Impingement Syndrome Research Articles

Postoperative hip bracing reduces kinesiophobia in patients undergoing hip arthroscopy: a randomized-controlled trial

IntroductionDetailed postoperative rehabilitation protocols after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) are still a matter of debate. Adjunctive hip bracing represents a promising tool to improve early patients’ mobilization. To present, the effect of hip brace therapy on postoperative functional outcomes and specific patient individual psychologic factors remains controversially discussed. Consequently, we aimed to report postoperative outcomes focusing on hip function, pain and kinesiophobia between braced and unbraced patients.Materials and methodsA prospective, randomized-controlled trial was conducted, including patients undergoing hip arthroscopy for FAIS. After exclusion, a final study cohort of 36 patients in the intervention group (postoperative hip brace) and 36 patients in the control group (no hip brace) were compared for kinesiophobia (Tampa Scale of Kinesiophobia), pain (Visual analog scale) and joint function (International Hip Outcome Tool-12) within the first six postoperative months.ResultsHip arthroscopy significantly improved all patient-reported outcomes in both groups. Intergroup analysis revealed significantly lower levels of kinesiophobia in braced patients at 6-months follow up (30.7 vs. 34.1, p = 0.04) while not negatively affecting pain and joint function. No intra- and postoperative complications occurred within both groups.ConclusionsThis study could demonstrate that bracing after hip arthroscopy can positively influence kinesiophobia, while the brace did not negatively impact postoperative pain and quality of life. Thus, hip bracing could be a viable assistive therapy in the postoperative rehabilitation phase after hip arthroscopy.

Primary Hip Arthroscopy Is Associated With Earlier Achievement of Substantial Clinical Benefit Compared With Revision Hip Arthroscopy for Femoroacetabular Impingement Syndrome

To compare time to achievement of clinically significant outcomes (CSOs) between patients undergoing primary and revision hip arthroscopy (HA) for femoroacetabular impingement syndrome. Patients undergoing primary and revision HA for femoroacetabular impingement syndrome with complete 6-month, 1-year, and 2-year Hip Outcome Score-Activities of Daily Living (HOS-ADL) and Sport Subscale (HOS-SSS) were identified. Revision patients were propensity matched 1:4 to primary patients with HA, controlling for age, sex, and body mass index (BMI). Time to achievement of minimal clinically important difference and substantial clinical benefit (SCB) were compared alongside cumulative CSO achievement at 6, 12, and 24 months. Hazard ratios (HRs) for predictors of earlier CSO achievement were identified with multivariate Cox regressions. Fifty patients with revision HA were propensity-matched to 200 patients with primary HA of similar age, sex, and BMI. Patients with primary HA demonstrated a greater prevalence of regular preoperative physical activity (87% vs 59%, P < .001). Patients with primary HA showed significantly greater SCB achievement for HOS-ADL at 6, 12, and 24 months (P < .001) and significantly greater SCB achievement for HOS-SSS at 12 and 24 months (P ≤ .001) compared with patients with revision HA. Patients with primary HA achieved SCB for HOS-ADL (P < .001) and HOS-SSS (P= .015) quicker than patients with revision HA. Predictors of earlier CSO achievement included preoperative PRO score (HR 0.98-1.02, P ≤ 0.007), lower BMI (HR 0.97, P= .038), presence of physical activity (HR 1.51, P= .038), and absence of revision status (HR 0.52-0.56, P ≤ .019). Patients with primary HA showed a quicker time to SCB achievement for HOS-ADL and HOS-SSS compared with patients with revision HA. Preoperative PRO score, lower BMI, regular physical activity, and primary HA status predicted earlier CSO achievement. Level III, retrospective comparative series.

Poster 186: The Utility of Preoperative Hip Injection Response as a Predictor of 2-Year Postoperative Outcomes Following Hip Arthroscopy for Femoroacetabular Impingement

