McMaster University

McMaster University

A stylized skeleton with a highlighted hip joint is superimposed over runners in a group.

Sports Medicine

Principal Investigators

A photo link to the bio of Dr. Femi Ayeni

Dr. Femi Ayeni
Director of the Sports Medicine Research Program

A photo link to the bio of Dr. Devin Peterson

Dr. Devin Peterson

*Please contact Nicole Simunovic (simunon@mcmaster.ca) for any student or research-related inquiries.

Current Research Initiatives

FAI Sports Research Collaboration

This collaboration will be the first of its kind in sports medicine and involve content experts from around the world to conduct high quality research for sports injuries of the hip.

FAI Systematic Review Initiative

This initiative will involve conducting comprehensive systematic reviews concerning FAI, other sports-related hip problems, and arthroscopic techniques to summarize the available evidence and inform future studies.

FIRST

FIRST logo

Using a two-arm, blinded randomized controlled trial design, we will compare arthroscopic lavage versus osteochondroplasty on FAI patient pain, function, and quality of life up to one year in patients across sites in Canada, Denmark, and Finland.

STABILITY

The aim of this study is to investigate the role of the augmentation of single bundle anatomic anterior cruciate ligament (ACL) reconstruction with or without lateral extra-articular tenodesis in individuals who are deemed as being at high risk of graft failure. Dr. Getgood at the Fowler Kennedy Sports Clinic in London, ON is the trial Principal Investigator. Dr. Devin Peterson is the local Principal Investigator for this study at McMaster University.

Background

Sports related injuries account for 30 to 40 percent of all unintentional injuries, and sports accidents are the leading cause of injury in young adults. With approximately 30 million children and adolescents participating in sports activities according to the U.S. Centers for Disease Control, the prevalence of sports injury is on the rise. Nearly 40 percent of sports injuries occur in children aged 5 to 14 years, and the severity of the injuries increase with age. High school aged individuals account for 2 million injuries that result in over 500,000 doctor visits and 30,000 hospitalizations in the United States. The prevalence is higher amongst the younger age groups as a result of immature bones, insufficient training, and overuse injuries. Sports injuries have lifelong effects on young individuals as fractures of a growth plate can interfere with skeletal growth and cause them to be unable to participate in physical activity. Sports injuries have also proven to increase the risk of fractures, arthritis, and joint degeneration in later life. In regards to research, there is need for additional research due to the lack of data on the long term effects of these injuries and the increasing prevalence of sports injuries.

Femoroacetabular Impingement

Femoroacetabular impingement (FAI) is a recently described condition that causes hip pain in the young adult. It occurs as a result of a size and shape mismatch between the femoral head and the acetabulum. With FAI, the femoral head (ball) and acetabular rim (socket) of the hip joint collide during hip flexion and rotation. This collision results in an impingement of the femur and acetabulum, and patients experience hip pain. The development of hip pain in this manner serves as an indicator for early hip damage and is often the presenting symptom. In addition, this pain can be a precursor to early hip damage such as cartilage delamination and labral tears of the hip. As the condition progresses, the resulting hip damage may lead to osteoarthritis (OA) of the hip.

The diagnosis and treatment of FAI have become one of the most popular clinical scenarios in orthopaedic surgery. The indications for surgery are increasingly being refined and include both paediatric and adult patients. Some estimates suggest that the rate of hip arthroscopy procedures will double over a 5 year span (2008-2013) and a large number of these procedures will relate to treating FAI. One can assume a significant increase in health care costs associated with this increase in treatment.

The current evidence for the management of FAI is limited to retrospective reviews or case series. Recent systematic reviews of the English literature have highlighted that the lack of level I or II evidence continues to limit the progression of FAI management. To date, no prospective randomised controlled trial (RCT) has been conducted to evaluate the treatment effect of surgical intervention for FAI.

Given the rarity of sports medicine surgeons who evaluate and treat FAI, we are moving to establish the first international FAI collaborative to allow for larger, more generalizable, and high quality studies to be conducted on a global scale. We held the first FAI Symposium at McMaster University in May 2013. This meeting brought together the foremost experts in sports medicine treating FAI. The meeting fostered important preliminary discussion regarding current practices and challenges with a focus on future research initiatives and establishing a collaborative. This collaborative is the first of its kind and will further McMaster’s reputation as a leader in clinical research.

Anterior Cruciate Ligament Reconstruction

The aim of anterior cruciate ligament (ACL) reconstruction is to regain functional stability of the knee following ACL injury, allowing patients to return to their pre-injury level of activity. The reconstruction procedure has evolved significantly since the early 1900’s, when the first ACL reconstruction was performed. Although the techniques have changed, the goal of the surgery remains the same. A large volume of literature has been published examining the results of ACL reconstruction. Most of these are case series, some including the results of ACL reconstructions with long term follow up (up to 15 years), which have reported satisfactory results. However, a more detailed analysis of much of the reported literature reveals several issues.

The goal of providing a rotationally stable knee following ACL reconstruction remains difficult to achieve. It is hypothesized that poor rotational control, and hence a positive pivot shift, may predispose to future graft failure and need for revision surgery. This is particularly problematic in young patients returning to pivoting sport, who have been shown to be at a much higher risk of early graft failure. A surgical procedure which addresses rotational control is therefore of utmost importance when treating the ACL deficient knee.

