Hip External Rotation Strength Research Articles

Association between hip muscle strength/function and hip cartilage defects in sub-elite football players with hip/groin pain

ObjectiveTo explore associations between hip muscle strength and cartilage defects (presence and severity) on magnetic resonance imaging (MRI) in young adults with hip/groin pain participating in sub-elite football. DesignSub-elite football players with hip/groin pain (>6 months) completed assessments of isometric hip strength and functional task performance. Hip cartilage defects were assessed using the Scoring Hip Osteoarthritis with MRI tool. This exploratory, cross-sectional study used logistic and negative binomial models to assess the relationships between hip muscle strength or functional task performance and hip cartilage defects, controlling for body mass index, age, testing site and cam morphology, incorporating sex-specific interaction terms. ResultsOne hundred and eighty-two (37 women) sub-elite (soccer or Australian football) players with hip/groin pain (age 26 ± 7 years) were included. Greater hip extension strength was associated with higher cartilage total score (adjusted incidence rate ratio [aIRR] 1.01, 95%CI: 1.0 to 1.02, p = 0.013) and superolateral hip cartilage defects (adjusted odds ratio (aOR) 1.03, 95% confidence interval (CI): 1.01 to 1.06, p < 0.01). In female sub-elite football players, greater hip external rotation strength was associated with lateral cartilage defects (aOR 1.61, 95%CI: 1.05 to 2.48, p = 0.03) and higher cartilage total score (aIRR 1.25, 95%CI: 1.01 to 1.66, p = 0.042). A one-repetition increase in one-leg rise performance was related to lower odds of superomedial cartilage defects (aOR 0.96, 95%CI: 0.94 to 0.99, p < 0.01). ConclusionsOverall, there were few associations between peak isometric hip muscle strength and overall hip cartilage defects. It is possible that other factors may have relevance in sub-elite football players. Additional studies are needed to support or refute our findings that higher one leg rise performance was associated with reduced superomedial cartilage defect severity and greater hip extension strength was related to higher cartilage defect severity scores.

No sign of weakness: a systematic review and meta-analysis of hip and calf muscle strength after anterior cruciate ligament injury

ObjectiveWe aimed to determine hip and lower-leg muscle strength in people after ACL injury compared with an uninjured control group (between people) and the uninjured contralateral limb (between limbs).DesignSystematic review...

Is there a subgroup of females with patellofemoral pain syndrome likely to benefit from proximal control exercises?

IntroductionPatellofemoral pain syndrome (PFPS) is one of the most popular complaints among young females. Proximal hip control exercises can improve hip strength and reduce the stresses and pain. However, there is a lack of studies that investigate predictors of the success of proximal hip control exercises in this disorder. This predictive validity diagnostic trial aimed to investigate the effect of body mass index, age, duration of symptoms, and knee angle valgus on proximal control exercise success to improve hip muscle abductors and external rotator isometric strength.MethodsFifty females with PFPS recruited from Ain shams University Hospital with a mean age of 25 years received proximal control exercises (transversus abdominis and multifidus activation, hip extensor, abductor and external rotator strengthening). Participants were assessed for hip strength using a handheld dynamometer, and dynamic knee valgus via video analysis using the Kinovea v.0.8.15 computer program.ResultsAge was found to be a predictor of success in hip abductor strength, and duration of symptoms a predictor of success in hip external rotator strength with proximal control exercises in patellofemoral pain syndrome female individuals, with no specific cut-off points.ConclusionsProximal control exercises can improve hip strength in females with PFPS with no specific cut-off points for the significant predictors found (age and duration of symptoms).