Objectives: The objective of this study is to determine whether response to preoperative lidocaine or corticosteroid intra-articular hip injections can predict 2-year postoperative outcomes in patients undergoing arthroscopic management of femoroacetabular impingement syndrome (FAIS). Methods: We performed a retrospective analysis of a prospective cohort consisting of patients who received a preoperative corticosteroid or lidocaine intra-articular hip injection and subsequently underwent hip arthroscopy for treatment of FAIS between 2014-2020. Patients were classified by injection received and labeled as “responders” if the injection provided pain relief. Lidocaine and corticosteroid cohorts were matched using 1:1 matching for age, BMI, and sex. Patient reported outcome (PRO) measurements including the Hip Disability and Osteoarthritis Outcome Score (HOOS), 12-item Short-Form Survey mental (SF-12 MCS) and physical component survey (SF-12 PCS), and visual analog scale (VAS) Pain were completed both preoperatively and 2-years postoperatively. Mean differences in preoperative and 2-year postoperative scores were calculated as was the percentage of patients achieving a mean clinically important difference (MCID). Floor and ceiling effects of PROs were also evaluated with 15% of patients achieving a maximum or minimum survey score deemed as significant. Results: Our cohort included 110 patients (55 lidocaine, 55 corticosteroid) with no significant differences in preoperative demographic variables (Table 1). Both cohorts demonstrated significant 2-year postoperative score improvements across all PROs, except SF-12 MCS, which was unchanged. Lidocaine non-responders demonstrated greater 2-year mean difference in all PROs, except for SF-12 MCS, when compared to lidocaine responders (Table 2). Lidocaine non-responders also achieved MCID at higher rates than responders in both HOOS Pain &amp; VAS Pain (Table 3). There was no difference in percentage of patients achieving MCID or mean difference in PROs between corticosteroid responders and non-responders. Ceiling and floor effects were seen in 2-year postoperative PROs of a combined lidocaine &amp; corticosteroid responder cohort. [Ceiling: HOOS ADL (34.6%) HOOS Pain (21.0%) HOOS Sport (28.4%); Floor: VAS Pain (34.6%)] Conclusions: Preoperative intra-articular hip injection response did not predict 2-year postoperative outcomes after hip arthroscopy for FAIS. Results from this study suggest that preoperative injection response should not be used in isolation to predict outcomes after arthroscopic treatment of FAIS.

Poster 210: Flexible Athletes with Borderline Hip Dysplasia Achieve Successful and Similar Outcomes after Hip Arthroscopy Compared to Flexible Athletes without Borderline Hip Dysplasia

Objectives: To compare minimum 2-year patient-reported outcomes and achievement of clinically significant outcomes in flexibles athletes with and without borderline hip dysplasia (BHD) undergoing primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) with capsular plication. Methods: Data was prospectively collected for patients undergoing primary hip arthroscopy for FAIS with borderline hip dysplasia (BHD), defined as a lateral center edge angle (LCEA) of 18° to 25°, with primary participation in a sport with high flexibility requirement including dance, gymnastics, figure skating, yoga, cheerleading, and martial arts. These patients were matched 1:2 to flexible athletes with an LCEA &gt;25° controlling for age, sex, body mass index (BMI) and follow up duration. Preoperative and minimum 2-year postoperative patient-reported outcomes included: Hip Outcome Score (HOS) Activities of Daily Living, HOS Sports Scale, International Hip Outcome Score 12, modified Harris Hip Score, and Visual Analog Scale for Pain. Cohort-specific Minimal Clinically Important Difference (MCID) and Patient Acceptable Symptom State (PASS) were calculated and compared between groups. Results: Fifty-two flexible athletes with BHD were matched to 104 flexible athletes without BHD. Similar sport participation (45% dance vs. 41%, p=0.874) and level of competition (74% vs. 74% recreational, p=0.877) were observed. Preoperative LCEA (22.2° ± 1.6 vs. 31.5° ± 3.9, p &lt; 0.001) and Tönnis angle (10.9 °± 3.7 vs. 5.8° ± 4.4, p &lt; 0.001) differed significantly between groups. Capsular plication was performed in all cases (100% and 100%, p = 1.000). Both groups achieved significant improvement in all PROs (p ≤ 0.001) with no differences in PROs between groups (p ≥ 0.147). High MCID (95.7%, 94.8%) and PASS (71.7%, 72.2%) achievement for any PRO was observed with no differences between groups (p ≥ 0.222). Conclusions: Flexible athletes with BHD achieve successful and similar outcomes to those without BHD after primary hip arthroscopy for FAIS with capsular plication.

