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المؤلفون: Munif Hatem, Anthony N Khoury, Joshua S. Bowler, Hal David Martin
المصدر: Journal of Hip Preservation Surgery
مصطلحات موضوعية: musculoskeletal diseases, 030222 orthopedics, medicine.medical_specialty, business.industry, Biomechanics, 030229 sport sciences, Lumbar vertebrae, Ischiofemoral impingement, Abnormal femoral torsion, medicine.disease, Low back pain, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Physical medicine and rehabilitation, medicine, AcademicSubjects/MED00960, medicine.symptom, Range of motion, business, Review Articles, Pelvis, Femoroacetabular impingement
الوصف: The term ‘hip–spine syndrome’ was introduced in recognition of the frequent occurrence of concomitant symptoms at the hip and lumbar spine. Limitations in hip range of motion can result in abnormal lumbopelvic mechanics. Ischiofemoral impingement, femoroacetabular impingement and abnormal femoral torsion are increasingly linked to abnormal hip and spinopelvic biomechanics. The purpose of this narrative review is to explain the mechanism by which these three abnormal hip pathologies contribute to increased low back pain in patients without hip osteoarthritis. This paper presents a thorough rationale of the anatomical and biomechanical characteristics of the aforementioned hip pathologies, and how each contributes to premature coupling and limited hip flexion/extension. The future of hip and spine conservative and surgical management requires the implementation of a global hip–spine–pelvis-core approach to improve patient function and satisfaction.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::c69145f5be7850ec8680b8944471958d
https://doi.org/10.1093/jhps/hnaa054 -
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المؤلفون: N. Rivas, Hal David Martin, J.F. Llano, B. Espinosa, William H. Marquez, Jaime Gallo, Jeisson Osorio, Juan Gómez-Hoyos
المصدر: Revista Española de Cirugía Ortopédica y Traumatología (English Edition). 63:77-85
مصطلحات موضوعية: musculoskeletal diseases, Orthodontics, 030222 orthopedics, Labrum, medicine.diagnostic_test, business.industry, Articular cartilage injuries, Magnetic resonance imaging, 030229 sport sciences, medicine.disease, Femoral cartilage, Asymptomatic, 03 medical and health sciences, 0302 clinical medicine, Deformity, Medicine, Orthopedics and Sports Medicine, Surgery, medicine.symptom, business, Cartilage damage, human activities, Femoroacetabular impingement
الوصف: Objective To establish the prevalence of lesions of the labrum and articular cartilage of the hip in asymptomatic elite soccer players by performing 3T magnetic resonance imaging. Methods Eighty-four asymptomatic hips of 42 professional soccer players were evaluated. Male subjects older than 18 years were included. Cam and pincer deformity were defined as an alpha angle greater than 55 degrees and a lateral centre edge angle greater than 39 degrees, respectively. Labral injuries were classified with the Czerny classification and cartilage damage was classified with the Outerbridge classification. Specific statistical tests were used to establish the relationship between anatomical variances of the hip and the presence of chondral and labral injuries. Results FAI morphology prevalence was 25%. Abnormalities such as cam (22.5%) and labral injuries (33.8%) were found. Those cases with reported labral injury were predominantly intrasubstance damage (18.8%). Anatomical features of FAI were found to be related to lesions of the femoral cartilage (p Conclusion Asymptomatic labral or cartilaginous injuries of the hip were reported in 25% of the included professional soccer players. These injuries were associated with anatomical features of FAI.
