Dataset Information

Characterization and Correction of Symptomatic Hip Impingement in American Football Linemen.

ABSTRACT:

Background

Femoroacetabular impingement (FAI) morphology can lead to range-of-motion deficits in football players. It is therefore important for physicians treating these players to be aware of the location and implications of FAI morphology.

Purpose/questions

We sought to characterize the radiographic deformity and dynamic impingement observed in a consecutive series of American football linemen with symptomatic, mechanical hip pain who underwent surgical treatment for FAI and to use software analysis to identify the location of impingement and terminal range of motion and the effects of simulated correction.

Methods

A retrospective analysis was conducted of 17 hips in 13 football linemen who underwent arthroscopic correction for symptomatic FAI. Computed tomography (CT) scans were used to generate preoperative three-dimensional models of the hips. Femoral and acetabular measurements, maximum hip flexion, abduction, internal rotation at 90° flexion (IR90), and flexion/adduction/internal rotation (FADIR) were determined, and areas of bony collision were defined. Simulated femoral correction was performed and motion analysis was repeated.

Results

Mean femoral version was 13.1° (range, 0 to 26°), while mean femoral neck-shaft angle was 132.1° (range, 123 to 145°). Mean maximum alpha angle on the radial reformatted CT was 69.2° (range, 48 to 95°) and was located at the 12:45 clock-face position (range, 11:30 to 2:15). Mean acetabular version values at 1:30 and 3:00 were 1.1° (range, -?11 to 11°) and 12.7° (range, 2 to 20°), respectively. Fifty-three percent of hips showed a "crossover" sign. Mean lateral center-edge angle was 31.7° (range, 25 to 44°). CT-derived motion analysis demonstrated a mean preoperative flexion of 108.2° (range, 73 to 127°), IR90 of 20.5° (range, 0 to 52°), and FADIR of 12.3° (range, 0 to 39°). Simulated correction resulted in significant improvements in flexion (6.6°), IR90 (11.3°), and FADIR (10.6°).

Conclusions

While cephalad retroversion was observed in approximately half of the hips, a significant cam deformity was seen maximally at 12:45, a more posterior cam location than that of the general population. Managing this pathology required obtaining preoperative and intraoperative images to characterize lesions and allow for their complete correction. With complete correction of the deformity, simulated range of motion demonstrated significant improvement in flexion, IR90, and FADIR maneuvers.

SUBMITTER: Ross JR

PROVIDER: S-EPMC6031539 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Publications

Characterization and Correction of Symptomatic Hip Impingement in American Football Linemen.

Ross James R JR Khan Moin M Noonan Benjamin C BC Larson Christopher M CM Kelly Bryan T BT Bedi Asheesh A

HSS journal : the musculoskeletal journal of Hospital for Special Surgery 20180305 2

<h4>Background</h4>Femoroacetabular impingement (FAI) morphology can lead to range-of-motion deficits in football players. It is therefore important for physicians treating these players to be aware of the location and implications of FAI morphology.<h4>Purpose/questions</h4>We sought to characterize the radiographic deformity and dynamic impingement observed in a consecutive series of American football linemen with symptomatic, mechanical hip pain who underwent surgical treatment for FAI and to ...[more]

