Do hip and groin muscle strength and symptoms change throughout a football season in professional male football players? A prospective cohort study with repeated measures.

OBJECTIVES: Groin injuries are common in professional male football and result in significant complaints, time-loss and cost. We aimed to study: 1. Normal values of hip muscle strength and self-reported hip and groin function (Hip And Groin Outcome Score (HAGOS)). 2. Changes in these values throughout the season. 3. If previous (groin) injuries, leg dominance or league were associated with these outcome measures. DESIGN: Prospective cohort study. METHODS: 313 professional male football players (11 clubs) participated. Player characteristics and previous injuries were registered. Hip muscle strength (hand-held dynamometer) and HAGOS measurements were done at the start, middle and end of the season. RESULTS: Data from 217 players were analysed. Adduction strength (mean±standard deviation, Nm/Kg) was 3.40±0.72 (start), 3.30±0.65 (mid) and 3.39±0.74 (end) (p=0.186). Abduction strength was 3.45±0.67, 3.14±0.57 and 3.28±0.61 (p<0.001). Adduction/abduction ratio was 1.00±0.21, 1.07±0.22 and 1.05±0.23 (p<0.001). Statistically, the HAGOS-subscale 'Pain' (median [interquartile range]) deteriorated slightly during the season (p=0.005), especially from mid-season (97.5 [90.6-100.0]) to end-of-season (95.0 [87.5-100.0]) (p=0.003). Other subscale scores remained unchanged between time points; 85.7 (symptoms), 100.0 (daily living), 96.9 (sports and recreation) 100.0, (physical activities) and 90.0 (quality of life). Previous injuries were associated with lower HAGOS-scores. Dominant legs had higher abduction strength (p<0.001) and lower adduction/abduction ratio (p<0.001). No differences between leagues were found for hip muscle strength and HAGOS-scores. CONCLUSIONS: In Dutch male professional football players, hip muscle strength and HAGOS-scores remained relatively stable throughout the season. Pain increased slightly, which while statistically significant, was not clinically relevant.

A Cam Morphology Develops in the Early Phase of the Final Growth Spurt in Adolescent Ice Hockey Players: Results of a Prospective MRI-based Study.

BACKGROUND: Cam morphologies seem to develop with an increased prevalence in adolescent boys performing high-impact sports. The crucial question is at what age the cam morphology actually develops and whether there is an association with an aberration of the shape of the growth plate at the cam morphology site. QUESTIONS/PURPOSES: (1) What is the frequency of cam morphologies in adolescent ice hockey players, and when do they appear? (2) Is there an association between an extension of the physeal growth plate and the development of a cam morphology? (3) How often do these players demonstrate clinical findings like pain and lack of internal rotation? METHODS: A prospective, longitudinal MRI study was done to monitor the proximal femoral development and to define the appearance of cam morphologies in adolescent ice hockey players during the final growth spurt. Young ice hockey players from the local boys' league up to the age of 13 years (mean age 12 ± 0.5 years) were invited to participate. From 35 players performing on the highest national level, 25 boys and their parents consented to participate. None of these 25 players had to be excluded for known disease or previous surgery or hip trauma. At baseline examination as well as 1.5 and 3 years later, we performed a prospective noncontrast MRI scan and a clinical examination. The three-dimensional morphology of the proximal femur was assessed by one of the authors using radial images of the hip in a clockwise manner. The two validated parameters were: (1) the alpha angle for head asphericity (abnormal > 60°) and (2) the epiphyseal extension for detecting an abnormality in the shape of the capital physis and a potential correlation at the site of the cam morphology. The clinical examination was performed by one of the authors evaluating (1) internal rotation in 90° of hip and knee flexion and (2) hip pain during the anterior impingement test. RESULTS: Cam morphologies were most apparent at the 1.5-year follow-up interval (10 of 25; baseline versus 1.5-year follow-up: p = 0.007) and a few more occurred between 1.5 and 3 years (12 of 23; 1.5-year versus 3-year follow-up: p = 0.14). At 3-year follow-up, there was a positive correlation between increased epiphyseal extension and a high alpha angle at the anterosuperior quadrant (1 o'clock to 3 o'clock) (Spearman correlation coefficient = 0.341; p < 0.003). The prevalence of pain on the impingement test and/or restricted internal rotation less than 20° increased most between 1.5-year (1 of 25) and the 3-year follow-up (6 of 22; 1.5-year versus 3-year follow-up: p = 0.02). CONCLUSION: Our data suggest that a cam morphology develops early during the final growth spurt of the femoral head in adolescent ice hockey players predominantly between 13 to 16 years of age. A correlation between an increased extension of the growth plate and an increased alpha angle at the site of the cam morphology suggests a potential underlying growth disturbance. This should be further followed by high-resolution or biochemical MRI methods. Considering the high number of cam morphologies that correlated with abnormal clinical findings, we propose that adolescents performing high-impact sports should be screened for signs of cam impingement, such as by asking about hip pain and/or examining the patient for limited internal hip rotation. LEVEL OF EVIDENCE: Level I, prognostic study.

