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Do Neuromuscular Alterations Exist for Patients With Acetabular Labral Tears During Function?

ABSTRACT: To determine if contact forces and electromyography (EMG) muscle amplitudes were altered during the lunge for patients with symptomatic labral tears compared with asymptomatic control subjects.Surface electromyography electrodes were placed over the gluteus medius, gluteus maximus, adductor longus, and rectus femoris muscles of the patients' involved limb and matched limb of asymptomatic controls. Subjects performed 3 trials of the lunge on a clinical force platform. An electrogoniometer tracked knee flexion motion during testing. Average root mean squared EMG muscle amplitudes for each muscle were calculated for the descent and ascent phases of the lunge, represented as a percentage of maximum activity (%MVIC). Peak knee flexion was calculated from the goniometer (°). The dependent variables from the force platform were lunge distance (%height), contact time (seconds), vertical impact force (%BW), and force impulse (%BW*s). Dependent variables were compared between groups using either independent samples t tests or Mann-Whitney U tests. Relations between dependent variables were assessed with Spearman Rho correlation coefficients. The level of significance was set at P ≤ .05.Twenty-one patients with symptomatic unilateral labral tears (14 females, 7 males) and 17 asymptomatic control subjects (11 females, 6 males) participated in this study. Average gluteus maximus EMG muscle amplitudes were reduced for symptomatic labral patients compared with asymptomatic controls during lunge ascent (51.6 ± 31.1 v 71.7 ± 36.3 [mean difference (MD): 20.1% (-2.4%, 42.6%)], P = .042). Average vertical impact force was reduced (21.8 ± 5.5 v 26.8 ± 7.3 [MD: 5.1%BW (0.84%BW, 9.3%BW)], P = .02) and average contact time (1.8 ± 0.4 v 1.5 ± 0.4 [MD: 0.27 seconds (0.006 seconds, 0.54 seconds)], P = .045) and force impulse (188.4 ± 42.4 v 162.6 ± 33.3 [MD: 25.8%BW*s (0.3%BW*s, 51.4%BW*s)], P = .042) were increased for symptomatic labral patients compared with asymptomatic controls. Vertical impact force was inversely correlated with gluteus medius muscle amplitudes during lunge descent for symptomatic labral patients (r = -0.452, P = .045).Our study shows that contact forces and EMG muscle amplitudes are altered during the lunge for patients with symptomatic labral tears. The presence of a relation between muscle amplitudes and contact forces suggests that targeting muscle impairments may restore function in these patients.Level III, case-control study.

SUBMITTER: Dwyer MK

PROVIDER: S-EPMC5568890 | biostudies-other | 2016 Jun

REPOSITORIES: biostudies-other

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Project description:PurposeThe purpose of this study was to systematically review the evidence in the literature to ascertain whether acetabular labral repair (ALR) or debridement (ALD) resulted in superior patient outcomes.MethodsThe systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Peer-reviewed studies comparing ALR and ALD published in English with full text available were included. Patients undergoing both open and arthroscopic surgery in randomized controlled trials, prospective cohort studies, retrospective cohort studies, and case-control studies were included. Studies were quantified for methodological quality using the MINORS criteria. Clinical outcomes were compared, with qualitative analysis, and quantitative analyses were performed using GraphPad Prism version 7. A P value <.05 was considered to be statistically significant.ResultsThere were 8 studies included (level of evidence [LOE] I = 1; LOE II = 2; LOE III = 5). The 7 studies compared 364 patients (369 hips) with ALR to 318 patients (329 hips) with ALD, with a mean follow-up time ranging between 32-120 months. Five studies found significantly improved patient reported outcomes with ALR (Harris Hip Score, Merle d'Aubigné, Pain, SF-12). Several studies compared the outcomes after ALR and ALD and found statistical significance in all investigated metrics in favor of ALR. One study found a significant improvement in abduction but no other study found any difference in range of motion. No study found any difference in complication rate, revision rate or conversion to total hip arthroplasty. Although, 2 studies found ALR reduced the rate of osteoarthritic progression.ConclusionCurrent literature suggests that acetabular labral repair may result in superior patient reported outcomes. However, there appears to be no significant difference in the rate of progression to total hip arthroplasty at up to 10-year follow-up.Level of evidenceLevel III, systematic review of Level I, II, and III studies.

