The role of lumbar lordosis and pelvic sagittal balance in femoroacetabular impingement

2018 ◽  
Vol 100-B (10) ◽  
pp. 1275-1279 ◽  
Author(s):  
R. R. Fader ◽  
M. A. Tao ◽  
M. A. Gaudiani ◽  
R. Turk ◽  
B. U. Nwachukwu ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Femoroacetabular Impingement ◽  
Lumbar Lordosis ◽  
Pelvic Tilt ◽  
Alpha Angle ◽  
Dynamic Imaging ◽  
Anterior Pelvic Tilt ◽  
Hip Flexion ◽  
Male Subjects

Aims The purpose of this study was to evaluate spinopelvic mechanics from standing and sitting positions in subjects with and without femoroacetabular impingement (FAI). We hypothesize that FAI patients will experience less flexion at the lumbar spine and more flexion at the hip whilst changing from standing to sitting positions than subjects without FAI. This increase in hip flexion may contribute to symptomatology in FAI. Patients and Methods Male subjects were prospectively enrolled to the study (n = 20). Mean age was 31 years old (22 to 41). All underwent clinical examination, plain radiographs, and dynamic imaging using EOS. Subjects were categorized into three groups: non-FAI (no radiographic or clinical FAI or pain), asymptomatic FAI (radiographic and clinical FAI but no pain), and symptomatic FAI (patients with both pain and radiographic FAI). FAI was defined as internal rotation less than 15° and alpha angle greater than 60°. Subjects underwent standing and sitting radiographs in order to measure spine and femoroacetabular flexion. Results Compared with non-FAI controls, symptomatic patients with FAI had less flexion at the spine (mean 22°, sd 12°, vs mean 35°, sd 8°; p = 0.04) and more at the hip (mean 72°, sd 6°, vs mean 62°, sd 8°; p = 0.047). Subjects with asymptomatic FAI had more spine flexion and similar hip flexion when compared to symptomatic FAI patients. Both FAI groups also sat with more anterior pelvic tilt than control patients. There were no differences in standing alignment among groups. Conclusion Symptomatic patients with FAI require more flexion at the hip to achieve sitting position due to their inability to compensate through the lumbar spine. With limited spine flexion, FAI patients sit with more anterior pelvic tilt, which may lead to impingement between the acetabulum and proximal femur. Differences in spinopelvic mechanics between FAI and non-FAI patients may contribute to the progression of FAI symptoms. Cite this article: Bone Joint J 2018;100-B:1275–9.

scholarly journals SQUATTING MECHANICS FOLLOWING AN OSTEOCHONDROPLASTY FOR IDIOPATHIC FEMOROACETABULAR IMPINGEMENT

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0015
Author(s):  
Henry B. Ellis ◽  
Amanda L. Fletcher ◽  
Kirsten Tulchin-Francis ◽  
Alex Loewen ◽  
Anthony Anderson ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
External Rotation ◽  
Alpha Angle ◽  
Hip Dislocation ◽  
Lower Limbs ◽  
Entire Cohort ◽  
Average Decrease ◽  
One Year ◽  
Hip Flexion ◽  
Hip Rotation

Background: Femoroacetabular impingement (FAI) is primarily due to the repetitive motion of aberrant bone in provocative positions such as hip flexion and internal rotation (IR). The purpose of this study is to evaluate the kinematic changes that occur in the hip during a squat prior to and following an osteochondroplasty for idiopathic FAI. Methods: Subjects were prospectively enrolled when scheduled to undergo hip preservation surgery for primary CAM hip impingement by one of 3 surgeons. Prior to the procedure, subjects were evaluated in the movement science lab while performing a standardized bilateral limb gravity squat. Kinematic data of the trunk, pelvis and lower limbs were analyzed during the descent phase of the squat. Statistical comparison of the operative and non-operative hips was performed prior to and at a minimum of one year following surgery. Results: Twenty-seven hips with a mean age of 16.3 years (12.4 – 19.9 years, 8 males) underwent an osteochondroplasty (8 arthroscopic, 19 surgical hip dislocation) resulting in a decrease in the alpha angle (60.8° versus 46.8°, p<0.001) and a significant improvement in HOOS and UCLA scores. When combining the entire cohort, no statistical difference was seen in side to side nor pre-operative to post-operative kinematic or kinetic data. Asymmetry was seen in the transverse plane hip rotation with 6/27 subjects demonstrating an average reduction of 9.4° in ROM on the affected side and a decrease in both peak IR and external rotation (ER) (average decrease 4.7°). Following osteochondroplasty, asymmetry resolved in 4/6 patients. Also, 16/27 subjects demonstrated asymmetry in rotation at 40° of hip flexion during the squat (11 more ER, 5 more IR) in which 37.5% had resolution of the asymmetry following an osteochondroplasty. Conclusion: Asymmetry in squatting mechanics in patients with FAI is not consistent with all subjects. Those with asymmetry in rotation at 40° of hip flexion during the squat or reduction in overall hip rotation may see a resolution in asymmetry following an osteochondroplasty. Dynamic impingement may present as asymmetry during different positions of hip flexion in a squat.