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المؤلفون: Marc R. Safran, Hal David Martin, Munif Hatem
المصدر: JBJS case connector. 10(3)
مصطلحات موضوعية: musculoskeletal diseases, Greater trochanter, Physical examination, 03 medical and health sciences, 0302 clinical medicine, Ischium, medicine, Humans, Orthopedics and Sports Medicine, Femur, Ultrasonography, Sciatica, 030222 orthopedics, integumentary system, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, 030229 sport sciences, Anatomy, Middle Aged, Magnetic Resonance Imaging, Sagittal plane, Increased femoral torsion, stomatognathic diseases, medicine.anatomical_structure, nervous system, Surgery, Female, Sciatic nerve, medicine.symptom, Sciatic Neuropathy, business, Tomography, X-Ray Computed
الوصف: Case A 64-year-old woman developed worsening sciatica associated with snapping at the hip over a period of 4 years. The physical examination and dynamic ultrasound revealed the snapping of the sciatic nerve (SN) provoked by impingement between the greater trochanter (GT) and the ischium. Additional imaging studies demonstrated hyperintense signal in the SN at the hip, sagittal imbalance, decreased ischiofemoral space, and increased femoral torsion. Conclusion Snapping and entrapment of the SN provoked by impingement between the GT and the ischium should be considered in the differential diagnosis of snapping hip and/or sciatica.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::26281d6fa4a30fc3be9176b699f9039d
https://pubmed.ncbi.nlm.nih.gov/32773704 -
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المصدر: Arthroscopy : the journal of arthroscopicrelated surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 37(1)
مصطلحات موضوعية: musculoskeletal diseases, Adult, Male, medicine.medical_specialty, Torsion Abnormality, Adolescent, medicine.medical_treatment, Osteotomy, Abnormal femoral torsion, 03 medical and health sciences, Arthroscopy, Disability Evaluation, Young Adult, 0302 clinical medicine, medicine, Humans, Orthopedics and Sports Medicine, Femur, Range of Motion, Articular, Decreased femoral torsion, Retrospective Studies, 030222 orthopedics, biology, business.industry, 030229 sport sciences, Middle Aged, musculoskeletal system, medicine.disease, biology.organism_classification, Spine, Oswestry Disability Index, Surgery, Increased femoral torsion, Valgus, Female, Hip Joint, Slipped capital femoral epiphysis, business, Follow-Up Studies
الوصف: To evaluate the outcomes of proximal femoral derotation osteotomy (PFDO) on the hip and spine function of patients with abnormal femoral torsion.This retrospective study included patients who underwent PFDO to treat increased or decreased femoral torsion between July 2014 and February 2019. The exclusion criteria were: previous fracture, fixation of slipped capital femoral epiphysis or osteotomy in the ipsilateral femur; PFDO associated to varus or valgus osteotomy; Tönnis grade 2 or 3 osteoarthritis; and PFDO performed to treat knee abnormalities. Hip function was assessed through the modified Harris Hip Score (mHHS). A subgroup of consecutive patients with low back pain before the PFDO and operated after 2017 had the spine function assessed through the Oswestry disability index (ODI).A total of 37 hips (34 patients) were studied: 15 hips with increased femoral torsion and 22 with decreased femoral torsion. Eight patients were male and 26 were female. The average age at PFDO was 33 years (range, 15-54 years). At a mean follow-up of 24 months (range, 12-65 months), the mean mHHS improved from 58.1 ± 14.3 before PFDO to 82 ± 15.6 at the most recent follow-up (P.001). Improvement in the mHHS above the minimum clinically important difference (MCID) was observed in 33 hips (89%). In the subgroup of 14 consecutive patients with ODI available, the ODI improved from a mean of 45% ± 16% before the PFDO to 22% ± 17% at the most recent follow-up (P = .001). Nine (64.3%) of the 14 patients presented improvement in the ODI above the MCID. Revision procedure with a larger intramedullary nail was necessary in 2 hips to treat nonunion.Proximal femoral derotation osteotomy improves the hip and spine function in patients with increased or decreased femoral torsion and nonarthritic hips.Level IV, therapeutic case series.
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المصدر: International Journal of Sports Physical Therapy. 13:208-213
مصطلحات موضوعية: musculoskeletal diseases, 030222 orthopedics, business.industry, 030229 sport sciences, Anatomy, medicine.disease, Acetabulum, 03 medical and health sciences, Femoral head, 0302 clinical medicine, medicine.anatomical_structure, Cadaver, medicine, Range of motion, Cadaveric spasm, business, Femoroacetabular impingement, Pelvis, Femoral neck
الوصف: Background Femoroacetabular impingement can produce abnormal biomechanics that lead to compensatory injuries around the hip and pelvis. Ligamentum teres pathologies are commonly associated with these bony deformities but a mechanism for injury has not been described in the literature. Purpose The purpose of this study was to describe a potential mechanism behind ligamentum teres injury and impingement between the femoral neck and acetabulum. Study Design Laboratory controlled cadaveric study. Methods Twenty-six hips from 15 embalmed cadavers (8 male; 7 female) with lifespans between 55-93 years were skeletonized. The hip was placed in 90 ° flexion and 0 ° abduction/adduction and internally rotated until the femoral head neck contacted the acetabulum. This position of impingement with respect to internal rotation was recorded with a goniometer. The hip was then further internally rotated until end range of motion was achieved and again the position of internal rotation recorded with a goniometer. Results The positions of internal rotation at which impingement occurred (mean 9 °; SD 4.2; Range -2 ° to 15 °) when compared to end range (mean 21 °; SD 5.7; Range 5 ° to 27 °) were significantly different (p
