Contributions of the Abductor Muscles to Rotational and Distractive Stability of the Hip in a Biomechanical Cadaveric Model

Overview

Journal Orthop J Sports Med

Specialty Orthopedics

Date 2024 Mar 6

PMID 38444567

Authors

Daniel P Lim

Lionel E Lazaro

Justin F Kyhos

Michael M Chau

Karen J Ladnier

Trevor J Nelson

Samuel A Eberlein

Michael B Banffy

Melodie F Metzger

Affiliations

Soon will be listed here.

Abstract

Background: The gluteus minimus (GMin) and gluteus medius (GMed) are important dynamic stabilizers of the hip, but quantitative data on their biomechanical roles in stabilizing the hip are currently lacking.

Purpose: To (1) establish a reproducible biomechanical cadaveric model of the hip abductor complex and (2) characterize the effects of loading the GMin and GMed on extraneous femoral rotation and distraction.

Study Design: Controlled laboratory study.

Methods: A total of 10 hemipelvises were tested in 4 muscle loading states: (1) unloaded, (2) the GMin loaded, (3) the GMed loaded, and (4) both the GMin and GMed loaded. Muscle loads were applied via cables, pulleys, and weights attached to the tendons to replicate the anatomic lines of action. Specimens were tested under internal rotation; external rotation; and axial traction forces at 0°, 15°, 30°, 60°, and 90° of hip flexion.

Results: When loaded together, the GMin and GMed reduced internal rotation motion at all hip flexion angles ( < .05) except 60° and reduced external rotation motion at all hip flexion angles ( < .05) except 0°. Likewise, when both the GMin and GMed were loaded, femoral distraction was decreased at all angles of hip flexion ( < .05).

Conclusion: The results of this study demonstrated that the GMin and GMed provide stability against rotational torques and distractive forces and that the amount of contribution depends on the degree of hip flexion.

Clinical Relevance: Improved understanding of the roles of the GMin and GMed in preventing rotational and distractive instability of the hip will better guide treatment of hip pathologies and optimize nonoperative and operative therapies.

References

Lustenberger D, Ng V, Best T, Ellis T . Efficacy of treatment of trochanteric bursitis: a systematic review. Clin J Sport Med. 2011; 21(5):447-53. PMC: 3689218. DOI: 10.1097/JSM.0b013e318221299c. View

Bogey R, Barnes L . An EMG-to-Force Processing approach for estimating in vivo hip muscle forces in normal human walking. IEEE Trans Neural Syst Rehabil Eng. 2017; 25(8):1172-1179. DOI: 10.1109/TNSRE.2016.2613021. View

Parvizi J, Leunig M, Ganz R . Femoroacetabular impingement. J Am Acad Orthop Surg. 2007; 15(9):561-70. DOI: 10.5435/00124635-200709000-00006. View

Johannsen A, Behn A, Shibata K, Ejnisman L, Thio T, Safran M . The Role of Anterior Capsular Laxity in Hip Microinstability: A Novel Biomechanical Model. Am J Sports Med. 2019; 47(5):1151-1158. DOI: 10.1177/0363546519827955. View

van Arkel R, Amis A, Cobb J, Jeffers J . The capsular ligaments provide more hip rotational restraint than the acetabular labrum and the ligamentum teres : an experimental study. Bone Joint J. 2015; 97-B(4):484-91. PMC: 4491667. DOI: 10.1302/0301-620X.97B4.34638. View

Beck M, Sledge J, Gautier E, Dora C, Ganz R . The anatomy and function of the gluteus minimus muscle. J Bone Joint Surg Br. 2000; 82(3):358-63. DOI: 10.1302/0301-620x.82b3.10356. View

Bunker T, Esler C, Leach W . Rotator-cuff tear of the hip. J Bone Joint Surg Br. 1997; 79(4):618-20. DOI: 10.1302/0301-620x.79b4.7033. View

Morosato F, Traina F, Cristofolini L . Standardization of hemipelvis alignment for in vitro biomechanical testing. J Orthop Res. 2017; 36(6):1645-1652. DOI: 10.1002/jor.23825. View

Pfirrmann C, Chung C, Theumann N, Trudell D, Resnick D . Greater trochanter of the hip: attachment of the abductor mechanism and a complex of three bursae--MR imaging and MR bursography in cadavers and MR imaging in asymptomatic volunteers. Radiology. 2001; 221(2):469-77. DOI: 10.1148/radiol.2211001634. View

10.

Flack N, Nicholson H, Woodley S . A review of the anatomy of the hip abductor muscles, gluteus medius, gluteus minimus, and tensor fascia lata. Clin Anat. 2011; 25(6):697-708. DOI: 10.1002/ca.22004. View

11.

Van Arkel R, Amis A, Jeffers J . The envelope of passive motion allowed by the capsular ligaments of the hip. J Biomech. 2015; 48(14):3803-9. PMC: 4655836. DOI: 10.1016/j.jbiomech.2015.09.002. View

12.

Delp S, Hess W, Hungerford D, Jones L . Variation of rotation moment arms with hip flexion. J Biomech. 1999; 32(5):493-501. DOI: 10.1016/s0021-9290(99)00032-9. View

13.

Boykin R, Anz A, Bushnell B, Kocher M, Stubbs A, Philippon M . Hip instability. J Am Acad Orthop Surg. 2011; 19(6):340-9. DOI: 10.5435/00124635-201106000-00004. View

14.

Davies J, Stiehl J, Davies J, Geiger P . Surgical treatment of hip abductor tendon tears. J Bone Joint Surg Am. 2013; 95(15):1420-5. DOI: 10.2106/JBJS.L.00709. View

15.

Safran M . Microinstability of the Hip-Gaining Acceptance. J Am Acad Orthop Surg. 2018; 27(1):12-22. DOI: 10.5435/JAAOS-D-17-00664. View

16.

Pennock A, Bomar J, Johnson K, Randich K, Upasani V . Nonoperative Management of Femoroacetabular Impingement: A Prospective Study. Am J Sports Med. 2018; 46(14):3415-3422. DOI: 10.1177/0363546518804805. View

17.

Han S, Alexander J, Thomas V, Choi J, Harris J, Doherty D . Does Capsular Laxity Lead to Microinstability of the Native Hip?. Am J Sports Med. 2018; 46(6):1315-1323. DOI: 10.1177/0363546518755717. View

18.

Mansell N, Rhon D, Meyer J, Slevin J, Marchant B . Arthroscopic Surgery or Physical Therapy for Patients With Femoroacetabular Impingement Syndrome: A Randomized Controlled Trial With 2-Year Follow-up. Am J Sports Med. 2018; 46(6):1306-1314. DOI: 10.1177/0363546517751912. View

19.

Ito H, Song Y, Lindsey D, Safran M, Giori N . The proximal hip joint capsule and the zona orbicularis contribute to hip joint stability in distraction. J Orthop Res. 2009; 27(8):989-95. DOI: 10.1002/jor.20852. View

20.

Byrd J . Femoroacetabular impingement in athletes: current concepts. Am J Sports Med. 2013; 42(3):737-51. DOI: 10.1177/0363546513499136. View