Paper 18: The Pendulum Has Swung: A 14-Year Analysis of Patients Presenting for Failed Hip Arthroscopy Shows Rising Incidence of Cam Over-Resection and Decreasing Incidence of Under-Resection

Background: There is a paucity of literature regarding prevalence of femoral resection in the setting of revision hip arthroscopy. Few studies have examined different types of resections and their presentation. Purpose: To describe the prevalence of femoral resection types in the setting of revision hip arthroscopy for residual femoroacetabular impingement syndrome (FAIS) symptomatology. Methods: A search of the institutional prospective registry was performed for patients who presented for evaluation of failed previous arthroscopy between February 2008 and June 2022, and subsequently underwent revision arthroscopy. AP and Dunn view radiographs were reviewed from our study population. On the basis of measurements on both radiographs, patients were divided into 3 categories: overresection (OR) in which the resection measured 5% or more of the femoral head diameter, underresection (UR) in which residual CAM morphology was found (alpha angle &gt;60°), and neutral resection, alpha angle less than 60° and no overresection. Both AP and Dunn radiographs were used to identify over- and under- resections. Results: A total of 622 hips were reviewed and measured on both AP and Dunn radiographs. Of the 622 hips, there were 373 right and 249 left hips. The average age was 33.7 ± 12.0, and the average body mass index (BMI) was 26.0 ± 5.2. Three hundred sixty-five hips were classified as UR and 265 hips as OR. The mean prevalence rates from 2008 to 2022 for neutral resection, over-resection and under-resection were 48.1%, 20.3%, and 31.6%, respectively. The prevalence rates of UR have decreased since 2008, while prevalence rates of OR have increased concomitantly. The steadily decreasing prevalence rates of UR was negatively correlated with the increasing OR ((R=-0.829, P&lt;.0001), as well as with neutral resections (R=-0.735, P=0.002). The ratio of UR to OR reversed entirely, from 4:1 in 2010, to 1: 2.3 ( P &lt; 0.00001) in 2020. Conclusions: Amongst patients presenting for failed hip arthroscopy over the last 14 years, the pendulum has swung from under-resection towards over-resection. Indeed, as of 2020, over-resections were more than twice as common as under-resections. This may be a result of heightened awareness in FAIS, and previous literature emphasizing the risks of under-resection. As we gain increased understanding of the risks of over-resection, the findings of this study highlight the importance of achieving an anatomical spherical resection.

Chondral regeneration in femoroacetabular lesions is favoured using peripheral blood stem cells with hyaluronan-based scaffold and micro-drilling: A prospective cohort study.

To determine whether intra-articular injections of peripheral blood stem cells (PBSC) with hyaluronan (HA)-based scaffold improve articular cartilage regeneration in chondral injuries caused by mixed-femoroacetabular impingement syndrome (FAIS) over a period longer than 24 months post-hip arthroscopy. In this prospective cohort study, patients with mixed-FAIS and chondral injury ≥ IIIB according to the International Cartilage Regeneration and Joint Preservation Society grade or III/IV of Konan/Haddad classification underwent intra-articular injection of PBSC with an HA-based scaffold and micro-drillings during hip arthroscopy. The degree of chondral repair was measured at baseline and 5 years using the International Cartilage Repair Society morphologic score system (MSS) as the primary outcome. Pain was measured at baseline and 5 years using the Visual Analogue Scale for Pain (VAS Pain), and hip functionality was measured at baseline (presurgery), 6 months, 1 year, and 5 years using the Hip Outcome Score (HOS). The largest diameter of injury, median follow-up, side effects, complications, and improvements were described. T-test, ANOVA with multiple comparisons, and statistical power were estimated. From initially 34 cases, 25 patients were enrolled. The median follow-up was 5.1 ± 0.3 years. One patient (4%) reported a few side effects with filgrastim administration. No infection, tumours, or synovitis was reported. The largest diameters in zones two, three, and four were 12.4 ± 3.1 mm (n = 8), 13.5 ± 2.8 mm (n = 14), and 11.4 ± 1.9 mm (n = 3), respectively. Ninety-two percent (23/25) of patients improved their outcomes. The MSS and HOS increased from 3.8 ± 1.1 to 9.6 ± 1.5 pts (p < 0.001) and from 65.5 ± 13.0 to 93.9 ± 2.4 pts (p < 0.001), respectively. The VAS-Pain decreased from 5.3 ± 0.7 to 1.3 ± 0.6 mm (p < 0.001). The obtained a posteriori power-size was 0.99. The intervention suggests a favourable impact on articular cartilage regeneration and clinical outcomes for hip chondral lesions in mixed-FAIS injuries after a median follow-up of 5.1 ± 0.3 years. Level IV.

Interleukin-6 and Interleukin-8 Gene Expressions Differ Between Male and Female Patients at Time of Hip Arthroscopy for Femoroacetabular Impingement Syndrome

Interleukin-6 and Interleukin-8 Gene Expressions Differ Between Male and Female Patients at Time of Hip Arthroscopy for Femoroacetabular Impingement Syndrome

Randomized feasibility study of an autologous protein solution versus corticosteroids injection for treating subacromial pain in the primary care setting - the SPiRIT trial.

