Femoro-acetabular Impingement: Physiotherapy
- Improve biomechanics of the hip through strengthening.
- Address muscles weakness to reduce excessive movement within the joint
- Education and ? activity modification until surgery ( if already not self limiting to reduce risk of secondary OA
- Physiotherapy is also important post operatively to regain strength and normal biomechanics
- Pain in groin or hip region
- Secondary spasm in the piriformis.
- Soft tissue mobilisations
- Manual therapy
- Muscle Energy techniques
- Strengthening exercises.
- Hip Distraction
What does the research say?
- There is growing evidence that femoro-acetabular impingement results in osteoarthritis of the hip joint.
- Patients with FAI usually present with deep groin pain exacerbated by deep hip ﬂexion.
- Pincer impingement is more common in middleaged athletic females.
- Cam impingement is commoner in young active males.
- Labral damage rarely occurs alone and may signify ongoing impingement.
- Radiology may reveal a non-spherical femoral head and/or retroverted acetabulum.
- Contrast enhanced MRI is useful to visualise a damaged labrum.
- Surgery is the treatment of choice and is effective in alleviating symptoms of FAI.
- The quality of the literature assessing clinical outcomes after open or arthroscopic treatment of FAI and labral pathology is limited. On the basis of the studies published to date, our hypothesis that arthroscopic techniques are as effective as open surgical techniques in achieving satisfactory clinical outcomes in the treatment of FAI and labral pathology was supported.
- Although open surgical dislocation with osteoplasty is the historical gold standard, the scientiﬁc data do not show that open techniques have outcomes superior to arthroscopic techniques.
- MR arthrography enables accurate detection and staging of lesions of the acetabular labrum and appears to be indicated in the assessment of chronic hip pain in patients with a strong suspicion of labral lesions.
Czerny et al (1996)
- Although magnetic resonance arthrography is an excellent positive predictor in diagnosing acetabular labral tears and articular cartilage abnormalities, it has limited sensitivity. A negative imaging study does not exclude important intra-articular pathology that can be identified and treated arthroscopically.
Keeney et al (2004)
- There are currently several methods of assessing the degree of impingement by use of CT and magnetic resonance imaging scans, which can be used in conjunction with magnetic resonance arthrography and arthroscopy to assess the damage caused to the underlying structures of the hip.
- Both open and arthroscopic surgical methods are used, with recent reports in athletes showing excellent results for lifestyle improvement and frequency of returning to sport.
- In cases of hip and groin pain in athletes, it is important to remember to look for typical history, and examination and imaging findings that may suggest a diagnosis of hip impingement. This article goes some way to explaining the principles, consequences and management of FAI.
- Between October 2000 and September 2005, 45 professional athletes underwent hip arthroscopy for the decompression of FAI. Operative and return-to-play data were obtained from patient records. Average time to follow-up was 1.6 years (range: 6 months to 5.5 years). Forty two (93%) athletes returned to professional competition following arthroscopic decompression of FAI. Three athletes did not return to play; however, all had diffuse osteoarthritis at the time of arthroscopy. Thirty-five athletes (78%) remain active in professional sport at an average follow-up of 1.6 years. Arthroscopic treatment of FAI allows professional athletes to return to professional sport.
- Surgical treatment for FAI reliably improves patient symptoms in the majority of patients without advanced osteoarthritis or chondral damage. Early evidence supports labral refixation. It is too soon to predict whether progression of osteoarthritis is delayed.
Ng et al, 2010
Current management of femoro-acetabular impingement
Current Orthopaedics, Volume 22, Issue 4, August 2008, Pages 300-310
M. Hossain, J.G. Andrew
Bedi A, Chen N, Robertson W, Kelly BT. The management of labral tears and femoroacetabular impingement of the hip in the young, active patient. Arthroscopy. 2008;24(10):1135-1145.
Byrd JWT, Jones KS. Diagnostic accuracy of clinical assessment, magnetic resonance imaging, magnetic resonance arthrography, and intra-articular injection in hip arthroscopy patients. Am J Sports Med 2004;32(7):1668–74.
Phillipon M, Schenker M, Briggs K, Kuppersmith D. Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression. Knee Surg Sports Traumatol Arthrosc (2007) 15:908–914
Manaster BJ, Zakel S. Imaging of Femoral Acetabular Impingement Syndrome. Clin Sports Med 25 (2006) 635–657