Cross-Education Effects of Hip Strengthening in Individuals with Chronic Ankle Instability

ABSTRACT Introduction/Purpose Chronic ankle instability (CAI) is associated with reduced balance, lumbopelvic stability, and hip strength. Accordingly, hip strengthening is an effective intervention for individuals with CAI. Cross-education through unilateral exercise is also beneficial to individuals with CAI, but cross-education effects of hip strengthening remain unknown. The purpose of this study was to determine cross-education effects of hip strengthening in individuals with CAI. Methods Thirty individuals with CAI were randomized into control (CON) and hip strengthening (HIP) groups. Baseline and postintervention tests of the uninvolved limb included lumbopelvic stability (unilateral hip bridge), handheld dynamometry (isometric hip extension, abduction, and external rotation strength), and balance (Star Excursion Balance Test (SEBT) in anterior, posterolateral (PL), and posteromedial directions). After baseline testing, HIP completed progressive hip strengthening of the involved limb three times per week for 8 wk, and CON did not. Repeated-measures analyses of variance assessed the effects of group and time on each outcome. Each group’s mean changes from baseline to postintervention were assessed via effect sizes. Statistical significance was set a priori at P &lt; 0.05. Results Of the 30 participants enrolled, 10 did not complete the postintervention data collection. Multiple imputations estimated missing data, and an intention-to-treat analysis was conducted. There were no significant group-by-time interactions for hip strength, balance, or lumbopelvic stability. HIP exhibited moderate effect sizes for SEBT-PL and hip bridge. All other effect sizes were small or negligible. Conclusions We did not identify a clear cross-education effect following unilateral hip strengthening in a cohort with CAI. Examination of baseline to postintervention effect sizes indicate a potential trend toward improved balance and lumbopelvic stability of the HIP group.

Comparing the Balance, Strength, and Range of Motion of Hip and Ankle Joints in Volleyball Players With and Without Dynamic Knee Valgus

Background and Aims Dynamic knee valgus (DKV) is an abnormal pattern of movement or abnormal alignment of the lower limb that causes changes in lower limb function in the frontal plane and absorption of excessive reaction force by the knee ligaments during sports activities, which can increase the risk of anterior cruciate ligament injury. This study aims to compare the balance, strength, and range of motion (ROM) of hip and ankle joints in volleyball players with and without DKV. Methods This is a quasi-experimental and causal-comparative study. Participants were 60 volleyball players (30 with DKV and 30 without DKV). The tuck jump test was used to evaluate their DKV. The ROM of knee and ankle joints was measured using a goniometer, while the isometric strength of the hip and ankle muscles was determined using a hand dynamometer. Then static and dynamic balances were evaluated by the Stork test and the Y balance test, respectively. Independent t-test was used to compare the means of variables between the two groups in SPSS software, version 24. Results The results showed a significant difference in static balance (P=0.005), dynamic balance (P≤0.05), hip abduction strength (P=0.03), hip external rotation strength (P=0.01), and ROM of ankle dorsiflexion (P=0.03) between the two groups, where those without DKV performed better. The difference in other variables was not significant between the two groups. Conclusion The results indicate the importance of improving hip abduction and hip external rotation strength as well as the ROM of ankle dorsiflexion for reducing the DKV, which should be considered in designing training protocols.

Hip Muscle Strength, Range of Motion, and Functional Performance in Young Elite Male Australian Football Players.

Hip and groin injuries are common in field sports such as football, with measurement of hip strength and range of motion (ROM) recommended for assessment of these conditions. We aimed to report hip strength, hip ROM, and functional task performance in young elite Australian football athletes. Cross-sectional study. Fifty-eight newly drafted Australian Football League athletes completed hip abduction, adduction, internal rotation, external rotation, and flexion strength testing with an adjustable stabilized or hand-held dynamometer. Hip internal rotation and external rotation, bent knee fall out, and ankle dorsiflexion ROM were also measured. Players completed hop for distance, side bridge, and star excursion balance functional tests. We compared findings between the dominant and nondominant limbs. We found small deficits unlikely to be clinically meaningful in the dominant limb for hip abduction and adduction strength, and a small deficit in the nondominant limb for external rotation strength and side bridge time. Athletes had lower hip internal rotation (mean difference 2.56°; 95% confidence interval, 0.87 to 4.26) and total rotation ROM (2.03°; 95% confidence interval, 0.06 to 4.01) on the dominant limb. There were no meaningful differences between dominant and nondominant limbs for hip strength, ROM, or functional tests. Our results may be used for benchmarking young male Australian football athletes when targeting optimal strength and returning from injury.

The association between hip/groin pain and hip strength in football players: An exploratory analysis of the FORCe cohort.