The primary aim of this study was to assess the feasibility of recruiting and retaining patients to a patient-blinded randomized controlled trial comparing corticosteroid injection (CSI) to autologous protein solution (APS) injection for the treatment of subacromial shoulder pain in a community care setting. The study focused on recruitment rates and retention of participants throughout, and collected data on the interventions' safety and efficacy. Participants were recruited from two community musculoskeletal treatment centres in the UK. Patients were eligible if aged 18 years or older, and had a clinical diagnosis of subacromial impingement syndrome which the treating clinician thought was suitable for treatment with a subacromial injection. Consenting patients were randomly allocated 1:1 to a patient-blinded subacromial injection of CSI (standard care) or APS. The primary outcome measures of this study relate to rates of recruitment, retention, and compliance with intervention and follow-up to determine feasibility. Secondary outcome measures relate to the safety and efficacy of the interventions. A total of 53 patients were deemed eligible, and 50 patients (94%) recruited between April 2022 and October 2022. Overall, 49 patients (98%) complied with treatment. Outcome data were collected in 100% of participants at three months and 94% at six months. There were no significant adverse events. Both groups demonstrated improvement in patient-reported outcome measures over the six-month period. Our study shows that it is feasible to recruit to a patient-blinded randomized controlled trial comparing APS and CSI for subacromial pain in terms of clinical outcomes and health-resource use in the UK. Safety and efficacy data are presented.

Poster 185: The Effect of Labrum Size on Cartilage Mechanics in a Patient with Cam-Type Femoroacetabular Impingement Syndrome

Poster 185: The Effect of Labrum Size on Cartilage Mechanics in a Patient with Cam-Type Femoroacetabular Impingement Syndrome

The Effect of Rehabilitation Exercises Accompanied by Ultrasound Waves on Improving the Range of Motion in Swimmers Suffering from Shoulder Impingement Syndrome

هدف البحث إلى إعداد تمرينات تأهيلية بأستخدام الأمواج فوق الصوتية لتأهيل السباحين المصابين بمتلازمة إنحشار الكتف، والتعرف على تأثير التمرينات التأهيلية بأستخدام الأمواج فوق الصوتية في تحسين المدى الحركي للسباحين المصابين بمتلازمة إنحشار الكتف، وأفترضت الباحثتان بأنه توجد فروق ذات دلاله احصائية بين نتائج اختبارات تأهيل السباحين المصابين بمتلازمة إنحشار الكتف القبلية والبعدية لمجموعة البحث التجريبية ولصالح الاختبارات البعدية، واعتمد المنهج التجريبي على عينة من السباحين المصابين بمتلازمة إنحشار الكتف البالغ عددهم (7) مصابين يمثلون ما نسبته (77.78%) من مجتمعهم المتمثل بالسباحين الذكور المصابين بمتلازمة إنحشار الكتف من النوع الأول من مختلف الأندية العراقية المحلية في محافظة البصرة للموسوم الرياضي (2022/2023)، والذين يرتادون إلى شعبة العلاج الطبيعي في مشفى البصرة العام التعليمي، وبعد التشخيص وتحديد الاختبارات واعداد التمرينات بالدمج مع التقنية قيد البحث في كل من الجلسات العلاجية التأهيلية البالغ عددها (18) جلسة بواقع (3) جلسات تحوي كل منها (4) تمرينات تأهيلية تم التجريب لمدة (6) اسابيع متتالية وبعد الانتهاء تمت معالجة النتائج بنظامSPSS الإصدارV28 وكانت أهم الاستنتاجات بأنه والتوصيات بأن دمج تمرينات تأهيلية مع أستخدام الأمواج فوق الصوتية ملائمة للجلسات العلاجية للسباحين المصابين بمتلازمة إنحشار الكتف، ولتطبيقها تأثير إيجابي في أستعادة المديات الحركية لمفصل الكتف في مختلف الإتجاهات لدى السباحين المصابين بمتلازمة إنحشار الكتف، ومن الضروري أن تهتم المستشفيات بتطوير خبرات المعالجين العاملين فيها عن كيفية تطبيق التمرينات التأهيلية بأستخدام الأمواج أستناداً إلى ما توصل إليه البحث الحالي من نتائج لتأهيل السباحين المصابين بمتلازمة إنحشار الكتف، وأن تلائم الأدوات والوسائل التأهيلية خصوصية السباحين المصابين بمتلازمة إنحشار الكتف وإمكانية توفيرها في المستشفيات، وأن تكون الحاجة إليها ضرورية عند تأهيل المصابين، ولابد من الإهتمام باستثمار خبرات الأكاديميين المتخصصين في التأهيل الرياضي عند تدريب المعالجين العاملين في المستشفيات بما يلائم حداثة أستخدام الأمواج فوق الصوتية باعتماد الية تعاون مستمرة بين وزارة الصحة والبيئة وكليات التربية البدنية وعلوم الرياضة.

