| 1. |
- Lindman, Ida, et al.
(author)
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Improvements After Arthroscopic Treatment for Femoroacetabular Impingement Syndrome in High-Level Ice Hockey Players : 2-Year Outcomes by Player Position
- 2021
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In: Orthopaedic Journal of Sports Medicine. - : SAGE Publications. - 2325-9671. ; 9:3
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Journal article (peer-reviewed)abstract
- Background: Ice hockey players often undergo arthroscopic treatment for femoroacetabular impingement syndrome (FAIS); however, only a few studies have reported postoperative patient-reported outcomes. It has been debated whether player position is related to FAIS. Purpose: To evaluate the change in patient-reported outcome measures (PROMs) in high-level ice hockey players from presurgery to 2 years after arthroscopic treatment for FAIS. The secondary aim was to evaluate differences in outcomes among player positions and whether stick handedness is related to the side of the symptomatic hip. Study Design: Case series; Level of evidence, 4. Methods: Ice hockey players undergoing treatment for FAIS between 2011 and 2019 were prospectively included. Preoperative and 2-year follow-up scores were collected for the following PROMs: HAGOS (Copenhagen Hip and Groin Outcome Score), iHOT-12 (12-item International Hip Outcome Tool), EQ-5D (EuroQol–5 Dimensions) and EQ-VAS (EuroQol–Visual Analog Scale), Hip Sports Activity Scale, and visual analog scale for overall hip function. Player position and stick handedness were collected from public sources. Preoperative and follow-up outcomes were compared for the entire cohort and among player positions. Results: The cohort included 172 ice hockey players with a mean age of 28 years, a mean body mass index of 25.6, and a mean symptom duration of 46.3 months. In the 120 players with 2-year follow-up data, there was significant improvement in all PROMs as compared with presurgery: HAGOS subscales (symptoms, 47.5 vs 68.0; pain, 57.0 vs 75.8; activities of daily living, 62.5 vs 81.0; sports, 40.0 vs 64.7; physical activity, 30.9 vs 57.2; quality of life, 32.5 vs 57.8), iHOT-12 (45.2 vs 66.7), EQ-5D (0.59 vs 0.75), EQ-VAS (68.3 vs 73.2), and visual analog scale for overall hip function (49.6 vs 69.2) (P <.0001 for all). At 2-year follow-up, 83% reported satisfaction with the procedure. There was no difference in the improvement in PROMs among player positions. Further, there was no significant relationship between stick handedness and side of symptomatic hip; however, because of the number of bilateral procedures and large number of left-handed shooters, no conclusions could be drawn. Conclusion: High-level ice hockey players undergoing arthroscopic treatment for FAIS reported improvements in PROMs 2 years after surgery, regardless of player position.
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| 2. |
- Wörner, Tobias, et al.
(author)
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Hip and groin function and strength in male ice hockey players with and without hip and groin problems in the previous season- a prospective cohort study
- 2021
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In: Physical Therapy in Sport. - : Elsevier BV. - 1466-853X. ; 52, s. 263-271
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Journal article (peer-reviewed)abstract
- Objective: To describe and compare hip and groin strength and function of male ice hockey players over one season in players with and without hip and groin problems in the previous season. Design: Prospective cohort study. Setting: Swedish male ice hockey. Participants: We followed 193 players from 10 teams during the 2017/2018 season. Main outcome measures: Hip adduction and abduction strength, 5 s squeeze test (5SST), and self-reported hip and groin function (Hip and Groin Outcome Score). Changes over the season and differences between players with and without problems in the previous season were analyzed by linear mixed models. Results: Adduction strength decreased slightly from pre-to mid-season and abduction strength increased slightly over the full season. However, self-reported function or pain did not change. Players with hip and groin problems in the previous season had significantly worse self-reported function, and more groin pain during the 5SST compared to players without. Strength measurments did not differ between groups. Conclusions: Hip muscle strength, groin pain, and self-reported function appear to remain stable throughout the season in male ice hockey players. Remaining impairments in players with problems in the previous season suggest that function does not recover by ice hockey participation alone.