Explore associations between peak hip strength in football players with hip/groin pain and healthy controls. Cross-sectional study. Male and female sub-elite football players (soccer and Australian football) with hip/groin pain >6-month duration and players without hip/groin pain were recruited across Melbourne and Brisbane, Australia. Demographic information and two questionnaires; the Copenhagen Hip and Groin Outcome Score and the International Hip Outcome Tool 33 were collected. Hand-held dynamometry was used to measure isometric hip strength for flexion, extension, abduction, adduction, internal rotation, and external rotation. Linear mixed effects models were used to compare strength measures between groups. 190 football players with hip/groin pain (mean ± standard deviation age, 27.8 ± 6.3 years) and 64 controls (age, 27.3 ± 5.6 years) were included in this study. Of these, 291 symptomatic limbs and 128 control limbs were used for analyses. Symptomatic players had lower peak hip adduction (adjusted mean difference = -0.18: 95 % confidence interval -0.27 to -0.08, P : 0.001), external rotation (-0.06: 95 % confidence interval -0.09 to -0.02, P : 0.003), and internal rotation strength (-0.06: 95 % confidence interval -0.10 to -0.03, P : 0.001) compared to controls. A sport-specific interaction was observed for hip abduction strength. When separated by football code, abduction strength was lower in symptomatic Australian football players compared to their same sport peers (-0.20: 95 % confidence interval -0.33 to -0.06, P : 0.004), but not in symptomatic soccer players (-0.05: 95 % confidence interval -0.15 to 0.06, P : 0.382). Hip adduction, internal rotation, and external rotation strength appears lower in football players with hip/groin pain independent of sex and football code. Hip abduction strength was lower in symptomatic Australian football players but not in soccer players.

Does hip muscle strength and functional performance differ between football players with and without hip dysplasia?

ObjectiveTo compare hip muscle strength and functional performance in football players with and without hip dysplasia and investigate if the relationships were modified by sex. DesignCross-sectional study. MethodsThis study compared football players with hip dysplasia (HD group) and without hip dysplasia (control group). Hip muscle strength (Nm/kg) and functional task performance were assessed in both groups. Linear regression with generalized estimating equations were used to assess differences between groups. Sex was assessed as a potential effect modifier. Results101 football players were included (HD group, n = 50, control group, n = 51). There was no difference in hip muscle strength or functional performance between the HD group and the control group. Results ranged from hip extension strength (Estimate −0.13.95%CI: 0.29 to 0.02, P = 0.087) to hip external rotation strength (Estimate 0.00.95%CI: 0.05 to 0.05, P = 0.918). No relationships were modified by sex or age. ConclusionsSimilar levels of hip muscle strength and functional performance were found in active football players with and without hip dysplasia. These findings differ from other studies. This may be due to our cohort having less advanced hip dysplasia than the surgical populations that have been previously investigated, or due to a beneficial effect of football participation on muscle strength and functional performance in people with hip dysplasia.

Hip rotation muscle strength is implicated in the progression of early post-traumatic osteoarthritis: A longitudinal evaluation up to 5 years following ACL reconstruction

IntroductionFollowing ACL reconstruction (ACLR), deficits in hip muscle strength and relationships to future outcomes are unknown. Methods111 participants one year after ACLR, completed hip external rotation (ER) and internal rotation (IR) strength assessment. At 1 (n = 111) and 5 (n = 74) years post-ACLR, participants completed a battery of functional, symptomatic (Knee Osteoarthritis Outcome Score (KOOS)) and structural assessments (radiography, magnetic resonance imaging (MRI)). Cartilage health of the patellofemoral and tibiofemoral compartments was assessed with the semiquantitative MRI Osteoarthritis Knee Score. Hip rotation strength was compared between-limbs, and relationships between hip strength at 1 year and functional, symptomatic and cartilage outcomes at 1 and 5 years were investigated with regression models. ResultsThe index (ACLR) limb had weaker hip ER (but not IR) strength compared to the contralateral side (standardised mean difference ER = −0.33 (95%CI -0.60, −0.07; IR = −0.11 (95%CI -0.37, 0.15). Greater hip ER and IR strength was associated with superior function at 1 and 5 years, and better KOOS-Patellofemoral symptoms at 5 years. Greater hip ER strength was associated with lower odds of worsening tibiofemoral cartilage lesions at 5 years (odds ratio 0.01, 95%CI 0.00, 0.41). ConclusionHip rotation strength may play a role in worsening function, symptoms and cartilage health after ACLR.

