Squatting biomechanics following physiotherapist-led care or hip arthroscopy for femoroacetabular impingement syndrome: a secondary analysis from a randomised controlled trial.

Autor:	Grant TM; Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Queensland, Australia.; School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia., Saxby DJ; Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Queensland, Australia.; School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia., Pizzolato C; Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Queensland, Australia.; School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia., Savage T; Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Queensland, Australia.; School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia.; Sydney Musculoskeletal Health, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia., Bennell K; Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia., Dickenson E; University of Warwick, Coventry, United Kingdom.; University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom., Eyles J; Sydney Musculoskeletal Health, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.; Department of Rheumatology, Royal North Shore Hospital, Sydney, New South Wales, Australia., Foster N; Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, United Kingdom.; STARS Education and Research Alliance, Surgical, Treatment and Rehabilitation Service, University of Queensland, Brisbane, Queensland, Australia., Hall M; Sydney Musculoskeletal Health, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia., Hunter D; Sydney Musculoskeletal Health, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.; Department of Rheumatology, Royal North Shore Hospital, Sydney, New South Wales, Australia., Lloyd D; Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Queensland, Australia.; School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia., Molnar R; Department of Orthopaedic Surgery, St George Hospital, Sydney, New South Wales, Australia.; Sydney Orthopaedic and Reconstructive Surgery, Sydney, New South Wales, Australia., Murphy N; Sydney Musculoskeletal Health, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.; Department of Orthopaedic Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia., O'Donnell J; Hip Arthroscopy Australia, Richmond, Victoria, Australia.; Department of Orthopaedic Surgery, Swinburne University of Technology, Melbourne, Victoria, Australia., Singh P; Hip Arthroscopy Australia, Richmond, Victoria, Australia.; Maroondah Hospital, Eastern Health, Melbourne, Victoria, Australia., Spiers L; Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia., Tran P; Department of Orthopaedic Surgery, Western Health, Melbourne, Victoria, Australia.; Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne, Melbourne, Victoria, Australia., Diamond LE; Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Griffith University, Gold Coast, Queensland, Australia.; School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia.
Jazyk:	angličtina
Zdroj:	PeerJ [PeerJ] 2024 Jun 24; Vol. 12, pp. e17567. Date of Electronic Publication: 2024 Jun 24 (Print Publication: 2024).
DOI:	10.7717/peerj.17567
Abstrakt:	Background: Femoroacetabular impingement syndrome (FAIS) can cause hip pain and chondrolabral damage that may be managed non-operatively or surgically. Squatting motions require large degrees of hip flexion and underpin many daily and sporting tasks but may cause hip impingement and provoke pain. Differential effects of physiotherapist-led care and arthroscopy on biomechanics during squatting have not been examined previously. This study explored differences in 12-month changes in kinematics and moments during squatting between patients with FAIS treated with a physiotherapist-led intervention (Personalised Hip Therapy, PHT) and arthroscopy. Methods: A subsample ( n = 36) of participants with FAIS enrolled in a multi-centre, pragmatic, two-arm superiority randomised controlled trial underwent three-dimensional motion analysis during squatting at baseline and 12-months following random allocation to PHT ( n = 17) or arthroscopy ( n = 19). Changes in time-series and peak trunk, pelvis, and hip biomechanics, and squat velocity and maximum depth were explored between treatment groups. Results: No significant differences in 12-month changes were detected between PHT and arthroscopy groups. Compared to baseline, the arthroscopy group squatted slower at follow-up (descent: mean difference -0.04 m∙s -1 (95%CI [-0.09 to 0.01]); ascent: -0.05 m∙s -1 [-0.11 to 0.01]%). No differences in squat depth were detected between or within groups. After adjusting for speed, trunk flexion was greater in both treatment groups at follow-up compared to baseline (descent: PHT 7.50° [-14.02 to -0.98]%; ascent: PHT 7.29° [-14.69 to 0.12]%, arthroscopy 16.32° [-32.95 to 0.30]%). Compared to baseline, both treatment groups exhibited reduced anterior pelvic tilt (descent: PHT 8.30° [0.21-16.39]%, arthroscopy -10.95° [-5.54 to 16.34]%; ascent: PHT -7.98° [-0.38 to 16.35]%, arthroscopy -10.82° [3.82-17.81]%), hip flexion (descent: PHT -11.86° [1.67-22.05]%, arthroscopy -16.78° [8.55-22.01]%; ascent: PHT -12.86° [1.30-24.42]%, arthroscopy -16.53° [6.72-26.35]%), and knee flexion (descent: PHT -6.62° [0.56- 12.67]%; ascent: PHT -8.24° [2.38-14.10]%, arthroscopy -8.00° [-0.02 to 16.03]%). Compared to baseline, the PHT group exhibited more plantarflexion during squat ascent at follow-up (-3.58° [-0.12 to 7.29]%). Compared to baseline, both groups exhibited lower external hip flexion moments at follow-up (descent: PHT -0.55 N∙m/BW∙HT[%] [0.05-1.05]%, arthroscopy -0.84 N∙m/BW∙HT[%] [0.06-1.61]%; ascent: PHT -0.464 N∙m/BW∙HT[%] [-0.002 to 0.93]%, arthroscopy -0.90 N∙m/BW∙HT[%] [0.13-1.67]%). Conclusion: Exploratory data suggest at 12-months follow-up, neither PHT or hip arthroscopy are superior at eliciting changes in trunk, pelvis, or lower-limb biomechanics. Both treatments may induce changes in kinematics and moments, however the implications of these changes are unknown. Trial Registration Details: Australia New Zealand Clinical Trials Registry reference: ACTRN12615001177549. Trial registered 2/11/2015. Competing Interests: David Lloyd has received research support from Arthrex and Orthopediatrics on an Australian Research Council Industrial Training and Transformation Centre grant, and from Orthocell on MTPConnect BioMedTech Horizons grant and Australian Research Council Industry Linkage grant. David J. Hunter has received consulting fees for scientific advisory roles from Pfizer, Lilly, Merck Serono, TLCBio, Kolon Tissuegene and Novartis. Nadine Foster is funded through an Australian National Health and Medical Research Council (NHMRC) Investigator Grant (ID: 2018182). No other potential Conflicts of Interest have been declared by any other authors. (© 2024 Grant et al.)
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