Yared Fares, Massaad Abir, Bakouny Ziad, Otayek Joeffroy, Bizdikian Aren-Joe, Ghanimeh Joe, Labaki Chris, Ghanem Diane, Ghanem Ismat, Skalli Wafa, Assi Ayman
Laboratory of Biomechanics and Medical Imaging, Saint Joseph University of Beirut, Beirut, LBN.
Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, FRA.
Cureus. 2023 Aug 18;15(8):e43733. doi: 10.7759/cureus.43733. eCollection 2023 Aug.
Femoro-acetabular impingement (FAI) may present as alterations in the skeletal morphology of the hip. Repercussions of FAI can be witnessed in self-selected speed walking as well as physical exercise such as running or fast speed walking. The aim of this study was to investigate changes in kinematics at different gait speeds in subjects presenting with radiological findings invoking FAI. One hundred thirty asymptomatic adults underwent biplanar X-rays with a calculation of 3D hip parameters: acetabular anteversion, abduction and tilt, vertical center edge angle (VCE), femoral anteversion, neck-shaft angle, acetabular coverage of the femoral head, femoral head diameter and neck length. Parameters were classified according to FAI clinical thresholds. Two groups were created: Control group (63 subjects having up to one subnormal hip parameter in favour of FAI) and Radiographic FAI group (67 subjects having ≥2 subnormal hip parameters that might cause FAI). All subjects underwent 3D gait analysis at self-selected and fast speed, from which kinematic parameters were generated. Arithmetic differences between fast and self-selected speed gait were considered as gait changes. Subjects in the Radiographic FAI group had decreased acetabular tilt (24 vs. 19˚), anteversion (19 vs. 16˚), abduction (55 vs. 53˚), femoral anteversion (18 vs. 14˚) and increased VCE (29 vs. 33˚, all p<0.05), compared to controls. Changes from self-selected to fast speed showed that subjects in the Radiographic FAI group had lower range of motion (ROM) pelvic rotation (7 vs. 4˚) and ROM hip flexion/extension (10 vs. 7˚), reduced hip extension (-4 vs. -2˚) and step length (16 vs. 13 cm; all p<0.05). The Radiographic FAI group had decreased acetabular abduction, anteversion and femoral anteversion in favour of FAI. When adapting from self-selected to fast speed gait, the Radiographic FAI group seemed to limit pelvic rotation and hip flexion/extension resulting in a decrease in step length. These kinematic limitations were previously reported in subjects with symptomatic FAI. Gait analysis could be considered as a functional diagnostic tool to assess FAI along with radiological assessment.
股骨髋臼撞击症（FAI）可能表现为髋关节骨骼形态的改变。在自选速度行走以及跑步或快速行走等体育锻炼中都能看到FAI的影响。本研究的目的是调查在具有提示FAI的影像学表现的受试者中，不同步态速度下的运动学变化。130名无症状成年人接受了双平面X线检查，并计算了3D髋关节参数：髋臼前倾角、外展角和倾斜角、垂直中心边缘角（VCE）、股骨前倾角、颈干角、股骨头的髋臼覆盖度、股骨头直径和颈长。参数根据FAI临床阈值进行分类。创建了两组：对照组（63名受试者，最多有一项髋关节参数低于正常范围提示FAI）和影像学FAI组（67名受试者，有≥2项可能导致FAI的低于正常范围的髋关节参数）。所有受试者在自选速度和快速速度下进行了3D步态分析，并由此生成运动学参数。快速速度和自选速度步态之间的算术差异被视为步态变化。与对照组相比，影像学FAI组的髋臼倾斜角（24°对19°）、前倾角（19°对16°）、外展角（55°对53°）、股骨前倾角（18°对14°）减小，VCE增大（29°对33°，所有p<0.05）。从自选速度到快速速度的变化表明，影像学FAI组的骨盆旋转活动度（ROM）（7°对4°）和髋关节屈伸ROM（10°对7°）较低，髋关节伸展减少（-4°对-2°），步长缩短（16 cm对13 cm；所有p<0.05）。影像学FAI组的髋臼外展、前倾角和股骨前倾角减小，提示FAI。当从自选速度步态转变为快速速度步态时，影像学FAI组似乎限制了骨盆旋转和髋关节屈伸，导致步长缩短。这些运动学限制此前在有症状的FAI受试者中已有报道。步态分析可被视为一种功能性诊断工具，与影像学评估一起用于评估FAI。
