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Objective Although hip arthroscopy is a widely adopted treatment option for hip-related pain, it is unknown whether preoperative clinical information can be used to assist surgical decision-making to avoid offering surgery to patients with limited potential for a successful outcome. We aimed to develop and validate clinical prediction models to identify patients more likely to have an unsuccessful or successful outcome 1 year post hip arthroscopy based on the patient acceptable symptom state. Methods Patient records were extracted from the Danish Hip Arthroscopy Registry (DHAR). A priori, 26 common clinical variables from DHAR were selected as prognostic factors, including demographics, radiographic parameters of hip morphology and self-reported measures. We used 1082 hip arthroscopy patients (surgery performed 25 April 2012 to 4 October 2017) to develop the clinical prediction models based on logistic regression analyses. The development models were internally validated using bootstrapping and shrinkage before temporal external validation was performed using 464 hip arthroscopy patients (surgery performed 5 October 2017 to 13 May 2019). Results The prediction model for unsuccessful outcomes showed best and acceptable predictive performance on the external validation dataset for all multiple imputations (Nagelkerke R 2 range: 0.25-0.26) and calibration (intercept range: -0.10 to -0.11; slope range: 1.06-1.09), and acceptable discrimination (area under the curve range: 0.76-0.77). The prediction model for successful outcomes did not calibrate well, while also showing poor discrimination. Conclusion Common clinical variables including demographics, radiographic parameters of hip morphology and self-reported measures were able to predict the probability of having an unsuccessful outcome 1 year after hip arthroscopy, while the model for successful outcome showed unacceptable accuracy. The externally validated prediction model can be used to support clinical evaluatio

Objectives: To explore relationships between groin pain and adductor squeeze strength in male academy football players over a 14-week period. Design: Longitudinal cohort study. Methods: Weekly monitoring of youth male football players consisted of reporting groin pain and testing long lever adductor squeeze strength. Players who reported groin pain at any time during the study period were stratified into the “groin pain” group while players who did not report pain remained in the “no groin pain” group. Baseline squeeze strength was retrospectively compared between groups. Players that developed groin pain were examined via repeated measures ANOVA at four timepoints: baseline, last squeeze before pain, pain onset, and return to pain-free. Results: 53 players were included (age 14.4 ± 1.6 years). Baseline squeeze strength was not different between players in the “groin pain” (n = 29, 4.35 ± 0.89 N/kg) versus “no groin pain” group (n = 24, 4.33 ± 0.90 N/kg, p = 0.83). At a group level, players with no groin pain maintained similar adductor squeeze strength throughout 14 weeks (p > 0.05). Compared to baseline (4.33 ± 0.90 N/kg), players with groin pain had decreased adductor squeeze strength at the last squeeze before pain (3.91 ± 0.85 N/kg, p = 0.003) and at pain onset (3.58 ± 0.78 N/kg, p < 0.001). Adductor squeeze strength at the point where pain subsided (4.06 ± 0.95 N/kg) was not different from baseline (p = 0.14). Conclusions: Decreases in adductor squeeze strength manifest one-week prior to groin pain onset and further decrease at pain onset. Weekly adductor squeeze strength may be an early detector for groin pain in youth male football players.

Introduction Previous studies showed that the Nordic hamstring exercise (NHE) effectively prevents primary hamstring injury. However, no study investigated the secondary preventing effect of the NHE on hamstring reinjury. The primary purpose of this study is to investigate the effectiveness of the NHE for preventing hamstring reinjury after return to play (RTP) following a hamstring injury in football players. The secondary purpose is to determine the effect of the NHE on sprint and jump performance. Methods and analysis This is an international multicentre, prospective, parallel-group randomised controlled trial study. Subjects include male or female football players aged 18-40 years and within 1 week of RTP following a hamstring injury will be randomised into Nordics or a control group. Subjects in both groups continue their regular football training, but the Nordics group will perform an additional NHE programme. An online questionnaire will be sent to the subjects in both groups once per week within the first 10 weeks, then continued at months 6, 9 and 12. In a (performance) substudy, we will evaluate the effect of the NHE on sprint and vertical jump performance at three time points (at the beginning of the study, after 10 weeks and 12 months of follow-up). The primary outcomes are the incidence of hamstring reinjury within 2 and 12 months. The secondary outcomes are sprint and jump performance, adherence to the programme, duration of reinjury and reinjury burden. Ethics and dissemination This study is approved by the medical ethics committee of Amsterdam University Medical Center (UMC) in the Netherlands (METC 2021_117), Faculty of Medicine Universitas Gadjah Mada in Indonesia (KE/FK/1248/EC/2021), Norwegian School of Sport Sciences in Norway (number 216-2 70 122) and Denmark (ethical submission in process). The study's findings will be disseminated in scientific peer-reviewed journals and presented at international conferences. Trial registration number NL9

