patients with PFP have investigated the effect of treatment among adults (>18 years of age). So, while systematic reviews and meta-analyses provide evidence-based recommendations for treating PFP, these recommendations are largely based upon the trials in adults. In the present article, we have summarised the findings on the efficacy of multimodal treatment (predominantly exercise) from the three largest trials concerning patients with PFP, focusing on the long-term success-rate 1 year after receiving multimodal treatment, and with a particular focus on the success rate across the different age groups, including both adolescents, young adults and adults. The results of this paper show that there appears to be a difference in the success rate between adolescents and adults, despite providing similar exercise treatment and having similar exercise compliance. While PFP may present in a similar fashion in adolescence and adults, it may not be the same underlying condition or stage, and different treatments may be required. Collectively, this highlights the importance of increasing our understanding of the underlying pathology, pain mechanisms and why treatment may-or may not-work in adolescents and adults with PFP.
Assuntos
Síndrome da Dor Patelofemoral/terapia , Adolescente , Adulto , Fatores Etários , Fita Atlética , Terapia Combinada , Terapia por Exercício , Humanos , Aparelhos Ortopédicos , Síndrome da Dor Patelofemoral/patologia , Cooperação do Paciente , Educação de Pacientes como Assunto , Resultado do TratamentoRESUMO
BACKGROUND/AIM: To recommend Patient-Reported Outcome (PRO) questionnaires to measure hip and groin disability in young-aged to middle-aged adults. METHODS: A systematic review was performed in June 2014. The methodological quality of the studies included was determined using the COnsensus-based Standards for the selection of health Measurement INstruments list (COSMIN) together with standardised evaluations of measurement properties of each PRO. RESULTS: Twenty studies were included. Nine different questionnaires for patients with hip disability, and one for hip and groin disability, were identified. Hip And Groin Outcome Score (HAGOS), Hip Outcome Score (HOS), International Hip Outcome Tool-12 (IHOT-12) and IHOT-33 were the most thoroughly investigated PROs and studies including these PROs reported key aspects of the COSMIN checklist. HAGOS and IHOT-12 were based on studies with the least ratings of poor study methodology (23% and 31%, respectively), whereas IHOT-33 and HOS had a somewhat larger distribution (46%). These PROs all contain adequate measurement qualities for content validity (except HOS), test-retest reliability, construct validity, responsiveness and interpretability. No information or poor quality rating on methodological aspects made it impossible to fully evaluate the remaining PROs at present. CONCLUSIONS: HAGOS, HOS, IHOT-12 and IHOT-33 can be recommended for assessment of young-aged to middle-aged adults with pain related to the hip joint, undergoing non-surgical treatment or hip arthroscopy. At present, HAGOS is the only PRO also aimed for young-aged to middle-aged adults presenting with groin pain and is recommended for use in this population. TRIAL REGISTRATION NUMBER: CRD42014009995.
Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Virilha , Quadril , Avaliação de Resultados da Assistência ao Paciente , Inquéritos e Questionários/normas , Adulto , Hérnia Inguinal/etiologia , Humanos , Pessoa de Meia-Idade , Psicometria , Adulto JovemRESUMO
BACKGROUND: Surgery for hip femoroacetabular impingement/acetabular labral tear (FAI/ALT) is exponentially increasing despite lacking investigation of the accuracy of various diagnostic measures. Useful clinical utility of these measures is necessary to support diagnostic imaging and subsequent surgical decision-making. OBJECTIVE: Summarise/evaluate the current diagnostic accuracy of various clinical tests germane to hip FAI/ALT pathology. METHODS: A computer-assisted literature search of MEDLINE, CINAHL and EMBASE databases using keywords related to diagnostic accuracy of the hip joint, as well as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for the search and reporting phases of the study. Quality assessment of bias and applicability was conducted using the Quality of Diagnostic Accuracy Studies-2 (QUADAS-2). Random effects models were used to summarise sensitivities (SN), specificities (SP), diagnostic odds ratio (DOR) and respective confidence intervals (CI). RESULTS: The employed search strategy revealed 21 potential articles, with one demonstrating high quality. Nine articles qualified for meta-analysis. The meta-analysis demonstrated that flexion-adduction-internal rotation (pooled SN ranging from 0.94 (95% CI 0.90 to 0.97) to 0.99 (95% CI 0.98 to 1.00); DOR 5.71 (95% CI 0.84 to 38.86) to 7.82 (95% CI 1.06 to 57.84)) and flexion-internal rotation (pooled SN 0.96 (95% CI 0.81 to 0.99); DOR 8.36 (95% CI 0.41 to 171.3) tests possess only screening accuracy. CONCLUSIONS: Few hip physical examination tests for diagnosing FAI/ALT have been investigated in enough studies of substantial quality to direct clinical decision-making. Further high-quality studies across a wider spectrum of hip pathology patients are recommended to discern the confirmed clinical utility of these tests. TRIALS REGISTRATION NUMBER: PROSPERO Registration # CRD42014010144.
