Excessive Hip Research Articles

Feasibility and Reliability Assessment of Video-Based Motion Analysis and Surface Electromyography in Children with Fragile X during Gait.

Fragile X Syndrome (FXS), the leading form of inherited intellectual disability and autism, is characterized by specific musculoskeletal conditions. We hypothesized that gait analysis in FXS could be relevant for the evaluation of motor control of gait, and help the understanding of a possible correlation between functional and intellectual abilities. Typical deficits in executive control and hyperactivity have hampered the use of standard gait analysis. The aim of our study was to quantitatively assess musculoskeletal alterations in FXS children in standard ambulatory conditions, in a friendly environment. Ten FXS children and sixteen controls, with typical neurodevelopment, were evaluated through four synchronized video cameras and surface electromyography; lower limb joints rotations, spatiotemporal parameters, duration of muscle contraction, activation timing and envelope peaks were determined. Reliability and repeatability of the video based kinematics analysis was assessed with respect to stereophotogrammetry. The Kruskal–Wallis Test (p < 0.05) or SPM1D were used to compare different groups of subjects. Results show a consistently altered gait pattern associated with abnormal muscle activity in FXS subjects: reduced knee and excessive hip and ankle flexion, and altered duration and activity onset on all the recorded muscles (Rectus/Biceps Femoris, Tibialis Anterior, Gastrocnemius Lateralis). Results of this study could help with planning personalized rehabilitations.

Lower limb biomechanics during gait in children with Achondroplasia

Achondroplasia is an autosomal dominant disorder that has been reported to be the most common condition associated with severe disproportionate short stature. A limited number of studies exist in the literature reporting kinematic abnormalities in children with Achondroplasia. Reported deviations include increased pelvic tilt, flexed knees during stance and excessive hip abduction. However, studies lack full 3-dimensional data and results are variable. The aim of this study was to examine differences in 3-dimensional kinematics during gait between children with Achondroplasia and age-matched controls A retrospective analysis was conducted of our gait laboratory database over a 20-year period. Eight children with Achondroplasia and 32 children with typical development were included. A full 3-dimensional kinematic analysis was performed using a CODA mpx30/cx1 active marker system. Increased flexion at all joints in the sagittal plane, increased hip abduction and foot supination in the coronal plane and increased external hip rotation were present for children with Achondroplasia. In contrast to other studies, increased knee varus was not an issue for the children in this study. This study provides a full description of the kinematic patterns associated with children with Achondroplasia and, as such, a comprehensive baseline for planning rehabilitation strategies in these children.

Sex Difference in Hip Adduction during the Stance Phase of Running: A Swing Phase Problem?

The purpose of the current study was 1) to evaluate sex differences in peak hip adduction during the late swing and stance phases of running and 2) to determine whether peak hip adduction during late swing is predictive of peak hip adduction during stance. A total of 15 female and 16 male heel strike runners ran over ground at a speed of 4 m·s-1. Hip joint kinematics during running were quantified using a 3D motion capture system. Sex differences in peak hip adduction during the late swing and stance phases were compared using independent-samples t-tests. Linear regression analysis was used to determine the relationship between late swing and stance phase hip adduction. Compared with males, females exhibited significantly greater peak hip adduction during both the late swing (8.5° ± 2.6° vs 6.1° ± 2.8°, P = 0.019) and the stance phases of running (13.3° ± 4.2° vs 9.6° ± 3.4°, P = 0.011). Furthermore, late swing peak hip adduction was predictive of subsequent stance phase peak hip adduction (r = 0.63, P < 0.001). Sex differences in hip adduction during stance are influenced in part by late swing phase hip adduction. Further studies are needed to identify potential causes of excessive hip adduction during the late swing phase of running.

Comparison of Modular Control during Side Cutting before and after Fatigue.

The purpose of this study was to clarify the coordination between the trunk and lower limb muscles during sidestep and to compare this coordination before and after fatigue intervention. The intervention was lateral jump until exhaustion. Nonnegative matrix factorization (NMF) was used to extract muscle synergies from electromyography. Subsequently, to compare the muscle synergies, a scalar product that evaluates the coincidence of synergies was calculated. Three muscle synergies were extracted before and after the intervention from the NMF analysis. In accordance with the evaluation of the scalar product, these synergies were the same before and after the intervention. One of these synergies that engaged the internal oblique/transversus abdominis, rectus femoris, and adductor muscle was activated from before landing to midstance during sidestep motion; therefore, this synergy is thought to suppress excessive hip abduction. However, the activation timing of this synergy was delayed after the intervention (P = 0.028, effect size: 0.54, Wilcoxon test). This delay is considered to decrease hip stability. Thus, this change may induce a reduction in hip control function.