This statement summarises and appraises the evidence on diagnostic tests and clinical information, and non-operative treatment of femoroacetabular impingement (FAI) syndrome and labral injuries. We included studies based on the highest available level of evidence as judged by study design. We evaluated the certainty of evidence using the Grading of Recommendations Assessment Development and Evaluation framework. We found 29 studies reporting 23 clinical tests and 14 different forms of clinical information, respectively. Restricted internal hip rotation in 0° hip flexion with or without pain was best to rule in FAI syndrome (low diagnostic effectiveness; low quality of evidence; interpretation of evidence: may increase post-test probability slightly), whereas no pain in Flexion Adduction Internal Rotation test or no restricted range of motion in Flexion Abduction External Rotation test compared with the unaffected side were best to rule out (very low to high diagnostic effectiveness; very low to moderate quality of evidence; interpretation of evidence: very uncertain, but may reduce post-test probability slightly). No forms of clinical information were found useful for diagnosis. For treatment of FAI syndrome, 14 randomised controlled trials were found. Prescribed physiotherapy, consisting of hip strengthening, hip joint manual therapy techniques, functional activity-specific retraining and education showed a small to medium effect size compared with a combination of passive modalities, stretching and advice (very low to low quality of evidence; interpretation of evidence: very uncertain, but may slightly improve outcomes). Prescribed physiotherapy was, however, inferior to hip arthroscopy (small effect size; moderate quality of evidence; interpretation of evidence: hip arthroscopy probably increases outcome slightly). For both domains, the overall quality of evidence ranged from very low to moderate indicating that future research on diagnosis and treatment may a

Purpose: Increasing age, high quadriceps strength, and low hamstring muscle strength are associated with hamstring strain injury in soccer. The authors investigated the age-related variation in maximal hamstring and quadriceps strength in male elite soccer players from under-13 (U-13) to the senior level. Methods: A total of 125 elite soccer players were included from a Danish professional soccer club and associated youth academy (first tier; U-13, n = 19; U-14, n = 16; U-15, n = 19; U-17, n = 24; U-19, n = 17; and senior, n = 30). Maximal voluntary isometric force was assessed for the hamstrings at 15° knee joint angle and for the quadriceps at 60° knee joint angle (0° = full extension) using an external-fixated handheld dynamometer. Hamstring-to-quadriceps strength (H:Q) ratio and hamstring and quadriceps maximal voluntary isometric force levels were compared across age groups (U-13 to senior). Results: Senior players showed 18% to 26% lower H:Q ratio compared with all younger age groups (P ≤ .026). Specific H:Q ratios (mean [95% confidence interval]) were as follows: senior, 0.45 (0.42–0.48); U-19, 0.61 (0.55–0.66); U-17, 0.56 (0.51–0.60); U-15, 0.59 (0.54–0.64); U-14, 0.54 (0.50–0.59); and U-13, 0.57 (0.51–0.62). Hamstring strength increased from U-13 to U-19 with a significant drop from U-19 to the senior level (P = .048), whereas quadriceps strength increased gradually from U-13 to senior level. Conclusion: Elite senior soccer players demonstrate lower H:Q ratio compared with youth players, which is driven by lower hamstring strength at the senior level compared with the U-19 level combined with a higher quadriceps strength. This discrepancy in hamstring and quadriceps strength capacity may place senior-level players at increased risk of hamstring muscle strain injuries.

Objectives: Reduced sports function is often observed after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Impaired muscle strength could be reasons for this. We aimed to investigate hip muscle strength after hip arthroscopy for FAIS and its association with sports function and participation. Design: Cross-sectional study. Methods: We included 45 patients (34 males; mean age: 30.6 ± 5.9 years) after unilateral hip arthroscopy for FAIS (mean follow-up [range]: 19.3 [9.8–28.4] months). Maximal isometric hip muscle strength (Nm/kg) including early- (0–100 ms) and late-phase (0–200 ms) rate of torque development (Nm∗kg−1∗s−1) for adduction, abduction, flexion, and extension was measured with an externally fixated handheld dynamometer and compared between operated and non-operated hip. Associations between muscle strength and self-reported sports function and return to sport were investigated. Results: For maximal hip muscle strength, no between-hip differences were observed for adduction, abduction, flexion, and extension (p ≥ 0.102). For rate of torque development, significantly lower values were observed for the operated hip in flexion at both 0–100 ms (mean difference: 1.58 Nm∗kg−1∗s−1, 95% CI [0.39; 2.77], p = 0.01) and 0–200 ms (mean difference: 0.72 Nm∗kg−1∗s−1, 95% CI [0.09; 1.35], p = 0.027). Higher maximal hip extension strength was significantly associated with greater ability to participate fully in preinjury sport at preinjury level (odds ratio: 17.71 95% CI [1.77; 177.60]). Conclusions: After hip arthroscopy for FAIS subjects show limited impairments in maximal and explosive hip muscle strength between operated and non-operated hip. Higher muscle strength was positively associated with higher sports function and ability to participate in sport.