Project description:ContextSymptomatic femoroacetabular impingement syndrome (FAIS) is a painful condition that leads to decreased function. How walking gait changes over time within the first year after surgery for FAIS and how these changes present in women are currently unknown.ObjectiveTo determine biomechanical gait differences between women with FAIS or labral tears and control individuals preoperatively and at 3 and 6 months postoperatively.DesignCase-control study.SettingLaboratory.Patients or other participantsA total of 18 female participants comprising 9 women in the FAIS group (age = 31.44 ± 7.47 years, height = 1.73 ± 0.08 m, mass = 73.61 ± 14.44 kg) and 9 women in the control group (age = 31.44 ± 6.65 years, height = 1.69 ± 0.06 m, mass = 60.93 ± 5.58 kg).Main outcome measure(s)Between-groups comparisons of the Hip Outcome Score Activities of Daily Living subscale (HOSADL) and gait biomechanics were conducted preoperatively and at the 3- and 6-month postoperative sessions. Statistical parametric mapping was performed on normalized time-series data.ResultsPreoperatively, the FAIS group had poor HOSADL scores (FAIS group = 64.1 ± 15.4 versus control group = 100.0 ± 0, P < .001), walked 15% slower, and exhibited several gait differences compared with the control group. Three months postoperatively, the FAIS group displayed greater vertical ground reaction force (P = .01), ankle-dorsiflexion angle (P = .02), and external dorsiflexion moment (P = .01) in midstance, as well as a greater knee-flexion angle through the second half of stance (P < .001). The FAIS group also demonstrated less hip-extension angle (P = .02) and hip-abduction angle (P = .01) through the second half of stance, which transitioned into less hip extension (P = .040) and hip abduction (P = .03) during the subsequent swing phase. The FAIS group improved their HOSADL to 87.6 ± 7.6 by 6 months postoperatively and had a greater dorsiflexion moment (P = .003) and ankle external rotation during stance (P = .03). In addition, the FAIS group showed a greater external hip external-rotation moment in late stance (P < .001).ConclusionsThe biomechanical differences between groups were most evident at 3 months postoperatively, suggesting that women with FAIS had more postoperative gait compensations in the short term after surgery. By 6 months postoperatively, patient-reported outcomes had markedly improved, and the FAIS group displayed few gait differences compared with the control group.

Project description:BackgroundThis study aimed to systematically evaluate the value of magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) in the diagnosis of acetabular labral tears.MethodsDatabases including PubMed, Embase, Cochrane Library, Web of Science, CBM, CNKI, WanFang Data, and VIP were electronically searched to collect relevant studies on magnetic resonance in the diagnosis of acetabular labral tears from inception to September 1, 2021. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias in the included studies by using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. RevMan 5.3, Meta Disc 1.4, and Stata SE 15.0 were used to investigate the diagnostic value of magnetic resonance in patients with acetabular labral tears.ResultsA total of 29 articles were included, involving 1385 participants and 1367 hips. The results of the meta-analysis showed that the pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, pooled diagnostic odds ratio, area under the curve of the summary receiver operating characteristic, and Q* of MRI for diagnosing acetabular labral tears were 0.77 (95% confidence interval [CI], 0.75-0.80), 0.74 (95% CI, 0.68-0.80), 2.19 (95% CI, 1.76-2.73), 0.48 (95% CI, 0.36-0.65), 4.86 (95% CI, 3.44-6.86), 0.75, and 0.69, respectively. The pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, pooled diagnostic odds ratio, area under the curve of the summary receiver operating characteristic, and Q* of MRA for diagnosing acetabular labral tears were 0.87 (95% CI, 0.84-0.89), 0.64 (95% CI, 0.57-0.71), 2.23 (95% CI, 1.57-3.16), 0.21 (95% CI, 0.16-0.27), 10.47 (95% CI, 7.09-15.48), 0.89, and 0.82, respectively.ConclusionMRI has high diagnostic efficacy for acetabular labral tears, and MRA has even higher diagnostic efficacy. Due to the limited quality and quantity of the included studies, the above results should be further validated.

Project description:PurposeTo assess the relationship of acetabular version with the length of the anterior and posterior labrum and to introduce a developed metric, the labral index, as a means of controlling for femoral head size when measuring labral length.MethodsOne hundred forty-eight patients who underwent hip arthroscopies for femoroacetabular impingement from October 2017 to October 2019 by a single hip surgeon were retrospectively reviewed. Magnetic resonance imaging arthrogram was used to measure central acetabular version (at the center of the femoral head) and cranial acetabular version (at the midpoint between the acetabular roof and center of the femoral head), as well as labral length at the anterior, posterior, and superolateral locations (3, 9, and 12 o'clock, respectively). Labral index was calculated by dividing anterior, posterior, and superolateral labral lengths by the radius of the femoral head. Pearson correlation analysis was used to assess the association between the 2 continuous variables. A priori alpha of 0.05 was established as the cutoff for significance.ResultsForty-three patients (26 female, 17 male) with an average age of 34.2 ± 11.6 years were included in analysis. Increased central anteversion was significantly associated with a larger anterior labral length and index (P = .023, r = 0.343 and .005, r = 0.415, respectively). Cranial anteversion weakly correlated with a significantly increased anterior labral index (P = .047, r = 0.304) but not with larger anterior labral length (P = .089, r = 0.262). No statistically significant association was present for central or cranial version with posterior or superolateral labral measurements. Lateral center edge angle did not correlate with labral size at any location.ConclusionsIn patients undergoing hip arthroscopy for symptomatic femoroacetabular impingement, greater acetabular anteversion was significantly associated but weakly correlated with increased anterior labral length, whereas no association was found between posterior labral length and acetabular version. The labral index may be a useful metric to normalize labral length relative to the radius of the femoral head that warrants further investigation for its clinical utility in guiding labral reconstruction versus labral repair.Level of evidenceLevel IV, diagnostic case series.

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Do Neuromuscular Alterations Exist for Patients With Acetabular Labral Tears During Function?

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