Effect of a Neuromuscular Training on Knee Valgus, Range of Motion and Muscle Strength of Soccer Players With Dynamic Knee Valgus

Background and Aims The present study aims to investigate the effect of a neuromuscular training program on knee valgus angle, and range of motion (ROM) and muscle strength of hip and ankle in male adolescent football players with dynamic knee valgus (DKV). Valgus knee is one of the most common neuromuscular abnormalities that is involved in causing non-contact damage to the anterior cruciate ligament (ACL). Methods This is a quasi-experimental study. Participants were 25 adolescent male football players with DKV who were purposefully selected from Shahin Football Academy in Amol, Iran and randomly divided into two groups of control and training. The existence of DKV was assessed by Squats test and the valgus angle were assessed by jump-landing test and Kinovea software. The abduction and external rotation strength and ROM of hip and the dorsiflexion and plantarflexion strength and ROM of ankle were evaluated with Manual Muscle Testing and a goniometer, respectively. After performing the pre-test assessments, the subjects in the training group performed neuromuscular training for 8 weeks, while the control group also participated in the physical fitness program of Shahin Football Academy. At the end, assessments were performed again in two groups. To examine the differences, repeated measures analysis of variance and Bonferroni post hoc test were used in SPSS software, version 24. The significance level was set at 0.05. Results The results showed a significant difference in knee valgus angle (P=0.001), abduction ROM of hip (P=0.01), external rotation ROM of hip (P=0.01), dorsiflexion ROM of ankle with knee extension (P=0.001), dorsiflexion ROM of ankle with knee flexion (P=0.001), hip abduction strength (P=0.002), hip external rotation strength (P=0.01), and plantarflexion strength of ankle (P=0.03) between the control and training groups. However, the results showed no significant difference in plantarflexion ROM of ankle and dorsiflexion strength of ankle (P&gt;0.05). After one month, the results showed the sustainability of the effect of training on abduction and external rotation ROM of hip, dorsiflexion ROM of ankle with knee extension and flexion, and dorsiflexion and plantarflexion strength of ankle. Conclusion The neuromuscular training can reduce the risk of non-contact ACL injury in male football players with DKV by improving strength and ROM of hip and ankle.

Do Highly Trained Mountain Runners Differ from Recreational Active Non-Runners on Range of Motion and Strength in the Hip and Ankle as Well as Postural Control?

The rules governing mountain running force athletes to implement into their training programmes uphill and downhill running on unstable surfaces, which are demanding for hip and ankle as well as for the postural control system. The aim of the present cross-sectional study was to compare highly trained mountain runners (MR) and recreational active non-runners (NR) on range of motion (ROM) and strength in the hip and ankle, as well as dynamic postural control. Thirty MR and thirty-two NR were included in the study. ROM was assessed using a digital inclinometer. Strength was measured using a hand-held dynamometer. Postural control was evaluated using the lower quarter Y-balance test (YBT-LQ). The results showed that MR, in relation to NR, had statistically significant smaller hip external rotation ROM (p = 0.007), lower hip external rotator (p = 0.006) and extensor (p = 0.023) strength and greater normalised anterior reach in the YBT-LQ (p = 0.028). Mountain running training may reduce hip external rotation ROM as well as hip external rotator and extensor strength. Moreover, such training may improve postural control. MR should implement exercises targeted at developing hip ROM and strength. Furthermore, it seems that mountain running training may be a good way to improve postural control.