PMID: 29983653

Similar Datasets

Project description:ObjectiveTo compare arthroscopic hip surgery with physiotherapy and activity modification for improving patient reported outcome measures in patients with symptomatic femoroacetabular impingement (FAI).DesignTwo group parallel, assessor blinded, pragmatic randomised controlled trial.SettingSecondary and tertiary care centres across seven NHS England sites.Participants222 participants aged 18 to 60 years with symptomatic FAI confirmed clinically and with imaging (radiography or magnetic resonance imaging) were randomised (1:1) to receive arthroscopic hip surgery (n=112) or a programme of physiotherapy and activity modification (n=110). Exclusion criteria included previous surgery, completion of a physiotherapy programme targeting FAI within the preceding 12 months, established osteoarthritis (Kellgren-Lawrence grade ≥2), and hip dysplasia (centre-edge angle <20 degrees).InterventionsParticipants in the physiotherapy group received a goal based programme tailored to individual patient needs, with emphasis on improving core stability and movement control. A maximum of eight physiotherapy sessions were delivered over five months. Participants in the arthroscopic surgery group received surgery to excise the bone that impinged during hip movements, followed by routine postoperative care.Main outcome measuresThe primary outcome measure was the hip outcome score activities of daily living subscale (HOS ADL) at eight months post-randomisation, with a minimum clinically important difference between groups of 9 points. Secondary outcome measures included additional patient reported outcome measures and clinical assessment.ResultsAt eight months post-randomisation, data were available for 100 patients in the arthroscopic hip surgery group (89%) and 88 patients in the physiotherapy programme group (80%). Mean HOS ADL was 78.4 (95% confidence interval 74.4 to 82.3) for patients randomised to arthroscopic hip surgery and 69.2 (65.2 to 73.3) for patients randomised to the physiotherapy programme. After adjusting for baseline HOS ADL, age, sex, and study site, the mean HOS ADL was 10.0 points higher (6.4 to 13.6) in the arthroscopic hip surgery group compared with the physiotherapy programme group (P<0.001)). No serious adverse events were reported in either group.ConclusionsPatients with symptomatic FAI referred to secondary or tertiary care achieve superior outcomes with arthroscopic hip surgery than with physiotherapy and activity modification.Trial registrationClinicalTrials.gov NCT01893034.

Project description:BackgroundDynamic 3-dimensional (3D) simulation of hip impingement enables better understanding of complex hip deformities in young adult patients with femoroacetabular impingement (FAI). Deep learning algorithms may improve magnetic resonance imaging (MRI) segmentation.Purpose(1) To evaluate the accuracy of 3D models created using convolutional neural networks (CNNs) for fully automatic MRI bone segmentation of the hip joint, (2) to correlate hip range of motion (ROM) between manual and automatic segmentation, and (3) to compare location of hip impingement in 3D models created using automatic bone segmentation in patients with FAI.Study designCohort study (diagnosis); Level of evidence, 3.MethodsThe authors retrospectively reviewed 31 hip MRI scans from 26 symptomatic patients (mean age, 27 years) with hip pain due to FAI. All patients had matched computed tomography (CT) and MRI scans of the pelvis and the knee. CT- and MRI-based osseous 3D models of the hip joint of the same patients were compared (MRI: T1 volumetric interpolated breath-hold examination high-resolution sequence; 0.8 mm3 isovoxel). CNNs were used to develop fully automatic bone segmentation of the hip joint, and the 3D models created using this method were compared with manual segmentation of CT- and MRI-based 3D models. Impingement-free ROM and location of hip impingement were calculated using previously validated collision detection software.ResultsThe difference between the CT- and MRI-based 3D models was <1 mm, and the difference between fully automatic and manual segmentation of MRI-based 3D models was <1 mm. The correlation of automatic and manual MRI-based 3D models was excellent and significant for impingement-free ROM (r = 0.995; P < .001), flexion (r = 0.953; P < .001), and internal rotation at 90° of flexion (r = 0.982; P < .001). The correlation for impingement-free flexion between automatic MRI-based 3D models and CT-based 3D models was 0.953 (P < .001). The location of impingement was not significantly different between manual and automatic segmentation of MRI-based 3D models, and the location of extra-articular hip impingement was not different between CT- and MRI-based 3D models.ConclusionCNN can potentially be used in clinical practice to provide rapid and accurate 3D MRI hip joint models for young patients. The created models can be used for simulation of impingement during diagnosis of intra- and extra-articular hip impingement to enable radiation-free and patient-specific surgical planning for hip arthroscopy and open hip preservation surgery.

Dataset Information

Characterization and Correction of Symptomatic Hip Impingement in American Football Linemen.

Background

Purpose/questions

Methods

Results

Conclusions

Publications

Characterization and Correction of Symptomatic Hip Impingement in American Football Linemen.

Similar Datasets

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