Classification of abnormal gait patterns of poststroke hemiplegic patients in principal component analysis.

The objective of this study was to classify the 10 types of characteristic abnormal gait by principal component analysis using quantitative indices of 10 types of abnormal gait. For abnormal gait pattern classification, principal component analysis was performed using the deviation values of the 10 types of abnormal gait of 90 subjects. Scatter plots of the factor loadings of the 1st and 2nd principal components of the 10 types of abnormal gait were prepared, and those arranged at near sites were grouped based on the positional relationship, through which abnormal gait patterns were classified. It was suggested that abnormal gait patterns can be classified into insufficient knee flexion, hip hiking, and excessive lateral shift of the trunk over the unaffected side in the swing phase; knee extensor thrust pattern accompanying forefoot contact in the stance phase in addition to circumduction gait of the swing phase; and flexed knee gait pattern accompanying retropulsion of the hip in addition to median whip in the stance phase and excessive hip external rotation in the swing phase. It was clarified by these principal component analyses that information contained in the results of the 10 quantitative indices of abnormal gait of the 90 poststroke hemiplegia patients was compressed into several abnormal gait patterns. If observational abnormal gait analysis is performed after understanding this gait pattern classification, it may help improve the accuracy of gait analysis by observation.

Improving abnormal gait patterns by using a gait exercise assist robot (GEAR) in chronic stroke subjects: A randomized, controlled, pilot trial

BackgroundAlthough the Gait Exercise Assist Robot (GEAR) has been reported to effectively improve gait of hemiplegic patients, no study has investigated its use in chronic stroke patients. It is possible to facilitate gait reorganization by gait training with less compensation using the GEAR even in chronic stroke patients. Research questionWhat are the effects of GEAR training on the abnormal gait patterns of chronic stroke subjects? MethodsSubjects were randomly assigned to either the GEAR group (n = 8) or the treadmill group (n = 11). Each group underwent 20 sessions (40 min/day, 5 days/week). The changes in the 10 types of abnormal gait patterns were evaluated using a three-dimensional motion analysis system and the Global Rating of Change (GRC) scale before and after the intervention, and at 1-month and 3-month follow-up assessment. ResultsIn the GEAR group, hip hiking at a 1-month follow-up assessment was markedly lesser than that before the intervention, and the excessive hip external rotation at 3-month follow-up assessment was notably lesser than that after the intervention, but the change in excessive hip external rotation was in the normal range. In the treadmill group, knee extensor thrust at a 1-month follow-up assessment was strikingly lesser than that before the intervention, but the difference was in the normal range. In the GEAR group, the GRC scale scores were considerably higher after the intervention, at a 1-month, and 3-month follow-up assessment than those before the intervention. But, in the treadmill group, only the GRC scale score at a 1-month follow-up assessment was visibly higher than that before the intervention. SignificanceGait training using the GEAR may be more effective than treadmill-training in improving the swing phase in chronic stroke subjects.

Correlation Between Pelvic Tilt Angle, Hip Range Of Motion And Hip Muscles Torque Ratios

