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      The association between specific sports activities and sport performance following hip arthroscopy for femoroacetabular impingement syndrome: A secondary analysis of a cross-sectional cohort study including 184 athletes

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          Abstract

          The main purpose of this secondary analysis was to compare the proportion of athletes with moderate-to-extreme difficulties in eight specific sport activities in athletes with optimal versus impaired sport performance after a hip arthroscopy for femoroacetabular impingement syndrome. Subjects were identified in a nationwide registry and invited to answer a return to sport and performance questionnaire, and the Copenhagen Hip and Groin Outcome Score Sport subscale investigating difficulties in eight specific sports activities (HAGOS sport items) as; none, mild, moderate, severe or extreme. Subjects were divided into two groups based on sport performance (optimal or impaired). The proportion of athletes with none-to-mild versus moderate-to-extreme difficulties in the eight specific sport activities was compared between groups. The association between difficulties in sport activities and sport performance were investigated using logistic regression analysis. One hundred and eighty-four athletes (31 athletes with optimal and 153 athletes with impaired sport performance) were included at a mean follow-up of 33.1 ± 16.3 months. Up to six athletes (<20%) with optimal sport performance had moderate-to-extreme difficulties in sport activities. Contrary, 43–108 athletes (28.1–70.6%) with impaired performance had moderate-to-extreme difficulties in sport activities. Furthermore, moderate-to-extreme difficulties in HAGOS sport items: ‘running as fast as you can’ and ‘kicking, skating etc.’ increased the odds (14.7 and 6.1 times, respectively) of having impaired sport performance. Many athletes with impaired sport performance reported moderate-to-extreme difficulties in sport activities, specifically moderate-to-extreme difficulties in ‘running as fast as you can’ and ‘kicking, skating etc.’ were associated with patients having impaired sport performance.

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          Most cited references 38

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          The etiology of osteoarthritis of the hip: an integrated mechanical concept.

          The etiology of osteoarthritis of the hip has long been considered secondary (eg, to congenital or developmental deformities) or primary (presuming some underlying abnormality of articular cartilage). Recent information supports a hypothesis that so-called primary osteoarthritis is also secondary to subtle developmental abnormalities and the mechanism in these cases is femoroacetabular impingement rather than excessive contact stress. The most frequent location for femoroacetabular impingement is the anterosuperior rim area and the most critical motion is internal rotation of the hip in 90 degrees flexion. Two types of femoroacetabular impingement have been identified. Cam-type femoroacetabular impingement, more prevalent in young male patients, is caused by an offset pathomorphology between head and neck and produces an outside-in delamination of the acetabulum. Pincer-type femoroacetabular impingement, more prevalent in middle-aged women, is produced by a more linear impact between a local (retroversion of the acetabulum) or general overcoverage (coxa profunda/protrusio) of the acetabulum. The damage pattern is more restricted to the rim and the process of joint degeneration is slower. Most hips, however, show a mixed femoroacetabular impingement pattern with cam predominance. Surgical attempts to restore normal anatomy to avoid femoroacetabular impingement should be performed in the early stage before major cartilage damage is present. Level V, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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            Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up.

            Over an eight-month period we prospectively enrolled 122 patients who underwent arthroscopic surgery of the hip for femoroacetabular impingement and met the inclusion criteria for this study. Patients with bilateral hip arthroscopy, avascular necrosis and previous hip surgery were excluded. Ten patients refused to participate leaving 112 in the study. There were 62 women and 50 men. The mean age of the patients was 40.6 yrs (95% confidence interval (CI) 37.7 to 43.5). At arthroscopy, 23 patients underwent osteoplasty only for cam impingement, three underwent rim trimming only for pincer impingement, and 86 underwent both procedures for mixed-type impingement. The mean follow-up was 2.3 years (2.0 to 2.9). The mean modified Harris hip score (HHS) improved from 58 to 84 (mean difference = 24 (95% CI 19 to 28)) and the median patient satisfaction was 9 (1 to 10). Ten patients underwent total hip replacement at a mean of 16 months (8 to 26) after arthroscopy. The predictors of a better outcome were the pre-operative modified HHS (p = 0.018), joint space narrowing >or= 2 mm (p = 0.005), and repair of labral pathology instead of debridement (p = 0.032). Hip arthroscopy for femoroacetabular impingement, accompanied by suitable rehabilitation, gives a good short-term outcome and high patient satisfaction.
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              Ground reaction forces at different speeds of human walking and running.

              In this study the variation in ground reaction force parameters was investigated with respect to adaptations to speed and mode of progression, and to type of foot-strike. Twelve healthy male subjects were studied during walking (1.0-3.0 m s-1) and running (1.5-6.0 m s-1). The subjects were selected with respect to foot-strike pattern during running. Six subjects were classified as rearfoot strikers and six as forefoot strikers. Constant speeds were accomplished by pacer lights beside an indoor straightway and controlled by means of a photo-electronic device. The vertical, anteroposterior and mediolateral force components were recorded with a force platform. Computer software was used to calculate durations, amplitudes and impulses of the reaction forces. The amplitudes were normalized with respect to body weight (b.w.). Increased speed was accompanied by shorter force periods and larger peak forces. The peak amplitude of the vertical reaction force in walking and running increased with speed from approximately 1.0 to 1.5 b.w. and 2.0 to 2.9 b.w. respectively. The anteroposterior peak force and mediolateral peak-to-peak force increased about 2 times with speed in walking and about 2-4 times in running (the absolute values were on average about 10 times smaller than the vertical). The transition from walking to running resulted in a shorter support phase duration and a change in the shape of the vertical reaction force curve. The vertical peak force increased whereas the vertical impulse and the anteroposterior impulses and peak forces decreased. In running the vertical force showed an impact peak at touch-down among the rearfoot strikers but generally not among the forefoot strikers. The first mediolateral force peak was laterally directed (as in walking) for the rearfoot strikers but medially for the forefoot strikers. Thus, there is a change with speed in the complex interaction between vertical and horizontal forces needed for propulsion and equilibrium during human locomotion. The differences present between walking and running are consequences of fundamental differences in motor strategies between the two major forms of human progression.
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                Author and article information

                Journal
                J Hip Preserv Surg
                J Hip Preserv Surg
                jhps
                Journal of Hip Preservation Surgery
                Oxford University Press
                2054-8397
                July 2019
                05 June 2019
                05 June 2019
                : 6
                : 2
                : 124-133
                Affiliations
                [1 ]Sports Orthopaedic Research Center—Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Allé 30, Hvidovre, Denmark and
                [2 ]Physical Medicine & Rehabilitation Research—Copenhagen (PMR-C), Department of Orthopaedic Surgery and Physical Therapy, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Allé 30, Hvidovre, Denmark
                Author notes
                Correspondence to: P. Hölmich. Email: per.hoelmich@ 123456regionh.dk
                Article
                hnz017
                10.1093/jhps/hnz017
                6662959
                © The Author(s) 2019. Published by Oxford University Press.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

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                Pages: 10
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