Capsular Management Techniques and Hip Arthroscopy.

There has been an increased emphasis on capsular management during hip arthroscopy in the literature in recent years. The capsule plays a significant role in the hip joint stability and studies have demonstrated that capsular closure can restore the biomechanics of the hip back to the native state. Capsular management also affects functional outcomes with capsular repair resulting in better clinical outcomes in some studies. Management of the capsule has evolved in recent years with more surgeons performing routine capsular closure. Management techniques and degree of capsular closure, however, can be quite variable between surgeons. This review will discuss hip capsular anatomy, the importance of the capsule in hip biomechanics, management of the capsule during arthroscopy, and functional outcomes as it relates to the various capsular closure techniques versus leaving the capsulotomy unrepaired.

Multifactorial Determinants of Running Injury Locations in 550 Injured Recreational Runners.

PURPOSE: Despite the health benefits of running, the prevalence of running-related injuries (RRI) remains high. The underlying risk factors between these injuries are still not well understood. Therefore, the aim of this study was to compare biomechanical, anthropometric, and demographic injury risk factors between different locations in injured recreational runners. METHODS: In this retrospective case-control analysis, 550 injured runners (49.6% female) with a medically diagnosed RRI were included. All runners had undergone an instrumented treadmill analysis to determine habitual footstrike pattern, vertical instantaneous load rate, peak vertical ground reaction force (vGRF) and cadence. Injuries were classified by location according to a recent consensus statement. A logistic regression model was used to determine the association between the biomechanical parameters and RRI locations. Because injuries can be associated with age, sex, and body mass index, these variables were also entered into the logistic regression. RESULTS: Strike pattern and peak vGRF were the only biomechanical variable distinguishing an injury from the group of injuries. A midfoot strike differentiated Achilles tendon injuries (odds ratio [OR], 2.27; 90% confidence interval [CI], 1.17-4.41) and a forefoot strike distinguished posterior lower leg injuries (OR, 2.59; 90% CI, 1.50-4.47) from the rest of the injured group. Peak vGRF was weakly associated with hip injuries (OR, 1.14; 90% CI, 1.05-1.24). Female sex was associated with injuries to the lower leg (OR, 2.65; 90% CI, 1.45-4.87) and hip/groin (OR, 2.22; 90% CI, 1.43-3.45). Male sex was associated with Achilles tendon injuries (OR, 1.923; 90% CI, 1.094-3.378). CONCLUSIONS: Sex, foot strike pattern, and vGRF were the only factors that distinguished specific injury locations from the remaining injury locations.

Changes in Knee and Trunk Alignment in People With Hip Pain and Healthy Controls When Using a Decline Board During Single-Leg Squat.