scholarly journals Acute Lower Extremity Running Kinematics After a Hamstring Stretch

2012 ◽  
Vol 47 (1) ◽  
pp. 5-14 ◽  
Author(s):  
Autumn L. Davis Hammonds ◽  
Kevin G. Laudner ◽  
Steve McCaw ◽  
Todd A. McLoda
Keyword(s):  
Pelvic Tilt ◽  
Knee Extension ◽  
Swing Phase ◽  
Treadmill Running ◽  
Control Group ◽  
Single Session ◽  
Anterior Pelvic Tilt ◽  
Hamstring Flexibility ◽  
Hip Flexion ◽  
Straight Leg Raise

Context: Limited passive hamstring flexibility might affect kinematics, performance, and injury risk during running. Pre-activity static straight-leg raise stretching often is used to gain passive hamstring flexibility. Objective: To investigate the acute effects of a single session of passive hamstring stretching on pelvic, hip, and knee kinematics during the swing phase of running. Design: Randomized controlled clinical trial. Setting: Biomechanics research laboratory. Patients or Other Participants: Thirty-four male (age = 21.2 ± 1.4 years) and female (age = 21.3±2.0 years) recreational athletes. Intervention(s): Participants performed treadmill running pretests and posttests at 70% of their age-predicted maximum heart rate. Pelvis, hip, and knee joint angles during the swing phase of 5 consecutive gait cycles were collected using a motion analysis system. Right and left hamstrings of the intervention group participants were passively stretched 3 times for 30 seconds in random order immediately after the pretest. Control group participants performed no stretching or movement between running sessions. Main Outcome Measure(s): Six 2-way analyses of variance to determine joint angle differences between groups at maximum hip flexion and maximum knee extension with an α level of .008. Results: Flexibility increased between pretest and post-test in all participants (F1,30 = 80.61, P&lt;.001). Anterior pelvic tilt (F1,30 = 0.73, P=.40), hip flexion (F1,30 = 2.44, P=.13), and knee extension (F1,30 = 0.06, P=.80) at maximum hip flexion were similar between groups throughout testing. Anterior pelvic tilt (F1,30 = 0.69, P=.41), hip flexion (F1,30 = 0.23, P=.64), and knee extension (F1,30 = 3.38, P=.62) at maximum knee extension were similar between groups throughout testing. Men demonstrated greater anterior pelvic tilt than women at maximum knee extension (F1,30 = 13.62, P=.001). Conclusions: A single session of 3 straight-leg raise hamstring stretches did not change pelvis, hip, or knee running kinematics.

Underarm bracing for adolescent idiopathic scoliosis leads to flatback deformity

2019 ◽  
Vol 101-B (11) ◽  
pp. 1370-1378 ◽  
Author(s):  
Jason P. Y. Cheung ◽  
Christopher H. W. Chong ◽  
Prudence W. H. Cheung
Keyword(s):  
Quality Of Life ◽  
Lumbar Spine ◽  
Lumbar Lordosis ◽  
Thoracic Kyphosis ◽  
Pelvic Tilt ◽  
Vertical Axis ◽  
Sacral Slope ◽  
Sagittal Vertical Axis ◽  
Pelvic Parameters

