La fonction musculaire au niveau de la hanche chez les patients présentant un conflit fémoro-acétabulaire symptomatique

Femoroacetabular impingement (FAI) is a pathomechanical process of the hip joint, which could lead to hip pain and functional disability. Aim of this thesis was to investigate hip muscle function in patients with a symptomatic FAI. Hip muscle function was first investigated before patients underwent any surgical treatment for managing FAI. It was shown that they present with reduced hip muscle strength (i.e., muscle weakness), probably due to hip muscle inhibition. Nevertheless, hip muscle weakness was not associated with exaggerated hip muscle fatigue. Hip muscle strength recovery was then evaluated in a series of patients after hip arthroscopy to treat FAI. These patients demonstrated a good recovery for all hip muscle groups, except for hip flexors. The case of a professional ice hockey player who underwent bilateral hip open surgeries for treating bilateral FAI was also documented. This report showed that iliotibial band dehiscence could occur after hip open surgery, thereby preventing hip abductor strength increase during rehabilitation and delaying the return to sport. In addition, the assessment of the rate of force development scaling factor for the hip muscles was evaluated in a group of healthy adults. This parameter seems to be promising for the evaluation of hip muscle inhibition. The testing protocol was feasible and reproducible for hip adductors, external rotators and flexors. Taken as a whole, these findings show that patients with symptomatic FAI demonstrate an impaired hip muscle function, which is however mainly resolved after surgical treatment.Le conflit fémoro-acétabulaire (femoroacetabular impingement, FAI) est une pathologie mécanique de la hanche qui peut causer des douleurs et limitations fonctionnelles. Le but de cette thèse était d’étudier la fonction musculaire au niveau de la hanche chez des patients présentant un FAI symptomatique. La fonction musculaire de la hanche a été évaluée, dans un premier temps, chez des patients avant qu’ils ne subissent une opération. Ces patients démontraient un déficit de force qui pourrait être expliqué par de l’inhibition musculaire. Cependant, ce déficit de force n’était pas associé à une plus grande fatigabilité musculaire. Dans un deuxième temps, les altérations de force musculaire ont été évaluées chez des patients ayant subi une arthroscopie de la hanche. Après l’opération, les patients récupéraient un niveau de force normal au niveau de tous les groupes musculaires de la hanche excepté les fléchisseurs. Le cas d’un joueur de hockey sur glace ayant subi une chirurgie ouverte aux deux hanches pour traiter un FAI bilatéral a aussi été décrit. On a démontré que la déhiscence de la bandelette iléo-tibiale pouvait survenir après chirurgie, empêcher l’augmentation de force musculaire des abducteurs de la hanche, et retarder la reprise du sport. Enfin, un protocole d’évaluation du taux de développement de la force normalisé, variable permettant d’estimer l’inhibition musculaire de la hanche, a été proposé chez des sujets sains. La fiabilité et reproductibilité des résultats ont été montrées au niveau des adducteurs, rotateurs externes, et fléchisseurs de la hanche. Ces résultats montrent que ces patients ont une fonction musculaire altérée au niveau de la hanche, qui est toutefois récupéré après une opération

Differences in trunk and thigh muscle strength, endurance and thickness between elite sailors and non-sailors

International audienceDinghy sailors lean their upper body over the windward side of the boat ('hiking') to keep the boat's balance and maximise its speed. Sustaining the hiking position is essential for competitive performance and this study examined sport-specific differences of muscles relevant for hiking in elite sailors. Knee extensor muscle strength as well as trunk muscle strength, muscle endurance and muscle thickness were assessed in elite dinghy sailors (n = 15) and compared to matched, non-sailing controls (n = 15). Isometric extensor strength was significantly higher in sailors at 60° (+14%) but not at 20° knee flexion. Sailors showed significantly higher trunk flexor (but not extensor) strength under isometric (+18%) and eccentric (+11%) conditions, which was associated to greater muscle thickness (rectus abdominis +40%; external oblique +26%) and higher endurance for ventral (+66%) and lateral (+61%) muscle chains compared to non-sailors. Greater muscles thickness and the particular biomechanical requirements to maintain the hiking position may drive the increases in isometric and eccentric muscle strength as well as ventral and lateral trunk endurance. The current findings identified sport-specific muscle function differences and provide performance benchmarks for muscle strength and endurance in elite sailors

Patient-reported outcome measures for hip-related pain: A review of the available evidence and a consensus statement from the International Hip-related Pain Research Network, Zurich 2018