Anterior pelvic tilt is associated with excessive foot pronation, excessive hip internal rotation (HIR), and knee valgus, which may lead to hip muscles strains, sciatic nerve compressions, and sacroiliac and lumbosacral joint instability. Posterior pelvic tilt is associated with feet supination and increased hip external rotation (HER), which may lead to tibial stress fractures, medial tibial stress syndrome, knee pain, anterior cruciate ligament injury, and low back pain. Hip adductors/abductors (add/abd) torque ratio (TR) below 80%, was associated with adductor strains. The average hip flexors/extensors (flex/ext) TR in sport performance was found to be 70%. There is a lack of evidence that correlates pelvic tilt angle with limited HIR, HER, add/abd TR, and flex/ext TR. PURPOSE: to examine the correlation between natural pelvic tilt angle and HIR, HER, add/abd TR, and flex/ext TR. METHODS: Twenty-six subjects participated in this study, fifteen females (22.0±2.8 years old, 163.5±7.5 cm, 65.9±10.4 kg) and eleven males (22.0±2.2 years old, 178.5±4.5 cm, 78.4±8.7 kg). Using a 3D motion analysis system, the measurement of both natural pelvic tilt (NPT) in standing natural position and HIR and HER in lunge position, for the right and left limbs, were recorded. Hip torques were collected with an isokinetic dynamometer, five trials at 30 deg/s and at 60 deg/s. RESULTS: The mean value for NPT was 5.7±5.4 deg. There were no significant correlations between NPT and the dependent variables for the right limb: HIR (r=-0.16, p=0.43), HER (r=-0.11, p=0.58), add/abd TR at 30 deg/s (r=-0.19 p=0.34), add/abd TR at 60 deg/s (r=-0.13 p=0.51), flex/ext TR at 30 deg/s (r=0.32 p=0.10) and flex/ext TR at 60 deg/s (r=-0.70 p=0.70). Similar results were observed for the left limb: HIR (r=-0.20, p=0.89), HER (r=-0.25, p=0.21), add/abd TR at 30 deg/s (r=-0.17 p=0.38), add/abd TR at 60 deg/s (r=-0.12 p=0.55), flex/ext TR at 30 deg/s (r=0.60 p=0.75) and flex/ext TR at 60 deg/s (r=-0.19 p=0.33). CONCLUSION: the measurement of NPT angle in standing natural position is not a good predictor of HIR, HER, add/abd TR, and flex/ext TR. Future research should look at these relations during functional dynamic movements and during pelvic tilt end range of motion.

Midstance hamstring length is a better indicator for hamstring lengthening procedures than initial contact length

BackgroundChildren with static encephalopathy often walk with excessive knee and hip flexion throughout the gait cycle. This crouch gait pattern can be debilitating. These children may undergo hamstring-lengthening procedures to correct this crouch gait. Some improve, while others remain in crouch gait or go into knee hyperextension postoperatively, which can ultimately be debilitating. Research questionHamstring muscle-tendon length models are frequently used as indicators when making recommendations for or against hamstring lengthening procedures. According to the literature, most clinicians use the length of the hamstring complex at the initial contact phase of the gait cycle as the primary deciding factor. We hypothesize that the length of this muscle-tendon complex at the midstance phase of the gait cycle is a more stringent criteria for lengthening procedures. MethodsA simplified hamstring length model was applied retrospectively to the pre and postoperative three dimensional gait analysis kinematics of 152 subjects to assess preoperative surgical indications and postoperative outcomes. ResultsOf the limbs with short hamstrings at initial contact preoperatively, 15% went into knee hyperextension following hamstring lengthening procedures. Cases of hyperextension were even higher (19%) if the hamstrings were also normal to long at midstance. If the hamstrings were short at midstance, only 6 % went into hyperextension. Increasing the criteria to short hamstrings at initial contact and midstance reduced the number of limbs with hyperextension to 0%. SignificanceIt appears that the length of the hamstrings at midstance is an additional predictor of the risk of post-op knee hyperextension from hamstring lengthening procedures, than utilizing the length at initial contact alone. Even though short hamstrings at midstance may be an additional predictor of positive outcomes, it also results in a more conservative approach to surgery by excluding almost half of the patients with short hamstrings at initial contact only, but who may benefit from surgery.

Clinical phenotypes based on clinical prognostic factors in patients with secondary hip osteoarthritis: preliminary findings from a prospective cohort study.

Recently, several clinical prognostic factors for hip osteoarthritis (OA) progression such as spinal malalignment, reduced spinal mobility, and excessive daily cumulative hip loading have been identified. This study aimed to identify clinical phenotypes based on clinical prognostic factors in patients with secondary hip OA using data from prospective cohort studies and to define the clinical features of each phenotype. Fifty patients participated. Two-step cluster analysis was performed to identify the phenotypes using the following potential prognostic factors for hip OA progression: spinal inclination in standing, thoracolumbar spine mobility, daily cumulative hip moment, and minimum joint space width (JSW) at baseline. Comprehensive basic and clinical features (age, body mass index, hip pain, Harris hip score, JSW, radiographic hip morphology, hip impairments, spinal alignment and mobility, and gait-related variables) and ratio of progressors in 12months were compared among the phenotypes using bootstrap method (unadjusted and adjusted for age). Three phenotypes were identified and each phenotype was characterized as follows (P < 0.05): phenotype 1 (30%)-relatively young age and higher daily cumulative hip loading; phenotype 2 (42.0%)-relatively older age, reduced JSW, and less spinal mobility; and phenotype 3 (28.0%)-changed thoracic spine alignment and less spinal (especially in the thoracic spine) mobility. The ratio of progressors among the phenotypes was not statistically significantly different. These characteristics remained after adjustment for age. Three phenotypes with similar progression risk were identified. This finding will help in designing treatment tailored to each phenotype for hip OA progression prevention.Key Points• Three phenotypes with similar progression risk were identified based on clinical prognostic factors.• Phenotype 1 was characterized by young age and higher daily cumulative hip loading.• Phenotype 2 was relatively old age and had reduced JSW and less spinal mobility.• Phenotype 3 had changed thoracic spine alignment and less thoracic spine mobility.

