Trunk, pelvis and lower limb walking biomechanics are similarly altered in those with femoroacetabular impingement syndrome regardless of cam morphology size,Gait & Posture

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Trunk, pelvis and lower limb walking biomechanics are similarly altered in those with femoroacetabular impingement syndrome regardless of cam morphology size
Gait & Posture ( IF 2.4 ) Pub Date : 2020-10-10 , DOI: 10.1016/j.gaitpost.2020.10.002
Trevor N Savage ₁ , David J Saxby ₂ , Claudio Pizzolato ₂ , Laura E Diamond ₃ , Nicholas J Murphy ₄ , Michelle Hall ₅ , Libby Spiers ₅ , Jillian Eyles ₆ , Bryce A Killen ₂ , Edin K Suwarganda ₂ , Edward J Dickenson ₇ , Damian Griffin ₇ , Camdon Fary ₈ , John O'Donnell ₉ , Robert Molnar ₁₀ , Sunny Randhawa ₁₁ , Stephan Reichenbach ₁₂ , Phong Tran ₁₃ , Tim V Wrigley ₅ , Kim L Bennell ₅ , David J Hunter ₆ , David G Lloyd ₂

Affiliation

Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE) | Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia; Kolling Institute of Medical Research, Institute of Bone and Joint Research, The University of Sydney, Sydney, New South Wales, Australia.
Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE) | Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia.
Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE) | Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia; Centre of Clinical Research Excellence in Spinal Pain, Injury & Health, School of Health & Rehabilitation Sciences, the University of Queensland, Brisbane, Queensland, Australia.
Kolling Institute of Medical Research, Institute of Bone and Joint Research, The University of Sydney, Sydney, New South Wales, Australia; Department of Orthopaedic Surgery, Gosford and Wyong Hospitals, New South Wales, Australia.
Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia.
Kolling Institute of Medical Research, Institute of Bone and Joint Research, The University of Sydney, Sydney, New South Wales, Australia; Department of Rheumatology, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia.
University of Warwick, Coventry, United Kingdom; University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, United Kingdom.
Department of Orthopaedic Surgery, Western Health, Melbourne, Victoria, Australia; Department of Surgery, The University of Melbourne, Victoria, Australia.
Hip Arthroscopy Australia; School of Health Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia.
Department of Orthopaedic Surgery, St George Hospital, Sydney, New South Wales, Australia; Sydney Orthopaedic and Reconstructive Surgery, Sydney, New South Wales, Australia.
Macquarie University Hospital, Macquarie University, Sydney, NSW, Australia.
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, Bern, Switzerland.
Department of Surgery, The University of Melbourne, Victoria, Australia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne, Melbourne, Victoria, Australia.

Background

Studies of walking in those with femoroacetabular impingement syndrome have found altered pelvis and hip biomechanics. But a whole body, time-contiuous, assessment of biomechanical parameters has not been reported. Additionally, larger cam morphology has been associated with more pain, faster progression to end-stage osteoarthritis and increased cartilage damage but differences in walking biomechanics between large compared to small cam morphologies have not been assessed.

Research question

Are trunk, pelvis and lower limb biomechanics different between healthy pain-free controls and individuals with FAI syndrome and are those biomechanics different between those with larger, compared to smaller, cam morphologies?

Methods

Twenty four pain-free controls were compared against 41 participants with FAI syndrome who were stratified into two groups according to their maximum alpha angle. Participants underwent three-dimensional motion capture during walking. Trunk, pelvis, and lower limb biomechanics were compared between groups using statistical parametric mapping corrected for walking speed and pain.

Results

Compared to pain-free controls, participants with FAI syndrome walked with more trunk anterior tilt (mean difference 7.6°, p < 0.001) as well as less pelvic rise (3°, p < 0.001), hip abduction (-4.6°, p < 0.05) and external rotation (-6.5°, p < 0.05). They also had lower hip flexion (-0.06Nm⋅kg⁻¹, p < 0.05), abduction (-0.07Nm⋅kg⁻¹, p < 0.05) and ankle plantarflexion moments (-0.19Nm⋅kg⁻¹, p < 0.001). These biomechanical differences occurred throughout the gait cycle. There were no differences in walking biomechanics according to cam morphology size.

Significance

Results do not support the hypothesis that larger cam morphology is associated with larger differences in walking biomechanics but did demonstrate general differences in trunk, pelvis and lower limb biomechanics between those with FAI sydrome and pain-free controls. Altered external biomechanics are likely the result of complex sensory-motor strategy resulting from pain inhibition or impingement avoidance. Future studies should examine internal loading in those with FAI sydnrome.

中文翻译：

股骨髋臼撞击综合征患者的躯干，骨盆和下肢行走生物力学均发生类似变化，而与凸轮形态大小无关

背景

对患有股骨髋臼撞击综合征的人的步行研究发现，骨盆和髋关节生物力学发生了改变。但是尚未报道整个时间上连续的生物力学参数评估。另外，较大的凸轮形态与更多的疼痛，更快的发展为终末期骨关节炎和增加的软骨损伤有关，但是尚未评估大型凸轮形态与小型凸轮形态之间行走生物力学的差异。

研究问题

健康的无痛对照和FAI综合征患者的躯干，骨盆和下肢的生物力学是否不同，凸轮形态较大（与较小）相比，那些生物力学是否不同？

方法

将二十四名无痛对照与41名FAI综合征参与者进行比较，他们根据最大α角度分为两组。参与者在行走过程中进行了三维动作捕捉。使用校正了步行速度和疼痛的统计参数映射在各组之间比较躯干，骨盆和下肢的生物力学。

结果

与无痛对照相比，FAI综合征参与者的躯干前倾更多（平均差异7.6°，p <0.001），盆腔抬高（3°，p <0.001），髋关节外展（-4.6°，p）更少<0.05）和外部旋转（-6.5°，p <0.05）。他们还具有较低的髋关节屈曲（-0.06Nm⋅kg ^-1，p <0.05），外展（-0.07Nm⋅kg ^-1，p <0.05）和踝plant屈力矩（-0.19Nm⋅kg ^-1，p <0.001））。这些生物力学差异贯穿整个步态周期。根据凸轮形态大小，步行生物力学没有差异。