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| 3. |
- Wörner, Tobias, et al.
(author)
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Psychological readiness is related to return to sport following hip arthroscopy and can be assessed by the Hip-Return to Sport after Injury scale (Hip-RSI)
- 2021
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In: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 1433-7347 .- 0942-2056. ; 29, s. 1353-1361
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Journal article (peer-reviewed)abstract
- PURPOSE: Psychological readiness may play an important role in the return to sport (RTS) process following hip arthroscopy (HA), but there are limited tools for the measurement of this construct. The aim of this study was to modify the Swedish version of the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale for use in HA patients and evaluate its psychometric properties.METHODS: Content validity of a modified version of the Swedish ACL-RSI (Hip-RSI) was evaluated through 127 HA patient responses and relevance ratings by an expert panel (35 patients, 9 surgeons, 11 physiotherapists). Items with low relevance were omitted. Construct validity was assessed by the association of Hip-RSI scores to hip-related sporting function (HAGOS sport) and quality of life (iHOT12). Hip-RSI scores were compared between patients who had not returned, or returned to sport participation, previous sport, and sport performance.RESULTS: Item reduction resulted in a 6-item Hip-RSI scale with adequate content validity for the target population. Construct validity of the full and the item-reduced scale was demonstrated by correlation to HAGOS sport and iHOT12 (r 0.631-0.752). A gradient increase in Hip-RSI scores was found for patients returning to sport participation, previous sport, and sport performance.CONCLUSION: The short version of the Swedish Hip-RSI is a valid tool for the assessment of psychological readiness to RTS and can be recommended to be used in HA patients. Higher psychological readiness to RTS, assessed by the Hip-RSI, is found with increasing levels of return to sports following HA.LEVEL OF EVIDENCE: III.
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| 4. |
- Wörner, Tobias, et al.
(author)
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Rapid decline of yearly number of hip arthroscopies in Sweden: a retrospective time series of 6,105 hip arthroscopies based on a national patient data register
- 2021
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In: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 92:5, s. 562-567
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Journal article (peer-reviewed)abstract
- Background and purpose - Hip arthroscopies (HAs) have increased exponentially worldwide and are expected to continue rising. We describe time trends in HA procedures in Sweden (10 million inhabitants) between 2006 and 2018 with a focus on procedure rates, surgical procedures, and patient demographics such as age and sex distribution. Patients and methods - We retrospectively collected data from the Swedish National Patient Register (NPR) for all surgeries including surgical treatment codes considered relevant for HA from 2006 to 2018. Surgical codes were validated through a multiple-step procedure and classified into femoroacetabular impingement syndrome (FAIS) related or non-FAIS related procedure. Frequencies, sex differences, and time trends of surgical procedures and patient demographics are presented. Results - After validation of HA codes, 6,105 individual procedures, performed in 4,924 patients (mean age 34 years [SD 12]) were confirmed HAs and included in the analysis. Yearly HA procedure rates increased from 15 in 2006 to 884 in 2014, after which a steady decline was observed with 469 procedures in 2018. The majority (65%) of HAs was performed in males. Male patients were younger, and surgeries on males more frequently included an FAIS-related procedure. Interpretation - Similar to previous studies in other parts of the world, we found dramatic increases in HA procedures in Sweden between 2006 and 2014. Contrary to existing predictions, HA rates declined steadily after 2014, which may be explained by more restrictive patient selection based on refined surgical indications, increasing evidence, and clinical experience with the procedure.
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| 5. |
- Wörner, Tobias, et al.
(author)
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Return to sport after hip arthroscopy : are you ready?
- 2021
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In: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 29:5, s. 1349-1352
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Journal article (other academic/artistic)
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| 6. |
- Wörner, Tobias
(author)
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Return to Sport after Hip Arthroscopy. Perspectives on a journey with many destinations.