Gender-Specific Sexual Activity After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: Position Matters

BackgroundThere is limited evidence on the safety of return to sexual activity after hip arthroscopy. AimTo determine the positional safety of sexual activity after hip arthroscopy relative to hip instability and/or impingement risk. Study DesignThis study is an observational study. Methods12 common sexual positions were identified based on previous research. Gender-specific hip motion was then assessed for the possibility of postarthroscopic hip instability (due to disruption of iliofemoral ligament [interportal capsulotomy] repair) and/or impingement (labral or capsular compressive stress with disrupted repair) for all 12 positions (both right and left hips; 15 unique male and 14 unique female positions). Instability risk was defined as greater than 0° hip extension, greater than 30° external rotation (ER), or greater than 30° abduction. Impingement risk was defined as greater than 90° hip flexion, greater than 10° internal rotation, and greater than 10° adduction. OutcomesA majority of both male and female sexual positions caused either instability or impingement, with only 4 positions in women and 4 positions in men deemed “safe” by avoiding excessive hip motion. ResultsReturn to sexual activity after hip arthroscopy may cause instability in 10/15 of male positions and 5/14 female positions. Most male positions (6/10) were at risk for instability because of excessive ER. 2 positions were unstable because of a combination of ER and extension, one was due to extension, and one abduction. In female instability positions, all 5 were unstable because of excessive abduction. Impingement may be observed in 5 of 15 male positions and 6 of 14 female positions. In male impingement positions, all were due to excessive adduction. 4 female positions risked impingement due to excessive flexion and 2 positions due to internal rotation. Clinical ImplicationsThis study demonstrates risks that should be considered when counseling patients preoperatively and postoperatively regarding sexual activity. Strengths & LimitationsThis study closely models a hip preservation patient population by using 2 young and otherwise healthy individuals. The most significant limitation of this investigation was its basis with only 2 young healthy volunteers (one male, one female) in a single motion capture session using surface-based spherical retroreflective markers from a previous investigation. ConclusionAfter hip arthroscopy, patients need to be made aware of the possibility of hip instability (10 of 15 men; 5 of 14 women) and impingement (5 of 15 men; 6 of 14 women) due to excessive hip motion that may compromise their outcome.Morehouse H, Sochacki KR, Nho SJ, et al. Gender-Specific Sexual Activity After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: Position Matters. J Sex Med 2020;17:658–664.

Patellar ligament rupture in a cat treated with autologous fascia lata graft augmentation

A five-year-old male domestic shorthair cat has been referred with a two-week history of lameness affecting the right hind limb. Gait assessment revealed an involuntary flexion of the stifle during...

Gait kinematics of the hip, pelvis, and trunk associated with external hip adduction moment in patients with secondary hip osteoarthritis: toward determination of the key point in gait modification

BackgroundA larger daily cumulative hip loading, which is the product of the external hip adduction moment (HAM) impulse during gait and the number of steps per day has been identified as a factor associated with the progression of secondary hip osteoarthritis (OA). The cause of the increased HAM impulse in patients with hip OA has not been identified. The purpose of this study was to identify the gait parameters associated with HAM impulse during gait in patients with secondary hip OA.MethodsFifty-five patients (age 22–65 years) with mild-to-moderate secondary hip OA participated in this cross-sectional study. The HAM impulse during gait was measured using a three-dimensional gait analysis system. To identify the gait parameters associated with HAM impulse, hierarchical multiple regression analysis was performed. The first model (basic model) included body weight and stance phase duration. The second models included gait parameters (gait speed; ground reaction force [GRF] in frontal plane; and hip, pelvic, and trunk angle in frontal plane) and hip pain in addition to the basic model.ResultsBody weight and stance phase duration explained 61% of the variance in HAM impulse. In the second model, which took into account body weight and stance phase duration, hip adduction angle (9.4%), pelvic tilt (6.5%), and trunk lean (3.2%) in addition to GRF explained the variance in the HAM impulse. Whereas larger hip adduction angle and pelvic tilt toward the swing limb were associated with a larger HAM impulse, larger trunk lean toward the stance limb was associated with smaller HAM impulse.ConclusionIn patients with excessive hip adduction and pelvic tilt toward the swing limb during gait, gait modification may contribute to the reduction of hip joint loading.

