Progress in diagnosis and hip arthroscopic treatment of borderline developmental dysplasia of hip with Cam-type femoroacetabular impingement / 中国修复重建外科杂志

OBJECTIVE@#To summarize the biomechanical characteristics, diagnosis, and hip arthroscopic treatment of borderline developmental dysplasia of hip (BDDH) with Cam-type femoroacetabular impingement (Cam FAI).@*METHODS@#The literature on BDDH with Cam FAI at home and abroad in recent years was extensively reviewed and analyzed.@*RESULTS@#In patients with BDDH and Cam FAI, the femoral neck anteversion angle and femoral neck shaft angle increase, the pelvis tilts, and the acetabulum rotates, resulting in instability of the hip joint. In order to maintain the stability of the hip joint, the direction of biomechanical action of the hip joint has changed, which further affects the anatomical structures such as the proximal femur and acetabular morphology. BDDH with Cam FAI can be diagnosed clinically by combining lateral center edge angle, anterior center edge angle, and acetabular index. BDDH with Cam FAI can be effectively treated through arthroscopic polishing of the edges of the acetabular proliferative bone, excision of Cam malformations, and minimally invasive repair of the glenoid lip and cartilage of the hip joint.@*CONCLUSION@#Currently, there is no unified standard for the diagnosis and treatment of BDDH with Cam FAI. Minimally invasive treatment of the hip under arthroscopy can achieve good early- and medium-term effectiveness, and has certain advantages in repairing and maintaining the integrity of the glenoid lip and suturing/compression joint capsule. However, the long-term effectiveness needs to be further followed up to determine. The timing of surgery, intraoperative bone edge depth polishing, and joint capsule suturing/compression techniques also need to be further explored.

Relationship between Femoroacetabular Impingement and Pubalgia in Professional Soccer Players / Relação do impacto femoroacetabular e pubalgia em jogadores profissionais de futebol de campo

Abstract Objective To analyze the relationship between pubalgia and femoroacetabular impingement (FAI) in professional athletes of a soccer club, defining the prevalence of these conditions in the sample studied. Methods It is an epidemiological, cross-sectional, and analytical study including 90 professional soccer players active from 2019 to 2021. We accessed the medical records of the subjects to retrieve information from the modified Pre-Competition Medical Assessment (PCMA) protocol, orthopedic physical examination, and anteroposterior pelvic radiographs to assess pubalgia and FAI, respectively. Inclusion criteria were athletes playing in the professional soccer club in the 2019 to 2021 season, who underwent a modified PCMA upon admission, and who signed an informed consent form. Results FAI was highly prevalent (85.6%) in the sample. This prevalence may occur because, in Brazil, people start playing sports early, not always in suitable fields, or with no proper equipment and supervision. In addition, the CAM-type impingement was the most frequent (62.2%). These injuries are related to high-intensity movements, including those associated with soccer. Furthermore, there is no dependency correlation between pubalgia and FAI. FAI was present in only 20% of athletes with pubalgia complaints. Conclusion There was a high prevalence of FAI in professional soccer players in the studied population (85.6%) but with no relationship between FAI and pubalgia.

Resumo Objetivo Analisar a relação entre a pubalgia e o impacto femoroacetabular (IFA) em atletas profissionais de um clube de futebol, definindo a prevalência de pubalgia e de impacto femoroacetabular na casuística estudada. Métodos É um estudo epidemiológico, transversal e analítico. Foram selecionados 90 atletas profissionais de futebol atuantes no período de 2019-2021. Foram acessados os prontuários para obtenção do protocolo PCMA modificado, além de exame físico ortopédico e de radiografias da bacia com incidência anteroposterior para avaliação de pubalgia e IFA, respectivamente. Critérios de Inclusão: Atletas que atuaram no clube de futebol de campo profissional na temporada de 2019 a 2021, que foram submetidos a aplicação do PCMA modificado na admissão e que assinaram o TCLE. Resultados O IFA apresentou elevada prevalência na amostra (85.6%), o que pode ocorrer pois, no Brasil, os jovens iniciam a prática esportiva em idade muito precoce, além do fato de os jogadores nem sempre praticarem o esporte em campos adequados ou com equipamentos e supervisão adequada. Ademais, o impacto tipo CAM foi o mais frequente (62.2%). O surgimento dessas lesões é relacionado a movimentos de alta intensidade, como os vistos no futebol. Outrossim, observou-se que não há correlação de dependência entre a pubalgia e o IFA. Foi visto que o IFA estava presente em apenas 20% dos atletas queixosos de pubalgia. Conclusão Há elevada prevalência de IFA em atletas de futebol profissional na população estudada (85.6%) e não houve relação entre o IFA e a presença de pubalgia.

Correlation between Intensity of Pain and Disability Due to Intra-articular Lesions in Patients with Femoroacetabular Impingement Syndrome / Correlação entre intensidade da dor e incapacidade com as lesões intra-articulares em pacientes com síndrome do impacto femoroacetabular

Abstract Objective To correlate radiographic alterations and lesions in intra-articular structures of the acetabulum with the intensity of pain and disability of patients diagnosed with femoroacetabular impingement syndrome. Methods A retrospective analysis of the preoperative data of 182 patients (190 hips) was performed. Clinical variables such as age, gender, the practice of physical activity, and radiographic variables, such as the Wiberg and alpha angles, were evaluated. Through an intraoperative video, the extent of the chondral and labial lesions was evaluated considering the clock-face method, the degree of joint involvement by the Outerbridge classification, and the presence of wave lesions. The variables were analyzed by linear regression, with the intensity of the pain assessed by the Visual Analog Scale (VAS), and functional disability measured by the Modified Harris Hip Score (mHHS). Results The mean age of the patients was of 38.5 ± 9.6 years, the mean intensity of the pain was of 7.8 ± 1.6, and the mean mHHS score was of 56.3 ± 12.7. In total, 61% of the sample were classified as Outerbridge III or IV, and 12.6% had wave lesions. There was a correlation between the male gender (r = 0.497) and lower intensity of the pain, and a correlation of age (r = -0.27), the male gender (r = 8.419) and physical activity with higher functional scores on the mHHS (r = 4.729). Conclusion There was no correlation of the radiographic and arthroscopic parameters of the present study and the intensity of pain and the disability of the patients. The male gender is related to lower intensity of pain, and higher functional ability is related to the male gender, lower age, and the practice of physical activity. Level of Evidence IV.