Aims The aim of this study was to determine the influence of pelvic parameters on the tendency of patients with adolescent idiopathic scoliosis (AIS) to develop flatback deformity (thoracic hypokyphosis and lumbar hypolordosis) and its effect on quality-of-life outcomes. Patients and Methods This was a radiological study of 265 patients recruited for Boston bracing between December 2008 and December 2013. Posteroanterior and lateral radiographs were obtained before, immediately after, and two-years after completion of bracing. Measurements of coronal and sagittal Cobb angles, coronal balance, sagittal vertical axis, and pelvic parameters were made. The refined 22-item Scoliosis Research Society (SRS-22r) questionnaire was recorded. Association between independent factors and outcomes of postbracing ≥ 6° kyphotic changes in the thoracic spine and ≥ 6° lordotic changes in the lumbar spine were tested using likelihood ratio chi-squared test and univariable logistic regression. Multivariable logistic regression models were then generated for both outcomes with odds ratios (ORs), and with SRS-22r scores. Results Reduced T5-12 kyphosis (mean -4.3° (sd 8.2); p < 0.001), maximum thoracic kyphosis (mean -4.3° (sd 9.3); p < 0.001), and lumbar lordosis (mean -5.6° (sd 12.0); p < 0.001) were observed after bracing treatment. Increasing prebrace maximum kyphosis (OR 1.133) and lumbar lordosis (OR 0.92) was associated with postbracing hypokyphotic change. Prebrace sagittal vertical axis (OR 0.975), prebrace sacral slope (OR 1.127), prebrace pelvic tilt (OR 0.940), and change in maximum thoracic kyphosis (OR 0.878) were predictors for lumbar hypolordotic changes. There were no relationships between coronal deformity, thoracic kyphosis, or lumbar lordosis with SRS-22r scores. Conclusion Brace treatment leads to flatback deformity with thoracic hypokyphosis and lumbar hypolordosis. Changes in the thoracic spine are associated with similar changes in the lumbar spine. Increased sacral slope, reduced pelvic tilt, and pelvic incidence are associated with reduced lordosis in the lumbar spine after bracing. Nevertheless, these sagittal parameter changes do not appear to be associated with worse quality of life. Cite this article: Bone Joint J 2019;101-B:1370–1378.

scholarly journals HIP-SPINE SYNDROME, RADIOGRAPHIC EVALUATION OF THE SAGITTAL BALANCE

2020 ◽  
Vol 19 (3) ◽  
pp. 184-188
Author(s):  
OMAR MOHAMAD MANSOUR ABDALLAH ◽  
XAVIER SOLER GRAELLS ◽  
ÁLYNSON LAROCCA KULCHESKI ◽  
PEDRO GREIN DEL SANTORO ◽  
MARCEL LUIS BENATO ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Lumbar Spine ◽  
Sagittal Balance ◽  
Lumbar Lordosis ◽  
Pelvic Tilt ◽  
Pelvic Incidence ◽  
Normal Values ◽  
Radiographic Evaluation ◽  
Sacral Slope ◽  
Level Ii

ABSTRACT Objectives The hip-spine syndrome (HSS) is defined as the simultaneous degeneration of the hip and lumbar spine. The objective of this study is to quantify the sagittal balance values in the population with HSS and to compare them with the normal sagittal balance parameters. Methods A retrospective study was conducted in which 30 patients with HSS who were waiting for total hip arthroplasty (THA) were evaluated. The lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI) and spinopelvic harmony (SH) angles and the BMI of these patients were measured. Results Seventeen women and 13 men participated in the study, with a mean LL of 39.55°, a mean SS of 36.92°, a mean PT of 25.77°, a mean PI of 62.72°, a mean SH of 23.17° and a mean BMI of 25.55. Only the SS did not present a changed value when compared to the normal values of the population. Conclusions HSS is increasingly present in our environment due to the aging population. Sagittal balance is gaining more and more attention in studies related to spinal pathologies. All the parameters measured in this study, except for SS, presented altered values when compared to the populational means. Evidence Level II. Observational and retrospective study.

Exercise-Induced Fibrinolysis – Fact or Fiction?

1982 ◽  
Vol 48 (02) ◽  
pp. 201-203 ◽  
Author(s):  
N A Marsh ◽  
P J Gaffney
Keyword(s):  
Plasminogen Activator ◽  
Degradation Products ◽  
Coagulation Factors ◽  
Vascular Wall ◽  
Strenuous Exercise ◽  
Fibrin Degradation Products ◽  
Real Increase ◽  
Exercise Induced ◽  
Male Subjects

SummaryThe effect of strenuous exercise on the fibrinolytic and coagulation mechanisms was examined in six healthy male subjects. Five min bicycle exercise at a work-rate of 800 to 1200 kpm. min−1 produced an abrupt increase in plasma plasminogen activator levels which disappeared after 90 min. However, there was no change in early or late fibrin degradation products nor was there a change in fibrinopeptide A levels or βthromboglobulin levels after exercise although activated partial thromboplastin times were significantly shortened. It is concluded that strenuous exercise does not produce any real increase in fibrinogen-fibrin conversion nor any real increase in the breakdown of these proteins. The role of exercise-induced release of plasminogen activator remains unclear, but probably helps to maintain plasma levels in a discontinuous manner concurrently with the continuous low-level secretion from the vascular wall. The shortening of partial thromboplastin time may be due to the raised levels of plasminogen activator changing the activation state of other coagulation factors.

scholarly journals Prevalence of Morphological Variations Associated With Femoroacetabular Impingement According to Age and Sex: A Study of 1878 Asymptomatic Hips in Nonprofessional Athletes