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Femoroacetabular impingement (FAI) syndrome is often treated with hip arthroscopy (HA) with the goal of enabling return to sport. While the number of HAs has been rising, little is known about the rehabilitation process or about outcomes related to return to sport (RTS) following the procedure. The overarching aim of this thesis wasto describe the rehabilitation process following HA in Scandinavia and to investigate RTS and factors potentially associated with it.We described current rehabilitation strategies following HA in Scandinavia by surveying specialized clinicians (62 physiotherapists and 28 surgeons) in Denmark, Norway, and Sweden. We then cross-sectionally described RTS rates in 127 patients 3–39 months following HA for FAI syndrome, defining RTS on a continuum according to consensus terminology. Subsequently, we measured patient-reported and clinically measured hip function in 33 patients 6–10 months following HA, comparing these patients with a healthy control group in a cross-sectional study. Finally, we modified and validated a patient-reported outcome measure, i.e., Hip—Return to Sport after Injury (Hip-RSI) scale, to assess psychological readiness to RTS in HA patients.Clinicians rated structured rehabilitation as very important and reported similar expectations regarding the rehabilitation timeline during the first three months following HA for FAI syndrome. Approaching RTS, clinicians’ expectations increasingly varied, with surgeons being more optimistic than physiotherapists. Nine out of ten patients returned to some sort of sport or physical activity, while half returned to their previous sport and only one out of five returned to their previous performance level. During the time when patients could be expected to RTS, they displayed impairments in self-reported hip function and in measures related to hip mobility. The Hip-RSIdisplayed adequate psychometric properties to be recommended as a valid tool in the assessment of psychological readiness in HA patients.In the absence of evidence-based rehabilitation protocols following HA, a description of current clinical practice may serve as a first step toward establishing clinical consensus, also highlighting areas for future research. Our description of RTS rates may be used to create realistic patient expectations regarding RTS. Impairments in hipmobility and mobility-related performance may influence but cannot fully explain observed RTS rates and impairments in self-reported function. Psychological readiness to RTS may play an important role in the RTS process following HA and can now be assessed and investigated further with the help of the Hip-RSI.
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| 7. |
- Wörner, Tobias, et al.
(author)
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The Perceived Demands of Ice Hockey Goaltending Movements on the Hip and Groin Region : An Elite Coach and Player Perspective
- 2021
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In: Orthopaedic Journal of Sports Medicine. - : SAGE Publications. - 2325-9671. ; 9:11
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Journal article (peer-reviewed)abstract
- Background: Many ice hockey goaltending techniques force hip joints and groin muscles into extreme ranges of motion, which may increase the risk of hip and groin problems. Purpose: To explore how elite goaltenders and goaltending coaches perceive the demands of common goaltending techniques on the hip and groin region. We further explored differences in perception between goaltenders and their coaches as well as between junior (age <20 years) and senior (age ≥20 years) goaltenders. Study Design: Cross-sectional survey. Methods: We developed a model to categorize common ice hockey goaltending techniques into quantifiable units and invited elite goaltenders and coaches in Sweden to complete an online survey. Participants were asked to rate the perceived demands of each technique on the hip and groin using a Likert scale (not at all, slightly, somewhat, very, or extremely demanding). Using the chi-square test, the proportion of participants perceiving each technique as very or extremely demanding were compared between goaltenders and coaches as well as between senior and junior goaltenders. Results: We received responses from 132 goaltenders and 43 coaches. The stances most frequently perceived as very or extremely demanding were the reverse vertical horizontal post-play (40%) and the butterfly save (25%). Among transitions, movements into the post were most frequently rated as very or extremely demanding (11%–40%). Several techniques were perceived as demanding by a larger share of coaches than goaltenders (difference, 13%–46%; P <.001–.028) and a larger share of senior versus junior goaltenders (difference, 12%–20%; P =.13–.18). Conclusion: The post-play and the butterfly were the goaltending techniques most frequently perceived as demanding, and more coaches than goaltenders percieved these techniques demanding. The results of this study may inform injury prevention efforts for ice hockey goaltending.
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