The specific objectives of the orthopaedic sports medicine theme are:

  • To establish the first international collaborative in the field of orthopaedic sports medicine.
  • To conduct comprehensive systematic reviews concerning FAI, other sports-related hip problems, and arthroscopic techniques to summarize the available evidence and inform future studies.
  • To determine the efficacy of surgical treatment for FAI.
  • To investigate optimal surgical mehtods for ACL reconstruction.

Recent Publications

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  • Knee Surg Sports Traumatol Arthrosc. 2013 Sep 26. [Epub ahead of print]

    A painful squat test provides limited diagnostic utility in CAM-type femoroacetabular impingement.

  • Knee Surg Sports Traumatol Arthrosc. 2013 Sep 21. [Epub ahead of print]

    Alpha angle correction in femoroacetabular impingement.

  • Knee Surg Sports Traumatol Arthrosc. 2013 Jul 11. [Epub ahead of print]

    Femoroacetabular impingement in elite ice hockey players.

  • Knee Surg Sports Troumatol Arthrosc. 2013; May 17. [Epub ahead of print]

    Surgical management of osteochondritis dessecans of the knee in the paediatric population: a systematic review addressing surgical techniques

  • Knee Surg Sports Traumatol Arthrosc. 2013;21:415-9.

    Sources and quality of literature addressing femoroacetabular impingement.

  • Arthroscopy. 2013;29:942-8.

    Surgical management of internal snapping hip syndrome: a systematic review evaluating open and arthroscopic approaches.

  • Arthroscopy. 2013;29:780-7.

    Consistency of reported outcomes after arthroscopic management of femoroacetabular impingement.

  • Indian J Orthop. 2013 Mar;47(2):168-73.

    Thromoboprophylaxis in routine arthroscopy of knee.

  • J Pediatr Orthop. 2013 Apr-May;33(3):227-31.

    The association between avulsions of the reflected head of the rectus femoris and labral tears: a retrospective study.

  • BMC Musculoskelet Disord. 2013 Feb 25;14:70.

    Radiographic union score for hip substantially improves agreement between surgeons and radiologists.

  • Knee Surg Sports Traumatol Arthrosc. 2013; Jul;21(7):1676-83.

    Surgical indications for treatment for femoroacetabular impingement with surgical hip dislocation.

  • Arthroscopy. 2012 Oct;28(10):1567-76.

    Return to preinjury activity levels after surgical management of femoroacetabular impingement in athletes

  • Arthroscopy. 2012 Aug; 28(8):1170-9.

    Surgical indications for arthroscopic management of femoracetabular impingement.

  • J Bone Joint Surg Am. 2012 Feb 15;94(4):298-307

    Efficacy of autologous platelet-rich plasma use for orthopaedic indications: a meta-analysis.

  • Knee Surg Sports Traumatol Arthrosc. 2012 Apr;20(4):767-77.

    Pivot shift as an outcome measure for ACL reconstruction: a systematic review.

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    Efficacy of Hip Arthroscopy for the Management of Septic Arthritis: A Systematic Review

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    Femoro-acetabular impingement clinical research: is a composite outcome the answer?

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    Hip arthroscopy in the setting of hip arthroplasty

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    Patients' values and preferences of the expected efficacy of hip arthroscopy for osteoarthritis: a protocol for a multinational structured interview-based study combined with a randomised survey on the optimal amount of information to elicit preferences

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    Femoroacetabular impingement in skeletally immature patients: a systematic review examining indications, outcomes, and complications of open and arthroscopic treatment

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    Inter- and intra-observer agreement of femoroacetabular impingement (FAI) parameters comparing plain radiographs and advanced, 3D computed tomographic (CT)-generated hip models in a surgical patient cohort

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    YouTube as an information source for femoroacetabular impingement: a systematic review of video content

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    Global discrepancies in the diagnosis, surgical management, and investigation of femoroacetabular impingement

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    Gait and lower extremity kinematic analysis as an outcome measure after femoroacetabular impingement surgery

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    Arthroscopic surgery for synovial chondromatosis of the hip: a systematic review of rates and predisposing factors for recurrence

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    Relationship between the alpha and beta angles in diagnosing CAM-type femoroacetabular impingement on frog-leg lateral radiographs

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    Trends in reporting of mechanisms and incidence of hip injuries in males playing minor ice hockey in Canada: a cross-sectional study

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    Extra-articular hip impingement: a systematic review examining operative treatment of psoas, subspine, ischiofemoral, and greater trochanteric/pelvic impingement

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    The etiology of femoroacetabular impingement: what we know and what we don't

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    Surgical management of labral tears during femoroacetabular impingement surgery: a systematic review

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    Results of the PeRception of femOroaCetabular impingEment by Surgeons Survey (PROCESS)

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    Current state-of-the-art of hip arthroscopy

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    Pre-operative intra-articular hip injection as a predictor of short-term outcome following arthroscopic management of femoroacetabular impingement

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    The learning curve for hip arthroscopy: a systematic review

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    The hip labrum reconstruction: indications and outcomes--a systematic review

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    Complications following hip arthroscopy: a retrospective review of the McMaster experience (2009-2012)

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    The structure and function of the anterolateral ligament of the knee: a systematic review

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    Prevalence of vitamin D inadequacy in athletes: a systematic-review and meta-analysis

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