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      Physical Therapy Protocol After Hip Arthroscopy : Clinical Guidelines Supported by 2-Year Outcomes

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Context:

          Femoroacetabular impingement (FAI) was first described by Ganz in 2003 and is a significant cause of decreased function and mobility. Femoroacetabular impingement must be treated in an individualized, goal-oriented, stepwise fashion. This protocol was developed with biomechanical considerations of soft tissue and bony structures surrounding the hip joint.

          Evidence Acquisition:

          The PubMed database was searched for scientific and review articles from the years 2000 to 2015 utilizing the search terms: hip rehabilitation, femoroacetabular impingement, and arthroscopy.

          Study Design:

          Clinical review.

          Level of Evidence:

          Level 5.

          Results:

          Five hundred ninety-five of 738 patients were available for follow-up showing improvement from preoperative to 2-year follow-up of 61.29 to 82.02 for modified Harris Hip Score (mHHS), 62.79 to 83.04 for Hip Outcome Score–Activities of Daily Living (HOS-ADL), 40.96 to 70.07 for Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), and 57.97 to 80.41 for Non-Arthritic Hip Score (NAHS); visual analog scale (VAS) scores decreased from 5.86 preoperatively to 2.94 postoperatively.

          Conclusion:

          Following a structured, criteria-based program, appropriate patients undergoing hip arthroscopy may achieve excellent outcomes and return to full independent activities of daily living as well as sport.

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          Most cited references18

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          Femoroacetabular impingement: a cause for osteoarthritis of the hip.

          Reinhold Ganz, Javad Parvizi, Martin Beck … (2003)
          A multitude of factors including biochemical, genetic, and acquired abnormalities may contribute to osteoarthritis of the hip. Although the pathomechanism of degenerative process affecting the dysplastic hip is well understood, the exact pathogenesis for idiopathic osteoarthritis has not been established. Based on clinical experience, with more than 600 surgical dislocations of the hip, allowing in situ inspection of the damage pattern and the dynamic proof of its origin, we propose femoroacetabular impingement as a mechanism for the development of early osteoarthritis for most nondysplastic hips. The concept focuses more on motion than on axial loading of the hip. Distinct clinical, radiographic, and intraoperative parameters can be used to confirm the diagnosis of this entity with timely delivery of treatment. Surgical treatment of femoroacetabular impingement focuses on improving the clearance for hip motion and alleviation of femoral abutment against the acetabular rim. It is proposed that early surgical intervention for treatment of femoroacetabular impingement, besides providing relief of symptoms, may decelerate the progression of the degenerative process for this group of young patients.
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            Valgus knee motion during landing in high school female and male basketball players.

            Kevin R. Ford, Gregory D. Myer, Timothy Hewett (2003)
            The purpose of this study was to utilize three-dimensional kinematic (motion) analysis to determine whether gender differences existed in knee valgus kinematics in high school basketball athletes when performing a landing maneuver. The hypothesis of this study was that female athletes would demonstrate greater valgus knee motion (ligament dominance) and greater side-to-side (leg dominance) differences in valgus knee angle at landing. These differences in valgus knee motion may be indicative of decreased dynamic knee joint control in female athletes. Eighty-one high school basketball players, 47 female and 34 male, volunteered to participate in this study. Valgus knee motion and varus-valgus angles during a drop vertical jump (DVJ) were calculated for each subject. The DVJ maneuver consisted of dropping off of a box, landing and immediately performing a maximum vertical jump. The first landing phase was used for the analysis. Female athletes landed with greater total valgus knee motion and a greater maximum valgus knee angle than male athletes. Female athletes had significant differences between their dominant and nondominant side in maximum valgus knee angle. The absence of dynamic knee joint stability may be responsible for increased rates of knee injury in females but is not normally measured in athletes before participation. No method for accurate and practical screening and identification of athletes at increased risk of ACL injury is currently available to target those individuals that would benefit from neuromuscular training before sports participation. Prevention of female ACL injury from five times to equal the rate of males would allow tens of thousands of young females to avoid the potentially devastating effects of ACL injury on their athletic careers.
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              The function of the hip capsular ligaments: a quantitative report.

              Hal D Martin, Adam Savage, Brett A Braly … (2008)
              Our purpose was to analyze the anatomy and quantitative contributions of the hip capsular ligaments. The stabilizing roles of the medial and lateral arms of the iliofemoral ligament, pubofemoral ligament, and ischiofemoral ligament were examined in 12 matched pairs of fresh-frozen cadaveric hips (6 male and 6 female hips). The motion at the hip joint was measured in internal and external rotation through ranges of motion from 30 degrees flexion to 10 degrees extension along a neutral swing path. The motion was standardized by use of frame stabilization and motion tracking. There is a clear and consistent ligamentous pattern within the hip corresponding to a distinct function and contribution to internal and external rotation. On releasing the ischiofemoral ligament, the greatest gain in range of motion was that of internal rotation. The largest increase of motion by releasing the pubofemoral ligament was observed in external rotation, especially during extension. The release of the medial and lateral arms of the iliofemoral ligament each gave the greatest increase of motion in external rotation, with the lateral arm release providing more range of motion in flexion and in a neutral position. The lateral arm release also showed a significant motion increase in internal rotation, primarily in extension. The ischiofemoral ligament controls internal rotation in flexion and extension. The lateral arm of the iliofemoral ligament has dual control of external rotation in flexion and both internal and external rotation in extension. The pubofemoral ligament controls external rotation in extension with contributions from the medial and lateral arms of the iliofemoral ligament. Together, these findings can have significant clinical applications. When abnormal muscular and osseous pathology can be eliminated as a cause of instability or restrictive range of motion, the understanding of the independent functions of the hip ligaments will aid in defining accurate assessment and nonsurgical and arthroscopic treatment techniques.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Sports Health
                Journal ID (iso-abbrev): Sports Health
                Journal ID (publisher-id): SPH
                Journal ID (hwp): spsph
                Title: Sports Health
                Publisher: SAGE Publications (Sage CA: Los Angeles, CA )
                ISSN (Print): 1941-7381
                ISSN (Electronic): 1941-0921
                Publication date (Electronic): 12 May 2016
                Publication date (Print): July 2016
                Publication date PMC-release: 1 July 2017
                Volume: 8
                Issue: 4
                Pages: 347-354
                Affiliations
                [† ]American Hip Institute, Hinsdale Orthopaedics, Westmont, Illinois
                [‡ ]Hospital for Special Surgery, New York, New York
                [§ ]Accelerated Physical Therapy, Chicago, Illinois
                Author notes
                [*] [* ]Benjamin G. Domb, MD, American Hip Institute, 1010 Executive Court, Suite 250, Westmont, IL 60559 (email: drdomb@ 123456americanhipinstitute.org ).
                Article
                Publisher ID: 10.1177_1941738116647920
                DOI: 10.1177/1941738116647920
                PMC ID: 4922519
                PubMed ID: 27173983
                SO-VID: f50fe350-49de-4dba-aae7-1447b481563b
                Copyright © © 2016 The Author(s)
                History
                Categories
                Subject: Current Research
                Custom metadata
                cover-date July/August 2016

                ScienceOpen disciplines: Sports medicine
                Keywords: femoroacetabular impingement (fai),hip rehabilitation,impingement
                Data availability:
                ScienceOpen disciplines: Sports medicine
                Keywords: femoroacetabular impingement (fai), hip rehabilitation, impingement

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