CRUZ, Francisco Bruno Nogueira. Lesões por Estresse do Labrum acetabular em atletas de alta performance : técnica artroscópica e retorno ao esporte. 2015. 32 f. Dissertação (Mestrado em Cirurgia) – Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, 2015. / Submitted by denise santos (denise.santos@ufc.br) on 2015-10-15T15:41:49Z No. of bitstreams: 1 2015_dis_fbncruz.pdf: 537044 bytes, checksum: 9543c47b8560e650424f836bc051feb1 (MD5) / Approved for entry into archive by denise santos(denise.santos@ufc.br) on 2015-10-15T15:50:46Z (GMT) No. of bitstreams: 1 2015_dis_fbncruz.pdf: 537044 bytes, checksum: 9543c47b8560e650424f836bc051feb1 (MD5) / Made available in DSpace on 2015-10-15T15:50:46Z (GMT). No. of bitstreams: 1 2015_dis_fbncruz.pdf: 537044 bytes, checksum: 9543c47b8560e650424f836bc051feb1 (MD5) Previous issue date: 2015 / Lesions of the acetabular labrum are known causes of hip pain and represent the beginning of a cascade of events that can lead to osteoarthritis. The treatment of FAI (femoroacetabular impingement) and labral tears is crucial for hip preservation in young and active athletes. Purpose: To define hip pathologies seen in high performance athletes, to describe the arthroscopic technique used to treat these diseases and to determine the return to sport of the professional players following hip arthroscopy. Methodology: The athletes included in the study are soccer players tied to International Federation of Football Associated (FIFA), unranked tennis players in the Association of Tennis Professionals (ATP). All patients underwent arthroscopy for intra-articular hip pathologies. Nine tennis players (6 males, 3 females), fifty-four soccer players (39 males, 14 females) were operated between May 2005 and July 2010. The mean age of the athletes was 25 years old (range 18-31). All athletes sought treatment after failure to play. Result: The average preoperative Wiberg’s CE angle was 37 degrees (range 33 to 42) and the average alpha angle was 72 degrees (range 65 to 83). All patients were diagnosed with femoroacetabular impingement (FAI) preoperatively. During arthroscopy, all players underwent labral repair and treatment of FAI (6 isolated pincer type, 57 combined type). The average size of the labral tear was 25 mm (range 5 to 40). On average three (range 2 to 5) suture anchors were used to repair the tear. Six players required microfracture of a chondral lesion on the acetabulum. In forty-one hips there was tear of the ligamentum teres which were treated with debridement. Two players underwent an iliopsoas release. The Modified Harris Hip Score (MHHS) improved from 61 to 90 (p=0.001). The median patient satisfaction was 10 (score from 1 to 10) after one year of surgery. All athletes returned to play professional level. Conclusion: This study demonstrated that arthroscopic treatment of FAI and chondro-labral dysfunction in high performance athletes provides a significant clinical improvement. Arthroscopic treatment of FAI is a safe and effective way for professional players to return to play. / Introdução: As lesões do labrum acetabular são causas conhecidas de dor no quadril e representam o início de uma cascata de eventos que podem levar a osteoartrose. O tratamento do IFA (Impacto Fêmoro-Acetabular) e das lesões labrais é crucial para a preservação do quadril em atletas jovens e ativos. Objetivo: Relatar as afecções do quadril vistas em atletas de alta performance, descrever a técnica artroscópica utilizada para tratar essas doenças e determinar o retorno dos jogadores profissionais ao esporte após artroscopia do quadril. Métodos: Os atletas incluídos no trabalho eram jogadores de futebol vinculados à Federação Internacional de Futebol e Associado (FIFA), tenistas ranqueados na Associação dos Tenistas Profissionais (ATP). Todos foram submetidos a artroscopia por patologias intra-articulares do quadril. Nove tenistas (6 homens, 3 mulheres), cinquenta e quatro jogadores de futebol (39 homens, 14 mulheres) foram operados entre Maio de 2005 e Julho de 2010. A média de idade dos atletas foi de 25 anos (variando de 18 a 31). Todos atletas procuraram tratamento após incapacidade para jogar. Resultados: A média pré-operatória do ângulo CE de Wiberg foi de 37 graus (variando de 33 a 42) e a média do ângulo alfa foi de 72 graus (variando de 65 a 83). Todos os pacientes tiveram o diagnóstico de impacto fêmoro-acetabular (IFA) no pré-operatório. Durante a artroscopia, todos os jogadores foram submetidos ao reparo labral e tratamento do IFA (sendo 6 do tipo pincer, 57 do tipo combinado). O tamanho médio da lesão labral foi de 25mm (variando de 5 a 40). Em média três (variando de 2 a 5) âncoras de sutura foram utilizadas para reparar a lesão. Seis jogadores precisaram de microfratura em uma lesão condral no acetábulo. Em quarenta e um quadris havia lesão do ligamento redondo que foi tratada com desbridamento. Dois jogadores foram submetidos a liberação do tendão do músculo iliopsoas. O escore modificado de quadril chamado Harris (MHHS) melhorou de 61 a 90 (p = 0,001). A satisfação média dos pacientes após 1 ano da cirurgia era de 10 pontos (escala de 1 a 10). Todos os atletas voltaram a jogar em nível profissional. Conclusão: Este estudo demonstrou que o tratamento artroscópico do IFA e de lesões labrais em atletas de alta performance proporciona melhora clínica significativa. O tratamento artroscópico para IFA é uma maneira segura e eficaz para promover o retorno ao esporte de jogadores profissionais.