The association between hip strength, physical function and dynamic balance in people with unilateral knee osteoarthritis: A cross-sectional study

BackgroundIn people with knee osteoarthritis, the association between multidirectional hip strength and physical function or balance is unknown. ObjectiveTo determine the relationship between hip flexion, extension, abduction, adduction, external and internal rotation strength and (1) physical function and (2) dynamic balance. DesignCross-sectional. MethodsForty-seven participants (20 men and 27 women, age 66.2 ± 8.2 years) with unilateral knee osteoarthritis were included. Hip strength was assessed with hand-held dynamometry; physical function was assessed with the 40m fast-paced walk test (40mFPWT), 30-s chair-stand test (30sCST), and stair-climb test (SCT); and dynamic balance was assessed in 3 directions using the Star Excursion Balance Test. Multivariable linear regression analysis was used to determine the strength of relationships between measures. ResultsHip strength, in all directions except for internal rotation, was positively associated with better physical function (40mFPWT: R2 = 0.48 to 0.65; SCT: R2 = 0.5 to 0.54; 30sCST: R2 = 0.39 to 0.42), and dynamic balance (anterior: R2 = 0.33 to 0.45; posteromedial: R2 = 0.32 to 0.45; posterolateral: R2 = 0.27 to 0.35). Hip strength, after adjusting for knee extension strength, explained an additional 8%–12% (p < 0.05) and 5%–12% (p < 0.05) reach in the anterior and posteromedial directions of the Star Excursion Balance Test, respectively. ConclusionsHip strength in multiple directions is associated with measures of physical function and dynamic balance in people with unilateral knee osteoarthritis. Clinicians are encouraged to consider hip strength in multiple directions in the context of the patients’ functional and/or balance goals when developing exercise programs for people with knee osteoarthritis.

The effectiveness of the comprehensive corrective exercise program on kinematics and strength of lower extremities in males with dynamic knee valgus: a parallel-group randomized wait-list controlled trial

BackgroundDynamic knee valgus (DKV) is a prevalent movement impairment widely regarded as a risk factor for lower extremity disorders such as patellofemoral pain syndrome. The present study aimed to investigate the effectiveness of the comprehensive corrective exercise program (CCEP) on kinematics and strength of lower extremities in males with DKV.MethodsThirty asymptomatic young men with DKV between the ages of 18 and 28 years participated in this study. They were randomly assigned to the intervention (n = 15) and control groups (n = 15). The intervention group performed the CCEP for three sessions per week for eight weeks, while the control group only did activities of daily living. Hip external rotator and abductor muscle strength and three-dimensional lower extremity kinematics consisting of knee varus/valgus, femur adduction/abduction, femur medial/lateral rotation, and tibial medial/lateral rotation were measured at the baseline and post-test. The data were analyzed using the analysis of covariance (ANCOVA).ResultsThere were significant improvements in all kinematics variables in the intervention group after the 8-week CCEP. Moreover, the strength of abductor and external rotator muscle improved in the intervention group (P < 0.05).ConclusionsThe CCEP led to substantial improvements in the selected variables of lower extremity kinematics and muscle strength in participants with DKV during a single-leg squat. These results imply that practitioners should adopt a comprehensive approach to pay simultaneous attention to both proximal and distal segments for improving DKV.Trial registrationThe protocol has been approved in the Registry of Clinical Trials (Registration N: IRCT20180821040843N1) on 2018-12-30.

Frontal plane lower extremity alignment in adolescent athletes with chronic hip adductor-related groin injury symptoms: A case-control study

ObjectiveTo compare trunk and lower extremity frontal plane projection angles (FPPA) during single leg squat (SLS) performance, perceived hip and groin function and symptoms, and isometric hip strength of adolescent athletes with chronic hip adductor-related groin injury (HARGI) symptoms and age, gender, and sport-matched healthy subjects. DesignCase-control study. SettingJunior Olympic Development Training Centre. ParticipantsTwenty-six athletes at 59.1 ± 60 weeks (range = 12–208 weeks) post-index grade II HARGI injury who had continued sport training (injury group) and 26 control group subjects. Main outcome measuresSLS trunk, hip, and knee FPPA, isometric hip strength standardized to bodyweight, and Copenhagen Hip and Groin Outcome Scores (HAGOS). ResultsThe injury group had greater bilateral knee FPPA, and greater injury side hip FPPA during maximum SLS. Injury group HAGOS subscale scores were lower than control group scores. Hip abductor, adductor, external rotator, and internal rotator strength was lower at the injury side of the injury group compared to the matched control group limb. Forward stepwise multiple regression analysis of the injury group found that 50% of injury side knee FPPA was predicted by hip internal rotator strength and time post-index HARGI; and 47% of injury side hip FPPA was predicted by other side hip flexor strength and the HAGOS function, sport and recreation subscale score (p = 0.002). ConclusionsGreater injury side hip and bilateral knee FPPA during maximum SLS, lower self-reported hip symptom and function scores, and less injury side hip abductor, adductor, external rotator and internal rotator strength suggests that adolescent athletes with chronic HARGI symptoms are at an increased risk for sustaining a non-contact knee injury. Impaired hip internal rotator strength at the side of the chronic HARGI was related to increased knee FPPA, and impaired hip flexor strength at the other side of the HARGI was related to increased hip FPPA. Findings support using SLS performance testing in this athlete group to help determine safe return to sport training readiness.