Resumo Objetivo Correlacionar alterações radiográficas e lesões de estruturas intra-articulares do acetábulo com a intensidade da dor e a incapacidade de pacientes com diagnóstico de síndrome do impacto femoroacetabular. Métodos Realiou-se uma análise retrospectiva de dados pré-operatórios de 182 pacientes (190 quadris). Foram avaliadas variáveis clínicas como idade, sexo e prática de atividade física, e variáveis radiográficas, como ângulo de Wiberg e o ângulo alfa. Por meio do vídeo intraoperatório, foi avaliada a extensão das lesões condrais e labiais considerando-se o método clock-face, o grau de comprometimento articular pela classificação de Outerbridge, e a presença de lesão em onda. As variáveis foram analisadas por meio de regressão linear, tendo como variáveis dependentes a intensidade da dor, avaliada pela Escala Visual Analógica (EVA), e a incapacidade funcional, mensurada pelo Harris Hip Score modificado (HHSm). Resultados A média de idade dos pacientes foi de 38,5 ± 9,6 anos, a da intensidade da dor, 7,8 ± 1,6, e a do HHSm, 56,3 ± 12,7. No total, 61% da amostra apresentava Outerbridge III ou IV, e 12,6% apresentava lesão em onda. Observou-se correlação do sexo masculino (r = 0,497) com menor intensidade da dor, e correlação da idade (r = −0,27), do sexo masculino (r = 8,419) e da realização de atividade física com maior escore funcional no HHSm (r = 4,729). Conclusão Não houve correlação dos parâmetros radiográficos e artroscópicos deste estudo com a intensidade da dor e a incapacidade dos pacientes. O sexo masculino está relacionado com menor intensidade da dor, e maior capacidade funcional está relacionada com o sexo masculino, menor idade, e a prática de atividade física. Nível de Evidência IV.

The Brazilian version of the Hip Sports Activity Scale: translation and cross-cultural adaptation

Abstract BACKGROUND: The Hip Sports Activity Scale (HSAS) is a reliable and valid tool for determining the levels of sports activities among patients with femoroacetabular impingement (FAI). OBJECTIVE: To translate and cross-culturally adapt the HSAS to the Brazilian Portuguese language. DESIGN AND SETTING: This was a cross-sectional study conducted at the State University of Rio de Janeiro. METHODS: The Brazilian version of the HSAS was developed following a process that comprised six steps: translation, synthesis, back-translation, review by committee, pretesting and submission of documentation to the developers. The translation phase involved three independent bilingual translators whose mother language was Brazilian Portuguese. The back-translation phase involved three independent translators whose mother language was English. In order to verify comprehension of the questionnaire, 30 undergraduate students in physical education (65% men), with mean age 23.2 years (standard deviation = 6.8), participated in the pre-testing phase. RESULTS: During the translation step, some terms and expressions were changed to obtain cultural equivalence to the original HSAS. In the pre-testing phase, each item of the scale showed a comprehension level of 100%. CONCLUSION: The HSAS was translated from English to the Brazilian Portuguese language and adapted to Brazilian culture. The HSAS validation is ongoing.

Correlation between the range of rotation of the hip and the radiographic signs of cam and pincer morphology in femoroacetabular impingement syndrome / Correlação entre amplitude de rotação do quadril e sinais radiográficos came e pincer na síndrome do impacto femoroacetabular

Abstract Objective: To determine whether hip rotation correlates with the radiographic signs of cam or pincer deformity after hip arthroscopy in patients with femoroacetabular impingement syndrome. Materials and Methods: This was a single-center retrospective study of data collected between 2014 and 2017. The study sample included 65 patients between 18 and 55 years of age who underwent hip arthroscopy for the treatment of unilateral femoroacetabular impingement. The following data were collected for the periods prior to and six months after surgery range of medial and lateral rotation of the hip; measures on anteroposterior X-rays of the pelvis obtained in the standing position and on ateral X-rays in the Ducroquet profile view; and score on the 33-item International Hip Outcome Tool. Results: Mean preoperative and postoperative values were as follows: 19.26 ± 10.39° and 30.95 ± 3.52°, respectively, for medial rotation of the hip (p < 0.001); 73.85 ± 6.62° and 68.12 ± 5.04°, respectively, for the anteroposterior alpha angle (p < 0.001); 56.97 ± 6.09° and 50.61 ± 5.39°, respectively, for the lateral alpha angle (p < 0.001); and 0.17 ± 0.11 and 0.07 ± 0.08, respectively, for the acetabular retroversion index (p < 0.001). The crossover sign was identified in 75.4% of the patients before surgery and in 44.6% after (p < 0.001). Although there was an increase in the range of hip rotation and an improvement in radiographic parameters after arthroscopy, we detected no direct correlation between the two. Conclusion: Hip arthroscopy can improve medial rotation of the hip, as well as reducing cam and pincer deformities, in patients with femoroacetabular impingement syndrome. However, those findings do not appear to be directly correlated.

