ARTHROSCOPY

Posted on the ORTHOSuperSite January 17, 2011

Age and symptoms important factors for hip arthroscopy referral

KOLOA, Hawaii — An in-place protocol for referring patients for hip arthroscopy will increase the odds of having better results with the procedure, according to an orthopedic investigator here.

Dean K. Matsuda, MD, said at Orthopedics Today Hawaii 2011 that age, symptoms, imaging and clinical factors are used to determine the prime candidates for hip arthroscopy.

Dean K. Matsuda

“Who do we refer for hip arthroscopy? In general it is patients who are in pain, or those who have mechanical symptoms thought to be from the hip,” he said. Potential hip arthroscopy patients should not have responded to conservative measures, such as activity changes and physical therapy, and should have minimal or no osteoarthritis (OA).

New indication

Pain coming from the hip is a relatively new indication, Matsuda said. “We used to think that deep groin pain was a result of intra-articular hip pathology, but we are seeing now that trochanteric pain may also be from an intra-articular hip problem.”

Symptoms signaling a referral include: moderate-to-severe hip pain that is worsened by flexion activities, such as squatting or prolonged sitting, that significantly limits activities and a positive impingement signon clinical examination — pain elicited with 90° of flexion and internal rotation and adduction of the femur.

There are also exceptions to these, he noted. “You should consider even mild pain, especially in the deep groin or lateral hip. Also, positive FADIR [flexion adduction with internal rotation] and FADER [flexion adduction with external rotation] may also see you picking up some other patients.”

In terms of age, he said, adolescent patients should be skeletally mature with documented closure of growth plates, and adult patients should be too young to be considered appropriate candidates for total hip arthroplasty or other reconstructive hip surgery — usually younger than 55 years. “But I can tell you this,” Matsuda added, “patients as young as 11 or 12 years old can benefit from this procedure, as well as people older than 60 years.”

Imaging

Imaging data should also be used in the decision. Morphology indicative of cam or pincer-type femoroacetabular impingement, such as pistol-grip deformity, femoral head-neck offset with an alpha angle greater than 50°, a positive posterior wall sign, acetabular retroversion (overcoverage with crossover sign), coxa profunda or protrusion, or damage of the acetabular rim.

He said that referrals should be made sooner rather than later to avoid irreversible third body wear. “Some insurers say 3 months of failed conservative care before referral. Early referrals are also starting to be supported in the literature and the insurers are starting to get on board with that.”

Matsuda stressed the importance of knowing when not to refer for hip arthroscopy and provided the following examples: cases of advanced OA; patients with moderate-to-severe dysplasia; patients who have not undergone the sufficient course of conservative treatment, especially in snapping hips. Physicians should also avoid referring patients for hip arthroscopy if there are no experienced hip arthroscopy surgeons in their referring area.

For further information: http://www.orthosupersite.com/view.aspx?rid=79500

SPORTS MEDICINE

Posted on the ORTHOSuperSite December 29, 2010

Shorter jump training program could lower risk of knee injury in female basketball players

An abridged, focused “jump training” program may help lower the risk of knee injuries in female basketball players, according to a study in the December issue of The Journal of Strength and Conditioning Research.

The program yields “similar positive effects on landing strategies and functional performance” compared to longer, more complex training programs – and thus may be more “user friendly” to coaches and athletes, the authors wrote.

In the jump training program, athletes received coaching and feedback on appropriate landing technique. The specific goal of the training was to decrease the knee valgus angle upon landing from jumps, as landing with the knee in the valgus position is believed to increase the risk of knee injury.

The training program

The study looked at 15 competitive female basketball players who completed the 4-week training program with three sessions per week. Knee valgus angles during two different landing tasks – a drop-jump and a jump-shot test – were compared before and after training. The women were also assessed on a crossover hop test to assess hop distance.

The results of the training showed significant improvements in proper landing technique, the study noted. On both tests, the women landed with reduced valgus angles. Landing from the jump shot, the valgus angle was reduced by an average of 4.5º on the left leg and 4.3º on the right leg.

On the crossover hop test, distance jumped increased by nearly 75% after jump training. The authors wrote that this indicates increased strength and stability of the knee, likely helping to protect against injury.

Still work to be done

The authors noted that female basketball players appear to be particularly prone to knee injuries, especially in ACL injuries Previous studies have shown that jump training programs can improve knee valgus angles in female basketball players and lead to reduced rates of ACL injuries, but most of these jump programs are intensive, feature a variety of other training elements and last 6 to 8 weeks.

“It remains unclear if it is jump training that makes the difference or a combined strength, flexibility, and jump-training program,” stated author Lee Herrington, PhD, MCSP, CSCS, in a press release.

While the study shows that a 4-week jump training program can significantly improve landing technique and improve knee strength and stability in female basketball players, the authors noted that a larger study would be needed to show a significant effect on knee or ACL injures.

Still, they wrote, the results show a significantly shorter program can produce results comparable to those of much longer and complex mixed-training programs. Shorter and more focused training programs may offer coaches, trainers and athletes a simpler – but still effective – way of reducing knee injury rates in female basketball players.

For further information: http://www.orthosupersite.com/view.aspx?rid=78923