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Navas L, Zimmerer A, Hausschild M. Recreational activity after open hip abductor repair. Arch Orthop Trauma Surg 2022. [PMID: 36547750 DOI: 10.1007/s00402-022-04734-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hip abductor tear (HAT) is an increasingly diagnosed cause of refractory lateral hip pain and dysfunction, affecting 10-25% of the general population. PURPOSE (1) to determine the rate of return to activity and to assess the physical and recreational activity of patients undergoing open hip abductor repair (oHATr) and (2) to describe the modification or initiation of new sports disciplines. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 28 patients (29 hips) who underwent an oHATr were prospectively analyzed at a midterm follow-up of 3.5 (range 2-5) years. The sports and recreational activity levels, as well as type of sports practiced before and after surgery, and The Veterans RAND 12 Item Health Survey (VR-12) were assessed via questionnaire. RESULTS At the final follow-up, all patients were active in sports after surgery. The duration and frequency of sports activities showed a slight decrease (48-42 min per week and 3.2-2.9 sessions per week, respectively) (p = 0.412 and 0.135, respectively). The VR-12 had a score of 45 (13.12-63.18) points for the physical component and 41 (32-53.8) points for the mental component. 100% of the patients would undergo the surgery again. 95% of patients were satisfied with the overall results of the surgical outcome, with 98% satisfied with their hip pain relief and ability to undertake daily and work activities. Moreover, 94% were satisfied with their ability to return to recreational activities. The failure rate in our cohort was approximately 14%. CONCLUSION All patients who underwent an oHATr were able to return at least to one type of sport. This cohort was highly satisfied with their sports involvement and recreational activity achievement. In addition, 88% of patients reported that oHATr improved sports activity. There was a shift from higher to lower impact sports. Furthermore, just 3 hips present a retear after surgery.
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Billuart F, Lalevée M, Brunel H, Van Driessche S, Beldame J, Matsoukis J. MRI assessment of minimally invasive anterolateral approaches in total hip arthroplasty. Orthop Traumatol Surg Res 2022; 108:103356. [PMID: 35724839 DOI: 10.1016/j.otsr.2022.103356] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/10/2022] [Accepted: 01/31/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Total hip arthroplasty (THA) on a minimally invasive anterolateral (MIAL) approach frequently leads to gluteus minimus and gluteus medius lesions, and sometimes to tensor fasciae latae (TFL) denervation. We therefore developed compensatory strategies, which we assessed on pre- and post-operative MRI: 1) to assess gluteus minimus and gluteus medius fatty infiltration (FI), 2) to assess TFL FI, and 3) to assess FI in the other periarticular muscles. HYPOTHESIS The modified MIAL approach reduces the rate of gluteus minimus and gluteus medius lesion. MATERIALS AND METHODS A continuous prospective single-surgeon series of THA using a MIAL approach included 25 patients. Femoral implantation was performed with the hip in extension so as to distance the proximal femur from the gluteals, avoiding muscle trauma. The superior gluteal nerve branch in the space between the gluteus medius and TFL, running toward the TFL, was systematically released and protected. MRI was performed preoperatively and at 3 months and 1 year post-surgery. FI was analyzed according to the Goutallier classification in all periarticular muscles. RESULTS One patient lacked preoperative MRI and was excluded, leaving 24 patients, for 72 MRIs. In 10/24 patients (41.7%) the gluteus minimus and in 8/24 patients (33.3%) the anterior third of the gluteus medius showed ≥2 grade increase in FI between preoperative and 1-year MRI, with significant increases in both at 3 months (p<0.001) and 1 year (p<0.001). At least a 2 grade increase in FI at 1 year was seen in 1 patient (4.2%) in the TFL, in 2 (8.3%) in the piriformis, and in 1 (4.2%) in the obturator internus. There were no significant differences in FI between preoperative, 3-month or 1-year MRI in any other periarticular muscles. CONCLUSION Femoral implantation in hip extension did not reduce the rate of gluteal lesions, which remained frequent. In contrast, release of the superior gluteal nerve branch could be effective in conserving TFL innervation. Some rare lesions of the proximal part of the pelvi-trochanteric muscles were also observed. LEVEL OF EVIDENCE IV, Prospective case series.