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_________::8682873b5cc4301e05c34b9d03c69202
https://doi.org/10.26603/ijspt20180208 -
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المؤلفون: Anthony N Khoury, Ian James Palmer, Samrat Yeramaneni, Manoj Reddy, Juan Gómez-Hoyos, Hal David Martin, Ricardo Schröder
المصدر: Journal of Hip Preservation Surgery
مصطلحات موضوعية: musculoskeletal diseases, Human cadaver, Centimeter, business.industry, medicine.medical_treatment, Biomechanics, Strain (injury), 030229 sport sciences, Anatomy, medicine.disease, Osteotomy, Hip abduction, body regions, 03 medical and health sciences, 0302 clinical medicine, medicine, Sciatic nerve, business, Research Articles, 030217 neurology & neurosurgery, Hip flexion
الوصف: Terminal hip flexion contributes to increased strain in peripheral nerves at the level of the hip joint. The effects of hip abduction and femoral version on sciatic nerve biomechanics are not well understood. A decrease in sciatic nerve strain will be observed during terminal hip flexion and hip abduction, independent of femoral version. Six un-embalmed human cadavers were utilized. Three Differential Variable Reluctance Transducers (DVRTs) sensors were placed on the sciatic nerve while the leg was flexed to 70° with a combination of − 10°, 0°, 20° and 40° adduction/abduction. DVRT placement included: (i) under piriformis, (ii) immediately distal to the gemelli/obturator, (iii) four centimeters distal to sensor two. A de-rotational osteotomy to decrease femoral version 10° was performed, and sciatic nerve strain was measured by the same procedure. Data were analyzed with three-way analysis of variance and Bonferroni post-hoc analysis to identify differences in the mean values of sciatic nerve strain between native and decreased version state, hip abduction angle and DVRT sensor location. Significant main effects were observed for femoral version (P = 0.04) and DVRT sensor location (P = 0.01). Sciatic nerve strain decreased during terminal hip flexion and abduction in the decreased version state. An 84.23% decrease in sciatic nerve strain was observed during hip abduction from neutral to 40° in the presence of decreased version at terminal hip flexion. The results obtained from this study confirm the role of decreased femoral version and hip abduction at terminal hip flexion to decrease the strain in the sciatic nerve.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::8ce51423ebfb6aa2d7df16974307f4ee
https://doi.org/10.1093/jhps/hnx008 -
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المؤلفون: Ricardo Schröder, Eric E. Johnson, Salvador Campos, Juan Gómez-Hoyos, Hal David Martin, Ian J. Palmer, Anthony N Khoury
المصدر: Arthroscopy: The Journal of Arthroscopic & Related Surgery. 33:305-313
مصطلحات موضوعية: musculoskeletal diseases, Supine position, 03 medical and health sciences, Distal femur, 0302 clinical medicine, Cadaver, medicine.ligament, Humans, Medicine, Orthopedics and Sports Medicine, Femur, Range of Motion, Articular, Pubic Bone, 030222 orthopedics, business.industry, 030229 sport sciences, Anatomy, musculoskeletal system, Pubofemoral ligament, Biomechanical Phenomena, body regions, External rotation, Ligaments, Articular, Hip Joint, Lumbar spine, Range of motion, Cadaveric spasm, business
الوصف: To determine the isolated function of the pubofemoral ligament of the hip capsule and its contribution to hip stability in external/internal rotational motion during flexion greater than 30° and abduction.Thirteen hips from 7 fresh-frozen pelvis-to-toe cadavers were skeletonized from the lumbar spine to the distal femur with the capsular ligaments intact. Computed tomographic imaging was performed to ensure no occult pathological state existed, and assess bony anatomy. Specimens were placed on a surgical table in supine position with lower extremities resting on a custom-designed polyvinylchloride frame. Hip internal and external rotation was measured with the hip placed into a combination of the following motions: 30°, 60°, 110° hip flexion and 0°, 20°, 40° abduction. Testing positions were randomized. The pubofemoral ligament was released and measurements were repeated, followed by releasing the ligamentum teres.Analysis of the 2,106 measurements recorded demonstrates the pubofemoral ligament as a main controller of hip internal rotation during hip flexion beyond 30° and abduction. Hip internal rotation was increased up to 438.9% (P .001) when the pubofemoral ligament was released and 412.9% (P.001) when both the pubofemoral and teres ligament were released, compared with the native state.The hypothesis of the pubofemoral ligament as one of the contributing factors of anterior inferior hip stability by controlling external rotation of the hip in flexion beyond 30° and abduction was disproved. The pubofemoral ligament maintains a key function in limiting internal rotation in the position of increasing hip flexion beyond 30° and abduction. This cadaveric study concludes previous attempts at understanding the anatomical and biomechanical function of the capsular ligaments and their role in hip stability.The present study contributes to the understanding of hip stability and biomechanical function of the pubofemoral ligament.