Association between sensorimotor function and visual assessment of postural orientation in patients with ACL injury

ObjectivesTo investigate the association between sensorimotor function and visual assessment of postural orientation during execution of weight-bearing activities in patients with anterior cruciate ligament reconstruction (ACLR). DesignCross-sectional study. SettingLaboratory. ParticipantsFifty-two individuals (23 women and 29 men, mean (SD) age 26.5 (6.4)) approximately 7 months after ACLR. Main outcome measuresSensorimotor function (proprioception, ankle dorsiflexion range of motion, and isometric muscle strength of the hip, knee, and trunk) were recorded on the injured leg. Postural orientation errors (POEs) were visually scored from video-recordings of the injured leg during execution of 5 functional tasks, and POE subscales activities of daily living (ADL) and Sport, and Total POE score were used in the analysis. ResultsLower hip external rotation strength was associated with higher Total POE score (B = −24.4, p = 0.041) and higher POE subscale ADL score (B = −24.9, p = 0.03). No associations between sensorimotor function and POE subscale Sport were found. ConclusionsDecreased hip external rotation strength might contribute to higher scores on the POE subscale ADL and the Total POE score, in men and women following ACLR. Future studies will reveal if strengthening of hip external rotation strength improves postural orientation.

Relationship between hip muscle strength and hip biomechanics during running in people with femoroacetabular impingement syndrome

BackgroundHip muscle weakness and altered hip biomechanics during walking are often observed in people with femoroacetabular impingement syndrome, although little is known about biomechanics during higher impact tasks. The aim of our study was to explore relationships between hip muscle strength and hip biomechanics during running in people with femoroacetabular impingement syndrome, including exploring sex as an effect-modifier of this relationship. MethodsForty-two adults with unilateral femoroacetabular impingement syndrome (20 females; age 18-50 years; alpha angle ≥60°) completed assessments of hip muscle strength and hip biomechanics during running. Strength was assessed using a hand-held dynamometer for the hip flexors, extensors, abductors, adductors, internal rotators, and external rotators. Hip biomechanics were assessed during overground running (3–3.5 m/s) using three-dimensional motion capture and a force plate. Linear models assessed the relationships between hip strength and hip biomechanics of the symptomatic limb, controlling for body mass and running velocity along with an interaction term (strength*sex). FindingsA significant negative relationship was observed between hip external rotator strength and hip frontal plane range of motion (i.e., excursion), independent of sex (estimate = −0.039, 95%CI −0.071 to −0.008, P = 0.02). Four sex-specific interactions were observed, with a significant positive relationship between hip external rotator strength and peak hip extension moment in women (estimate = −0.413, 95%CI −0.713 to −0.114, P = 0.01) but not in men. InterpretationWe found significant relationships between hip external rotator strength and stance phase running biomechanics, providing further understanding on two impaired physical measures that may inform exercise-based management strategies in femoroacetabular impingement syndrome.