CONTEXT: Hip pain is associated with reduced hip muscle strength, range of movement (ROM), and decreased postural stability. Single-leg squat is a reliable and valid method to measure dynamic balance. OBJECTIVE: To evaluate the influence of physical characteristics and use of a decline board on squat performance in a hip pain population. DESIGN: Cross-sectional study setting. Clinical Patients: In total, 33 individuals scheduled for arthroscopic hip surgery were matched with 33 healthy controls. INTERVENTIONS: Hip and ankle ROM, hip strength, and trunk endurance were assessed, along with knee and trunk kinematics during squat on flat and 25° decline surfaces. MAIN OUTCOME MEASURES: Between-group and surface differences in alignment, between-group strength and ROM, and associations between alignment and physical characteristics were assessed and determined using mixed model analysis of variance and Pearson R. RESULTS: The hip pain group had significantly less strength and ROM for all directions except abduction strength and ankle dorsiflexion (P > .02). No differences existed between the 2 groups for trunk (P < .70) or knee displacement (P < .46) during squat on either surface. When the 2 groups were combined (n = 66), decline squat significantly reduced knee medial displacement in both limbs by approximately 1 cm (P < .01). Decline squat reduced trunk lateral movement on 1 side only (P = .03). Reduced knee displacement during decline squat showed fair association with less hip-extension strength (r = -.29), hip-flexion strength (r = -.25), and less dorsiflexion (r = -.24). Strength and range were not associated with trunk displacement. CONCLUSIONS: Decline squat reduced medial knee and lateral trunk displacement regardless of hip pain. Reductions may be greater in those with lesser hip muscle strength and dorsiflexion. Use of a decline board during squat for improving knee and trunk alignment should be considered as a goal of exercise intervention.

Performance and Return to Sport After Hip Arthroscopy in the National Basketball Association.

PURPOSE: To determine: (1) return to sport (RTS) rate in National Basketball Association (NBA) players following hip arthroscopy, (2) postoperative career length and games per season, (3) pre- and postoperative performance, and (4) postoperative performance compared with control players. METHODS: NBA athletes who underwent hip arthroscopy and matched controls were identified. RTS was defined as playing in at least 1 game after surgery. Player efficiency ratings were used for performance evaluation. Continuous variables of each group were compared using a 2-tailed paired samples Student t test for normally distributed data. χ2 was used to analyze categorical data. RTS was used as the primary outcome with statistical significance defined by a P value < .05. A Bonferroni correction was used to control for the remaining multiple comparisons with statistical significance defined by a P value ≤.008. RESULTS: Twenty-three players (24 hips) were analyzed (mean age 27.5 ± 3.1 years; mean experience in the NBA 5.8 ± 2.8 years at time of surgery). Small forwards (n = 8, 33.3%) represented the largest proportion of players that underwent hip arthroscopy. Twenty players (21 surgeries, 87.5%) were able to RTS in NBA at an average of 5.7 ± 2.6 months. The overall 1-year NBA career survival rate of players undergoing hip arthroscopy was 79.2%. Players in the control group (5.2 ± 3.5 years) had a similar career length as (P = .068) players who underwent surgery (4.4 ± 3.0 years). There was no significant (P = .045) decrease in games per season following surgery. There was no significant difference in performance postoperatively compared with preoperatively (P = .017) and compared with matched controls following surgery (P = .570). CONCLUSIONS: The RTS rate for NBA athletes after hip arthroscopy is high. There was no decrease in games played, career lengths, or performance following hip arthroscopy in NBA players versus preoperatively and matched controls. LEVEL OF EVIDENCE: Level III case-control study.

Demographic and Radiographic Factors Associated With Intra-articular Hip Cartilage Injury: A Cross-sectional Study of 1511 Hip Arthroscopy Procedures.

BACKGROUND: Moderate to severe (grade 3-4) hip joint cartilage injury seems to impair function in patients with femoroacetabular impingement syndrome. PURPOSE: To investigate whether demographic and radiographic factors were associated with moderate to severe hip joint cartilage injury. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Patients were identified in the Danish Hip Arthroscopy Registry. The outcome variables were acetabular cartilage injury (modified Beck grade 0-2 vs 3-4) and femoral head cartilage injury (International Cartilage Repair Society grade 0-2 vs 3-4). Logistic regressions assessed the association with the following: age (<30 vs 30-50 years); sex; sport activity level (Hip Sports Activity Scale); alpha angle (AA) assessed as normal (AA <55°), cam (55°≤ AA <78°), or severe cam (AA ≥78°); lateral center-edge angle (LCEA) assessed as normal (25°≤ LCEA ≤ 39°), pincer (LCEA >39°), or borderline dysplasia (LCEA <25°); joint space width (JSW) assessed as normal (JSW >4.0 mm), mild reduction (3.1 mm ≤ JSW ≤ 4.0 mm), or severe reduction (2.1 mm ≤ JSW ≤ 3.0 mm). RESULTS: A total of 1511 patients were included (mean ± SD age: 34.9 ± 9.8 years). Male sex (odds ratio [OR], 4.42), higher age (OR, 1.70), increased AA (cam: OR, 2.23; severe cam: OR, 4.82), and reduced JSW (mild: OR, 2.04; severe: OR, 3.19) were associated (P < .05) with Beck grade 3-4. Higher age (OR, 1.92), increased Hip Sports Activity Scale (OR, 1.13), borderline dysplasia (OR, 3.08), and reduced JSW (mild: OR, 2.63; severe: OR, 3.04) were associated (P < .05) with International Cartilage Repair Society grade 3-4. CONCLUSION: Several demographic and radiographic factors were associated with moderate to severe hip joint cartilage injury. Most notably, increased cam severity and borderline dysplasia substantially increased the risk of grade 3-4 acetabular and femoral head cartilage injury, respectively, indicating that specific deformity may drive specific cartilage injury patterns in the hip joint.