Effects of Manual Therapy with Kinesiotaping on Pain, Disability, Range of Motion in Subacromial Impingement Syndrome

Effects of Manual Therapy with Kinesiotaping on Pain, Disability, Range of Motion in Subacromial Impingement Syndrome

Worker's compensation and no-fault insurance are associated with decreased patient reported outcomes and higher rates of revision at 2 and 5 years follow-up compared to patients with commercial insurance undergoing hip arthroscopy for femoroacetabular impingement.

To investigate the patient reported outcomes (PROs) of patients undergoing hip arthroscopy (HA) for femeroacetabular impingement syndrome (FAIS), a condition where irregular bone growth in the hip joint leads to friction and pain during movement, who have worker's compensation (WC) or no-fault insurance (NF) versus commercial insurance (CI) at both 2year and 5year follow-up. This was a single center, single surgeon, retrospective analysis performed between August 2007 and May 2023 of consecutive patients that underwent HA, a minimally invasive surgical procedure used to diagnose and treat problems inside the hip joint through small incisions, for FAIS. Patients were divided into two cohorts-those with WC/NF and those with commercial insurance (CI). Patient reported outcomes (PROs), which included modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS), were collected preoperatively, as well as at least 2-year postoperatively. Additionally, other clinically relevant outcomes variables including prevalence of revision surgery and conversion to total hip arthroplasty were recorded. Three hundred and forty three patients met inclusion criteria. There were 32 patients in the WC/NF cohort and 311 patients in the commercial cohort. When controlling for age, sex, and Body Mass Index (BMI), WC/NF status was associated with lower mHHS at both 2year (β = - 8.190, p < 0.01, R2 = 0.092) and 5year follow-up (β = - 16.60, p < 0.01, R2 = 0.179) and NAHS at 5year follow up (β = - 13.462, p = 0.03, R2 = 0.148). The WC/NF cohort had a lower rate of achieving Substantial Clinical Benefit (SCB) for mHHS at 2-years follow-up (66.7% vs. 84.1%, p = 0.02).The rate of revision hip arthroscopy was significantly higher in the worker's compensation/no fault cohort than the commercial insurance cohort (15.6% vs. 3.5%, p < 0.01). The rate of conversion to total hip arthroplasty (THA) in the WC/NF cohort was not significantly different than the rate of conversion to THA in the commercial insurance cohort (0.0% vs. 3.2%, p = 0.30). Patients with WC/NF insurance may expect a significant improvement from baseline mHHS and NAHS following HA for FAIS at short-term follow-up. However, this improvement may not be as durable as those experienced by patients with CI. Additionally, WC/NF patients should be counseled that they have a higher risk of undergoing revision hip arthroscopy than similar CI patients. III, Retrospective Comparative Prognostic Investigation.

Update on Rehabilitation Strategies for Swimmers' Shoulder: A Narrative Review

AbstractSwimmers' shoulder is one of the common overuse injuries having multifactorial causes with a gradual onset. Swimmers' experience pain in the pull-through phase, during the mid-stroke wherein the arm is maximally internally rotated and adducted. This occurs due to a significant amount of force generated by the pectorals, latissimus dorsi, subscapularis, serratus anterior, rhomboids, and supraspinatus for this movement. The repetitive use of shoulder muscles during the swim strokes predisposes it to overuse injuries among which shoulder impingement is common. It hinders participation of athletes in competitive events and reduces the efficiency of the swim performance. This review aims to provide a consolidated overview and identify various rehabilitation strategies and exercise programs for swimmers' shoulder. A thorough search was done on PubMed, ScienceDirect, Web of Science, Cochrane, CINAHL, and Clinical Key to find relevant articles in relation to the rehabilitation strategies available for swimmers' shoulder. Overall, this review suggests that aquatic concentric-eccentric exercise, Kinesio taping, land-based strengthening exercises, and rhythmic stabilization exercises significantly improve pain and functional activity in individuals with swimmers' shoulder.