Surgery to correct cam femoroacetabular impingement (FAI) is increasingly popular. Despite this, no known study has used motion analysis and ground reaction forces to quantify the outcome of surgery for FAI. The goal of this study was to compare the preoperative and postoperative lower-extremity joint kinematic and kinetic measurements of cam FAI patients during activities of daily living with use of a high-speed motion capture system and force platforms. We hypothesized that the lower-extremity joint mechanics of FAI patients during level walking and maximal squatting would resemble more those of healthy control subjects, after surgery. Ten patients with unilateral symptomatic cam FAI, who underwent corrective surgery using an open or combined technique, performed walking and maximal depth squatting trials preoperatively and postoperatively. Thirteen healthy control subjects, matched for age, sex and body mass index, provided normative data. Results showed that postoperatively, FAI patients had reduced hip ROM in the frontal and sagittal planes, produced smaller peak hip abduction and external rotation moments, and generated less peak hip power compared to the control group during level walking. During maximal squatting, postoperative FAI patients squatted to a greater depth, and had larger knee flexion and ankle dorsiflexion angles, as well as the sum of all joint angles of the affected limb at maximal depth compared to the preoperative values. The lower-extremity joint and pelvic mechanics of FAI patients did not fully return to normal after surgery. Although surgery seemed to reduce hip pain and restore a normal femoral head-neck offset, it further impaired muscle function as a result of muscle incisions. More research is needed to determine the effects of muscle incisions, which could help improve surgical techniques and develop better rehabilitation programs for FAI patients.

Surgery to correct cam femoroacetabular impingement (FAI) is increasingly popular. Despite this, no known study has used motion analysis and ground reaction forces to quantify the outcome of surgery for FAI. The goal of this study was to compare the preoperative and postoperative lower-extremity joint kinematic and kinetic measurements of cam FAI patients during activities of daily living with use of a high-speed motion capture system and force platforms. We hypothesized that the lower-extremity joint mechanics of FAI patients during level walking and maximal squatting would resemble more those of healthy control subjects, after surgery. Ten patients with unilateral symptomatic cam FAI, who underwent corrective surgery using an open or combined technique, performed walking and maximal depth squatting trials preoperatively and postoperatively. Thirteen healthy control subjects, matched for age, sex and body mass index, provided normative data. Results showed that postoperatively, FAI patients had reduced hip ROM in the frontal and sagittal planes, produced smaller peak hip abduction and external rotation moments, and generated less peak hip power compared to the control group during level walking. During maximal squatting, postoperative FAI patients squatted to a greater depth, and had larger knee flexion and ankle dorsiflexion angles, as well as the sum of all joint angles of the affected limb at maximal depth compared to the preoperative values. The lower-extremity joint and pelvic mechanics of FAI patients did not fully return to normal after surgery. Although surgery seemed to reduce hip pain and restore a normal femoral head-neck offset, it further impaired muscle function as a result of muscle incisions. More research is needed to determine the effects of muscle incisions, which could help improve surgical techniques and develop better rehabilitation programs for FAI patients.

