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Final version - Femoroacetabular Impingement is a mechanical or functional problem?

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Danilo Catelli

on 27 February 2015

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Transcript of Final version - Femoroacetabular Impingement is a mechanical or functional problem?

A) CT scan

B) Anthropometric measurements

C) Passive BIODEX® (net passive moment
and the movement amplitude):
flexion/extension
adduction/abduction
internal/external rotation

D) Simultaneous EMG

E) Design computer software based on the experimental data

F) Modeling the hip joint stiffness and the net passive moment
in all 3 degrees of freedom

G) Compare the model with the results found on
BIODEX® primary test
Femoroacetabular Impingement is a mechanical or functional problem?
APA 7305
Danilo S. Catelli
Femoroacetabular Impingement (FAI)
- Pathomechanical process --> Hip pain

- 14% men / 5.5% women

- Precursor of osteoarthritis


- Variations:
- Clinical exam (low accuracy)




- Anteroposterior radiography

- CT scan / MRI scan (gold standard)

- Alpha angle > 50º
We are studying the features of:

- Gait
- Bone
- Muscle
- sFAI / aFAI
Thank you!
- cam FAI (proximal femur)
- pincer FAI (acetabulum)
- mixed
(Kennedy et al, 2009; Dimmick et al, 2013; Jung et al, 2011)
Measurement Techniques
8.6%
5.3%
86.1%
(Beck et al, 2004)
cam - pain during flex + int rot
pincer - pain during max ext + ext rot
Literature Review
Problem
The FAI patients have a closer ligament connection between the head of the femur and the acetabulum with respect to control.


Hypothesis
Study 1
Viscoelastic hip comportment in subjects with Femoroacetabular Impingement (FAI)
Objectives
Compare the behavior of hip soft tissue:

- 3 groups: sFAI aFAI and Control
- Non-volunteer movements of the hip
- Test and compare the net passive moment and the range of motion in:
flexion/extension
adduction/abduction
internal/external rotation
Research Design
Methods
Statistics
MANOVA

p<0.05
A) CT scan

B) Muscle biopsy (titin)

C) Anthropometric measurements

D) Passive BIODEX® (net passive moment and the movement amplitude):
flexion/extension
adduction/abduction
internal/external rotation

E) Simultaneous EMG


Study 2
Development of a computational model to predict hip soft tissue stress and strain for sFAI
compared to aFAI and healthy subjects
Objectives
To develop a model to calculate stress and strain of soft tissues at the hip joint to determine hip joint stiffness based on sFAI, aFAI and age and BMI matched subjects.
Research Design
Methods
Statistics
Person’s Correlation for a normal data distribution (or)

Spearman’s Correlation for a non-normal data distribution
Study 3
Femoroacetabular Impingement:
an intervention proposal
Objectives
To propose and test an intervention able to minimize the pain caused by FAI.
Research Design
Methods
Statistics
One-way ANOVA to compare both groups

McNemar test to compare the indirect pain in a pre and post intervention
A) CT scan

B) Anthropometric measurements

C) Passive BIODEX® (net passive moment and the movement amplitude):
flexion/extension
adduction/abduction
internal/external rotation

D) Simultaneous EMG

E) Indirect test of pain
Numeric Pain Rating Scale (NPRS)

F) Groups division

G) Intervention (Physiotherapist)

H) Anthropometric measurements

I) BIODEX® retest

J) Pain retest

(Notzli, 2002)
Topics
FAI
overview
gap
Study 1
Study 2
Study 3
What comes first:
The bone starts affecting the movement, or the movement affects the bone growth?
Problem
Gap
But:
What is the cause of FAI?
"it has been suggested that the tightening of hip ligaments [...] may cause high pressure at the anterosuperior head-neck junction..."
(Kennedy et al, 2009)
"The motion itself was clearly not restricted by bony boundaries or the cam lesion, suggesting a capsular or ligaments restraint of neutral internal rotation."
(Audenaert et al, 2011)
Decreased sagittal ROM during extension could be related to soft tissue.
(Adapted by Lamontagne 2013)
iliofemoral ligament
Hypothesis
Net Passive Moment:

sFAI > aFAI > Control

Flexion
Extension
Abduction
Internal Rotation

Range of motion:

sFAI < aFAI < Control

Flexion
Extension
Abduction
Internal Rotation
(Whittington, 2008)
(Silder, 2008)
(Kennedy, 2009; Ng, 2012)
Limitations
- Relaxed state of deeper muscles could not be verified using surface EMG;

- Eventual pain could be determinant for reduced ROM in sFAI;

- A simultaneous image exam (ultrasound) could be needed to check the impingement;

- The results are about soft tissue feature and not just ligaments.
Hypothesis
Trained sFAI:

- Increased ROM
Flexion
Extension
Abduction
Internal Rotation

- Reduced Pain
All movements
What are the effects of femoroacetabular deformity on joint mechanics and function during various daily activities?
Possibility....
There is a close connection between coxo-femoral joint and a movement adaption due to pain.
The aFAI subjects at risk have tighter ligaments at the coxo-femoral joint than control (alpha angle > 50º).
sFAI
aFAI
The subject at risk are:

- Alpha angle larger than 50 degrees

- Femoral neck shaft angle higher than 125 degrees*

- No pain
Symptomatic subject:

- Alpha angle larger than 50 degrees

- Femoral neck shaft angle higher than 125 degrees*

- Pain!!
- Hip and pelvic alterations during gait (Kennedy, 2009):
Lower peak hip abduction
Lower frontal range of motion

- Muscle weakness (Casartelli, 2011):
Hip adduction, abduction, flexion and ext rotation
Lower EMG activity on TFL

- Bone density (Speirs, 2013):
Cam-type FAI has a higher subchondral bone density

- Differences between sFAI and aFAI (Ng, 2012/13):
sFAI higher stresses in hip joint during squat
Both lower range of motion during squat
sFAI smaller femoral neck-shaft angles

- EMG Muscle activities during squat (Mantovani, 2013):
Lower GMax and higher RF in sFAI
Lower range of motion
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