Squatting biomechanics following physiotherapist-led care or hip arthroscopy for femoroacetabular impingement syndrome: a secondary analysis from a randomised controlled trial.

Femoroacetabular impingement syndrome (FAIS) can cause hip pain and chondrolabral damage that may be managed non-operatively or surgically. Squatting motions require large degrees of hip flexion and underpin many daily and sporting tasks but may cause hip impingement and provoke pain. Differential effects of physiotherapist-led care and arthroscopy on biomechanics during squatting have not been examined previously. This study explored differences in 12-month changes in kinematics and moments during squatting between patients with FAIS treated with a physiotherapist-led intervention (Personalised Hip Therapy, PHT) and arthroscopy. A subsample (n = 36) of participants with FAIS enrolled in a multi-centre, pragmatic, two-arm superiority randomised controlled trial underwent three-dimensional motion analysis during squatting at baseline and 12-months following random allocation to PHT (n = 17) or arthroscopy (n = 19). Changes in time-series and peak trunk, pelvis, and hip biomechanics, and squat velocity and maximum depth were explored between treatment groups. No significant differences in 12-month changes were detected between PHT and arthroscopy groups. Compared to baseline, the arthroscopy group squatted slower at follow-up (descent: mean difference -0.04 m∙s-1 (95%CI [-0.09 to 0.01]); ascent: -0.05 m∙s-1 [-0.11 to 0.01]%). No differences in squat depth were detected between or within groups. After adjusting for speed, trunk flexion was greater in both treatment groups at follow-up compared to baseline (descent: PHT 7.50° [-14.02 to -0.98]%; ascent: PHT 7.29° [-14.69 to 0.12]%, arthroscopy 16.32° [-32.95 to 0.30]%). Compared to baseline, both treatment groups exhibited reduced anterior pelvic tilt (descent: PHT 8.30° [0.21-16.39]%, arthroscopy -10.95° [-5.54 to 16.34]%; ascent: PHT -7.98° [-0.38 to 16.35]%, arthroscopy -10.82° [3.82-17.81]%), hip flexion (descent: PHT -11.86° [1.67-22.05]%, arthroscopy -16.78° [8.55-22.01]%; ascent: PHT -12.86° [1.30-24.42]%, arthroscopy -16.53° [6.72-26.35]%), and knee flexion (descent: PHT -6.62° [0.56- 12.67]%; ascent: PHT -8.24° [2.38-14.10]%, arthroscopy -8.00° [-0.02 to 16.03]%). Compared to baseline, the PHT group exhibited more plantarflexion during squat ascent at follow-up (-3.58° [-0.12 to 7.29]%). Compared to baseline, both groups exhibited lower external hip flexion moments at follow-up (descent: PHT -0.55 N∙m/BW∙HT[%] [0.05-1.05]%, arthroscopy -0.84 N∙m/BW∙HT[%] [0.06-1.61]%; ascent: PHT -0.464 N∙m/BW∙HT[%] [-0.002 to 0.93]%, arthroscopy -0.90 N∙m/BW∙HT[%] [0.13-1.67]%). Exploratory data suggest at 12-months follow-up, neither PHT or hip arthroscopy are superior at eliciting changes in trunk, pelvis, or lower-limb biomechanics. Both treatments may induce changes in kinematics and moments, however the implications of these changes are unknown. Australia New Zealand Clinical Trials Registry reference: ACTRN12615001177549. Trial registered 2/11/2015.

Comparison of upper and lower trapezius electromyographic activity during Y-raise exercise with and without isometric adduction in healthy volunteers

BACKGROUND: Lower trapezius (LT) plays an important role in maintaining the stability of the scapula. Sufficient activation of LT can reduce the risk of rotator cuff tear and shoulder impingement syndrome. The Y-raise exercise has been recommended for effective LT activation. However, the upper trapezius (UT) can be co-activated during universal Y-raise exercise. OBJECTIVE: This study aimed to compare the activity of the UT, LT, and serratus anterior (SA) during Y-raise exercise with and without isometric adduction (IAD) using Thera-Band. METHODS: 21 healthy males voluntarily participated in the study. The participants were asked to perform Y-raise exercise with and without IAD using Thera-Band. Surface electromyography was used to measure the muscle activity of UT, LT, and SA during Y-raise exercise with and without IAD. Paired t-test was used to analyze the significance of the muscle activity of UT, LT, and SA as well as the activity ratio of LT/UT and LT/SA. The significance level was set at α= 0.05. RESULTS: Compared with Y-raise exercise without IAD, the muscle activity of UT and SA decreased (p= 0.001 and p= 0.003, respectively), whereas that of LT increased (p= 0.038) during Y-raise exercise with IAD. Additionally, the activity ratio of LT/UT and LT/SA was greater during Y-raise exercise with IAD (p= 0.001 and p= 0.001, respectively). CONCLUSION: Y-raise exercise with IAD using Thera-Band is recommended as an efficient exercise to selectively activate the LT and increase the activity ratio of LT/UT and LT/SA.