Hip-related pain is a well-recognised complaint among active young and middle-aged active adults. People experiencing hip-related disorders commonly report pain and reduced functional capacity, including difficulties in executing activities of daily living. Patient-reported outcome measures (PROMs) are essential to accurately examine and compare the effects of different treatments on disability in those with hip pain. In November 2018, 38 researchers and clinicians working in the field of hip-related pain met in Zurich, Switzerland for the first International Hip-related Pain Research Network meeting. Prior to the meeting, evidence summaries were developed relating to four prioritised themes. This paper discusses the available evidence and consensus process from which recommendations were made regarding the appropriate use of PROMs to assess disability in young and middle-aged active adults with hip-related pain. Our process to gain consensus had five steps: (1) systematic review of systematic reviews; (2) preliminary discussion within the working group; (3) update of the more recent high-quality systematic review and examination of the psychometric properties of PROMs according to established guidelines; (4) formulation of the recommendations considering the limitations of the PROMs derived from the examination of their quality; and (5

Editorial Commentary: Do Patients With Femoroacetabular Impingement Syndrome Already Show Hip Muscle Atrophy?

Muscle atrophy, fatty degeneration, and strength deficits of the hip abductors, flexors, and even external rotators are well-known clinical and radiologic findings in patients with advanced hip osteoarthritis. More recently, in the context of prearthritic hip diseases, the role of hip muscle function in femoroacetabular impingement syndrome (FAIS) has gained greater focus for hip surgeons. Several studies have shown that patients with FAIS present with activation deficits of the hip muscles, which may result in hip muscle weakness. Nevertheless, previous studies have yet to determine whether young and mainly active patients with FAIS already show hip muscle atrophy. Future research is required to further characterize hip muscle function in patients with FAIS. Of particular interest is the investigation of whether both qualitative (muscle fatty degeneration) and quantitative (muscle atrophy) morphologic alterations of the hip muscles are present in patients with FAIS, as well as whether these alterations are sex specific and/or related to the underlying hip morphology

Validity and reproducibility of the Physical Activity Scale for the Elderly (PASE) questionnaire for the measurement of the physical activity level in patients after total knee arthroplasty

International audienceBackground: The need for valid and reproducible questionnaires to routinely assess the physical activity level of patients after total knee arthroplasty (TKA) is of particular concern in clinical settings. Aims of this study were to evaluate the validity and reproducibility of the physical activity scale for the elderly (PASE) questionnaire in TKA patients, with a particular view on gender differences. Methods: A total of 50 elderly patients (25 women and 25 men aged 70 +/- 6 years) following primary unilateral TKA were recruited. The reproducibility was evaluated by administering the PASE questionnaire during two occasions separated by 7 days. The construct (criterion) validity was investigated by comparing the physical activity level reported by patients in the PASE questionnaire to that measured by accelerometry. Reproducibility was evaluated using intraclass correlation coefficients (ICC3,1) for reliability and standard error of measurement (SEM) and smallest detectable change (SDC) for agreement, while validity was investigated with Pearson correlation coefficients. Results: Reliability of the PASE total score was acceptable for men (ICC = 0.77) but not for women (ICC = 0.58). Its agreement was low for both men and women, as witnessed by high SEM (32% and 35%, respectively) and SDC (89% and 97%, respectively). Construct validity of the PASE total score was low in both men (r = 0.45) and women (r = 0.06). Conclusions: The PASE questionnaire has several validity and reproducibility shortcomings, therefore its use is not recommended for the assessment of physical activity level in patients after TKA, particularly in women

Differences in gait characteristics between total hip, knee, and ankle arthroplasty patients: a six-month postoperative comparison.

International audienceBACKGROUND: The recovery of gait ability is one of the primary goals for patients following total arthroplasty of lower-limb joints. The aim of this study was to objectively compare gait differences of patients after unilateral total hip arthroplasty (THA), total knee arthroplasty (TKA) and total ankle arthroplasty (TAA) with a group of healthy controls. METHODS: A total of 26 TAA, 26 TKA and 26 THA patients with a mean (+/- SD) age of 64 (+/- 9) years were evaluated six months after surgery and compared with 26 matched healthy controls. Subjects were asked to walk at self-selected normal and fast speeds on a validated pressure mat. The following spatiotemporal gait parameters were measured: walking velocity, cadence, single-limb support (SLS) time, double-limb support (DLS) time, stance time, step length and step width. RESULTS: TAA and TKA patients walked slower than controls at normal (pTKA>THA). THA patients demonstrated no gait differences compared with controls. In contrast, TAA and TKA patients still demonstrated gait differences compared to controls, with slower walking velocity and reduced SLS in the involved limb. In addition, TAA patients presented marked side-to-side asymmetries in gait characteristics

Rehabilitation and return to sport after bilateral open surgery for femoroacetabular impingement in a professional ice hockey player: A case report