Background: Hip arthroscopy is a viable treatment for femoroacetabular impingement syndrome (FAIS). Clinically relevant improvements in hip function and pain after surgery are often reported, but it is less clear how many patients achieve an acceptable symptom state (Patient Acceptable Symptom State [PASS]). Purpose: To investigate the proportion of patients who achieved a PASS 12 to 24 months after hip arthroscopy and to determine the cutoff scores of the 2 recommended and valid patient-reported outcome measures (the subscales of the Copenhagen Hip and Groin Outcome Score [HAGOS] and the International Hip Outcome Tool—33 [iHOT-33]) for which patients are most likely to achieve PASS. Study Design: Cohort study; Level of evidence, 3. Methods: Eligible study patients were identified in the Danish Hip Arthroscopy Registry. An electronic questionnaire was used to collect data on PASS, HAGOS, and iHOT-33 12 to 24 months after surgery. PASS was measured using an anchor question. Receiver operating characteristic curve analyses were applied to identify the PASS cutoff values of HAGOS and iHOT-33 scores. Results: A total of 137 individuals (mean age at surgery, 35.4 ± 9.4 years) were included in the study at a mean follow-up of 18.5 ± 3.2 months after surgery. At follow-up, 64 individuals (46.7%; 95% CI, 38.6-55.1) reported PASS. Higher HAGOS and iHOT-33 values were observed for participants who reported PASS compared with those who did not report PASS (Cohen d ≥ 1.06; P <.001). Cutoff scores for HAGOS subscales (42.5-82.5) and iHOT-33 (67.00) showed excellent to outstanding discriminative ability in predicting PASS (area under the curve, 0.82-0.92). Conclusion: In total, 46% of individuals having hip arthroscopy for FAIS achieved PASS at 12 to 24 months of follow-up. Patients who achieved PASS had statistically significant and substantially better self-reported hip function compared with those who did not achieve PASS. Cutoff values at HAGOS subscales and iHOT-33 sho

The aims of this study were to investigate changes in selected performance measures during an off-season period, their association, and the potential role of age and previous hamstring injury in semi-professional and amateur football players. Seventy-four male players (age: 25 ± 4 years, stature: 178.0 ± 6.6 cm, body mass: 74.9 ± 8.1 kg) were assessed at the beginning and end of the off-season summer-period for sprint, change-of-direction performance and eccentric hamstring strength. Small to medium increases in sprint times were observed at 5 (d = 0.26, p = 0.057), 10 (d = 0.42, p < 0.001) and 30 m (d = 0.64, p < 0.001). Small (d = −0.23, p = 0.033) improvements were observed for COD performance, and no changes in eccentric hamstring strength (d = 0.10, p = 0.317). The changes in the outcomes were not affected by age (p = 0.449 to 0.928) or previous hamstring injury (p = 0.109 to 0.995). The impaired sprint performance was not related to changes in eccentric hamstring strength (r = −0.21 to 0.03, p = 0.213 to 0.856), instead, changes in COD performance were associated with changes in eccentric hamstring strength (r = −0.42, p = 0.008).