Hip Screening of a Professional Ballet Company Using Ultrasound-Assisted Physical Examination Diagnosing the At-Risk Hip.

The artistic nature of dance in combi- nation with the technical perfection required during performance makes it a highly demanding discipline. Starting at a young age, serious ballet students undergo long hours of training. Professional ballet dancers continue to train intensively in order to maintain their technical proficiency. Hip pathology in ballet dancers has been frequently reported in the literature, including femoroacetabular impingement syndrome, hip instability, muscle injuries, and early osteoarthritis. Screening programs to identify these hip joint pathologies (at- risk hips) in ballet dancers when they are still asymptomatic or their injury does not affect their performance are useful to aid in the development of prevention and treatment strategies. The purpose of this cross-sectional study was to identify hips at risk in the members of a professional ballet company using ultrasound-assisted physical examination. A high prevalence of cam lesions was detected in this cohort. Dancers with cam lesions were more likely to have an acetabular labral tear. In addition, there was a positive correlation between cam lesions and positive dial test, which is an indication of hip microinstability. Work of this kind can help to improve understanding of hip pathology in dancers and facilitate activity modification programs to prevent progression of their hip injuries.

Role of Hip Injury and Giving Way in Pain Exacerbation in Hip Osteoarthritis: An Internet-Based Case-Crossover Study.

OBJECTIVE: To evaluate the association between hip injury/giving way and hip pain exacerbations in patients with symptomatic hip osteoarthritis (OA). METHODS: We conducted an internet-based case-crossover study to assess hip injury and giving way for hip pain exacerbation. Eligible participants with symptomatic hip OA were followed up for 90 days and asked to complete online questionnaires at baseline and 10-day intervals (control periods). They also logged on to the study web site to complete questionnaires for an episode of a hip pain exacerbation (case periods) defined as an increase of 2 points in pain intensity compared with the baseline rating on a numeric rating scale (range 0-10). The relationship of hip injury and giving way to the risk of pain exacerbation was examined using conditional logistic regression. RESULTS: Of 252 patients recruited into the study, we included 133 patients (53%) who provided data from both case and control periods. Hip injury during the last 7 days increased the risk of hip pain exacerbation (odds ratio [OR] 2.74 [95% confidence interval (95% CI) 1.62-4.62]). The hip giving way during the last 2 days was associated with an increased risk of hip pain exacerbation (OR 2.10 [95% CI 1.30-3.39]) and showed a significant relationship between the number of hip giving way events and the risk of hip pain exacerbations (P < 0.001). CONCLUSION: Hip injury and episodes of the hip giving way were significantly related to pain exacerbation in patients with symptomatic hip OA. Methods to prevent exposure to injury may help to reduce the burden of pain in patients with hip OA.

Japanese version of the international PROMs "Vail Hip Score": Reliability, validity, and responsiveness according to the COSMIN checklist.

