Comprehensive Evaluation of Hip Arthroscopy for Elite Athletes with Femoroacetabular Impingement and Associated Pathology

Femoroacetabular impingement (FAI) is a recognized source of debilitating hip pain among elite athletes. Hip arthroscopy, including labral repair, and FAI lesion correction have been gaining notoriety as methods to mitigate pain and enable athletes to return to their respective sports. PURPOSE: To provide a comprehensive understanding of the clinical presentation, surgical intervention, and outcomes of elite athletes suffering from hip pain attributed to FAI and associated pathology. METHODS: Elite athletes (n = 35; females = 12) from various sports, including basketball, soccer, martial arts, water polo, and weightlifting, participated. Following unsuccessful conservative management (e.g., analgesic medications, physical therapy), all participants consented to undergo hip arthroscopy. The surgical procedures were conducted under epidural anesthesia with patients in the supine position. We assessed the modified Harris hip score (MHHS) both preoperatively and at the 12-week postoperative mark. After surgery, athletes followed individualized physical therapy programs with physician supervision. RESULTS: The intraoperative findings revealed labral detachment in all 35 athletes, alongside various FAI lesions and cartilage defects. Surgical interventions included labral repair using bioabsorbable anchors, burring pincer and cam lesions, and inducing subchondral bone microfractures where necessary. Postoperatively, athletes exhibited statistically significant improvements, with a mean preoperative MHHS of 69 (at 1 week) rising to a mean postoperative MHHS of 92 (at 12 weeks) (t(34) = -9.62, p d = 2.29). Notably, 29 athletes (83%) reported being pain-free and returning to pre-surgical activity levels within 12 weeks. Three athletes (8.5%) endured residual pain due to iliopsoas tendinitis but resumed full activity between 15-18 weeks postoperatively. Three athletes (8.5%) developed heterotopic ossification but did not require reoperation. CONCLUSION: Hip arthroscopy involving classic labral and FAI lesion repair provides a successful approach for correcting hip pathology in elite athletes. This intervention, although continually evolving, remains a potent tool in the arsenal of sports medicine, allowing for the restoration of hip joint biomechanical function

Sacral Stress Fracture — Wrestling

CASE HISTORY: During preseason, a 35-year-old wrestler complained of pain in his lower back concurrently with a tingling sensation in the left thigh and buttocks. PHYSICAL EXAM: The wrestler was examined by a physical therapist (PT) and, while discussing prior medical history, the athlete mentioned a previous diagnosis of a mild herniated disk (Grade 1). Upon clinical examination, the athlete demonstrated a full range of motion with some discomfort in passive hip extension. The PT suggested rest and rehabilitation through electrical stimulation, alongside the strengthening of the lumbar spine and hip abductor muscles. Ten days later, the athlete presented to an orthopedic surgeon (Ortho) complaining of the same discomfort. During the examination, the Ortho noticed the same localized tenderness over the left sacroiliac joint. Results for both the Lasegue and FABER tests were negative. Although there was no significant sign of fracture or edema, the Ortho suggested obtaining lumbar and pelvis X-Rays. He prescribed anti-inflammatory medication and performed a corticosteroid injection in the left sacroiliac joint. After treatment, the athlete had immediate relief and was able to compete the following day in his competitive event. One week later, the athlete returned to the outpatient clinic complaining that the pain was still localized in the left sacroiliac joint. The Ortho performed the hop test, which was positive. The athlete was then referred for an MRI of the spine and pelvis followed by a CT scan. DIFFERENTIAL DIAGNOSIS: 1. Spinal Disc Herniation Aggravation; 2. Sacroiliac Joint Misalignment; 3. Sciatic Neuritis; 4. Musculotendinous Strain; and 5. Sarcoma. TESTS & RESULTS: X-Ray: Clear; Hop test: Positive; MRI: a) Lumbar region: Mild L5-S1 herniation (Grade 1) with the lumbar spine curvature found to be within normal limits and b) Pelvis: Edema with associated marrow changes due to a non-displaced sacral stress fracture; CT Scan: Fracture line along with sclerosis parallel to the sacroiliac joint. FINAL DIAGNOSIS: Stress fracture on the left, anterior column of the sacrum. DISCUSSION: Clear X-Rays are associated with 20%-38% of misdiagnoses of sacral fractures. When a stress fracture is suspected, MRI should be the indicated exam, followed by a CT scan. Our clinical case gives an indication of the decision-making process so that other physicians can apply lateral thinking to their own cases. OUTCOME OF THE CASE: 1. Rehabilitation: Rest and light weight-bearing exercises (4 months) and 2. Anti-osteoporotic treatment: Calcium and Vitamin D. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: Return to participation: 5-12 months

Association between Self-Reported Prior Nights’ Sleep and Single-Task Gait in Healthy Young Adults: An Exploratory Study Using Machine Learning

Failure to obtain 7-9 hours of sleep has been associated with decreased gait speed in young adults. While Machine Learning (ML) has been used to identify sleep quality in young adults, there are no current studies that have used ML to identify prior night’s sleep in a sample of young adults. PURPOSE: To use ML to identify prior night’s sleep in healthy young adults using single-task walking gait. METHODS: Participants (n=126, age 24.3±4.0yrs; 65% female) completed a survey on their prior night’s sleep and performed a 2-minute walk around a 6m track. Gait data were collected using inertial sensors. Participants were split into 2 groups (\u3c7hs or \u3e9hs: poor sleepers; 7-9hs: good sleepers) and gait characteristics were used to classify participants into each group using ML models via a 10-fold cross validation. A post-hoc ANCOVA was used to assess gait differences. RESULTS: Using Random Forest Classifiers (RFC), top 9 features were extracted. Classification results suggest a 0.79 correlation between gait parameters and prior night’s sleep. The RFC models had a 65.03% mean classification accuracy rate. Top 0.3% of the models had 100% classification accuracy rate. The top 9 features were primarily characteristics that measured variance between lower limb movements. Post-hoc analyses suggest significantly greater variances between lower limb characteristics. CONCLUSION: Good sleepers had more asymmetrical gait patterns (faster gait speed, less trunk motion). Poor sleepers had trouble maintaining gait speed (increased variance in cadence, larger stride lengths, and less time spent in single leg support time). Although the mechanisms of these gait changes are unknown, these findings provide evidence that gait is different for individuals who not receive 7-9 hours of sleep the night before. As evidenced by the high correlation co-efficient of our classification models, gait may be a good way of identifying prior night’s sleep