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المؤلفون: Ian James Palmer, Anthony N Khoury, Eric E. Johnson, Hal David Martin, Ricardo Schröder, Juan Gómez-Hoyos
المصدر: Arthroscopy: The Journal of Arthroscopic & Related Surgery. 33:101-107
مصطلحات موضوعية: Male, musculoskeletal diseases, Facet (geometry), medicine.medical_treatment, Osteotomy, Zygapophyseal Joint, Facet joint, 03 medical and health sciences, 0302 clinical medicine, Lumbar, Cadaver, Femoracetabular Impingement, Humans, Medicine, Orthopedics and Sports Medicine, Aged, Orthodontics, 030222 orthopedics, Lumbar Vertebrae, business.industry, Anatomy, Middle Aged, Ischium, Biomechanical Phenomena, medicine.anatomical_structure, Lesser Trochanter, Female, Tomography, X-Ray Computed, business, Cadaveric spasm, 030217 neurology & neurosurgery
الوصف: Purpose To assess the relation between ischiofemoral impingement (IFI) and lumbar facet joint load during hip extension in cadavers. Methods Twelve hips in 6 fresh T1-to-toes cadaveric specimens were tested. A complete pretesting imaging evaluation was performed using computed tomography scan. Cadavers were positioned in lateral decubitus and fixed to a dissection table. Both legs were placed on a frame in a simulated walking position. Through a posterior lumbar spine approach L3-4 and L4-5 facet joints were dissected bilaterally. In addition, through a posterolateral approach to the hip, the space between the ischium and the lesser trochanter was dissected and measured. Ultrasensitive, and previously validated, piezoresistive force sensors were placed in lumbar facet joints of L3-4 and L4-5. Lumbar facet loads during hip extension were measured in native hip conditions and after simulating IFI by performing lesser trochanter osteotomy and lengthening. Four paired t -tests were performed comparing normal and simulated IFI on the L3-L4 and L4-L5 facet joint loads. Results After simulating IFI, mean absolute differences of facet joint load were 10.8 N (standard error of the mean [SEM] ±4.53, P = .036) for L3-4 at 10° of hip extension, 13.71 N (SEM ±4.53, P = .012) for L3-4 at 20° of hip extension, 11.49 N (SEM ±4.33, P = .024) for L4-5 at 10° of hip extension, and 6.67 N (SEM ±5.43, P = .245) for L4-5 at 20° of hip extension. A statistically significant increase in L3-4 and L4-5 lumbar facet joint loads of 30.81% was found in the IFI state as compared with the native state during terminal hip extension. Conclusions Limited terminal hip extension due to simulated IFI significantly increases L3-4 and L4-5 lumbar facet joint load when compared with non-IFI native hips. Clinical Relevance This biomechanical study directly links IFI to increased lumbar facet loads and supports the clinical findings of IFI causing lumbar pathology. Assessing and treating (open or endoscopic) hip disorders that limit extension could have benefit in patients with concomitant lower back symptoms.