BACKGROUND: This study aimed to develop a Japanese version of the international PROMs "Vail Hip Score (Vail10)" and to establish its reliability, validity, and responsiveness with COSMIN check-list. METHODS: The study was conducted from March 2016 to October 2017 and included 46 patients totaling 47 joints. Disorders included 30 cases of FAI (55%), 13 cases of DDH (28%), and 4 others (8%). We administered an identical set of PROMs (5 measures: Japanese-version iHOT12 (pilot draft), Japanese-version Vail10, Japanese-version Oxford Hip Score, JHEQ, and SF36) twice in these subjects. We determined interclass correlation coefficients for the first and second round [ICC(1,2)], as well as the Cronbach α coefficient for patient responses to each of the 10 items in Vail10. In addition, we determined Spearman rank correlation coefficients of Vail10, OHS, JHEQ, satisfaction VAS, the 8 subscales of SF36, and the 3 QOL summary scores. RESULTS: ICC for the total score of all 10 items in Vail10 was 0.96. Cronbach α coefficient was 0.96. Bland-Altman plot analysis showed a solid agreement. Regarding the validity, Spearman rank correlation coefficients, only satisfaction VAS, and SF36 subscales of PF and BP had r > 0.45 (p < 0.01 in both administration rounds). The SDC (1.32) was smaller than the MIC (8.14). CONCLUSIONS: After developing the Japanese version of Vail10, we examined its Reliability, validity, and responsiveness by administering the measure to patients with acetabular labral tear. Correlations were strong and demonstrated the efficacy of the Japanese version of Vail10.

Recognizing and Managing Snapping Hip Syndrome in Dancers.

BACKGROUND: Snapping hip syndrome (SHS) is a common hip pathology in dancers. SHS can be either internal or external, resulting from muscle tendon tightness from repetitive hip flexion and extension, accompanied with hip abduction and/or external rotation. Muscular tightness may cause the tendon to become taut and snap over a bony prominence during hip movement, leading to muscular weakness and reduced range of motion from pain. Because SHS is poorly identified and can present similarly to other hip pathologies, many SHS incidences are underreported or misdiagnosed. Though SHS can begin as a harmless popping sensation, pain can become severe enough to limit dancers' activities and potentially result in the development of concomitant issues. EVALUATION: Physical examination for snapping hip includes moving the hip from flexion, abduction, and external rotation (FABER) into extension, adduction, and rotated to a neutral position. Dynamic ultrasound can also be used to study SHS, as using this method allows clinicians to observe the snapping tendon in real-time. Radiographs and magnetic resonance imaging may serve to rule out other differential diagnoses. MANAGEMENT: Conservative management through rehabilitative therapy is the standard for initial management. In severe cases, arthroscopic intervention may be useful in releasing tension in the pathological tendon. Active rest with training modifications should be attempted to mitigate further injury. CONCLUSION: Early and comprehensive examination and management can help to reduce SHS risk and potentially decrease the ability of this debilitating condition to derail a dancer's career.

Which Seems to Be Worst? Pain Severity and Quality of Life between Patients with Lateral Hip Pain and Low Back Pain.

Purpose: The aim of this study was to compare the pain severity, health-related quality of life (HRQoL), and risk of continue having pain with prognostic risk scores (PRS), between patients referring greater trochanteric pain syndrome (GTPS) and chronic low back pain (CLBP). Methods: A descriptive, cross-sectional design using nonprobability convenience sampling was performed. A total sample of 102 patients were recruited from two primary health-care centers and divided into GTPS (n = 51) and CLBP (n = 51) groups. The primary outcome was pain severity which was assessed with the Spanish version of the Graded Chronic Pain Scale (GCPS). The secondary outcome was the HRQoL which was measured using the Spanish version of EuroQoL Five Dimensions and Five Levels (EQ-5D-5L) as well as the PRS. Results: Significant differences (P<0.05) were found within both groups in the pain severity global score with a medium effect size showing greater values for the CLBP group with regards to the GTPS group. The PRS in both groups did not show statistical differences (P>0.05). Nevertheless, subjects referring CLBP showed greater levels in the PRS than patients with GTPS. Comparing both groups, the HRQoL showed statistical differences (P<0.05) in the "pain/discomfort" domain in the CLBP group with respect to the GTPS group, but not in the other domains. Conclusions: Patients who suffered from CLBP showed greater pain severity and HRQoL discomfort with regard to patients with GTPS. Despite greater scores for CLBP, the PRS did not seem to be different between both conditions.

Hip Arthroscopy - State of the Art in 2018.

The field of hip arthroscopy has undergone considerable change in the past 25 years and continues to evolve at a rapid pace. Lessons from the early complications and challenges of hip arthroscopy have led to improved safety and refinement of instrumentation and techniques. The pathophysiology of hip injuries is better understood, and advances in surgical technique have helped expand indications, particularly as a shift from pathology resection to anatomic repair and reconstructive procedures has occurred. As the field has progressed, longitudinal outcome studies are now available to help judge efficacy. The purpose of this review is to highlight the past 30 years of hip arthroscopy, the current practice trends, and future directions of the field.