Surgery to correct cam femoroacetabular impingement (FAI) is increasingly popular. Despite this, no known study has used motion analysis and ground reaction forces to quantify the outcome of surgery for FAI. The goal of this study was to compare the preoperative and postoperative lower-extremity joint kinematic and kinetic measurements of cam FAI patients during activities of daily living with use of a high-speed motion capture system and force platforms. We hypothesized that the lower-extremity joint mechanics of FAI patients during level walking and maximal squatting would resemble more those of healthy control subjects, after surgery. Ten patients with unilateral symptomatic cam FAI, who underwent corrective surgery using an open or combined technique, performed walking and maximal depth squatting trials preoperatively and postoperatively. Thirteen healthy control subjects, matched for age, sex and body mass index, provided normative data. Results showed that postoperatively, FAI patients had reduced hip ROM in the frontal and sagittal planes, produced smaller peak hip abduction and external rotation moments, and generated less peak hip power compared to the control group during level walking. During maximal squatting, postoperative FAI patients squatted to a greater depth, and had larger knee flexion and ankle dorsiflexion angles, as well as the sum of all joint angles of the affected limb at maximal depth compared to the preoperative values. The lower-extremity joint and pelvic mechanics of FAI patients did not fully return to normal after surgery. Although surgery seemed to reduce hip pain and restore a normal femoral head-neck offset, it further impaired muscle function as a result of muscle incisions. More research is needed to determine the effects of muscle incisions, which could help improve surgical techniques and develop better rehabilitation programs for FAI patients.

Surgery to correct cam femoroacetabular impingement (FAI) is increasingly popular. Despite this, no known study has used motion analysis and ground reaction forces to quantify the outcome of surgery for FAI. The goal of this study was to compare the preoperative and postoperative lower-extremity joint kinematic and kinetic measurements of cam FAI patients during activities of daily living with use of a high-speed motion capture system and force platforms. We hypothesized that the lower-extremity joint mechanics of FAI patients during level walking and maximal squatting would resemble more those of healthy control subjects, after surgery. Ten patients with unilateral symptomatic cam FAI, who underwent corrective surgery using an open or combined technique, performed walking and maximal depth squatting trials preoperatively and postoperatively. Thirteen healthy control subjects, matched for age, sex and body mass index, provided normative data. Results showed that postoperatively, FAI patients had reduced hip ROM in the frontal and sagittal planes, produced smaller peak hip abduction and external rotation moments, and generated less peak hip power compared to the control group during level walking. During maximal squatting, postoperative FAI patients squatted to a greater depth, and had larger knee flexion and ankle dorsiflexion angles, as well as the sum of all joint angles of the affected limb at maximal depth compared to the preoperative values. The lower-extremity joint and pelvic mechanics of FAI patients did not fully return to normal after surgery. Although surgery seemed to reduce hip pain and restore a normal femoral head-neck offset, it further impaired muscle function as a result of muscle incisions. More research is needed to determine the effects of muscle incisions, which could help improve surgical techniques and develop better rehabilitation programs for FAI patients.