Predicting gait adaptations due to ankle plantarflexor muscle weakness and contracture using physics-based musculoskeletal simulations.

Deficits in the ankle plantarflexor muscles, such as weakness and contracture, occur commonly in conditions such as cerebral palsy, stroke, muscular dystrophy, Charcot-Marie-Tooth disease, and sarcopenia. While these deficits likely contribute to observed gait pathologies, determining cause-effect relationships is difficult due to the often co-occurring biomechanical and neural deficits. To elucidate the effects of weakness and contracture, we systematically introduced isolated deficits into a musculoskeletal model and generated simulations of walking to predict gait adaptations due to these deficits. We trained a planar model containing 9 degrees of freedom and 18 musculotendon actuators to walk using a custom optimization framework through which we imposed simple objectives, such as minimizing cost of transport while avoiding falling and injury, and maintaining head stability. We first generated gaits at prescribed speeds between 0.50 m/s and 2.00 m/s that reproduced experimentally observed kinematic, kinetic, and metabolic trends for walking. We then generated a gait at self-selected walking speed; quantitative comparisons between our simulation and experimental data for joint angles, joint moments, and ground reaction forces showed root-mean-squared errors of less than 1.6 standard deviations and normalized cross-correlations above 0.8 except for knee joint moment trajectories. Finally, we applied mild, moderate, and severe levels of muscle weakness or contracture to either the soleus (SOL) or gastrocnemius (GAS) or both of these major plantarflexors (PF) and retrained the model to walk at a self-selected speed. The model was robust to all deficits, finding a stable gait in all cases. Severe PF weakness caused the model to adopt a slower, "heel-walking" gait. Severe contracture of only SOL or both PF yielded similar results: the model adopted a "toe-walking" gait with excessive hip and knee flexion during stance. These results highlight how plantarflexor weakness and contracture may contribute to observed gait patterns.

Gait Pattern of Adults with Cerebral Palsy and Spastic Diplegia More Than 15 Years after Being Treated with an Interval Surgery Approach: Implications for Low-Resource Settings.

Background:Single-event multilevel surgery (SEMLS) approach is regarded as the golden standard in developed countries to improve gait and functional mobility in children with cerebral palsy (CP). However, this approach is not always feasible in developing countries. Therefore, orthopedic surgery based on an interval surgery approach (ISA) is still commonly used in developing countries, although little is known about the long term outcomes of an ISA. Therefore, the aim of this study was to describe the gait patterns of adults with CP, who have been treated with ISA, which started more than 15 years ago.Materials and Methods:Thirty adults with CP and spastic diplegia, who received ISA treatment 21.6–33.7 years ago, were recruited for this study and participated in three-dimensional gait analysis. Twenty kinematic and nondimensional temporal-distance parameters were captured, while the overall gait deviation index (GDI) was also calculated. Data of the adults with CP were compared to normative data of typically developing (TD) adults.Results:Although all adults with CP were still ambulant, their gait parameters significantly differed from TD adults, with a lower GDI in the adults with CP. The CP gait patterns were characterized by excessive hip flexion and hip internal rotation as well as a stiff-knee gait.Conclusion:Although different to TD adults, the gait patterns observed in the adult with CP treated with ISA is in line with other studies. Gait patterns suggest that derotation osteotomies potentially could have improved the long term gait patterns. Although SEMLS might be the preferred treatment method, potentially resulting in better outcomes, ISA can also be used to treat children with CP in developing countries as India and South Africa, where a SEMLS approach is not always feasible.

Down Syndrome: Gait Pattern Alterations in Posture Space Kinematics.