RESUMO Objetivo: Correlacionar rotação medial do quadril com sinais radiográficos came e pincer de pacientes com síndrome do impacto femoroacetabular submetidos a artroscopia. Materiais e Métodos: Estudo retrospectivo com prontuários consecutivos de 2014 a 2017 em único centro. O estudo incluiu 65 pacientes com impacto femoroacetabular unilateral, de ambos os sexos e idade entre 18 e 55 anos, com indicação de artroscopia do quadril. Os dados colhidos no pré-operatório e pós-operatório de seis meses foram: amplitude de rotação medial e rotação lateral do quadril, mensurações de radiografia anteroposterior da pelve em ortostatismo e perfil de Ducroquet, escala visual analógica de dor e questionário de qualidade de vida International Hip Outcome Tool 33. Resultados: A amplitude pré-operatória de rotação medial do quadril foi, em média, 19,26 ± 10,39°, e pós-operatória, 30,95 ± 3,52° (p < 0,001). Para ângulo alfa anteroposterior, o valor médio pré-operatório foi 73,85 ± 6,62°, e após cirurgia, 68,12 ± 5 , 0 4 ° ( p < 0,001). Já o ângulo alfa perfil pré - operatório e pós- operatório foi, respectivamente, 56,97 ± 6,09° e 50,61 ± 5,39° (p < 0,001). O sinal do cruzamento foi presente em 75,40% (pré-cirurgia) e após cirurgia em 44,60% (p < 0,001). O índice de retroversão acetabular pré-operatório, em média, foi 0,17 ± 0,11, e pós-operatório, 0,07 ± 0,08 (p < 0,001). Embora tenham sido observados aumento na amplitude de rotação do quadril e melhora dos parâmetros radiográficos após artroscopia, não houve correlação direta entre as variáveis. Conclusão: A artroscopia do quadril pode promover normalização da amplitude de rotação medial do quadril e redução dos sinais radiográficos came e pincer nos pacientes com síndrome do impacto femoroacetabular, porém, estes achados não possuem correlação direta.

Treatment of Hip Wave Lesion Using Reverse Microfracture: A Retrospective Clinical Study / Tratamento da lesão em onda do quadril através da microfratura reversa: Estudo clínico retrospectivo

Abstract Objective The present study aims to evaluate the treatment of hip wave lesion using reverse microfracture, which is a simple and cheap surgical procedure. Methods We retrospectively analyzed 19 patients with acetabular wave lesion treated with reverse microfracture. The patients were assessed by magnetic nuclear resonance imaging (MRI) at the time of diagnosis and 6 months after the surgery and functionally evaluated using the Harris Hip Score (HHS) and the visual analogue scale (VAS) for pain in the preoperative period, and 3 and 6 months after the surgery. Results The statistical data showed a significant improvement in HHS and VAS 6 months after the surgery. Six months after the surgery, the MRI revealed that the area subjected to reverse microfracture presented cartilage with the same visual characteristics observed in areas with no chondral injury. Conclusion We conclude that the reverse microfracture proved to be an effective, reproducible method for the treatment of wave lesion.

Resumo Objetivo Avaliar o tratamento desta lesão, através da microfratura reversa, que é um procedimento simples e sem aumento de insumos na cirurgia. Métodos Foram analisados retrospectivamente 19 pacientes submetidos a tratamento da lesão em onda no acetábulo, através da microfratura reversa. Utilizamos a ressonância nuclear magnética (RNM) no momento do diagnóstico e 6 meses após a cirurgia, avaliação funcional pelo Harris Hip Score (HHS) e escala visual e analógica (EVA) da dor no pré-operatório, e 3 e 6 meses após a cirurgia. Resultadoos dados estatísticos mostraram melhora significativa do HHS e EVA da dor após 6 meses da cirurgia. A RNM após 6 meses da cirurgia mostrou que na área que foi submetida à microfratura reversa, a cartilagem se apresentou com as mesmas características visuais que nas áreas sem lesão condral. Conclusão Concluímos que a microfratura reversa se mostrou eficaz e reprodutível no tratamento da lesão em onda.

Osteotomy at the base of femoral neck and osteoplasty for the treament of scfe / Osteotomia na base do colo femoral e osteoplastia para o tratamento da epifisiolistese

ABSTRACT Objective: To compare the clinical outcomes between patients with moderate and severe slipped capital femoral epiphysis (SCFE) treated with osteotomy at the base of neck and osteoplasty and with healthy individuals. Methods: Comparative cohort with 12 patients (14 hips) with moderate and severe SCFE who underwent osteotomy at the base of neck and osteoplasty between 2007 and 2014. The mean age at surgery was 13.3 ± 2.5 years and the mean follow-up was 3.8 ± 2.2 years. We assessed the level of hip pain by the visual analog scale (VAS) and anterior impingement test (AIT); the level of function using the Harris Hip Score (HHS) and 12-Item Short Form Health Survey (SF-12), the range of motion (ROM) by goniometry and Drehmann sign, and the hip muscular strength by isokinetic and Trendelenburg sign. Results: The level of pain was slightly higher in the SCFE cohort compared with healthy hips (VAS, 0.8 ± 1.4 vs 0 ± 0, 0.007; AIT, 14% vs 0%, p = 0.06; respectively). No differences were observed between the SCFE and control cohort for the functional scores (HHS, 94 ± 7 vs 100 ± 1, p = 0.135); except for ROM, with increased internal rotation (37.3º ± 9.4º vs 28.7º ± 8.2º, p < 0.001), and strength, with decreased abduction torque (75.5 ± 36.9 Nm/Kg vs 88.5 ± 27.6 Nm/Kg, p = 0.045) in the SCFE cohort. Conclusion: The osteotomy at the base of neck and the osteoplasty restored the hip motion and muscle strength, except for the abductor strength, to near normal levels, representing a viable option for the treatment of moderate and severe SCFE. Level of Evidence III, Ambidirectional Cohort Study.