Assuntos
Impacto Femoroacetabular/diagnóstico , Humanos , Lacerações/diagnóstico , Exame Físico/métodos , Exame Físico/normas , Curva ROC , Padrões de Referência , Ruptura/diagnósticoRESUMO
BACKGROUND: The analgesic effect of the adductor canal block (ACB) after knee surgery has been evaluated in a number of trials. We hypothesized that the ACB would provide substantial pain relief to patients responding with moderate to severe pain after arthroscopic knee surgery. METHODS: Fifty subjects with moderate to severe pain after arthroscopic knee surgery were enrolled in this placebo-controlled, blinded trial. All subjects received two ACBs; an initial ACB with either 30 ml ropivacaine 7.5 mg/ml (n = 25) (R group) or saline (n = 25) (C group) and after 45 min a second ACB with the opposite study medication, according to randomization. Primary outcome was pain during 45 degrees active flexion of the knee at 45 min after the first block, assessed on a 0-100 mm visual analogue scale. Secondary outcome measures were: pain at rest and during flexion of the knee, worst pain experienced during a 5-m walk, patient's evaluation of muscle strength during walk, and amount of sufentanil administered during the 90-min study period. RESULTS: Regarding primary outcome, mean pain score difference between groups was 34 (95% CI: 25 to 44) mm, P < 0.001, in favour of the R group. At rest, mean pain score difference was 32 (23 to 41) mm, P < 0.001, and during walk: 21 (6 to 36) mm, P = 0.01 in favour of the R group. There were no differences between groups regarding other secondary outcome measures. CONCLUSION: The ACB is a relevant option for patients with moderate to severe pain after arthroscopic knee surgery.
Assuntos
Artroscopia/métodos , Joelho/cirurgia , Bloqueio Nervoso/métodos , Dor Pós-Operatória/tratamento farmacológico , Adulto , Amidas , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Anestésicos Locais , Artroscopia/efeitos adversos , Feminino , Humanos , Masculino , Força Muscular , Medição da Dor , Ropivacaina , Coxa da Perna , Resultado do TratamentoRESUMO
Handheld dynamometry (HHD) is a promising tool for obtaining reliable hip strength measurements in the clinical setting, but intertester reliability has been questioned, especially in situations where testers exhibit differences in upper-extremity muscle strength (male vs female). The purpose of this study was to examine the intertester reliability concerning strength assessments of hip abduction, adduction, external and internal rotation, flexion and extension using HHD, and to test whether systematic differences in test values exist between testers of different upper-extremity strength. Fifty healthy individuals (29 women), aged 25 ± 5 years were included. Two physiotherapist students (one female, one male) of different upper-extremity strength performed the measurements. The tester order and strength test order were randomized. Intraclass correlation coefficients were used to quantify reliability, and ranged from 0.82 to 0.91 for the six strength test. The female tester systematically measured lower strength values for all isometric strength tests (P < 0.05). In hip strength assessments using HHD, systematic bias exists between testers of different sex, which is likely explained by differences in upper-extremity strength. Hence, to improve intertester reliability, the dynamometer likely needs external fixation, as this will eliminate the influence of differences in upper-extremity strength between testers.