Posterior Bony Impingement-Potential Mechanism of Ligamentum Teres Tears.

PURPOSE: To describe a potential causal mechanism of ligamentum teres (LT) tears, a specific treatment for posterior impingement of the LT, and to report the minimum 2-year outcome of this treatment. METHODS: We retrospectively reviewed data collected from 1,251 hip arthroscopies performed by the senior surgeon over a 26-month period. During this time, 424 LT tears were identified including 9 patients with isolated partial LT tears caused by impingement of the LT against a prominent acetabular fossa posterior wall and no other intra-articular pathology. All 9 patients were treated with LT tear debridement and excision of the impinging bony prominence using an arthroscopic burr. Patients were followed with a modified Harris hip score and nonarthritic hip score for a minimum of 24 months (mean, 29 months; range, 24-38 months). RESULTS: After surgery, all patients returned to their preinjury level of activity. The modified Harris hip score increased from a mean of 58.9 preoperatively (range, 41.8-84.7) to 89.2 (range, 70.3.5-96.7) (P = .02) at a minimum of 2-year follow-up. Similarly, the nonarthritic hip score increased from a mean of 56.2 (range, 35-90) to 91.9 (range, 81.5-98.5) (P = .01) at a minimum of 2 years after surgery. There were no complications associated with the procedure and no revision surgeries performed over the 2-year follow-up. CONCLUSIONS: LT tears may, very uncommonly, be caused by impingement of the mid-part of the ligament against a prominent posterior acetabular fossa edge. In this group of 9 cases, debridement of the torn ligament segment, in combination with resection of the impinging bone, was associated with marked symptomatic improvement and full return to activities for a minimum of 2 years. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Risk Factors for Groin Injury and Groin Symptoms in Elite-Level Soccer Players: A Cohort Study in the Dutch Professional Leagues.

Background Groin injury and groin symptoms are common in soccer players. The relationship of groin injury and groin symptoms to reduced hip range of motion (ROM) and previous injury is unclear. Objectives To conduct a retrospective assessment of associations between previous injury and preseason hip ROM and preseason prevalence of severe groin symptoms, and to prospectively identify risk factors for within-season groin injury. Methods During the period of 2015 to 2016, 190 players from 9 Dutch professional soccer clubs participated in this cohort study with prospective and retrospective elements. Univariate and multivariate logistic regressions were used to predict preseason severe groin symptoms, identified using the Copenhagen Hip and Groin Outcome Score, from a history of previous groin injury, general injury (minimum of 1 week in duration) in the previous season, and hip ROM. Cox regression was used to predict within-season groin injury. Results Point prevalence of severe groin symptoms was 24% and within-season incidence of groin injury was 11%. Total, training, and match groin injury incidences were 0.5, 0.2, and 2.6 injuries per 1000 playing hours, respectively. A history of more than 1 previous groin injury was associated with current severe groin symptoms (odds ratio = 3.0; 95% confidence interval: 1.0, 8.3; P = .038). General injury sustained in the previous season (ankle, knee, thigh, shoulder; median, 9 weeks of time loss) was a risk factor for groin injury (hazard ratio = 5.1; 95% confidence interval: 1.8, 14.6; P = .003). Conclusion Severe injuries in the previous season to locations other than the groin increase the risk of groin injury the next season. A history of groin injury is associated with current severe groin symptoms. Preseason hip ROM does not identify players at risk for groin injury. Level of Evidence Prevention, level 2b. J Orthop Sports Phys Ther 2018;48(9):704-712. Epub 23 May 2018. doi:10.2519/jospt.2018.7990.

Arthroscopic Surgical Procedures Versus Sham Surgery for Patients With Femoroacetabular Impingement and/or Labral Tears: Study Protocol for a Randomized Controlled Trial (HIPARTI) and a Prospective Cohort Study (HARP).