RESUMO Objetivo: Comparar resultados clínicos de pacientes com escorregamento epifisário proximal do fêmur (EEPF) moderado e grave tratados com osteotomia basocervical e cervicoplastia com indivíduos saudáveis. Métodos: Coorte comparativa com 12 voluntários saudáveis e 12 pacientes (14 quadris) com EEPF moderado e grave submetidos à osteotomia basocervical e cervicoplastia entre 2007 e 2014. A média de idade na cirurgia foi de 13,3 ± 2,5 anos e o seguimento médio de 3,8 ± 2,2 anos. Avaliou-se nível de dor no quadril utilizando a escala visual analógica (EVA) e o teste de impacto anterior (TIA); nível de função usando o Harris Hip Score (HHS) e o 12-Item Short Form Health Survey (SF-12); amplitude de movimento (ADM) com goniometria e sinal de Drehmann; e força muscular do quadril com dinamômetro isocinético e sinal de Trendelenburg. Resultados: O nível de dor foi ligeiramente maior na coorte de EEPF comparado a quadris saudáveis (EVA, 0,8 ± 1,4 vs 0 ± 0, 0,007; TIA, 14% vs 0%, p = 0,06; respectivamente). Não foram observadas diferenças entre os grupos EEPF e controle para os escores funcionais (HHS, 94 ± 7 vs 100 ± 1, p = 0,135), exceto para ADM, com aumento da rotação interna (37,3º ± 9,4º vs 28,7º ± 8,2º, p < 0,001), e força, com diminuição do torque de abdução (75,5 ± 36,9 Nm/Kg vs 88,5 ± 27,6 Nm/Kg, p = 0,045), para o grupo EEPF. Conclusão: A osteotomia basocervical e a cervicoplastia restauraram o movimento do quadril e a força muscular, com exceção da força abdutora, a níveis próximos do normal, representando uma opção viável para o tratamento de EEPF moderado e grave. Nível de Evidência III, Estudo de Coorte Ambidirecional.

Effect of neuromuscular training on femoroacetabular impingement / 中国康复理论与实践

ObjectiveTo observe the effect of neuromuscular training on femoroacetabular impingement. MethodsFrom January, 2017 to November, 2021, 27 patients with femoroacetabular impingement in Beijing Rehabilitation Hospital were randomly divided into control group (n = 13) and observation group (n = 14). The control group accepted routine rehabilitation training, and the observation group accpeted neuromuscular training in addition. They were assessed with Visual Analogue Scale (VAS) for pain, peak torque (PT) of hip flexion and extension, Y-balance test (YBT) and simplified International Hip Outcome Tool (iHOT-12) before and after treatment. ResultsThe VAS score, PT, YBT score and iHOT-12 score improved in the observation group after treatment (|t| > 3.628, P < 0.01), while the VAS score and PT improved in the control group (|t| > 3.409, P < 0.01). After treatment, the VAS score, PT, YBT score and iHOT-12 score were better in the observation group than in the control group (|t| > 2.067, P < 0.05). ConclusionNeuromuscular training can relieve the pain of patients with femoroacetabular impingement, and improve the muscle strength and function of hip joint.

Artroscopia de la cadera: indicaciones y contraindicaciones / Hip Arthroscopy: Indications and Contraindications

Introducción: Las enfermedades que afectan la articulación de la cadera son numerosas, y dentro de las variantes de tratamiento quirúrgico se encuentra la artroscopia, la que ha ganado gran popularidad en la actualidad por sus ventajas. Objetivo: Actualizar la información sobre la artroscopia de cadera como modalidad de tratamiento quirúrgica mínimo-invasiva en relación con sus indicaciones y contraindicaciones. Métodos: Se realiza una búsqueda y análisis de la información sobre el tema en el período comprendido entre el primero de septiembre y el 31 de octubre de 2020. Se emplearon las siguientes palabras para la búsqueda: hip arthroscopy, snapping hip syndrome, impingement hip síndrome, y a partir de la información obtenida se revisaron 307 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline, mediante el gestor de búsqueda y administrador de referencias EndNote. De ellos se seleccionaron 47 citas de los últimos cinco años para la revisión. Análisis y síntesis de la información: Se hace referencia a los trabajos publicados que abordan información sobre la artroscopia de cadera. Se analizan las indicaciones tanto en entidades intrarticulares como periarticulares, con especial énfasis en las primeras y el choque femoroacetabular. Con relación a las contraindicaciones se dividen en absolutas y relativas para su mejor comprensión. Conclusiones: La artroscopia de la cadera es un método quirúrgico útil en una gran variedad de afecciones de la articulación y sus ventajas son numerosas. Esta modalidad quirúrgica permite el diagnóstico de entidades difíciles de detectar por los métodos imagenológicos disponibles en la actualidad y por ende el tratamiento efectivo desde etapas tempranas con el propósito de conservar la articulación(AU)

Introduction: The diseases that affect the hip joint are numerous, and among the variants of surgical treatment is arthroscopy, which has gained great popularity today due to its advantages. Objective: To bring up to date the information on hip arthroscopy as a minimally invasive surgical treatment modality in relation to its indications and contraindications. Methods: A search and analysis of information on the subject was carried out from September 1 to October 31, 2020. The following search words were used: hip arthroscopy, snapping hip syndrome, impingement hip syndrome. Founded on the information obtained, 307 articles published in PubMed, Hinari, SciELO and Medline databases were reviewed, using the EndNote search manager and reference manager. Forty-seven citations of the total were selected for this review. They were published in the last five years. Analysis and synthesis of the information: Reference is made to published papers that address information on hip arthroscopy. Indications for both intra-articular and peri-articular entities are analyzed, with special emphasis on the former and femoroacetabular impingement. In relation to the contraindications, they are divided into absolute and relative for their better understanding. Conclusions: Arthroscopy of the hip is a useful surgical method in wide variety of joint conditions and its advantages are numerous. This surgical modality allows the diagnosis of entities that are difficult to detect by currently available imaging methods and therefore effective treatment from early stages in order to preserve the joint(AU)

Fisioterapia de rehabilitación y pinzamiento femoroacetabular / Rehabilitation Physiotherapy and Femoroacetabular Impingement