Background: Hamstring strain injuries are common in many sports. Following a hamstring injury, deficits in peak and explosive strength may persist after return to sport potentially affecting sprint performance. Assessment of repeated-sprint ability is recognized as an important part of the return to sport evaluation after a hamstring injury.Purpose: This purpose of this exploratory cross-sectional study was to compare sprinting performance obtained during a repeated-sprint test between football players with and without a previous hamstring strain injury.Methods: Forty-four fully active sub-elite football players, 11 with a previous hamstring strain injury during the preceding 12 months (cases; mean age, SD: 25.6 ± 4.4) and 33 demographically similar controls (mean age, SD: 23.2 ± 3.7), were included from six clubs. All players underwent a repeated-sprint test, consisting of six 30-meter maximal sprints with 90 seconds of recovery between sprints. Sprint performance was captured using high-speed video-recording and subsequently assessed by a blinded tester to calculate maximal sprint velocity, maximal horizontal force, maximal horizontal power, and mechanical effectiveness.Results: A significant between-group difference was seen in favor of players having a previous hamstring injury over 6 sprints for maximal velocity (mean difference: 0.457 m/s, 95% CI: 0.059-0.849, p = 0.025) and mechanical effectiveness (mean difference: 0.009, 95% CI: 0.001-0.016, p = 0.020).Conclusion: Repeated-sprint performance was not impaired in football players with a previous hamstring strain injury; in fact, higher mean maximal sprinting velocity and better mechanical effectiveness were found in players with compared to without a previous hamstring injury. The higher sprinting velocity, which likely increases biomechanical load on the hamstring muscles, in previously injured players may increase the risk of recurrent injuries.Level of evidence: 3b.

Hip-related pain can significantly impact quality of life, function, work capacity, physical activity and family life. Standardised measurement methods of physical capacity of relevance to young and middle-aged active adults with hip-related pain are currently not established. The aim of this consensus paper was to provide recommendations for clinical practice and research on standardised measurement methods of physical capacity in young and middle-aged active adults with hip-related pain. Four areas of importance were identified: (1) clinical measures (range of motion, muscle strength, functional impairments), (2) laboratory-based measures (biomechanics and muscle function (muscle activity, size and adiposity)), (3) physical activity, and (4) return to sport/performance. The literature was reviewed, and a summary circulated to the working group to inform discussion at the consensus meeting. The working group developed clinical and research recommendations from the literature review, which were further discussed and modified within the working group at the consensus meeting. These recommendations were then presented to all 38 International Hip-related Pain Research Network (IHiPRN) participants for further discussion, refinement and consensus voting. Therefore, the recommendations voted on were based on a combination of current evidence and expert opinion. The consensus meeting voted on 13 recommendations, six of which were clinically orientated, and seven more research specific. We recommended that clinicians working with young and middle-aged active adults with hip-related pain assess strength using objective methods of measurement, and clinically assess performance of functional tasks, including walking and running. Physical activity should be quantified using both self-reported and objective measures, and patient expectations of recovery should be quantified prior to treatment. It was recommended that return to physical activity (including sport and occupatio

There is no agreement on how to classify, define or diagnose hip-related pain-a common cause of hip and groin pain in young and middle-aged active adults. This complicates the work of clinicians and researchers. The International Hip-related Pain Research Network consensus group met in November 2018 in Zurich aiming to make recommendations on how to classify, define and diagnose hip disease in young and middle-aged active adults with hip-related pain as the main symptom. Prior to the meeting we performed a scoping review of electronic databases in June 2018 to determine the definition, epidemiology and diagnosis of hip conditions in young and middle-aged active adults presenting with hip-related pain. We developed and presented evidence-based statements for these to a panel of 37 experts for discussion and consensus agreement. Both non-musculoskeletal and serious hip pathological conditions (eg, tumours, infections, stress fractures, slipped capital femoral epiphysis), as well as competing musculoskeletal conditions (eg, lumbar spine) should be excluded when diagnosing hip-related pain in young and middle-aged active adults. The most common hip conditions in young and middle-aged active adults presenting with hip-related pain are: (1) femoroacetabular impingement (FAI) syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without a distinct osseous morphology (labral, chondral and/or ligamentum teres conditions), and that these terms are used in research and clinical practice. Clinical examination and diagnostic imaging have limited diagnostic utility; a comprehensive approach is therefore essential. A negative flexion-adduction-internal rotation test helps rule out hip-related pain although its clinical utility is limited. Anteroposterior pelvis and lateral femoral head-neck radiographs are the initial diagnostic imaging of choice-advanced imaging should be performed only when requiring additional detail of bony or soft-tissue morpho

Hip-related pain is a well-recognised complaint among active young and middle-aged active adults. People experiencing hip-related disorders commonly report pain and reduced functional capacity, including difficulties in executing activities of daily living. Patient-reported outcome measures (PROMs) are essential to accurately examine and compare the effects of different treatments on disability in those with hip pain. In November 2018, 38 researchers and clinicians working in the field of hip-related pain met in Zurich, Switzerland for the first International Hip-related Pain Research Network meeting. Prior to the meeting, evidence summaries were developed relating to four prioritised themes. This paper discusses the available evidence and consensus process from which recommendations were made regarding the appropriate use of PROMs to assess disability in young and middle-aged active adults with hip-related pain. Our process to gain consensus had five steps: (1) systematic review of systematic reviews; (2) preliminary discussion within the working group; (3) update of the more recent high-quality systematic review and examination of the psychometric properties of PROMs according to established guidelines; (4) formulation of the recommendations considering the limitations of the PROMs derived from the examination of their quality; and (5) voting and consensus. Out of 102 articles retrieved, 6 systematic reviews were selected and assessed for quality according to AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews). Two showed moderate quality. We then updated the most recent review. The updated literature search resulted in 10 additional studies that were included in the qualitative synthesis. The recommendations based on evidence summary and PROMs limitations were presented at the consensus meeting. The group makes the following recommendations: (1) the Hip and Groin Outcome Score (HAGOS) and the International Hip Outcome Tool (iHOT) instruments (long and r

