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Addressing Extra-Articular Impingement in the Athlete 解决运动员的关节外撞击问题
IF 0.4 4区 医学 Q4 SPORT SCIENCES Pub Date : 2024-09-01 DOI: 10.1016/j.otsm.2024.151109
Michael K. Ryan

Extra-articular impingement (EAI) is an atypical, infrequent source of hip pain. Unlike femoroacetabular impingement (FAI) and acetabular dysplasia (AD), EAI results from abnormal contact of the proximal femur and trochanteric region, and the ischium or subspine areas. Hip pain and potential instability are reported. Causes of EAI include a narrowed ischiofemoral space, coxa valga, femoral torsion abnormalities, avulsion malunions, and more complex deformities resulting from pediatric hip diseases. Unique history and examination findings not commonly seen with standard FAI are noted, including pain with standing and hip extension and imbalanced hip motion with excessive internal rotation and limited external rotation (or vice versa). Surgical indications are yet to be definitively defined, but surgical treatment options include lesser trochanter resection, femoral osteotomy, and surgical hip dislocation. Proper workup and surgical planning have demonstrated good outcomes for treatment of EAI with these techniques, but information to optimally define which patients benefit most from which surgeries is pending.

关节外撞击(EAI)是一种不典型、不常见的髋关节疼痛来源。与股骨髋臼撞击(FAI)和髋臼发育不良(AD)不同,EAI 是由于股骨近端和转子区与骶骨或脊柱下区域的异常接触造成的。据报道,患者会出现髋部疼痛和潜在的不稳定性。导致 EAI 的原因包括股骨髁间隙狭窄、髋臼畸形、股骨扭转异常、撕脱性畸形以及由小儿髋关节疾病导致的更复杂的畸形。一些独特的病史和检查结果在标准FAI中并不常见,包括站立和髋关节伸展时疼痛,以及髋关节活动不平衡,内旋过度而外旋受限(反之亦然)。手术适应症尚未明确,但手术治疗方案包括小转子切除术、股骨截骨术和髋关节脱位手术。采用这些技术治疗 EAI 时,正确的检查和手术规划已证明取得了良好的疗效,但仍有待相关信息以最佳方式确定哪些患者可从哪些手术中获益最多。
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引用次数: 0
Revision Hip Arthroscopy: Getting It Right the Second Time 髋关节镜翻修术:第二次正确操作
IF 0.4 4区 医学 Q4 SPORT SCIENCES Pub Date : 2024-09-01 DOI: 10.1016/j.otsm.2024.151108
Roger Quesada-Jimenez , Elizabeth G. Walsh , Benjamin G. Domb

Hip arthroscopy procedures have become increasingly common in the last few decades for treating both intra and extra-articular hip pathologies. Despite advancements in the field, some patients may not experience improvement and may eventually require revision hip arthroscopy. The multifactorial causes for failure, unknown impacts of the primary procedure and previous iatrogenic considerations can create added complexity for the revision. Given that revision hip arthroscopy has had more variation in patient outcomes and higher rates of subsequent conversion to hip arthroplasty, compared with primary hip arthroscopy, it is imperative to have a good algorithm for patient selection and to understand the various surgical options available to address different pathologies. In this review, we explore the current diagnostic algorithms, etiologies, surgical procedures, outcomes, and provide insights into future directions in the field of revision hip arthroscopy.

过去几十年来,髋关节镜手术在治疗髋关节内、外病变方面越来越常见。尽管该领域取得了进步,但一些患者的病情可能没有得到改善,最终可能需要进行髋关节镜翻修手术。失败的多因素原因、初次手术的未知影响以及先前的先天性因素都会增加翻修手术的复杂性。与初次髋关节镜手术相比,翻修髋关节镜手术的患者预后差异更大,随后转为髋关节置换术的比例也更高,因此必须有一个良好的患者选择算法,并了解针对不同病理的各种手术方案。在这篇综述中,我们探讨了当前的诊断算法、病因、手术方法、结果,并对翻修髋关节镜领域的未来发展方向提出了见解。
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引用次数: 0
Managing the Hip in Supraphysiologic Motion Athletes 管理超生理运动运动员的髋关节
IF 0.4 4区 医学 Q4 SPORT SCIENCES Pub Date : 2024-09-01 DOI: 10.1016/j.otsm.2024.151107
Robert M. Putko, Marc R. Safran

The supraphysiologic hip in artistic athletes poses a unique challenge to the discerning sports medicine practitioner. Through stretching and repetitive microtraumatic motions, a cascade of soft tissue laxity, increased strain on surrounding soft tissue structures, and microinstability can develop, resulting in both soft tissue and bony injury. In addition, extra-articular pathology can predominantly affect the artistic athlete. Thus, a thorough understanding of the anatomy and pathophysiology as the hip is ranged to the extremes is paramount to establishing an adequate diagnosis and developing a treatment plan. Through a careful history along with a targeted and thorough physical exam in addition to diagnostic imaging, one can accurately identify the sources of pain and dysfunction. Treatment can range from conservative and interventional nonoperative modalities to open and/or arthroscopic hip surgery. Surgical techniques should not only address the identified pathology but also take care to not limit the extremes of hip motion required by the artistic athlete's sport. Despite the high demands of hip motion and function (supraphysiologic motion and function) the artistic athlete can return to high levels of performance if one pays attention to these factors.