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712097789
Author(s):  
Rodolfo Morales-Avalos ◽  
Adriana Tapia-Náñez ◽  
Mario Simental-Mendía ◽  
Guillermo Elizondo-Riojas ◽  
Michelle Morcos-Sandino ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Alpha Angle ◽  
Cross Sectional Study ◽  
Level Of Evidence ◽  
Crossover Sign ◽  
Cross Sectional ◽  
Radiographic Findings ◽  
Morphological Variations ◽  
Pelvic Radiographs ◽  
Center Edge

Background: Radiographic findings related to the cam and pincer variants of femoroacetabular impingement (FAI) include measurements of the alpha angle and lateral center-edge angle (LCEA). The function of these radiographic findings has been put into question because of high heterogeneity in reported studies. Purpose: The aim of this study was 3-fold: (1) to determine the prevalence of cam and pincer variants according to sex and age on anteroposterior (AP) pelvic radiographs from an asymptomatic nonathletic population, (2) to identify the most common radiographic signs of cam- and pincer-type variants, and (3) to determine if there are variations in the prevalence of these radiographic signs according to sex and age. Study Design: Cross-sectional study; Level of evidence, 3. Methods: There were 3 independent observers who retrospectively analyzed the 939 AP pelvic radiographs (1878 hips) of patients aged 18 to 50 years who did not have hip symptoms and who were not professional athletes. The prevalence of the cam and pincer variants according to the alpha angle and LCEA, respectively, and the presence of other radiographic signs commonly associated with these variables were determined in the overall population and by subgroup according to sex and age group (18-30, 31-40, and 41-50 years). Descriptive and inferential statistics were used to analyze the study sample. Results: The mean age of the included population was 31.0 ± 9.2 years, and 68.2% were male. The prevalence of the cam-type variant was 29.7% (558/1878), and that of the pincer-type variant was 24.3% (456/1878). The radiographic signs that were most associated with the cam and pincer variants were a pistol-grip deformity and the crossover sign, respectively. Significant differences ( P < .001) in the prevalence of these variants were identified between men and women in both variants. No differences were observed in the alpha angle or LCEA according to sex or age. Conclusion: Radiographic findings suggestive of FAI had significant variations with respect to sex and age in this study sample. This study provides information to determine the prevalence of these anatomic variants in the general population.

scholarly journals Morphological Changes of the Hip Commonly Associated With Femoroacetabular Impingement Are Not Correlated With Rotational Range of Hip Motion in Elite Soccer Athletes

2021 ◽  
pp. 194173812097366
Author(s):  
André Orlandi Bento ◽  
Guilherme Falótico ◽  
Keelan Enseki ◽  
Ronaldo Alves Cunha ◽  
Benno Ejnisman ◽  
...  
Keyword(s):  
Femoroacetabular Impingement ◽  
Lower Limb ◽  
Clinical Relevance ◽  
Morphological Changes ◽  
Alpha Angle ◽  
Soccer Players ◽  
Level Of Evidence ◽  
Rotational Movement ◽  
Professional Soccer ◽  
Significant Difference

Background: Morphological changes characteristic of femoroacetabular impingement (FAI) are common in soccer players. However, the clinical relevance of such anatomical variations is still not well-defined. Hypothesis: We hypothesized that high alpha angle values and/or acetabular retroversion index (ARI) are correlated with rotational range of motion (ROM) of the hip and that there are clinical-radiological diferences between the dominant lower limb (DLL) and nondominant lower limb (NDLL) in professional soccer players. Study Design: Cross-sectional. Level of Evidence: Level 3. Methods: A total of 59 male professional soccer players (average age 25.5 years, range 18-38 years) were evaluated in the preseason. As main outcome measures, we evaluated the alpha angle and the ARI and hip IR and ER ROM with radiographic analysis. Results: The measurements taken on DLL and NDLL were compared and a significant difference was found between the sides in the ER ( P = 0.027), where the DLL measures were 1.54° (95% CI, 0.18-2.89) greater than the NDLL. There were no significant differences between the sides in the measures of IR ( P > 0.99), total ROM ( P = 0.07), alpha angle ( P = 0.250), and ARI ( P = 0.079). The correlations between the rotation measurements and the alpha angle in each limb were evaluated and the coefficient values showed no correlation; so also between the ARI and rotation measures. Conclusion: Morphological changes of the femur or acetabulum are not correlated with hip IR and ER ROM in male professional soccer players. ER on the dominant side was greater than on the nondominant side. There was no significant difference in the other measurements between sides. Clinical Relevance: In clinical practice, it is common to attribute loss of hip rotational movement to the presence of FAI. This study shows that anatomical FAI may not have a very strong influence on available hip rotational movement in professional soccer athletes.

Sign in / Sign up

Export Citation Format

Share Document