This statement summarises and appraises the evidence on diagnosis, prevention and treatment of the most common lower extremity muscle injuries in sport. We systematically searched electronic databases, and included studies based on the highest available evidence. Subsequently, we evaluated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework, grading the quality of evidence from high to very low. Most clinical tests showed very low to low diagnostic effectiveness. For hamstring injury prevention, programmes that included the Nordic hamstring exercise resulted in a hamstring injury risk reduction when compared with usual care (medium to large effect size; moderate to high quality of evidence). For prevention of groin injuries, both the FIFA 11+programme and the Copenhagen adductor strengthening programme resulted in a groin injury risk reduction compared with usual care (medium effect size; low to moderate quality of evidence). For the treatment of hamstring injuries, lengthening hamstring exercises showed the fastest return to play with a lower reinjury rate compared with conventional hamstring exercises (large effect size; very low to low quality of evidence). Platelet-rich plasma had no effect on time to return-to-play and reinjury risk (trivial effect size; moderate quality of evidence) after a hamstring injury compared with placebo or rehabilitation. At this point, most outcomes for diagnosis, prevention and treatment were graded as very low to moderate quality of evidence, indicating that further high-quality research is likely to have an important impact on the confidence in the effect estimates.

The 1st International Hip-related Pain Research Network meeting discussed four prioritised themes concerning hip-related pain in young to middle-aged adults: (1) diagnosis and classification of hip-related pain; (2) patient-reported outcome measures for hip-related pain; (3) measurement of physical capacity for hip-related pain; (4) physiotherapist-led treatment for hip-related pain. Thirty-eight expert researchers and clinicians working in the field of hip-related pain attended the meeting. This manuscript relates to the theme of physiotherapist-led treatments for hip-related pain. A systematic review on the efficacy of physiotherapist-led interventions for hip-related pain (published separately) was conducted and found that strong evidence for physiotherapist-led treatments was lacking. Prior to the meeting, draft consensus recommendations for consideration in the meeting were also developed based on the systematic review. The draft consensus recommendations were presented to all of the meeting participants via email, at least 1 week prior to the meeting. At the meeting, these recommendations were discussed, revised and voted on. Six recommendations for clinical practice and five recommendations for research were included and all gained consensus. Recommendations for clinical practice were that (i) Exercise-based treatments are recommended for people with hip-related pain. (ii) Exercise-based treatment should be at least 3 months duration. (iii) Physiotherapist-led rehabilitation after hip surgery should be undertaken. (iv) Patient-reported outcome measures, measures of physical impairment and measures of psychosocial factors should be used to monitor response to treatment. (v) Physical activity (that may include sport) is recommended for people with hip-related pain. (vi) Clinicians should discuss patient expectations, use shared-decision making and provide education. Recommendations for research were (i) Reporting of exercise programmes: Exercise descriptors

Background: Previously published studies have reported injury rates ranging from 0.74 to 3.3 per 1000 h of exposure in CrossFit participants. However, the existing body of evidence is mainly based on experienced participants; therefore, the injury incidence and injury rate within novice CrossFit participants remains relatively unknown. The aim of this study wasto investigate the injury incidence and injury rate among novice participants in an eight-week CrossFit program. Methods: This survey-based prospective cohort study included CrossFit Copenhagenrsquo;s novice members who began an eight-week, free-of-charge membership period. A questionnaire was distributed at baseline and at eight-week follow-up. Information about exposure was retrieved through the online booking system. Injury incidence, defined as proportion of participants who sustained an injury, and injury rates per 1000 h of exposure were calculated. Results: Among the 168 included participants, a total of 28 injuries (14.9 were reported. The number of injured participants and total exposure time resulted in an injury rate per 1000 h of exposure of 9.5. Conclusions: Compared to the existing body of evidence, the findings in this study indicate that the risk of injuries is higher among novice participants than among experienced CrossFit participants.