艺术运动员的超生理髋关节给运动医学从业者带来了独特的挑战。通过拉伸和重复的微创伤运动,会产生一连串的软组织松弛、周围软组织结构应力增加和微不稳定性,从而导致软组织和骨骼损伤。此外,关节外病变也会主要影响艺术类运动员。因此,充分了解髋关节的解剖结构和病理生理学,对确定适当的诊断和制定治疗计划至关重要。通过仔细询问病史、有针对性的全面体格检查以及影像诊断,可以准确确定疼痛和功能障碍的来源。治疗方法包括保守治疗和介入性非手术治疗,以及开放性和/或关节镜髋关节手术。手术技术不仅要解决已确定的病理问题,还要注意不要限制艺术运动员运动所需的髋关节极限运动。尽管对髋关节运动和功能的要求很高(超生理运动和功能),但只要注意这些因素,艺术运动员就能恢复到高水平的运动表现。
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引用次数: 0
Editorial Board (pick up from previous issue) 编辑委员会(接上一期)
IF 0.4 4区 医学 Q4 SPORT SCIENCES Pub Date : 2024-09-01 DOI: 10.1053/S1060-1872(24)00058-3
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引用次数: 0
Arthroscopic Labral Management: Ignore, Debride, Repair or Reconstruct 关节镜下唇囊处理:忽略、剥离、修复或重建
IF 0.4 4区 医学 Q4 SPORT SCIENCES Pub Date : 2024-09-01 DOI: 10.1016/j.otsm.2024.151106
Ali S. Noorzad, Marc J. Philippon

Since its inception, there has been considerable advancement made in the field of hip arthroscopy in not only the technological and technical capabilities but our overall understanding of hip biomechanics and pathology. At the center of much of this progress is the surgeon's approach to the acetabular labrum. In this section, we will discuss the treatment considerations regarding the acetabular labrum and the various treatment modalities that have been tried and tested over time. To refer to the various techniques as treatment options would erroneously imply that all treatment modalities are considered equally in the management of each form of labral pathology. We will discuss the variety of techniques as it is presented in the literature, their respective outcomes, as well as our preferred method for each type of acetabular labral pathology.

髋关节镜技术自诞生以来取得了长足的进步,这不仅体现在技术能力上,也体现在我们对髋关节生物力学和病理学的整体理解上。这一进步的核心是外科医生处理髋臼唇的方法。在本节中,我们将讨论有关髋臼唇的治疗注意事项以及经过长期尝试和检验的各种治疗方法。如果将各种技术称为治疗方案,就会错误地认为在治疗各种形式的髋臼唇病变时,所有的治疗方法都是同等重要的。我们将讨论文献中介绍的各种技术、它们各自的疗效,以及我们对每种髋臼唇病变的首选方法。
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引用次数: 0
Hip Injuries in the Pediatric Athlete—Pelvic Apophyseal Avulsions 小儿运动员的髋关节损伤-骨盆顶骨撕脱伤
IF 0.4 4区 医学 Q4 SPORT SCIENCES Pub Date : 2024-09-01 DOI: 10.1016/j.otsm.2024.151110
Rishi Sinha , Ben Johnson , William Z. Morris , Philip L. Wilson , Henry B. Ellis

Pelvic apophyseal avulsion fractures have been occurring more commonly in young athletes in the context of increased intensive year-round training and early specialization in youth sports, and this diagnosis must be considered in the pediatric patient presenting with hip pain. An understanding of the relevant anatomy can guide the history and physical exam to arrive at the diagnosis, which is usually confirmed with plain radiographs. Although nonoperative management remains the mainstay of treatment for these patients, surgery may be warranted for ischial tuberosity fractures displaced > 2 cm and for symptomatic nonunions. The objective of this review is to provide a comprehensive overview of pelvic apophyseal avulsion injuries.