International audienceBackground: The aim of this case report was to describe the rehabilitation and return to sport of a professional ice hockey player with symptomatic femoroacetabular impingement (FM) after bilateral open hip surgery.Case description: A 21-year-old professional ice hockey player with symptomatic FAT underwent bilateral surgical hip dislocations within a 6-week time period. After the second surgery (right hip), he experienced right hip pain due to iliotibial band dehiscence, which required additional revision surgery. The athlete underwent a standardized rehabilitation protocol. Hip muscle strength was objectively assessed during rehabilitation.Outcomes: Iliotibial band dehiscence did not allow the athlete to increase ipsilateral hip abductor strength. This prolonged the rehabilitation period for 12 weeks. The athlete returned to training on the ice without physical contact and to competitive matchplay after 7 and 8 months, respectively.Discussion: This case report showed that iliotibial band dehiscence occurred after open hip surgery and delayed the return to sport of this athlete. Standardized rehabilitation following bilateral open hip surgery was however successful for the return to sport of this professional ice hockey player with bilateral symptomatic FAI. (C) 2014 Elsevier Ltd. All rights reserved

Sex-Specific Differences in Hip Muscle Cross-sectional Area and Fatty Infiltration in Patients With Femoroacetabular Impingement Syndrome

Background: Patients with femoroacetabular impingement syndrome (FAIS) show sex-specific differences in hip muscle function, hip morphology, and symptoms. Possible differences in hip muscle characteristics between men and women with FAIS are unknown. Purpose: To compare hip muscle cross-sectional area (CSA) and fatty infiltration between men and women with FAIS and investigate possible associations with patient-reported outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively analyzed preoperative axial pelvic magnetic resonance imaging scans of 104 patients (54 women) who underwent hip surgery for FAIS. The main outcome measures were side-to-side percentage asymmetry in hip muscle CSA and involved-side fatty infiltration as measured with the Goutallier scale for a total of 10 hip muscles. Patient-reported outcomes included duration of hip symptoms, iHOT-12 (12-item International Hip Outcome Tool), and Hip Sports Activity Scale. Results: Women showed larger hip abductor muscle CSA asymmetry than men (P =.018), particularly for the gluteus medius (P =.049), while men exhibited more fatty streaks (grade 1) in the gluteus medius (P =.015) than women. Duration of symptoms was associated only with fatty infiltration of obturator externus in men (rS = –0.55, P =.018). iHOT-12 was associated with CSA asymmetry of the gluteus minimus (r = –0.41, P =.011) and iliopsoas (r = –0.36, P =.028) in men and with piriformis fatty infiltration (rS = –0.56, P =.030) in women. The Hip Sports Activity Scale was associated with iliopsoas CSA asymmetry (rS = 0.32, P =.026) and with fatty infiltration of the tensor fasciae latae (rS = –0.45, P =.046) and obturator externus (rS = –0.50, P =.023) in women. Conclusion: Patients with FAIS demonstrated few sex-specific quantitative and qualitative alterations of hip muscles. Women showed greater hip abductor muscle atrophy than men, particularly for the gluteus medius, while men showed a higher degree of fatty infiltration in this same muscle. The duration of hip symptoms was not associated with muscle atrophy. Patient-reported hip pain/function and sport activity level were only moderately associated with isolated muscular variables.ISSN:2325-967

Effectiveness of multicomponent lower extremity injury prevention programmes in team-sport athletes : an umbrella review

Epub ahead of printObjective: To identify which exercise combinations are most effective as part of a lower extremity injury prevention programme for team-sport athletes. Design: Umbrella review. Data sources: A comprehensive literature search was performed in PubMed, Scopus, Cochrane Library and PEDro databases. Studies published between January 2000 and March 2017 were included in this umbrella review. Study eligibility criteria: Moderate to high-quality systematic reviews that investigated the effectiveness of a combination of two or more exercise components, that is, strength, agility, plyometrics, balance, stretching, technique, warm-up and functional activity, regarding injury incidence/rate of lower extremity injuries in team-sport athletes. The methodological quality of the included systematic reviews was independently assessed by two reviewers using the Assessing the Methodological Quality of Systematic Reviews measurement tool and the Grading of Recommendations Assessment, Development and Evaluation guidelines were used to assess the overall quality of evidence for particular outcomes. Results: Twenty-four systematic reviews met the inclusion criteria. Multicomponent exercise interventions were effective in reducing the injury incidence/rate of lower extremity, knee, ACL and ankle injuries, but not groin injuries. Strength and balance exercise components were included in 10 of 11 effective injury prevention programmes for the lower extremity, knee, ACL and ankle injuries. Summary/conclusion: Lower extremity injury prevention programmes in team sports are effective in preventing lower extremity, knee, ACL and ankle injuries. Lower extremity muscle strength and balance exercises should be prioritised in lower extremity injury prevention programmes for team-sport athletes