High-load injuries in the adolescent athlete's hip; clinical and experimental studies and outcome measures

摘要

The diagnosis and treatment of hip and groin symptomshas often been a problem area in orthopaedicsand sports medicine. Hip and groin pain and injuriesare common among athletes and in the increasinglyactive population. In recent years, femoroacetabularimpingement (FAI) has emerged as one of the mostcommon causes of hip and groin disability in thisgroup and it is a known risk factor in the developmentof osteoarthritis (OA) of the hip. Technical advancementand improved instruments have made surgicalhip arthroscopy the mainstay treatment option in patientswith debilitating FAI and the indications for hiparthroscopy are increasing.The aetiology of FAI is not known. Several theorieshave been proposed. One of them is that a growthdisturbance in the proximal femur, caused by heavyloads during skeletal maturation, is a factor in FAIdevelopment. FAI has been seen to be more commonin athletes in certain sports, leading to pain, reducedrange of motion (ROM) and performance.Despite the increase in the number of hip arthroscopiesthat are performed, outcome measurements forthe young and middle-aged, active patient with hipand groin pain have been lacking. Other instrumentsdeveloped for older patients with osteoarthritis of thehip have been used, but their psychometric propertiesin this patient group are deficient.In a clinical study, the morphological characteristicsand ROM of the hips were compared in a group ofathletes and a group of non-athletes. No difference inhip morphology was found between the groups, butthe athletes had significantly lower ROM and osteoarthritiswas more common among the athletes.The strength of the porcine proximal femoral physiswas investigated in two biomechanical studies. Thephyseal plate was found to be the weakest point inthe proximal femur. Injuries were seen after repeatedphysiological loading in and around the physeal plateboth on MRI and histologically.Two patient-reported outcome measurements (HRPROMs)developed for these patient groups werefound, the iHOT12 and HAGOS. Using standardisedmethods, the HR-PROMs were translated andadapted to Swedish and the Swedish versions weretested in a clinical study to measure their psychometricproperties.Morphological changes of FAI increase the risk ofOA development. Injuries created in and around thephyseal plate in the proximal femur during physiologicalloads can lead to morphological changes andFAI. The Swedish versions of the iHOT12 and HAGOShave good psychometric properties and can beused clinically and for research.