Gait characteristics in Down syndrome (DS) are documented in terms of discrete kinematic variables. However, such features are strictly interrelated and reflect neurological and developmental delays. A phenotypical, quantitative assessment of how multi-joint walking patterns are activated and controlled during gait would enhance the understanding of locomotor mechanisms in such patients. We adopted an analysis framework based on principal component analysis: the gait kinematics of 221 patients aged 6-45 were expressed in terms of a reduced set of one-dimensional movement components. Their time course during the gait cycle was described by score vectors, here called principal positions; its second time derivative, called principal acceleration, characterized the activity of the neuromuscular controller on each component. Outcomes were compared to an age-matched group of 49 healthy individuals. After controlling for the effect of walking speed, we observed that the main alterations in gait patterns emerged in the fourth component which is mostly devoted to stability management (group differences, p < 0.001). Rather, the main sagittal-plane locomotor patterns showed only subtle differences from the control group. Using statistical parametrical mapping, we found when (step-to-step transitions) and how (interrelated joints motion) the fourth movement deviated from normal: in particular, an excessive hip adduction and trunk inclination during the transition between single and double support phases. These findings match the neurological and sensorimotor trait of DS and suggest the promotion of targeted rehabilitative interventions. Furthermore, this paper opens to the adoption of principal positions and principal accelerations to investigate the neuromuscular control of movement patterns during locomotion.

In vivo kinematic analysis of replaced hip during stationary cycling and computer simulation of optimal cup positioning against prosthetic impingement

BackgroundDynamic hip kinematics during stationary cycling after total hip arthroplasty (THA) have been unclear. Furthermore, no computer simulation of optimal cup position based on in vivo kinematics has yet been assessed. MethodsThis study consisted of 7 patients who underwent unilateral primary THA for symptomatic osteoarthritis. Using a flat-panel X-ray detector, continuous radiographs were obtained during stationary cycling. We analyzed the three-dimensional replaced hip kinematics from the top to the bottom position of the crank using image-matching techniques and quantified minimum liner-to-stem neck distance. Simulation analyses with in vivo kinematics were performed to examine patient-specific optimal cup placement against prosthetic impingement. FindingsDuring stationary cycling, pelvis showed 27.1° of posterior tilt on average without significant change. Hip flexed by 59.4° and 19.3° on average at the top and bottom positions, respectively. Minimum liner-to-neck distance was 8.8 mm on average at the bottom position. Liner-to-neck, bone-to-bone, or bone-to-component impingement was not observed at any positions in any hips. Simulation analysis of cup placement showed that larger cup anteversion, inclination, and use of elevated liner significantly decreased the minimum distance between posterior liner and stem neck. Cup anteversion of more than 30° with elevated liner could cause posterior liner-to-neck impingement at bottom position. InterpretationStationary cycling after THA provides no excessive hip range of motion or liner-to-neck contact. Cup placement and use of elevated liner significantly influence the minimum liner-to-neck distance, in some cases simulating posterior prosthetic impingement.

The Effect of Valgus Control Instruction Exercises on Pain, Strength, and Functionality in Active Females With Patellofemoral Pain Syndrome.

Patellofemoral pain syndrome (PFPS) is sometimes related to excessive hip adduction and internal rotation, as well as knee valgus during weightbearing activities in females. Research on injury prevention and rehabilitation strategies has shown the positive effects of valgus control instruction (VCI) exercise programs in training. A VCI program would result in a positive change in pain, eccentric hip muscle torque, and performance in females with PFPS. Controlled laboratory study. Level 1. Sixty-four amateur female volleyball players from our university (age, 18-25 years) with PFPS and equal years of exercise experience were randomly divided into VCI (n = 32; age, 22.1 ± 5.88 years) and control (n = 32; age, 23.1 ± 6.49 years) groups. Function (single, triple, and crossover hops), strength (hip abductor and external rotators), pain (visual analog scale), and knee valgus angle (single-leg squat) were assessed at baseline and after intervention. There was a significant difference before and after implementation of the VCI program with regard to pain (49.18% ↓, P = 0.000), single-leg hop test (24.62% ↑, P = 0.000), triple-hop test (23.75% ↑, P = 0.000), crossover hop test (12.88% ↑, P = 0.000), single-leg 6-m timed hop test (7.43% ↓, P = 0.000), knee dynamic valgus angle (59.48% ↓, P = 0.000), peak abductor to adductor eccentric torque ratio (14.60% ↑, P = 0.000), peak external (59.73% ↑, P = 0.023) and internal rotator (15.45% ↑, P = 0.028) eccentric torques, and the ratio of peak external to internal rotator eccentric torque (40.90% ↑, P = 0.000) ( P < 0.05). PFPS rehabilitation and prevention programs should consider VCI exercises to decrease pain, improve strength, and increase athletes' functional performance. This study investigated the effect of VCI exercises on knee valgus angle, pain, and functionality of individuals with PFPS. The VCI program improves performance, knee dynamic valgus angle, and strength in participants with PFPS. A controlled and optimal knee valgus angle during a functional task is the most important factor for injury prevention specialists. VCI training can be used as a supplemental method to prevent and treat lower extremity injury in patients with PFPS.