Study Design Study protocol for a randomized controlled trial and a prospective cohort. Background The number of arthroscopic surgical procedures for patients with femoroacetabular impingement syndrome (FAIS) has significantly increased worldwide, but high-quality evidence of the effect of such interventions is lacking. Objectives The primary objective will be to determine the efficacy of hip arthroscopic procedures compared to sham surgery on patient-reported outcomes for patients with FAIS (HIP ARThroscopy International [HIPARTI] Study). The secondary objective will be to evaluate prognostic factors for long-term outcome after arthroscopic surgical interventions in patients with FAIS (Hip ARthroscopy Prospective [HARP] Study). Methods The HIPARTI Study will include 140 patients and the HARP Study will include 100 patients. The international Hip Outcome Tool-33 will be the primary outcome measure at 1 year. Secondary outcome measures will be the Hip disability and Osteoarthritis Outcome Score, Arthritis Self-Efficacy Scale, fear of movement (Tampa Scale of Kinesiophobia), Patient-Specific Functional Scale, global rating of change score, and expectations. Other outcomes will include active hip range of motion, hip muscle strength tests, functional performance tests, as well as radiological assessments using radiographs and magnetic resonance imaging. Conclusion To determine the true effect of surgery, beyond that of placebo, double-blinded placebo-controlled trials including sham surgery are needed. The HIPARTI Study will direct future evidence-based treatment of FAIS. Predictors for long-term development and progression of degenerative changes in the hip are also needed for this young patient group with FAIS; hence, responders and nonresponders to treatment could be determined. J Orthop Sports Phys Ther 2018;48(4):325-335. doi:10.2519/jospt.2018.7931.

Atrapamientos y choques extraarticulares de la cadera: revisión de la literatura / Extra-articular hip impingement: a review of the literature

El dolor inguinal o de cadera es un motivo de consulta muy frecuente. Debido a las múltiples causas que pueden generarlo, y a que en muchas ocasiones comparten características clínicas y demográficas, las pruebas de imagen desempeñan un papel complementario en el diagnóstico etiológico. Se han descrito nuevas formas de atrapamiento extraarticular de la cadera como causa de dolor y limitación funcional, en especial en pacientes jóvenes activos. Incluyen el atrapamiento isquiofemoral, el choque subespinoso o de la espina iliaca anteroinferior, el atrapamiento del iliopsoas y el choque pélvico-trocantéreo. De forma general, se deben a un problema mecánico que conduce al contacto anormal o excesivo entre el fémur proximal y la pelvis ósea, o las partes blandas interpuestas. Realizamos una revisión actualizada de estas formas de atrapamiento extraarticular de la cadera, describiendo la fisiopatología, las manifestaciones clínicas, los hallazgos radiológicos más comunes y el tratamiento

Hip and groin pain is a common clinical problem. Multiple causes can generate hip or groin pain, often sharing clinical and demographic characteristics. Diagnostic imaging tests play an important role in the etiological diagnosis. New forms of extra-articular hip impingement have recently been recognized as a cause of hip pain and limited function especially in young active patients. These conditions include ischiofemoral impingement, anterior inferior iliac spine and subspine impingement, iliopsoas impingement and greater trochanteric-pelvic impingement. In general, they are caused by a mechanical conflict with an abnormal or excessive contact between the proximal femur and pelvis and/or soft tissue between them. In this manuscript we review the physiopathology, clinical presentation, the most common radiologic findings and treatment of these forms of extra-articular hip impingement

The Development and Validation of a Subjective Assessment Tool for the Hip in the Athletic Population.

BACKGROUND: No validated functional assessments are available that are designed specifically to evaluate the performance and function of the athletic hip. Subsections of some validated outcome assessments address recreation, but a full assessment dedicated to athletic hip function does not exist. Current hip scoring systems may not be sensitive to subtle changes in performance and function in an athletic, younger population. HYPOTHESIS: The patient-athlete subjective scoring system developed in this study will be validated, reliable, and responsive in the evaluation of hip function in the athlete. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Based on the results of a pilot questionnaire administered to 18 athletic individuals, a final 10-item questionnaire was developed. Two hundred fifty competitive athletes from multiple sports completed the final questionnaire and 3 previously validated hip outcome assessments. Each athlete was self-assigned to 1 of 3 injury categories: (1) playing without hip/groin trouble; (2) playing, but with hip/groin trouble; and (3) not playing due to hip/groin trouble. The injury categories contained 196, 40, and 14 athletes, respectively. Correlations between the assessment scores and injury categories were measured. Responsiveness testing was performed in an additional group of 24 injured athletes, and their scores before and after intervention were compared. RESULTS: The Kerlan-Jobe Orthopaedic Clinic (KJOC) Athletic Hip Score showed high correlation with the modified Harris Hip Score, the Nonarthritic Hip Score, and the International Hip Outcome Tool. The new score stratified athletes by injury category, demonstrated responsiveness and accuracy, and varied appropriately with improvements in injury category after treatment of injuries. CONCLUSION: The new KJOC Athletic Hip Score is valid, reliable, and responsive for evaluation of the hip in an athletic population. The results support its use for the functional assessment of the hip in future studies.