由于青少年运动中全年密集训练和早期专业化训练的增加,骨盆顶骨撕脱性骨折在年轻运动员中更为常见,因此对于出现髋部疼痛的儿童患者,必须考虑这一诊断。对相关解剖结构的了解可以指导病史和体格检查,从而得出诊断结果,而诊断结果通常要通过X光平片来确认。虽然非手术治疗仍是这些患者的主要治疗方法,但对于移位超过 2 厘米的峡部结节骨折和无症状的非关节畸形,可能需要进行手术治疗。本综述旨在全面概述骨盆顶骨撕脱伤。
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引用次数: 0
Imaging and Preoperative Planning of Athletic Hip Pathology 运动髋关节病变的成像和术前规划
IF 0.4 4区 医学 Q4 SPORT SCIENCES Pub Date : 2024-09-01 DOI: 10.1016/j.otsm.2024.151105
Cody Lee , Asheesh Bedi

Proper imaging is essential for treatment planning of athletic hip pathology. Plain radiographs are a valuable imaging modality, as they can provide useful information regarding patient native anatomy and hip pathoanatomy. Both acetabular- and femoral-sided pathology can be examined using a variety of radiographic views including the AP pelvis, cross table lateral, modified Dunn, and false profile views. Computed tomography can be utilized to further characterize the hip in the coronal and sagittal planes with the added information of axial imaging. This can aid in assessment of hip dysplasia and femoroacetabular impingement. Magnetic resonance imaging can be useful in evaluation soft tissue pathology of the hip, as well as in assessment of the cartilage. Ultrasound offers a noninvasive method of imaging the hip and can be useful in dynamic studies.

正确的成像对于运动髋关节病变的治疗规划至关重要。X光平片是一种很有价值的成像方式,因为它能提供有关患者原生解剖结构和髋关节病理解剖的有用信息。髋臼侧和股骨侧的病变都可以通过各种影像学切面进行检查,包括AP骨盆切面、横台侧切面、改良Dunn切面和假轮廓切面。计算机断层扫描可利用轴向成像的附加信息,进一步确定髋关节在冠状面和矢状面的特征。这有助于评估髋关节发育不良和股骨髋臼撞击。磁共振成像有助于评估髋关节软组织病变和软骨。超声波是一种非侵入性的髋关节成像方法,可用于动态研究。
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引用次数: 0
Diagnosis and Treatment of Young Adult Hip Injuries (Part II) 青壮年髋关节损伤的诊断和治疗(第二部分)
IF 0.4 4区 医学 Q4 SPORT SCIENCES Pub Date : 2024-09-01 DOI: 10.1016/j.otsm.2024.151129
Travis G. Maak MD
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引用次数: 0
Physical Therapy Paradigms in Athletic Return to Play After Hip Surgery 髋关节手术后运动员重返赛场的物理治疗范例
IF 0.4 4区 医学 Q4 SPORT SCIENCES Pub Date : 2024-09-01 DOI: 10.1016/j.otsm.2024.151111
Ashley M. Campbell , Michael Voight , JW Thomas Byrd

Hip arthroscopy has become the predominant surgical approach for managing femoroacetabular impingement (FAI) and associated intra-articular pathologies, particularly in athletes. Despite advancements in surgical techniques, rehabilitation protocols, especially those governing return to play (RTP), have not kept pace in terms of specificity and objectivity. This article reviews current practices and introduces a comprehensive, multi-factorial continuum for RTP that extends beyond mere time-based criteria to include an athlete's overall readiness, encompassing both physical and psychological aspects. Through a phased rehabilitation strategy beginning in the preoperative phase and extending through to full return to competition, this paper aims to present a more nuanced continuum for RTP that accounts for an athlete's readiness beyond temporal benchmarks. The phases outlined include preoperative preparation, immediate postoperative care, early rehabilitation, reconditioning, performance enhancement, and final return to play, each phase tailored to integrate clinical milestones with biomechanical and psychosocial factors. This approach advocates for a shift towards personalized rehabilitation protocols that align with the biological healing processes and functional milestones essential for a successful return to sports.

髋关节镜已成为治疗股骨髋臼撞击症(FAI)及相关关节内病变的主要手术方法,尤其是在运动员中。尽管手术技术在不断进步,但康复方案,尤其是有关重返赛场(RTP)的康复方案在特异性和客观性方面却没有跟上步伐。本文回顾了当前的做法,并介绍了一个全面的、多因素的 RTP 连续体,该连续体超越了单纯的时间标准,还包括运动员的整体准备情况,包括身体和心理两方面。通过从术前阶段开始到完全恢复比赛的分阶段康复策略,本文旨在提出一个更细致的 RTP 连续体,该连续体考虑了运动员在时间基准之外的准备情况。所概述的阶段包括术前准备、术后即时护理、早期康复、修整、提高表现和最终重返赛场,每个阶段都根据临床里程碑与生物力学和社会心理因素相结合而量身定制。这种方法提倡向个性化康复方案转变,使之与成功重返运动场所必需的生物愈合过程和功能里程碑相一致。
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Table of Contents (pick up from previous issue w/updates) 目录(接上一期/更新内容)
IF 0.4 4区 医学 Q4 SPORT SCIENCES Pub Date : 2024-09-01 DOI: 10.1053/S1060-1872(24)00057-1
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期刊
Operative Techniques in Sports Medicine
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