First-line treatment for femoroacetabular impingement syndrome and hip-related quality of life: study protocol for a multicentre randomised controlled trial comparing a 6-month supervised strength exercise intervention to usual care (the Better Hip Trial)

IntroductionFemoroacetabular impingement syndrome (FAIS) is a motion-related and position-related clinical condition of the hip associated with pain, reduced physical function and hip-related quality of life (QoL). Interestingly, higher maximal muscle...

Association of Patient Satisfaction 2 Years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome With Minimum 10-Year Patient-Reported Outcomes and Survivorship

Background: Previous studies have shown that short-term outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) predict midterm outcomes, but a limited number of studies have evaluated whether short-term outcomes predict long-term outcomes and survivorship. Purpose: To evaluate whether achieving clinically significant outcomes at 2 years after hip arthroscopy for FAIS can predict patient-reported outcomes (PROs) and survivorship at 10 years. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary hip arthroscopy for FAIS between June 2012 and December 2012 with a minimum 10-year follow-up were identified. Using previously established thresholds, we classified patients who achieved the 2-year Patient Acceptable Symptom State (PASS) for the visual analog scale (VAS) for satisfaction as the high satisfaction group and patients who did not as the low satisfaction group. Minimum 10-year PROs were then compared between the groups, including scores for the Hip Outcome Score (HOS)–Activities of Daily Living and –Sports Specific, the modified Harris Hip Score, the VAS for pain, and the VAS for satisfaction. Reoperation-free survivorship was compared. Results: Of 120 eligible consecutive patients, 85 patients were included (70.8% follow-up rate), of whom 61.2% were female. The mean age was 34.0 ± 12.8 years, and the mean body mass index was 25.4 ± 4.6. Of the 85 patients, 29 (34.1%) did not achieve PASS for the VAS for satisfaction at 2 years postoperatively compared with 56 (65.9%) who did. The low satisfaction group had significantly worse acetabular chondral grades at the time of surgery (P = .008). At minimum 10-year follow-up, the high satisfaction group showed significantly better HOS-Activities of Daily Living, HOS-Sports Specific, modified Harris Hip Score, VAS pain, and VAS satisfaction scores (P≤ .031). Compared with the low satisfaction group, the high satisfaction group had a significantly lower rate of secondary surgery (1.8% vs 24.1%, respectively; P = .002). Conclusion: Patients who achieved PASS for the VAS for satisfaction at 2 years after hip arthroscopy demonstrated superior minimum 10-year outcomes compared with patients who did not, including greater PRO scores and a higher survivorship rate. The high satisfaction group had lower grade acetabular cartilage damage at the time of surgery compared with those who did not achieve PASS for the VAS for satisfaction at 2 years.

Can Multimodal Analgesia Reduce Postoperative Opioid Consumption in Patients Undergoing Shoulder Arthroscopy? A Retrospective Study.

The aim of this study was to investigate whether multimodal analgesia can decrease postoperative opioid usage in patients undergoing shoulder arthroscopy. Patients diagnosed with subacromial impingement syndrome who underwent acromioplasty at our institution between October 2022 and November 2023 were retrospectively analyzed. Patients were divided into an observation group and a control group based on postoperative pain management methods. The control group received intravenous self-controlled electronic analgesia (sufentanil injection 1 μg/kg + butorphanol injection 4 mg + 0.9% NaCl injection to 100 mL), while the observation group received multimodal analgesia (ropivacaine subacromial pump 3 mL/h, combined with oral celecoxib and acetaminophen). Visual Analog Scale (VAS) scores were recorded preoperatively and at various postoperative time points, and opioid usage, length of hospital stay, and analgesia-related complications within 1 week postoperatively were compared between groups. The 36-item Short Form Health Survey (SF-36) scores and the Constant-Murley score (CMS), were also assessed 1 day and 1 week after treatment. One hundred thirty-two patients were included in the study, 66 in the observation group and 66 in the control group. In the control group, there were 46 males and 20 females, with a mean age of 55.47 ± 11.42 years and in the observation group 44 males and 22 females, with a mean age of 56.13 ± 12.19 years The observation group consistently reported significantly lower pain intensity compared to the control group at 8 h (T1), 24 (T2), and 48 h (T3) after surgery (p < 0.05). Additionally, the observation group exhibited significantly lower opioid usage and complication rates compared to the control group (p < 0.05). SF-36 scores and CMS scores were significantly higher in the observation group 1 week after treatment compared to the control group (p < 0.05). Following shoulder arthroscopy, multimodal analgesia effectively reduces opioid consumption, lowers complication rates, and provides effective short-term pain relief. This approach carries significant implications for improving patient outcomes.

