Highlights
- •The lateral band of the iliofemoral shows larger strains than the medial band.
- •The latero-distal portions of the lateral band show large strains during the test.
- •The test loosened the medial band in end-range of motion.
Abstract
Background
Flexion-abduction-external-rotation (FABER) test is one of the most used tests during
the clinical assessment of the hip joint. The limited range of motions reached could
be due to iliofemoral ligament tightness, but no study has assessed capsular ligament
strain during this test. The main objective of this study is to report strains within
the iliofemoral ligament during the FABER test using a segmental approach.
Methods
9 hips were harvested, and all muscles were removed. Hemispherical markers (∅ 2.6 mm)
were glued on the lateral and medial borders of both the medial and lateral iliofemoral
bands, separating each border into proximal, mid, and distal portions. The lower limb
was placed in a FABER test position. A laser scanner allowed to digitize the 3D surface
of the capsule. A Kruskal-Wallis test was performed to assess the effect of ligaments,
borders, and portions.
Findings
The lateral band of the iliofemoral ligament showed greater strains (14.6 ± 11.4%)
compared to the medial band (−8.7 ± 14.2%) (p < 0.001). The greatest strains were observed in the distal portion of the lateral
border of the lateral band (51.1 ± 21.5%). A decrease in strain was observed in the
mid-portion of the medial border of the medial iliofemoral ligament (−27.9 ± 8.9%).
Interpretation
The FABER test is used to assess pain at the hip. Our results show that the limited
range of motion at the hip during this test might be caused by increased strains in
the lateral band. These results demonstrate that a limitation of joint range of motion
during the FABER could be due to an excessive tension of the lateral band of the iliofemoral
ligament.
Keywords
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References
- The reliability of Faber test hip range of motion measurements.Int. J. Sports Phys. Ther. 2016; 11: 1101-1105
- Textbook of radiographic positioning and related Anatomy-E-Book. Elsevier Health Sciences, 2013
- Hip capsular strain varies between ligaments dependent on both hip position- and applied rotational force.Knee Surg. Sports Traumatol. Arthrosc. 2020; 28: 3393
- Physical Rehabilitation-E-Book: Evidence-Based Examination, Evaluation, and Intervention.Elsevier Health Sciences, 2007
- New aspects of the morphology and function of the human hip joint ligaments.Am. J. Anat. 1991; 192: 1-13
- Regional material properties of the human hip joint capsule ligaments.J. Orthop. Res. 2001; 19: 359-364
- Evaluation of stretching position by measurement of strain on the ilio-femoral ligaments: an in vitro simulation using trans-lumbar cadaver specimens.Man. Ther. 2009; 14: 427-432
- Ligament strain on the iliofemoral, pubofemoral, and ischiofemoral ligaments in cadaver specimens: biomechanical measurement and anatomical observation.Clin. Anat. 2014; 27: 1068-1075
- The proximal hip joint capsule and the zona orbicularis contribute to hip joint stability in distraction.J. Orthop. Res. 2009; 27: 989-995
- Collagen type III predominance in newborns with congenital dislocation of the hip.Acta Orthop. Scand. 1986; 57: 362-365
- The Physiology of the Joints.Vol. 2. The Lower Limb, 2019
- Range of motion in anterior femoroacetabular impingement.Clin. Orthop. Relat. Res. 2007; 458: 117-124
- What performance characteristics determine elite versus nonelite athletes in the same sport?.Sports Health. 2013; 5: 542-547
- The function of the hip capsular ligaments: a quantitative report.Arthroscopy. 2008; 24: 188-195
- The pattern and technique in the clinical evaluation of the adult hip: the common physical examination tests of hip specialists.Arthroscopy. 2010; 26: 161-172
- Function of the ligamentum teres in limiting hip rotation: a cadaveric study.Arthroscopy. 2014; 30: 1085-1091
- Variations in acetabular anatomy with reference to total hip replacement.J. Bone Joint Surg. (Br.). 2008; 90: 308-313
- Kinesiology of the Musculoskeletal System-e-Book: Foundations for Rehabilitation.Elsevier Health Sciences, 2016
- Idiopathic osteo-arthritis of the hip.Ann. Rheum. Dis. 1962; 21: 31-39
- Prevalence of increased alpha angles as a measure of cam-type femoroacetabular impingement in youth ice hockey players.Am. J. Sports Med. 2013; 41: 1357-1362
- Arthroscopic hip labral repair.Arthrosc. Tech. 2013; 2: e73-e76
- Foundations of Clinical Research: Applications to Practice.vol. 892. Pearson/Prentice Hall Upper Saddle River, NJ2009
- Is the hip capsule thicker in diseased hips?.Bone Joint Res. 2016; 5: 586-593
- The joint capsule: structure, composition, ageing and disease.J. Anat. 1994; 184: 503-509
- Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis.Br. J. Sports Med. 2015; 49: 811
- Tensile properties of the hip joint ligaments are largely variable and age-dependent - an in-vitro analysis in an age range of 14-93 years.J. Biomech. 2016; 49: 3437-3443
- Influence of standardized procedures on the reliability of hip clinical assessment.J. Manipulative Physiol. Ther. 2021; 44: 137-145
- Diagnostics of femoroacetabular impingement and labral pathology of the hip: a systematic review of the accuracy and validity of physical tests.Arthroscopy. 2012; 28: 860-871
- Hip joint pathology: relationship between patient history, physical tests, and arthroscopy findings in clinical practice.Scand. J. Med. Sci. Sports. 2017; 27: 342-350
- Acetabular and femoral anteversion: relationship with osteoarthritis of the hip.J. Bone Joint Surg. Am. 1999; 81: 1747-1770
- Positive FABER distance test is associated with higher alpha angle in symptomatic patients.Knee Surg. Sports Traumatol. Arthrosc. 2019; 27: 3158-3161
- New insight into the iliofemoral ligament based on the anatomical study of the hip joint capsule.J. Anat. 2020; 236: 946-953
- In vivo magnetic resonance imaging study of the hip joint capsule in the flexion abduction external rotation position.Sci. Rep. 2022; 12: 6656
- Low back pain in professional golfers: the role of associated hip and low back range-of-motion deficits.Am. J. Sports Med. 2004; 32: 494-497
- Capsular ligaments of the hip: anatomic, histologic, and positional study in cadaveric specimens with MR arthrography.Radiology. 2012; 263: 189-198
- Hip capsule dimensions in patients with femoroacetabular impingement: a pilot study.Clin. Orthop. Relat. Res. 2012; 470: 3306-3312
- Evaluation of the patient with hip pain.Am. Fam. Physician. 2014; 89: 27-34
- ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion--part I: ankle, hip, and spine.Int. Soc. Biomech. 2002; 35: 543-548
- Hip capsular thickness correlates with range of motion limitations in femoroacetabular impingement.Knee Surg. Sports Traumatol. Arthrosc. 2018; 26: 3178-3187
Article info
Publication history
Published online: February 02, 2023
Accepted:
January 31,
2023
Received:
September 14,
2022
Identification
Copyright
© 2023 Elsevier Ltd. All rights reserved.