Introducción: Durante los últimos 20 años el tratamiento del pinzamiento acetabular ha sido quirúrgico, sin embargo, se ha propuesto el manejo conservador y la aplicación de protocolos de fisioterapia individualizada como tratamiento para el pinzamiento femoroacetabular, lo cual es fundamental para reestablecer la función de la articulación. Objetivo: Comparar los resultados entre la fisioterapia de rehabilitación del pinzamiento femoroacetabular y el tratamiento quirúrgico. Métodos: El artículo se dividió en conceptos para facilitar la revisión bibliográfica de los últimos 5 años en la base de datos de Pubmed con el sistema MeSH, Embase, Cochrane Library, Medline y BVS. Se utilizaron las siguientes palabras clave en el buscador, combinadas con el operador AND: femoroacetabular impingement, fhysiotherapy AND femoroacetabular impingement, femoroacetabular impingement treatment, Non-operative Management of Femoroacetabular Impingement. Análisis y síntesis de la información: Se incluyeron en la revisión todos los metaanálisis, ensayos clínicos aleatorizados y controlados, estudios prospectivos y artículos de revisión que comparan el tratamiento quirúrgico versus la fisiopterapia de rehabilitación en el tratamiento del síndrome de pinzamiento femoroacetabular, así como los que proponen la fisioterapia como opción de tratamiento inicial para el pinzamiento femoroacetabular, con la finalidad de evidenciar el grado de beneficio que tiene el manejo con fisioterapia en comparación con el quirúrgico. Conclusiones: La fisioterapia de rehabilitación ofrece un efecto beneficioso para el mejoramiento de la sintomatología, lo que permite, la disminución del dolor de cadera, además de restablecer la función y fuerza de la articulación(AU)

Introduction: During the last 20 years the treatment of acetabular impingement has been surgical; however, conservative management and the application of individualized physiotherapy protocols have been proposed as treatment for femoroacetabular impingement. This is essential to re-establish joint function. Objective: To compare the results between rehabilitation physiotherapy of femoroacetabular impingement and surgical treatment. Methods: The article was divided into concepts to facilitate the bibliographic review of the last 5 years in the Pubmed database with the MeSH system, Embase, Cochrane Library, Medline and BVS. The keywords used in the search engine, combined with the AND operator were femoroacetabular impingement, fhysiotherapy AND femoroacetabular impingement, femoroacetabular impingement treatment, Non-operative Management of Femoroacetabular Impingement. Analysis and synthesis of the information: All meta-analyzes, randomized and controlled clinical trials, prospective studies and review articles comparing surgical treatment versus rehabilitation physiotherapy in the treatment of femoroacetabular impingement syndrome were included in the review, as well as those that propose physiotherapy as an initial treatment option for femoroacetabular impingement, in order to demonstrate the degree of benefit that physiotherapy management has compared to surgery. Conclusions: Rehabilitation physiotherapy offers a beneficial effect for the improvement of symptoms, which allows the reduction of hip pain, in addition to restoring the function and strength of the joint(AU)

Dolor de cadera en adolescentes: estudio y tratamiento / Hip pain in adolescent: assessment and treatment

En adolescentes que consultan por dolor de cadera o pelvis, es crucial una adecuada historia clínica para orientarnos sobre la etiología del dolor y comprender los mecanismos que lo generan. Es importante conocer y realizar un exhaustivo examen físico, con especial énfasis en la cadera, incluyendo pruebas específicas para diferentes patologías, además de comprender las indicaciones de los diferentes estudios de imágenes, para así lograr un correcto diagnóstico.Entre las causas más frecuentes de coxalgia en adolescentes debemos considerar la epifisiolisis, el pinzamiento femoroacetabular con o sin roturas del labrum, las lesiones avulsivas de la pelvis, la coxa saltans, entre otras. Aunque son poco frecuentes, patologías sistémicas como reumatológicas y oncológicas también deben ser descartadas en adolescentes. Un diagnóstico de certeza nos permitirá realizar una adecuada estrategia de tratamiento, a fin de lograr una rehabilitación precoz y evitar futuras complicaciones.

In adolescents presenting with hip or pelvis pain, an adequate medical history is crucial to guide the etiology and understand the mechanisms that generate it. It is important to know and carry out an exhaustive physical examination, with special attention to the hip, including specific tests for different pathologies, in addition to understand the indications of the different imaging studies, in order to achieve a correct diagnosis. Among the most frequent causes of hip pain in adolescents, we must rule out slipped capital femoral epiphysis, femoroacetabular impingement with or without labral tears, avulsion lesions of the pelvis, snapping hip, among others. Although rare, systemic pathologies such as rheumatologic and oncologic diseases must also be ruled out in adolescents. An accurate diagnosis will allow us to carry out an adequate treatment strategy, in order to achieve early rehabilitation and avoid future complications.

Functional outcomes of arthroscopic treatment in 230 femoroacetabular impingement cases / Functional result of arthroscopic treatment in 230 impacts femoroacetabulares

ABSTRACT Objective: To analyze the functional outcomes after arthroscopic treatment of femoroacetabular impingement (FAI). Methods: 194 patients (131 males and 63 females), with a mean age of 39 (15-68) years old for men and 43 (16-58) years old for women. The average follow-up was 17 months (2 to 71). 103 patients presented Cam-type FAI, 102 mixed and 25 Pincer. "Unilateral" arthroscopy was performed in 161 cases, "Bilateral" (only once each side) in 46 cases and, "Multiple" (more than one procedure on the same hip) in 23. The female sex was prevalent in the Pincer type FAI (76%), while males were prevalent in Mixed and Cam type, 74.5% and 72.8%, respectively. Results: The mean HHSpre score was 63.7 and 87.1 for HHSpost, i.e. 73.11%. Differences appeared between "mixed" and "unilateral" groups. The complications percentage in this series was 18.7% and 7% progressed to total hip arthroplasty. Conclusion: The arthroscopic FAI treatment improved the postoperative clinical scores of these patients, especially in cases of mixed-type FAI, which presented a higher improvement rate. Insufficient femoral osteoplasty was the main cause for surgical re-intervention, particularly in the initial cases of this series. Level of Evidence II, Retrospective study.