Knee and hip dynamic muscle strength in individuals with femoroacetabular impingement syndrome scheduled for hip arthroscopy: A case-control study

BackgroundThe primary aim of this study was to compare knee and hip dynamic muscle strength of individuals with femoroacetabular impingement (FAI) syndrome scheduled for hip arthroscopy with healthy controls. Our secondary aim was to compare hip and knee muscle strength between male and female patients with FAI syndrome.MethodsOne hundred and thirty-four individuals with femoroacetabular impingement syndrome scheduled for hip arthroscopy and 134 healthy controls matched for sex and age (within 5 years range) underwent an isokinetic assessment of knee extension and flexion and hip abduction, adduction, external rotation and internal rotation dynamic muscle strength. Two MANOVAs were conducted to compare isokinetic peak torque and total work between groups and sexes.FindingsIndividuals with femoroacetabular impingement syndrome demonstrated lower values of all variables representing knee and hip isokinetic peak torque and total work measures when compared to healthy controls, with differences ranging from 0.09 Nm/kg (95%CI: 0.06–0.12 Nm/kg) to 0.64 Nm/kg (95%CI: 0.49–0.79 Nm/kg). Female participants from both FAI syndrome and control group showed less knee and hip muscle strength compared to male participants. There was no significant interaction between group and sex regarding knee or hip isokinetic peak torque and total work (p > 0.05).InterpretationIndividuals with femoroacetabular impingement syndrome scheduled for hip arthroscopy present impairments in knee or hip dynamic muscle strength when compared to controls. Female participants present less knee and hip muscular strength compared to male participants, these between-sex differences are similar for both FAI syndrome and control group participants.

Anterior Cruciate Ligament Reconstruction Recovery and Rehabilitation: A Systematic Review.

The success of anterior cruciate ligament (ACL) reconstruction is influenced by effective rehabilitation. Previously published, comprehensive systematic reviews evaluating rehabilitation after ACL reconstruction have studied Level-I and II evidence published through 2012. Interval studies continue to evaluate the efficacy of various rehabilitative modalities. A total of 824 articles from 2012 to 2020 were identified using multiple search engines. Fifty Level-I or II studies met inclusion criteria and were evaluated using the Consolidated Standards of Reporting Trials (CONSORT) criteria and National Institutes of Health (NIH) Study Quality Assessment Tools. Accelerated rehabilitation can be effective for patients with semitendinosus-gracilis grafts. Blood flow restriction (BFR) training with high-intensity exercise is not effective for ACL reconstruction recovery. Postoperative bracing does not offer any advantages or improve limb asymmetry. Cryotherapy is an effective analgesic when used perioperatively. The early introduction of open kinetic chain exercises may improve ACL reconstruction outcomes, and high-intensity plyometric exercise is not effective. Estimated pre-injury capacity (EPIC) levels may be more accurate than the Limb Symmetry Index (LSI) when using functional test results to predict reinjury rates, and hip external rotation strength may be the most accurate predictor of the hop test performance. Nerve blocks can provide postoperative analgesia with minimal complication risk. Neuromuscular electrical stimulation is effective when used independently and in combination with rehabilitative exercises. Psychological readiness should be evaluated both objectively and subjectively before allowing patients to safely return to sport. Electromyography biofeedback may help to regain muscular function, and whole-body vibration therapy can improve postural control. Supervised rehabilitation is more effective than unsupervised rehabilitation. Various rehabilitative modalities following ACL reconstruction are effective in improving surgical outcomes and return-to-sport rates. Further evidence and improved study design are needed to further validate modalities including accelerated rehabilitation, BFR training, functional testing, and return-to-sport criteria. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

The natural history of greater trochanteric pain syndrome: an 11-year follow-up study

