A link between femoroacetabular impingement and athletic pubalgia has been reported clinically. One proposed origin of athletic pubalgia is secondary to repetitive loading of the pubic symphysis, leading to instability and parasymphyseal tendon and ligament injury. Hypothesis/
The purpose of this study was to investigate the effect of simulated femoral-based femoroacetabular impingement on rotational motion at the pubic symphysis. The authors hypothesize that the presence of a cam lesion leads to increased relative symphyseal motion.
Controlled laboratory study.
Twelve hips from 6 fresh-frozen human cadaveric pelvises were used to simulate cam-type femoroacetabular impingement. The hips were held in a custom jig and maximally internally rotated at 90° of flexion and neutral adduction. Three-dimensional motion of the pubic symphysis was measured by a motion-tracking system for 2 states: native and simulated cam. Load-displacement plots were generated between the internal rotational torque applied to the hip and the responding motion in 3 anatomic planes of the pubic symphysis.
As the hip was internally rotated, the motion at the pubic symphysis increased proportionally with the degrees of the rotation as well as the applied torque measured at the distal femur for both states. The primary rotation of the symphysis was in the transverse plane and on average accounted for more than 60% of the total rotation. This primary motion caused the anterior aspect of the symphyseal joint to open or widen, whereas the posterior aspect narrowed. At the torque level of 18.0 N·m, the mean transverse rotation in degrees was 0.89° ± 0.35° for the native state and 1.20° ± 0.41° for cam state. The difference between cam and the native groups was statistically significant (P < .03).
Dynamic femoroacetabular impingement as caused by the presence of a cam lesion causes increased rotational motion at the pubic symphysis.
Repetitive loading of the symphysis by cam impingement is thought to lead to increased symphyseal motion, which is one possible precursor to athletic pubalgia.
[Show abstract][Hide abstract] ABSTRACT: Femoroacetabular impingement (FAI) causes pain and chondrolabral damage via mechanical overload during movement of the hip. It is caused by many different types of pathoanatomy, including the cam 'bump', decreased head-neck offset, acetabular retroversion, global acetabular overcoverage, prominent anterior-inferior iliac spine, slipped capital femoral epiphysis, and the sequelae of childhood Perthes' disease. Both evolutionary and developmental factors may cause FAI. Prevalence studies show that anatomic variations that cause FAI are common in the asymptomatic population. Young athletes may be predisposed to FAI because of the stress on the physis during development. Other factors, including the soft tissues, may also influence symptoms and chondrolabral damage. FAI and the resultant chondrolabral pathology are often treated arthroscopically. Although the results are favourable, morphologies can be complex, patient expectations are high and the surgery is challenging. The long-term outcomes of hip arthroscopy are still forthcoming and it is unknown if treatment of FAI will prevent arthrosis.
[Show abstract][Hide abstract] ABSTRACT: The etiology of mechanical hip pain in the absence of osteoarthritic changes requires a careful consideration of static and dynamic factors. Dynamic factors result from abnormal stress and contact between the femoral head and acetabular rim with hip motion, whereas static factors result from asymmetric and supraphysiologic loads between the femoral head and acetabular socket when in the standing or axially loaded position. Compensatory motion resulting from restricted terminal hip motion may adversely affect dynamic muscle forces across the hip joint, leading to several other related extra-articular symptoms and pain. An appreciation of abnormal hip morphology and hip joint mechanics is required to understand the important role of both static and dynamic stresses in the development of hip pain and early onset osteoarthritis in the young hip. This review describes the static and dynamic factors associated with mechanical hip pain to allow for the development of a thoughtful and effective treatment plan.
Operative Techniques in Sports Medicine 12/2012; 20(4):260–272. DOI:10.1053/j.otsm.2012.09.004 · 0.20 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES: The objective of the present study was to investigate whether differences exist in adductor squeeze test values and hip joint range of motion between athletes with longstanding groin pain and injury-free controls. DESIGN: Observational study with a case control design. METHODS: Eighteen Gaelic football players with current longstanding groin pain and 18 matched injury-free controls were assessed on their performance of the adductor squeeze test. Adductor squeeze test values were quantified using a sphygmomanometer. A fluid-filled inclinometer was used to assess hip joint internal and external rotation range of motion. A bent knee fall-out test was also utilised to examine hip joint range of motion. RESULTS: A significant difference in adductor squeeze test values was observed between the control group (269±25mmHg) and longstanding groin pain group (202±36mmHg; p<0.01). Furthermore the longstanding groin pain group had a decreased bent knee fall-out (p<0.01) bilaterally, as well as decreased hip joint internal rotation (p<0.05) and hip joint external rotation (p<0.05) range of motion bilaterally when compared to the control group. CONCLUSIONS: Gaelic football players with longstanding groin pain exhibit decreased adductor squeeze test values and hip joint range of motion when compared to non-injured players. These findings have implications for assessment and rehabilitation practices, as well as return to play criteria.
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