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Affiliation(s)
- Fabien Billuart
- Laboratoire d'analyse du mouvement, institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du Commerce, 75015 Paris, France; Université Paris-Saclay, UVSQ, Erphan, 78000 Versailles, France
| | - Matthieu Lalevée
- Centre hospitalier universitaire de Rouen, service de chirurgie orthopédique et traumatologique, 37, boulevard Gambetta, 76000 Rouen, France.
| | - Helena Brunel
- Laboratoire d'analyse du mouvement, institut de formation en masso-kinésithérapie Saint-Michel, 68, rue du Commerce, 75015 Paris, France
| | | | - Julien Beldame
- Institut clinique du Pied-Paris, Ramsay santé, clinique blomet, 136, rue Blomet, 75015 Paris, France; Clinique Mégival, 1328, avenue de la Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - Jean Matsoukis
- Département de Chirurgie Orthopédique, Groupe Hospitalier du Havre, BP 24, 76083 Le Havre cedex, France
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Lalevée M, Curado J, Matsoukis J, Beldame J, Brunel H, Van Driessche S, Billuart F. Comparative MRI assessment of three minimally invasive approaches in total hip arthroplasty. Orthop Traumatol Surg Res 2022; 108:103354. [PMID: 35716987 DOI: 10.1016/j.otsr.2022.103354] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/10/2022] [Accepted: 04/22/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Minimally invasive approaches (direct anterior approach: DAA; minimally invasive anterolateral: MIAL; piriformis-sparing posterior approach: PSPA) are widely used for total hip arthroplasty (THA), with a muscle-sparing objective. There are no published comparative studies of muscle damage secondary to these approaches. The aim of the present study was to compare fatty infiltration (FI) on MRI induced by DAA, MIAL and PSPA in THA 1) in the tensor fasciae latae (TFL) and sartorius muscles, 2) in the gluteal muscles, and 3) in the pelvitrochanteric muscles. HYPOTHESIS Greater FI is induced by DAA in anterior muscles, by MIAL in gluteal muscles and by PSPA in pelvitrochanteric muscles. MATERIALS AND METHODS Three continuous prospective series of THA by DAA, MIAL and PSPA included 25 patients each. MRI was performed preoperatively and at 1 year postoperatively. FI was graded on the Goutallier classification in all periarticular hip muscles. Muscles showing ≥2 grade aggravation at 1 year were considered damaged. RESULTS Nine patients whose preoperative MRI was uninterpretable were excluded. In all, 66 patients (21 DAA, 24 MIAL and 21 PSPA) with 132 MRI scans were analyzed. TFL was damaged in 2/21 DAA patients (9.5%), 1/24 MIAL patients (4.2%) and 0/21 PSPA patients (0%). There were no sartorius lesions. The anterior third of the gluteus medius was damaged in 8/24 MIAL patients (33.3%) and the gluteus minimus in 10/24 (41.7%), compared to 1/21 DAA patients (4.8%) and 0/21 PSPA patients (0%). The mid and posterior thirds of the gluteus medius and the gluteus maximus were never damaged. The piriformis muscle was damaged in 3/21 DAA patients (14.3%), 2/24 MIAL patients (8.3%) and 2/21 PSPA patients (9.5%). The obturator internus was damaged in 4/21 DAA patients (19%), 1/24 MIAL patients (4.2%) and 16/21 PSPA patients (76.2%). The obturator externus and quadratus femoris were mainly damaged in PSPA patients: respectively, 5/21 (23.8%) and 4/21 patients (19%)). CONCLUSION The muscle-sparing properties of minimally invasive hip approaches are only theoretical. In the present series, there were rare TFL lesions with DAA and MIAL. Gluteus medius and minimus lesions were frequent in MIAL. Pelvitrochanteric muscles lesions were more frequent in PSPA, but found in all 3 approaches. These findings should help guide surgeons in their choice of approach and in informing patients about the damage these minimally invasive approaches can cause. LEVEL OF EVIDENCE III, prospective comparative study.