Femoroacetabular impingement (FAI) is a hip condition which can limit hip motion and cause pain particularly in young and athletic patients. It is considered as a patho-mechanical process leading to progressive and degenerative damage of the joint. Surgical treatment for femoroacetabular impingement focuses on improving the clearance for hip motion, reducing the femoral impact against the acetabular labrum. The procedure involves the surgical resection of the cause of impingement which consists of trimming the acetabular rim and/or the femoral head-neck offset. Currently, there are no comprehensive tools available for pre-operative planning of FAI surgery and so the area and depth of bone resection are identified based on the skill and experience of the surgeon. This means that it is difficult to predict the degree to which the procedure will be successful, in terms of reducing pain and increasing the range of motion (RoM) of the hip, prior to surgery. In addition, resection can lead to increased stress in the remaining bone which in some cases can result in post-operative femoral neck fracture, a recognized risk of FAI surgery which is increased if the bone is osteoporotic. This thesis describes the development of a framework that will enable a tool to be created that can be used for the diagnosis, preoperative planning and selection of treatment for patients with cam-type FAI. The framework consists of a number of complementary 3-dimensional finite element (FE) models. The models are created from computer tomography (CT) data from actual patients with cam-type FAI. The first FE model was developed in order to predict the stress distribution in the head-neck region of the femur following resection surgery for FAI enabling the effect of resection depth to be investigated under loading conditions corresponding to typical daily activities. The model demonstrates that resection depth should be kept to less than one third of the diameter of the neck in order to ensure structural integrity. The second finite element model developed utilises a quasi-brittle damage plasticity material formulation to investigate the mechanism and risk of femoral neck fracture following femoral osteochondroplasty in osteoporotic and non osteoporotic hips. Predictions indicate that fracture can occur in osteoporotic hips during typical daily activities. Also, the likelihood of fracture increases when patients are subjected to high load conditions and activities, even in non-osteoporotic patients. The third FE model was developed to assess the reduction in the internal rotation movement in hips with cam-type FAI and identify and examine the areas where impingement occurs. The model shows that FAI can result in a significant reduction in hip motion and that impingement area and RoM are patient dependant. All three FE models were validated with results from experimental studies. The three models combined provide the framework for a virtual osteochondroplasty tool. The procedure for using the tool involves undertaking a virtual resection of a FAI hip based on the areas of impingement identified by the RoM analysis provided by the third FE model. Finite element models one and two are employed to ensure that the virtual resection remains within safe limits and stress does not elevate in the remaining bone to levels that would significantly increase the risk of femoral neck fracture. The framework was validated by comparing the RoM predicted following a virtual osteochondroplasty undertaken on a model of a hip from an actual patient with FAI with the results from a model of the same hip created from CT scan data taken after an actual osteochondroplasty had been performed on the patient using a resection area and depth identified in the conventional way by a surgeon.

Resumo não disponível

Resumo não disponível

Resumo não disponível

Osteoarthritis of the hip frequently occurs in the absence of osteoarthritis in other large joints, suggesting that local factors are important in its pathogenesis. Hip morphology has been recognised as a potential local biomechanical risk factor for the development of hip osteoarthritis. There are no adequate studies examining osteoarthritis development in the hip. Historical cohorts are either limited by a short follow up or by small numbers. This thesis explores the natural history of hip osteoarthritis in a large population cohort with particular attention to hip morphology as a predictor of osteoarthritis development. Software was developed which allows objective measurements of hip morphology in a reproducible manner. Hip morphology was then measured in a 1000 subject cohort. A detailed description of hip morphology is presented in this thesis, with interesting observations of wide variation and a bimodal distribution for alpha angle (a measure of cam-type femoroacetabular impingement). This is suggestive of a discrete pathological entity, which was associated with osteoarthritis in the cross-sectional analysis. No significant changes exist in terms of morphology during the course of the study and no significant relationship exists between age and hip morphology. Longitudinal analysis of hip morphology with radiographic osteoarthritis and total hip replacement revealed a significant association between cam-type femoroacetabular impingement and acetabular dysplasia with both outcome measures. Measurements of hip morphology were independently predictive of outcome when controlling for baseline age, BMI and joint space width, and significantly increased our ability to predict osteoarthritis and total hip replacement. Similar associations were seen when considering hip pain and symptomatic osteoarthritis as the outcome measures of interest. Pincer-type femoroacetabular impingement was not significantly associated with any of the outcome measures of interest and pain remains relatively poorly explained by both hip morphology and/or radiographic change. The understanding of hip morphology and its role in the natural history of osteoarthritis is significantly improved by this research. Further research is now required to determine whether these morphological abnormalities represent modifiable risk factors for osteoarthritis progression.