Computer-assisted anteverting eccentric rotational acetabular osteotomy for recurrent posterior dislocation associated with acetabular retroversion: a case report

BackgroundAcetabular retroversion is a rotatory abnormality of the entire hemipelvis that includes anterior over-coverage and posterior deficiency of the acetabulum, and is associated with pincer-type femoroacetabular impingement and posterior hip instability. Acetabular retroversion is thought to cause posterior dislocation of the hip in athletes due to both the pincer-type femoroacetabular impingement and posterior hip instability.Case presentationA 26-year-old Japanese man had acetabular retroversion that induced recurrent posterior dislocation of his hip due to excessive hip flexion while wakeboarding. We performed anteverting eccentric rotational acetabular osteotomy using preoperative three-dimensional planning and an intraoperative computerized navigation system. Our patient was able to return to sports activities 1 year postoperatively.ConclusionsBoth preoperative three-dimensional surgical planning software and an intraoperative navigation system can provide a highly accurate map for this complicated surgery that simultaneously improves the pincer-type femoroacetabular impingement and posterior deficiency of the acetabulum.

The predictive value of the clinical sign of excessive hip abduction for developmental dysplasia of the hip (DDH)

Aim To assess the relationship between the clinical sign of excessive hip abduction (abduction of the hip 90 degrees or more) and developmental dysplasia of the hip (DDH). Methods The research was conducted on 450 newborns in the Neonatal Unit at the Clinic of Gynecology and Obstetrics and the Clinic of Orthopedics and Traumatology of the University Clinical Centre, Tuzla, between 30th August 2011 and 30th April 2012. Clinical (degree of hip abduction) and ultrasound examination of all newborns hip were performed using the Graf method on their first day of life. Results Clinical sign of excessive hip abduction showed significant predictive value for DDH. There were 37 (8.2%) newborns with the clinical sign of excessive hip abduction, of which 13 of them had DDH while 24 of them did not have this clinical sign. There were 89 newborns, in the overall sample, with one of the forms of DDH, 13 (12.7%) of them had this clinical sign, while from 324 newborns witouth DDH, 24 (6.9%) had this clinical sign. Excessive hip abduction had a positive predictive value (PPV) of 35.1% and a negative predictive value (NPV) of 78.5% for DDH. Conclusion Excessive hip abduction is an useful and important clinical sign of DDH. Doctors who perform the first examination of the child after birth, would have to turn their attention to this clinical sign. The newborns with this clinical sign would have to go to an ultrasound examination of the hips for further diagnosis.

Hip Taping Positively Alters Running Kinematics in Asymptomatic Females.

Greater functional knee valgus (FKV) is thought to contribute to a greater risk of sustaining overuse running injuries. The hip is commonly implicated in greater functional knee valgus, but no studies have investigated the effects of hip taping on running kinematics. The present study investigated whether or not hip taping altered hip and knee kinematics compared to sham and no taping in female runners demonstrating excessive functional knee valgus. Lower limb stance-phase kinematics were collected from 23 female runners using three-dimensional motion capture. Participants performed over ground running at 3.5 m/s and 5.0 m/s. Three taping conditions (no tape; sham tape; hip tape) were tested. Statistical inference was performed using Statistical Parametric Mapping Hotelling's paired t-tests, with post-hoc paired t-tests. Hip taping significantly decreased hip adduction and internal rotation angles throughout stance phase by up to 7°, compared to sham and no taping. Hip taping significantly increased knee adduction, internal rotation, flexion, and reduced peak knee flexion angles, compared to no tape. Hip taping reduced excessive hip motion by clinically meaningful magnitudes, and also benefited knee frontal and transverse plane kinematics at the slower running speed. Hip taping may provide an immediate solution in correcting FKV in running.