RESUMO Objetivo: Avaliar os resultados funcionais após tratamento artroscópico do impacto femoroacetabular (IFA). Métodos: Foram selecionados 194 pacientes (131 do sexo masculino e 63 do sexo feminino), com idade média de 39 (15-68) anos no caso dos homens e 43 (16-58) anos para as mulheres. O seguimento médio foi de 17 meses (2 a 71). 103 pacientes apresentaram IFA tipo Came, 102 Misto e 25 tipo Pincer. A artroscopia única foi realizada em 161 casos; a bilateral (somente uma vez cada lado) em 46 casos e a múltipla (mais de um procedimento no mesmo quadril) em 23. O sexo feminino foi prevalente no IFA do tipo Pincer (76%) e o masculino nos tipos Misto e Came, 74,5% e 72,8%, respectivamente. Resultados: A média do escore HHSpré foi de 63,7 para HHSpós de 87,1, ou seja 73,11% Ficaram evidenciadas diferenças nos grupos "misto" e "único". O percentual de complicações desta série foi de 18,7% e 7% evoluíram para artroplastia total do quadril. Conclusão: O tratamento artroscópico IFA melhorou os escores clínicos, principalmente nos casos de IFA do tipo misto, que apresentou maior taxa de melhora, A osteoplastia femoral insuficiente foi a principal causa para reintervenção cirúrgica, particularmente nos casos iniciais desta série. Nível de Evidência II, Estudo retrospectivo.

Arthroscopic Treatment of Femoroacetabular Impingement in Slipped Capital Femoral Epiphysiolysis: A Case Report / Tratamento artroscópico do impacto femoroacetabular na epifisiólise capital femoral proximal: Relato de caso

Abstract Slipped capital femoral epiphysiolysis (SCFE) may result in femoroacetabular impingement (FAI) of the hip in up to one third of the cases. Residual deformity of the cam-type, or "pistol-grip", is associated with chondrolabral injury, resulting in pain, functional disability, and early osteoarthritis. The arthroscopic treatment with osteochondroplasty proved to be beneficial in a selected case of FAI secondary to SCFE.

Resumo A epifisiólise capital femoral proximal (ECFP) pode resultar em impacto femoroacetabular (IFA) do quadril em até um terço dos casos. A deformidade residual em came ou "cabo de pistola" está associada a lesão condrolabral, resultando em dor, incapacidade funcional, e osteoartrose precoce. O tratamento artroscópico com osteocondroplastia mostrou-se benéfico em um caso selecionado de IFA secundário a ECFP.

Research status and development trend of bibliometrics and visualization analysis in the assessment of femoroacetabular impingement / 中国组织工程研究

BACKGROUND: Exploring the research status and development trend of femomacetabular impingement, and finding out the research direction and hot spot of femomacetabular impingement are helpful for domestic scholars to grasp the latest information in this field and explore the most cutting-edge treatment direction. OBJECTIVE: To explore the research status and the development trend of femoroacetabular impingement in the world. METHODS: The science citation index of Wed of Science core collection was used to retrieve English literature on femoroacetabular impingement from January 1, 2005 to February 20, 2020. The bibliometric methods were used to conduct data statistics and analysis. Meanwhile, VOS viewer software was used for visualization conversion to analyze the research status and the development trend of femoroacetabular impingement. RESULTS AND CONCLUSION: (1) Totally 3 158 literatures were included. The literatures concerning global scientific research of femoroacetabular impingement are increasing year by year. The number of the United States published is largest. The United States makes the greatest contribution in the world, ranking the top (1 659 papers), whose number of the citations (37 019 papers) and H index (87 papers) are the highest. The number of literatures is 43 in China. It ranks 14 and the citations are 301; H index is 9. (2) ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY who contributed the largest number of relevant literatures (426 papers) is more than of the second magazine (287 papers) named AMERICAN JOURNAL OF SPORTS MEDICINE. UNIV BERN (University of Bern) and HOSP SPECIAL SURG (Hospital for Special Surgery) are two institutions which have the largest amount of research publications. (3) Currently, the research topics on femoroacetabular impingement are focusing on five areas, including epidemiology, disease progression, diagnosis, treatment and prognosis. In recent years, the primary field of research is treatment and the hip arthroscopic operation becomes a research hotspot. (4) From the analysis on the current development trend of femoroacetabular impingement, there is still very big exploration space in this area and the number of published literatures continuous increases. The United States remains a leader in this field. The further study is required in China. In recent years, the research direction focuses on the aspect of treatment of femoroacetabular impingement. Hip arthroscopic operation is research focus on femoroacetabular impingement.

Clinical outcomes of hip arthroscopic treatment for femoroacetabular impingement:a comparative study between Inside-out and Outside-in approach / 中国骨伤

OBJECTIVE@#To compare the clinical outcomes and complications of hip arthroscopic treatment for femoroacetabular impingement (FAI) performed with either Inside-out or Outside-in approach.@*METHODS@#The clinical date of 48 patients with FAI treated by hip arthroscopy surgery and follow-up from June 2016 to June 2019 were retrospectively analyzed. According to the different operative methods, the patients were divided into two groups. Inside-out group, from central compartment to peripheral compartment;Outside-in group, from peripheral compartment to central compartment. There were 14 males and 10 females in Inside-out group with an averageage of (39.8±7.6)years old, 13 males and 11 females in Inside-out group with an average age of (39.5±9.1)years old in Outside-in group. There was no significant difference in age, gender, body mass index, side, impingement type, medical history and follow-up time between the two groups. The complication occurrence rate, modified Harris hip score (mHHS)and nonarthritic hip score (NAHS) were compared between these two groups.@*RESULTS@#The mHHs and NAHS scores of the two groups were significantly higher than those before operation, but there was no significant difference between the two groups (@*CONCLUSION@#Both hip arthroscopic surgery methods can obtain satisfactory clinical efficacy in the treatment of FAI, but the incidence of postoperative complications of Outside-in surgical method is lower. The out-side in method can be preferentially selected for the patients with the indications of operation.