Radiographic Hip Anatomy Correlates With Range of Motion and Symptoms in National Hockey League Players.

BACKGROUND: Hip disorders in athletes have been increasingly recognized. PURPOSE: To characterize radiographic hip anatomy for National Hockey League (NHL) players and correlate it with hip range of motion and hip symptoms and/or surgery. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Fifty-nine professional hockey players (118 hips) with 1 NHL organization (mean age, 24.2 years; range, 18-36) prospectively underwent history and physician examination by 2 independent orthopaedic surgeons. Current or previous groin and/or hip pain or surgery was noted. Anteroposterior (AP) pelvis and bilateral Dunn lateral radiographs were obtained for all players with assessment of hip morphology by 2 blinded independent orthopaedic surgeons. RESULTS: Good to very good reliability of radiographic assessments was noted (intraclass correlation coefficients = 0.749-0.958). Sixty-four percent of athletes had a positive crossover sign, while 86% and 60% had a positive posterior wall sign and a prominent ischial spine sign, respectively. Twenty-one percent of hips demonstrated dysplastic acetabular features (lateral center edge angle <25°). Eighty-five percent and 89% of hips demonstrated cam-type morphology based on alpha angle (>50° Dunn lateral) and head-neck offset, respectively. Good to very good reliability was noted for ROM assessments (intraclass correlation coefficient >0.69). Mean hip flexion was 107.4º ± 6.7º, and mean hip internal rotation was 26.1º ± 6.6º. Thirty-one percent of hips had a history of hip-related pain and/or surgery. Higher AP, Dunn lateral, and maximal alpha angles correlated with decreased hip internal rotation ( P = .004). Greater AP alpha angle correlated with decreased hip extension/abduction ( P = .025), and greater Dunn lateral and maximal alpha angle correlated with decreased hip flexion/abduction ( P = .001). A positive posterior wall sign correlated with increased straight hip abduction, while other radiographic acetabular parameters were not predictive of range of motion. Only decreased hip external rotation and total arc of motion correlated with an increased risk for current or prior hip symptoms or surgery ( P < .001). CONCLUSION: Hip anatomy in NHL players is characterized by highly prevalent cam-type morphology (>85%) and acetabular retroversion (>60%). In addition, acetabular dysplasia (21%) was relatively common. Greater cam-type morphology correlated with decreased hip range of motion, and a positive crossover sign correlated with increased hip abduction. Decreased hip external rotation and total arc of motion were predictive of hip-related pain and/or surgery.

Effects of hip joint transverse plane range of motion with a modeled effusion and capsular tear: A cadaveric study.

BACKGROUND: Multiple factors contribute to range of motion of the hip joint in the transverse plane: bony anatomy, hip capsule, corresponding ligaments, articular labrum, ligamentum teres, and negative intra-articular pressure. We hypothesized that violation of the negative pressure of the hip and simulation of an effusion would increase range of motion in the transverse plane in a cadaver model. METHODS: Ten hip specimens were obtained and dissected with the femur and iliac wing mounted in a custom joint-testing rig in neutral position. Specimens were tested at 0 and at 90° of flexion with 1.5Nm internal and external rotational torque. Three conditions were assessed: (1) intact specimen, (2) an effusion modeled by a 10ml saline infusion, and (3) a capsular tear. FINDINGS: The modeled effusion decreased rotational range of motion limits in both 0 and 90° of flexion, with a greater effect on the specimens at 0° flexion in external rotation with 4.1° less external rotation (p=0.009). A modeled capsular tear increased rotational motion limits in 0° of flexion in both internal and external rotation and in 90° flexion in internal rotation only (p<0.025). INTERPRETATION: An effusion may decrease the rotation of the hip, and a capsular tear may increase its rotation. This should be considered in hips with traumatic capsular tears or arthroscopic portals.