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Affiliation(s)
- Matthieu Lalevée
- Centre Hospitalier Universitaire de Rouen, Service de Chirurgie Orthopédique et Traumatologique, 37, boulevard Gambetta, 76000 Rouen, France.
| | - Jonathan Curado
- Centre Hospitalier Universitaire de Rouen, Service de Chirurgie Orthopédique et Traumatologique, 37, boulevard Gambetta, 76000 Rouen, France
| | - Jean Matsoukis
- Département de Chirurgie Orthopédique, Groupe Hospitalier du Havre, BP 24, 76083 Le Havre cedex, France
| | - Julien Beldame
- Institut Clinique du Pied-Paris, Ramsay Santé, Clinique Blomet, 136, rue Blomet, 75015 Paris, France; Clinique Mégival, 1328, avenue de la Maison-Blanche, 76550 Saint-Aubin-sur-Scie, France
| | - Helena Brunel
- Laboratoire d'Analyse du Mouvement, Institut de Formation en Masso-kinésithérapie Saint-Michel, 68, rue du Commerce, 75015 Paris, France
| | | | - Fabien Billuart
- Laboratoire d'Analyse du Mouvement, Institut de Formation en Masso-kinésithérapie Saint-Michel, 68, rue du Commerce, 75015 Paris, France; Université Paris-Saclay, UVSQ, Erphan, 78000 Versailles, France
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Llurda-Almuzara L, Perez-Bellmunt A, Labata-Lezaun N, López-de-Celis C, Canet-Vintró M, Cadellans-Arroniz A, Moure-Romero L, Aiguadé-Aiguadé R. Relationship between lower limb EMG activity and knee frontal plane projection angle during a single-legged drop jump. Phys Ther Sport 2021; 52:13-20. [PMID: 34365085 DOI: 10.1016/j.ptsp.2021.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To assess a relationship between lower limb muscle activity and the frontal plane knee kinematics during a single-legged drop jump. DESIGN Correlation study; SETTING: Functional Anatomy Laboratory. PARTICIPANTS 35 healthy collegiate male athletes. MAIN OUTCOME MEASURES Muscle activity (%MVIC) of gluteus maximus, gluteus medius, biceps femoris, semitendinosus, vastus medialis quadriceps, vastus lateralis quadriceps, medial gastrocnemius and lateral gastrocnemius; peak knee frontal plane projection angle; and Pearson's correlation coefficients between muscle activity and peak knee frontal plane projection angle. All outcomes were assessed for both dominant and non-dominant limbs. RESULTS Significant correlations (r = 0.46-0.60, P < 0.05) were found between the muscle activities of the gluteus maximus, gluteus medius, biceps femoris, and semitendinosus, when compared to the knee frontal plane projection angle. CONCLUSION Gluteal muscles and hamstring muscles are associated with the peak knee frontal plane projection angle during a single-legged drop jump test. Thus, gluteal and hamstring muscle activities should be considered when developing rehabilitation or injury prevention programs.
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Affiliation(s)
- Luis Llurda-Almuzara
- Anatomy Unit, Basic Sciences Department, Universitat Internacional de Catalunya, 08195, Sant Cugat, Barcelona, Spain; ACTIUM functional anatomy group, Universitat Internacional de Catalunya, 08195, Sant Cugat, Barcelona, Spain
| | - Albert Perez-Bellmunt
- Anatomy Unit, Basic Sciences Department, Universitat Internacional de Catalunya, 08195, Sant Cugat, Barcelona, Spain; ACTIUM functional anatomy group, Universitat Internacional de Catalunya, 08195, Sant Cugat, Barcelona, Spain.
| | - Noé Labata-Lezaun
- Anatomy Unit, Basic Sciences Department, Universitat Internacional de Catalunya, 08195, Sant Cugat, Barcelona, Spain; ACTIUM functional anatomy group, Universitat Internacional de Catalunya, 08195, Sant Cugat, Barcelona, Spain
| | - Carlos López-de-Celis
- ACTIUM functional anatomy group, Universitat Internacional de Catalunya, 08195, Sant Cugat, Barcelona, Spain; Physiotherapy Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195, Sant Cugat, Barcelona, Spain
| | - Max Canet-Vintró
- Anatomy Unit, Basic Sciences Department, Universitat Internacional de Catalunya, 08195, Sant Cugat, Barcelona, Spain; ACTIUM functional anatomy group, Universitat Internacional de Catalunya, 08195, Sant Cugat, Barcelona, Spain
| | - Aida Cadellans-Arroniz
- ACTIUM functional anatomy group, Universitat Internacional de Catalunya, 08195, Sant Cugat, Barcelona, Spain; Physiotherapy Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195, Sant Cugat, Barcelona, Spain
| | - Lourdes Moure-Romero
- Nursing and Physiotherapy Department, University of Lleida, 25198, St. Lleida, Spain
| | - Ramón Aiguadé-Aiguadé
- Nursing and Physiotherapy Department, University of Lleida, 25198, St. Lleida, Spain; Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25198, St. Lleida, Spain
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