A case report of bilateral atypical origin of pectoralis minor.

In the existing literature, various insertion variations and classifications for the Pectoralis Minor (PMi) muscle have been reported. However, there is limited information on inferior origin variations of the PMi muscles and a certain classification is lacking. During routine cadaver dissection of an adult male, variations in the origin of the bilateral PMi muscles were identified. Morphometric measurements of the PMi were conducted using ImageJ software, and the unusual origin patterns of the PMi were categorized into specific types. The PMi muscle demonstrated a bilateral variations. On the right side, the PMi displays a bifid structure comprising medial and lateral fibers. The left PMi originate from the superolateral margins of the 4th to 6th costae and terminate at the anterosuperior surface of the coracoid process. The length of the right medial fiber before merging was 5.67 ± 0.04cm, while that of the right lateral fiber was 6.68 ± 0.05cm. The distance between the two fibers was measured as 0.43cm, with a length of 3.33 ± 0.02cm. The length and diameter of the muscle fibers extending to the 6th costa were 2.63 ± 0.01cm and 0.46cm, respectively. Potential variations in PMi arising from impairment during development may occasionally manifest as asymptomatic conditions or predispose individuals to shoulder impingement, rotator cuff dysfunction, shoulder-related disorders, and functional impairments. Therefore, careful attention to this variation is considered in surgical planning.

Short-term Outcomes After Hip Arthroscopic Surgery in Patients Participating in Formal Physical Therapy Versus a Home Exercise Program: A Prospectively Enrolled Cohort Analysis

Background: Physical therapy is frequently utilized in the postoperative care of femoroacetabular impingement syndrome (FAIS). There has been limited research into the efficacy of a structured home exercise program (HEP) compared with formal physical therapy (FPT) in this patient population. Purpose/Hypothesis: The purpose was to evaluate the short-term outcomes of patients utilizing FPT versus an HEP after hip arthroscopic surgery for FAIS. It was hypothesized that both groups would show similar improvements regarding outcome scores, which would improve significantly compared with their preoperative scores. Study Design: Cohort study; Level of evidence, 2. Methods: Patients undergoing hip arthroscopic surgery for FAIS at a single center between October 2020 and October 2021 were prospectively enrolled. Patients were allowed to self-select FPT or an HEP and were administered a survey preoperatively and at 1 month, 3 months, 6 months, and 12 months postoperatively. The survey included the Single Assessment Numeric Evaluation, visual analog scale for pain, 12-item International Hip Outcome Tool, Patient-Reported Outcomes Measurement Information System Physical Function, and patient satisfaction with physical therapy and overall care. Statistical analysis was conducted between the 2 groups and within groups to compare preoperative and postoperative scores. Results: The patients’ mean age was 32.6 ± 10.4 years, with 47.2% being female and 57.4% choosing the HEP. At 12 months postoperatively, no significant differences were reported between the FPT and HEP groups regarding the Single Assessment Numeric Evaluation score (P = .795), visual analog scale for pain score (P > .05), Patient-Reported Outcomes Measurement Information System Physical Function T-score (P = .699), 12-item International Hip Outcome Tool score (P = .582), and patient satisfaction (P > .05). Outcome scores at 12 months postoperatively were significantly improved from the preoperative scores across all measures in both groups (P < .001). Conclusion: There were no significant differences regarding patient outcomes between FPT and the HEP at 1-year follow-up after hip arthroscopic surgery for FAIS when patients selected their own treatment, with both groups demonstrating significant improvements in their outcome scores from their preoperative values. These findings suggest that a structured HEP may be a viable alternative to FPT after hip arthroscopic surgery in patients who prefer a self-directed rehabilitation program.