Femoroacetabular Impingement: Injury etiology and performance outcomes following arthroscopic surgery

Mullins, Karen (2018) Femoroacetabular Impingement: Injury etiology and performance outcomes following arthroscopic surgery. Doctoral thesis, Waterford Institute of Technology.

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Abstract

Introduction: Femoroacetabular impingement syndrome (FAI) is a recently described pathophysiological deformity of the hip joint which has been cited as a possible risk factor for the development of osteoarthritis of the hip in later life. It is highly prevalent in young athletes (Ellis et al., 2011; Philippon et al., 2007; Philippon et al., 2013), and surgical intervention is often recommended to remove impinging bone and repair damaged intra-articular tissue. There are many outcome measuring tools to determine the efficacy of treatment, although the vast majority are subjective in nature and rely heavily on patient opinion. There is a paucity of research which objectively examines the effect of surgical intervention on athletic performance. The aim of phase one of this research was to determine the effect of FAI syndrome on functional performance among athletes and quantify the changes in these measures following arthroscopic surgery. Whether the movement patterns associated with a field sport are associated with the onset of a hip pathology is unknown. There are many measurement techniques available to quantify movements during training and match play. Previous use of video and optoelectronic analysis together is limited (Bartlett, 2001), furthermore the kinematic patterns of a joint throughout the entirety of a field sport have not been quantified. The aim of the second phase of research was to quantify hip movement patterns throughout an entire competitive hurling game. Methods: Competitive sportsmen with symptomatic FAI syndrome were compared to age, gender and activity-level matched controls. Patients were tested at baseline (n=59), 12 weeks post-surgery (n=47) and 1-year post surgery (n=35), while controls were tested initially (n=66), 12 weeks (n=32) and one year later (n=23) with no interruption to customary levels of training or competition. Participants carried out functional tests which included a 10-m sprint, a modified agility T-test, a maximal deep squat test, and a single leg drop jump test (reactive strength index). Hip range of motion was also assessed by measuring maximal hip flexion, hip abduction and hip internal rotation (at 900 hip flexion). Patients were also asked to report any presence of anterior groin pain throughout the testing. At the 1-year follow-up, data was recorded regarding the return to play status of the patients. For the second phase of research, 10 intercounty hurlers were video recorded during the National Hurling league and all movements of the game were quantified and categorised using Dartfish software. Three hurlers were recorded using an optoelectronic system while carrying out the movements identified during the video analysis while wearing 43 reflective markers on joint segments. Kinematic data for the hip joint was generated and percentage game time spent in predetermined zones of hip movement were calculated. Results: At baseline, the FAI syndrome group was significantly slower during the 10-m sprint (3%, p=0.002) and agility T-test (8%, p<0.001); and had lower hip ROM levels (p<0.001). Twelve weeks post-surgery; the patient group had significantly improved on the agility T-test (p<0.001), and in all three measures of ROM (p<0.001). At the 1-year analysis, further improvements were recorded among the patients for squatting depth and RSI (p<0.05). No significant changes were noted among the control group scores after 12 weeks or 1 year compared to baseline and significant time x group interaction effects for acceleration, agility, squat depth and ROM were recorded. Additionally, at 1-year there were no significant differences between the groups for the athletic variables measured. The percentage of patients reporting pain reduced from baseline to 1-year for the 10m-sprint (47% to 8%), agility (60% to 8%) and during the squatting depth measure (52% to 8%). At one year, 83% of patients had returned to full training/competition at an average time of 17 weeks (range 8 – 52 weeks). Hurlers spend the majority of a hurling game carrying out low intensity movements such as walking interspersed with high speed running. Based on the analysis of the discrete movements of hurling, the side-line cut displays high levels internal rotation with increased flexion (approximately 25o and 45o respectively) in the lead leg as well as increased external rotation in abduction in the contralateral leg and places the hip in an “at risk” position. Conclusion: The results of this prospective study demonstrate the negative impact of symptomatic FAI syndrome on range of hip motion, speed and agility of competitive athletes, compared with matched controls. Arthroscopic surgical correction of FAI syndrome results in significant improvements in athletic function with reduction in pain as early as 12 weeks post-operation. Continued improvement was evident at one year, with performance now comparable to that of healthy controls for speed, agility, power and squatting depth. Arthroscopic correction of FAI syndrome is recommended for athletes who wish to continue sports participation and improve athletic performance. This is the first study to quantify hip movements for the entire duration of a field sport. This was necessary to gain a greater understanding of the overall movement patterns the hip joint carries out. This can serve to educate coaches, doctors and physiotherapists so appropriate load management protocols can be ensured.

Item Type: Thesis (Doctoral)
Uncontrolled Keywords: Femoroacetabular impingement, injury etiology, arthroscopic surgery
Departments or Groups: *NONE OF THESE*
Divisions: School of Health Sciences > Department of Health, Sport and Exercise Studies
Depositing User: Derek Langford
Date Deposited: 28 Aug 2018 09:58
Last Modified: 28 Aug 2018 09:58
URI: http://repository.wit.ie/id/eprint/3284

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