Subspine Hip Impingement: Clinical and Radiographic Results of its Arthroscopic Treatment / Impacto subespinhal do quadril: Resultados clínicos e radiográficos do tratamento artroscópico

Abstract Objective To evaluate the clinical and radiographic results as well as complications related to patients undergoing arthroscopic treatment of subspine hip impingement. Methods We retrospectively evaluated 25 patients (28 hips) who underwent arthroscopic treatment of subspine impingement between January 2012 and June 2018. The mean follow-up was 29.5 months, and the patients were evaluated clinically by using the Harris hip score modified by Byrd (MHHS), the non-arthritic hip score (NAHS), and in terms of internal rotation and hip flexion. In addition, the following items were evaluated by imaging exams: the center-edge (CE) acetabular angle, the Alpha angle, the presence of a sign of the posterior wall, the degree of arthrosis, the presence of heterotopic hip ossification, and the Hetsroni classification for subspine impingement. Results There was an average postoperative increase of 26.9 points for the MHHS, 25.4 for the NAHS (p < 0.0001), 10.5° in internal rotation (p < 0.0024), and 7.9° for hip flexion (p < 0.0001). As for the radiographic evaluation, an average reduction of 3.3° in the CE angle and of 31.6° for the Alpha angle (p < 0.0001). Eighteen cases (64.3%) were classified as grade 0 osteoarthritis of Tönnis, and 10 (35.7%) were classified as Tönnis grade 1. Two cases (7.1%) presented grade 1 ossification of Brooker. Most hips (n = 15, 53.6%) were classified as type II of Hetsroni et al. Conclusion In the present study, patients undergoing arthroscopic treatment with subspine impingement showed improvement in clinical aspects and radiographic patterns measured postoperatively, with an average follow-up of 29.5 months.

Resumo Objetivo Avaliar os resultados clínicos e radiográficos assim como as complicações relacionadas a pacientes submetidos ao tratamento artroscópico do impacto subespinhal do quadril. Métodos Foram avaliados retrospectivamente 25 pacientes (28 quadris) submetidos ao tratamento artroscópico de impacto subespinhal entre janeiro de 2012 e junho de 2018. O seguimento médio foi de 29,5 meses, e os pacientes foram avaliados clinicamente pelo Harris hip score modificado por Byrd (MHHS), o non-arthritic hip score (NAHS), e quanto à rotação interna e flexão do quadril. Além disso, foram avaliados por exames de imagem: o ângulo center-edge (CE) acetabular, o ângulo alfa, a presença de sinal da parede posterior, o grau de artrose, a presença de ossificação heterotópica do quadril e a classificação de Hetsroni para Impacto Subespinhal. Resultados Observou-se aumento médio pós-operatório de 26,9 pontos para o MHHS, 25,4 para o NAHS (p < 0,0001), 10,5° na rotação interna (p < 0,0024) e 7,9° para flexão do quadril (p < 0,0001). Quanto à avaliação radiográfica, observou-se redução média de 3,3° no ângulo CE e de 31,6° para o ângulo alfa (p < 0,0001). Foram classificados 18 casos (64,3%) como artrose grau 0 de Tönnis e 10 (35,7%) como Tönnis 1. Dois casos (7,1%) apresentaram ossificação grau 1 de Brooker. A maioria dos quadris (n = 15; 53,6%) foi classificada como tipo II de Hetsroni et al. Conclusão No presente estudo, os pacientes submetidos a tratamento artroscópico de impacto subespinhal apresentaram melhora nos aspectos clínicos e nos padrões radiográficos aferidos pós-operatoriamente, com seguimento médio de 29,5 meses.

Functional Outcomes of Arthroscopic Treatment in Femoroacetabular Impingement in Patients over 60 Years Old Compared with Patients Aged 40 Years or Younger / Resultados funcionais do tratamento artroscópico no impacto femoroacetabular em pacientes com mais de 60 anos em comparação com pacientes com 40 anos ou menos

Abstract Objective To evaluate the functional outcomes of patients diagnosed with femoroacetabular impingement (FAI) older than 60 years, compared with those of patients of age 40 years or younger. Methods This was a retrospective review of patients with FAI who underwent hip arthroscopy between 2010 and 2015. The patients were adults aged over 60 years with Tönnis ≤ 1 matched in a 1:1 ratio with adults aged 40 years or younger, according to the type of deformity (cam, pincer, or mixed), sex, and the date when the surgery was performed. Results Thirty-four patients were included in each group. The mean age was 30.6 ± 6.9 years and 65.6 ± 4.6 years in the control and case groups, respectively. There were no significant differences between the groups at 1-year follow-up (p > 0.05). In the group with older patients (case group), we observed a change in the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score from 46.3 to 22.0 in the 1st postoperative year, while the control cases improved in the WOMAC score from 38.1 to 7.2 in relation to the preoperative stage. Conclusion In the group of patients ≤ 40 years old, a considerable change was observed in the WOMAC score without a statistical significance compared with the > 60 years group. This observation suggests that hip arthroscopy is beneficial when there is an appropriate selection of patients with FAI, regardless the age of the patient.

Resumo Objetivo Avaliar os resultados funcionais de pacientes diagnosticados com impacto femoroacetabular (IFA) e com mais de 60 anos de idade em comparação aos resultados de pacientes com até 40 anos de idade. Métodos Esta é uma revisão retrospectiva de pacientes com IFA submetidos à artroscopia do quadril entre 2010 e 2015. Os pacientes eram adultos com mais de 60 anos de idade e Tönnis ≤ 1, alocados na proporção de 1:1 com adultos de até 40 anos de idade, de acordo com o tipo de deformidade (came, pincer, ou misto), sexo e data de realização da cirurgia. Resultados Trinta e quatro pacientes foram incluídos em cada grupo. A idade média foi de 30,6 ± 6,9 anos e 65,6 ± 4,6 anos nos grupos controle e de casos, respectivamente. Não houve diferenças significativas entre os grupos no acompanhamento de 1 ano (p > 0.05). No primeiro ano após a cirurgia, a pontuação Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) passou de 46,3 para 22,0 no grupo de pacientes mais velhos (casos) e de 38,1 para 7,2 no grupo controle em comparação ao estágio pré-operatório. Conclusão O grupo de pacientes com até 40 anos de idade apresentou uma mudança considerável na pontuação WOMAC, mas sem significado estatístico em comparação ao grupo de pacientes acima de 60 anos. Essa observação sugere que a artroscopia do quadril é benéfica quando a seleção de pacientes com IFA é apropriada, independentemente da idade dos indivíduos.

