BACKGROUND/ PURPOSE: The number of hip arthroscopies (HAs) performed in the United States is increasing exponentially. Previous authors have shown improvements in short- and mid-term functional outcomes after HA. Despite established overall improvements, functional and objective impairments may persist. In particular, preliminary work demonstrates differences in hip strength between patients who undergo HA when compared to healthy controls at 12- and 24-months post-operative. The purpose of this clinical commentary is to highlight the persistent hip muscle strength and neuromuscular deficits that occur after HA, as well as propose the utilization of neuromuscular electrical stimulation (NMES) as an adjunct to strengthening exercises in early post-operative rehabilitation to address deficits. DESCRIPTION OF TOPIC: Arthrogenic muscle inhibition (AMI), drives neuromuscular dysfunction and has been shown to occur in peripheral joints. The knee and hip have historically benefited from NMES to aid in improved muscular function, such as in those who have undergone anterior cruciate ligament reconstruction, total hip or knee arthroplasties. Improving muscular strength is a hallmark component of rehabilitation after HA, however, current post-operative HA rehabilitation protocols do not include NMES as a standard treatment intervention. Therapeutic intervention strategies to target muscular inhibition after HA, in particular with the goal to address neural reflex inhibition, have not been thoroughly investigated. This absence of understanding of this important problem yields a critical gap in the treatment of post-operative muscular deficits in patients after HA. DISCUSSION: The consequence of hip muscle inhibition is likely to include deficits in strength and function, similar to that seen in other muscular groups. Filling the void of current knowledge with regard to muscle inhibition and strength deficits after hip arthroscopy is critical to establish standardized post-operative rehabilitation protocols, as well as to provide targeted training to address muscular inhibition. Ultimately, these strategies could produce improved outcomes guided by robust evidence-based protocols. LEVEL OF EVIDENCE: 5.
BACKGROUND/ PURPOSE: The number of hip arthroscopies (HAs) performed in the United States is increasing exponentially. Previous authors have shown improvements in short- and mid-term functional outcomes after HA. Despite established overall improvements, functional and objective impairments may persist. In particular, preliminary work demonstrates differences in hip strength between patients who undergo HA when compared to healthy controls at 12- and 24-months post-operative. The purpose of this clinical commentary is to highlight the persistent hip muscle strength and neuromuscular deficits that occur after HA, as well as propose the utilization of neuromuscular electrical stimulation (NMES) as an adjunct to strengthening exercises in early post-operative rehabilitation to address deficits. DESCRIPTION OF TOPIC: Arthrogenic muscle inhibition (AMI), drives neuromuscular dysfunction and has been shown to occur in peripheral joints. The knee and hip have historically benefited from NMES to aid in improved muscular function, such as in those who have undergone anterior cruciate ligament reconstruction, total hip or knee arthroplasties. Improving muscular strength is a hallmark component of rehabilitation after HA, however, current post-operative HA rehabilitation protocols do not include NMES as a standard treatment intervention. Therapeutic intervention strategies to target muscular inhibition after HA, in particular with the goal to address neural reflex inhibition, have not been thoroughly investigated. This absence of understanding of this important problem yields a critical gap in the treatment of post-operative muscular deficits in patients after HA. DISCUSSION: The consequence of hip muscle inhibition is likely to include deficits in strength and function, similar to that seen in other muscular groups. Filling the void of current knowledge with regard to muscle inhibition and strength deficits after hip arthroscopy is critical to establish standardized post-operative rehabilitation protocols, as well as to provide targeted training to address muscular inhibition. Ultimately, these strategies could produce improved outcomes guided by robust evidence-based protocols. LEVEL OF EVIDENCE: 5.
Authors: N C Casartelli; N A Maffiuletti; J F Item-Glatthorn; S Staehli; M Bizzini; F M Impellizzeri; M Leunig Journal: Osteoarthritis Cartilage Date: 2011-04-12 Impact factor: 6.576
Authors: Jeffrey J Nepple; Peter Goljan; Karen K Briggs; Sean E Garvey; Mark Ryan; Marc J Philippon Journal: Arthroscopy Date: 2015-06-20 Impact factor: 4.772
Authors: Stephanie C Petterson; Ryan L Mizner; Jennifer E Stevens; Leo Raisis; Alex Bodenstab; William Newcomb; Lynn Snyder-Mackler Journal: Arthritis Rheum Date: 2009-02-15