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المؤلفون: Shane J. Nho, Jeffrey S. Grzybowski, Thomas H. Wuerz, Michael J. Salata, Alejandro A. Espinoza Orías, Hal David Martin, Richard C. Mather, Sang H. Song
المصدر: Arthroscopy: The Journal of Arthroscopic & Related Surgery. 32:1571-1580
مصطلحات موضوعية: Adult, Joint Instability, Male, musculoskeletal diseases, medicine.medical_specialty, Rotation, medicine.medical_treatment, Joint stability, Joint Capsule Release, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Cadaver, medicine, Humans, Orthopedics and Sports Medicine, Range of Motion, Articular, Aged, Aged, 80 and over, 030222 orthopedics, business.industry, Neutral zone, Soft tissue, 030229 sport sciences, Middle Aged, Biomechanical Phenomena, Surgery, Capsulotomy, Female, Hip Joint, Cadaveric spasm, Range of motion, business, Nuclear medicine
الوصف: To evaluate the effect of capsulotomy size and subsequent repair on the biomechanical stability of hip joint kinematics through external rotation of a cadaveric hip in neutral flexion.Eight fresh-frozen cadaveric hip specimens were used in this study. Each hip was tested under torsional loads of 6 N·m applied by a servohydraulic frame and transmitted by a pulley system. The test conditions were (1) neutral flexion with the capsule intact, (2) neutral flexion with a 4-cm interportal capsulotomy, (3) neutral flexion with a 6-cm capsulotomy, and (4) neutral flexion with capsulotomy repair. Soft tissue was retained during all interventions. Measures indicating joint kinematics (range of motion [ROM], hysteresis area [HA], and neutral zone [NZ]) were obtained for each condition.For all hip specimens, the average ROM, HA, and NZ were calculated relative to the intact capsular state (100%) and expressed in terms of percentage (± SD). The findings for ROM were as follows: intact, 100%; 4 cm, 107.42% ± 5.69%; 6 cm, 113.40% ± 7.92%; and repair, 99.78% ± 3.77%. The findings for HA were as follows: intact, 100%; 4 cm, 108.30% ± 9.30%; 6 cm, 115.30% ± 13.92%; and repair, 99.47% ± 4.12%. The findings for NZ were as follows: intact, 100%; 4 cm, 139.61% ± 62.35%; 6 cm, 169.25% ± 78.19%; and repair, 132.03% ± 64.38%. Statistically significant differences in ROM existed between the intact and 4-cm conditions (P = .039), the intact and 6-cm conditions (P.0001), the 4-cm and repair conditions (P = .033), and the 6-cm and repair conditions (P.0001). There was no statistically significant difference between the intact and repair conditions (P.99) or between the 4- and 6-cm conditions (P = .126).Under laboratory-based conditions, larger-sized capsulotomies were accompanied by increases in all 3 measures of joint mobility: ROM, HA, and NZ at time zero. Complete capsular closure effectively restored these measures when compared with the intact condition.Cadaveric models consisting of the hip joint with surrounding soft tissue were used under laboratory testing conditions to investigate potential iatrogenic joint instability resulting from expansive capsulotomies, showing that complete capsular closure leads to reconstitution of original joint stability properties at time zero.
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المؤلفون: Munif Hatem, Anthony N Khoury, Hal David Martin, Asadullah Helal
المصدر: Orthopaedic Journal of Sports Medicine
مصطلحات موضوعية: musculoskeletal diseases, hip, hip injuries, Instability, Article, 03 medical and health sciences, Femoral head, joint instability, 0302 clinical medicine, Medicine, Orthopedics and Sports Medicine, Hip injury, arthroscopy, Hip dysplasia, Orthodontics, 030222 orthopedics, medicine.diagnostic_test, business.industry, Arthroscopy, Joint instability, 030229 sport sciences, medicine.disease, hip dysplasia, Acetabulum, medicine.anatomical_structure, business
الوصف: Background: The stabilization of the femoral head is provided by the distal acetabulum when the hip is in a flexed position. However, the osseous parameters for the diagnosis of hip instability in flexion are not defined. Purpose/Hypothesis: To determine whether the osseous parameters of the distal acetabulum are different in hips demonstrating anteroinferior subluxation in flexion under dynamic arthroscopic examination, compared with individuals without hip symptoms. The hypothesis was that the morphometric parameters of the anterior acetabular horn are distinct in hips with anteroinferior instability compared with asymptomatic hips. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 30 hips with anteroinferior instability in flexion under dynamic arthroscopic examination were identified. A control group of 60 hips (30 patients), matched by age and sex, was formed from individuals who had undergone pelvis magnetic resonance imaging (MRI) for nonorthopaedic reasons. Unstable and control hips were compared according to the following parameters assessed on axial MRI scans of the pelvis: anterior sector angle (ASA), anterior horn angle (AHA), posterior sector angle (PSA), posterior horn angle (PHA), acetabular version, lateral center-edge angle, acetabular inclination (Tönnis angle), and femoral head diameter. Results: The coverage of the femoral head by the anterior acetabular horn was decreased in unstable hips compared with the control group (mean ASA, 54.8° vs 61°, respectively; P < .001). Unstable hips also had a steeper anterior acetabular horn, with an increased mean AHA compared with controls (52.5° vs 46.8°, respectively; P < .001). An ASA 50° had a sensitivity of 0.77, a specificity of 0.72, a negative predictive value of 0.86, and a positive predictive value of 0.57 for anteroinferior hip instability. There was no statistically significant difference in the mean PSA, PHA, acetabular version, lateral center-edge angle, acetabular inclination, or femoral head diameter between unstable hips and controls. Conclusion: Abnormal morphology of the anterior acetabular horn is associated with anteroinferior instability in hip flexion. The ASA and AHA can aid in the diagnosis of hip instability.
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