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Tensile Strain in the Anterior Part of the Acetabular Labrum During Provocative Maneuvering of the Normal Hip
Christopher J. Dy, MD, MSPH1; Matthew T. Thompson, MS1; Matthew J. Crawford, DO, PhD2; Jerry W. Alexander, BS1; Joseph C. McCarthy, MD3; Philip C. Noble, PhD1
1 6550 Fannin, Smith Tower, Suite 2512, Houston, TX 77030. E-mail address for P.C. Noble: pnoble@bcm.edu
2 4204 Range View Cove, Austin, TX 78746
3 125 Parker Hill, Suite 575, Boston, MA 02120
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Institute of Orthopedic Research and Education and the John S. Dunn Foundation. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Institute of Orthopedic Research and Education and The Methodist Hospital, Houston, Texas

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Jul 01;90(7):1464-1472. doi: 10.2106/JBJS.G.00467
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Background: Injury of the acetabular labrum is a well recognized cause of hip pain in the young, active patient. The exact mechanism of these injuries remains a subject of speculation, although femoroacetabular impingement and twisting maneuvers have both been proposed as critical factors. We examined the hypothesis that torsional maneuvers of the morphologically normal hip joint generate mechanical strain within the acetabular labrum, particularly in areas that are prone to injury.

Methods: Seven human cadaver specimens were loaded during five separate maneuvers with external rotation or abduction torques applied to the hip in neutral alignment and in moderate flexion or extension. Tensile strain within the acetabular labrum was measured with use of the technique of roentgen stereophotogrammetric analysis.

Results: Substantial tensile strains were generated within the labrum during each of the loading maneuvers, with no significant difference in strain being noted between the maneuvers. Maximum strain in the anterior part of the labrum averaged 13.6% ± 7.8% in the axial direction and 8.4% ± 3.0% in the circumferential direction. The highest mean and maximum strain values were found at the two o'clock position of the labrum, with the highest strain concentration at the bone-labrum interface.

Conclusions: External rotation and abduction maneuvers of the morphologically normal human hip joint in moderate flexion or extension can generate substantial tensile strains in the anterior part of the acetabular labrum. This finding supports the hypothesis that injury to the anterior part of the labrum may occur from recurrent twisting or pivoting maneuvers of the hip joint in moderate flexion or extension without femoroacetabular impingement.

Clinical Relevance: The substantial amounts of tensile strain generated during loading of the morphologically normal hip are indicative of a mechanical process that may accelerate the onset of degenerative disease.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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