BackgroundGreater trochanteric pain syndrome (GTPS) is a musculoskeletal condition which can cause disability and reduce quality of life. However, limited evidence is available on the long-term outcomes of people with GTPS. Our aims were to determine the long-term prevalence of GTPS; to calculate the proportion of people with GTPS who had developed hip osteoarthritis (OA); and to determine the level of function and quality of life, 11-years after initial GTPS diagnosis.MethodsA prospective 11-year natural history study. Two groups [GTPS group (n = 24), asymptomatic control (ASC) group (n = 20)] were evaluated at baseline, 12-months and 11-years. At 11-years all participants completed the modified Harris Hip Score (mHHS), Oswestry Disability Index (ODI) and Assessment of Quality-of-Life questionnaire. At 11-year follow-up 20/24 GTPS and 19/20 ASC participants were clinically assessed for GTPS and hip OA, completed the 10 metre-walk-test, timed up and go, and hip abduction and external rotation strength testing.ResultsAt 11-year follow-up 45.0% of GTPS participants had GTPS compared to 5.3% of ASC participants (p = 0.008), OR [95% CI]: 10.19 [1.95, 104.3], and 35.0% of GTPS participants were clinically diagnosed with hip OA compared to none of the ASC participants (p = 0.002), OR [95% CI]: 21.6, [2.3, 2898.0]. GTPS participants reported more pain and disability than ASC participants via the ODI, mean difference [95% CI]: 6.1 [0.7, 11.6] but not the modified Harris Hip Score, mean difference [95% CI]: -3.3 [-10.3, 3.7]. Both groups had similar levels of quality of life and measures of function.ConclusionsGTPS is a chronic condition: people with GTPS at baseline had twice the odds of being clinically diagnosed with GTPS or hip OA than the control group at 11-years. Further, there appears to be a temporal relationship between GTPS and the development of hip OA. This finding highlights the need to identify effective treatments that address the underlying impairments associated with GTPS. Pain and function results varied depending on the assessment tools used. Between group differences in quality of life seen at baseline are not found at the 11-year follow-up. The small sample size means the results must be considered with caution.Level of EvidenceLevel II Natural history Study.

Hip rotation strength after anterior cruciate ligament injury: relationship to functional, symptomatic and structural outcomes

Introduction: Hip muscle strength is often implicated in pathoaetiology and management of knee related conditions, including as part of holistic rehabilitation after anterior cruciate ligament (ACL) injury. Despite this, no studies have investigated how hip rotation strength relates to outcomes after ACL reconstruction (ACLR). This study aimed to assess the associations of hip rotation strength at 1 year post-ACLR, to function, patient reported outcomes (PROMs) and imaging outcomes at 1 and 5 years. A secondary aim was to compare hip rotation strength between the injured and non-injured sides. Methods: 111 participants 1 year following ACLR completed hip external-rotation (ER) and internal-rotation (IR) muscle strength assessment with a hand-held dynamometer (peak torque normalised to bodyweight). At 1- and 5-years post-ACLR, participants completed functional (hop testing battery, one leg rise), self-reported (Anterior Knee Pain Scale (AKPS), Knee Osteoarthritis Outcome Score) and MRI and radiographic assessment. Cartilage health of the patellofemoral and tibiofemoral compartments was assessed using the semiquantitative MRI Osteoarthritis Knee Score. Regression models (controlling for age and sex) assessed the relationships between hip rotation strength at 1 year post-ACLR and functional tests, patient reported outcomes and cartilage findings at 1 and 5 years. Results: The injured side had significantly weaker hip ER strength compared to the non-injured side (p=0.014, effect size (ES) =-0.33 (95%CI -0.60 to -0.07). There was no difference between sides for hip IR strength (p=0.411, ES = -0.11 (95%CI -0.37 to 0.15). Weaker hip ER and IR strength was significantly associated with lower performance on all functional tests and worse AKPS scores at 1 and 5 years. Lower hip ER strength was significantly associated with worsening tibiofemoral cartilage lesions at 5 years (p=0.017, Odds Ratio 0.01 (95%CI 0.00 to 0.41). Hip strength was not associated with any patellofemoral imaging outcomes. Discussion: Hip rotation strength may play a role in worsening knee function, symptoms and tibiofemoral cartilage health after ACLR, though further prognostic studies are needed. Hip ER strength of 0.1 Nm/kg higher resulted in 0.63 times lower odds of tibiofemoral cartilage worsening at 5 years. The hip rotator muscles may influence outcomes given their vital role in single leg propulsion and force absorption. Associations to PROMs and structure may also reflect global reductions in lower extremity strength, or reduced activity levels and increased BMI observed after ACL injury. A link between hip strength and patellofemoral outcomes is less clear from our findings. Conflict of interest statement: My co-authors and I acknowledge that we have no conflicts of interest of relevance to the submission of this abstract.