Femoroacetabular Impingement and Acetabular Labral Tears - Part 2: Clinical Diagnosis, Physical Examination and Imaging / Impacto femoroacetabular e lesão do lábio acetabular - Parte 2: Diagnóstico clínico, exame físico e imagiologia

Abstract The clinical diagnosis of femoral acetabular impingement (FAI) continues to evolve as the understanding of normal and pathological hips progresses. Femoral acetabular impingement is currently defined as a syndrome in which the diagnosis consists of the combination of a previously-obtained comprehensive clinical history, followed by a consistent and standardized physical examination with specific orthopedic maneuvers. Additionally, radiographic and tomographic examinations are used for the morphological evaluation of the hip, and to ascertain the existence of sequelae of childhood hip diseases and the presence of osteoarthritis. The understanding of the femoral and acetabular morphologies and versions associated with images of labral and osteochondral lesions obtained through magnetic resonance imaging (MRI) contributes to the confirmation of this syndrome in symptomatic patients, and helps in the exclusion of differential diagnoses such as iliopsoas tendon snaps, subspine impingement, ischiofemoral impingement, and other hip joint pathologies.

Resumo O diagnóstico clínico do impacto femoroacetabular continua a evoluir conforme o entendimento dos quadris normal e patológico progride. Impacto femoroacetabular é atualmente definido como uma síndrome na qual o diagnóstico se baseia no somatório de uma história clínica abrangente obtida previamente, seguida de um exame físico coerente e padronizado com manobras ortopédicas específicas. Além disso, exames radiográficos e tomográficos são usados para a avaliação morfológica do quadril, e para verificar a existência de sequelas de doenças do quadril da infância e a presença de osteoartrose. O entendimento da morfologia e versão femoral e acetabular associado às imagens de lesões labrais e osteocondrais obtidas com a ressonância magnética contribuem para a confirmação da síndrome nos pacientes sintomáticos, além de auxiliar na exclusão de diagnósticos diferenciais, como ressalto do tendão do músculo iliopsoas, impacto subespinhal, impacto isquiofemoral, e outras patologias da articulação do quadril.

Femoroacetabular Impingement and Acetabular Labral Tears - Part 1: Pathophysiology and Biomechanics / Impacto femoroacetabular e lesão do lábio acetabular - Parte 1: Fisiopatologia e biomecânica

Abstract Femoroacetabular impingement (FAI) is an important cause of hip pain, and the main etiology of hip osteoarthritis in the young population. Femoroacetabular impingement is characterized by subtle alterations in the anatomy of the acetabulum and proximal femur, which can lead to labrum tearing. The acetabular labrum is essential to the stability of the hip joint. Three types of FAI were described: cam (anespherical femoral head), pincer (acetabular overcoverage) and mixed (characteristics of both cam and pincer). The etiology of FAI is related to genetic and environmental characteristics. Knowledge of this condition is essential to adequately treat patients presenting with hip pain.

Resumo O impacto femoroacetabular (IFA) é uma importante causa de dor no quadril, e a principal etiologia da osteoartrose do quadril no jovem. O IFA é caracterizado por alterações sutis da anatomia do acetábulo e do fêmur proximal que podem causar lesões do complexo condrolabial. O lábio é uma estrutura fibrocartilaginosa essencial na estabilidade articular. Três tipos de IFA são descritos: came (onde há uma anesfericidade da cabeça femoral), pincer (onde há uma sobrecobertura acetabular) e misto (que apresenta características de ambos). A etiologia do IFA está relacionada com características genéticas e ambientais. O conhecimento desta doença e sua fisiopatologia é essencial para o tratamento de pacientes que apresentam dor no quadril.

Femoroacetabular Impingement and Acetabular Labral Tears - Part 3: Surgical Treatment / Impacto femoroacetabular e lesão do lábio acetabular - Parte 3: Tratamento cirúrgico

Abstract In the last 15 years, the diagnosis of femoroacetabular impingement has become more frequent; with the advance of surgical indications, different techniques have been developed. Surgical treatment includes a wide variety of options, namely: periacetabular osteotomy, surgical hip dislocation, arthroscopy with osteochondroplasty via a small incision, modified anterior approach technique, and exclusively arthroscopic technique. The type of approach should be chosen according to the complexity of the morphology of the femoroacetabular impingement and to the surgeon's training. The techniques most used today are arthroscopy, surgical dislocation of the hip, and periacetabular osteotomy. The present article aims to describe the current main surgical techniques used to treat femoroacetabular impingement, their indications, advantages and disadvantages, complications and clinical results.

Resumo Nos últimos 15 anos, o diagnóstico do impacto femoroacetabular tem se tornado cada vez mais frequente; com o avanço do entendimento de quais pacientes potencialmente se beneficiariam do tratamento cirúrgico, diferentes técnicas foram desenvolvidas. O tratamento cirúrgico inclui grande variedade de opções, sendo elas: osteotomia periacetabular, técnica de luxação cirúrgica do quadril, artroscopia com osteocondroplastia via pequena incisão, técnica via anterior modificada, e técnica exclusivamente artroscópica. O tipo de abordagem deve ser escolhido de acordo com a complexidade da morfologia do impacto femoroacetabular e com o treinamento do cirurgião. As técnicas mais utilizadas atualmente são a artroscopia, a luxação cirúrgica do quadril e a osteotomia periacetabular. O presente artigo busca descrever as principais técnicas cirúrgicas utilizadas para o tratamento do impacto femoroacetabular, suas indicações, vantagens e desvantagens, complicações e resultados clínicos.