{"id":475,"date":"2020-05-29T13:49:21","date_gmt":"2020-05-29T11:49:21","guid":{"rendered":"http:\/\/sipal.org\/?p=475"},"modified":"2020-07-03T12:43:04","modified_gmt":"2020-07-03T10:43:04","slug":"sindrome-femoroacetabolare-il-conflitto-che-proibisce-lo-stretching-e-gli-esercizi-di-mobilita-articolare-dellanca","status":"publish","type":"post","link":"https:\/\/sipal.org\/index.php\/2020\/05\/29\/sindrome-femoroacetabolare-il-conflitto-che-proibisce-lo-stretching-e-gli-esercizi-di-mobilita-articolare-dellanca\/","title":{"rendered":"Conflitto femoroacetabolare: proibito lo stretching dell’anca."},"content":{"rendered":"\n
\"\"<\/figure><\/div>\n\n\n\n

Esasperare lo stretching aggrava l’insulto meccanico.<\/h3>\n\n\n\n

L\u2019esordio del conflitto femoroacetabolare a volte \u00e8 rappresentato da lieve coxalgia nei movimenti di flessione dell\u2019anca ai massimi gradi, come quando si portano le ginocchia al petto, oppure, negli sport di combattimento, quando si esegue una tecnica di calcio alto. Segue prima una perdita della fluidit\u00e0 dei movimenti dell\u2019anca, poi una progressiva diminuzione dell\u2019ampiezza del movimento articolare, specie in flessione e intrarotazione. Inconsapevolmente si accorcia il passo nella corsa. Il dolore pu\u00f2 diventare acuto compiendo certi movimenti.<\/p>\n\n\n\n

Ne soffrono spesso sportivi incalliti, giovani e meno giovani, in genere agonisti in discipline che comportano repentine sollecitazioni dell\u2019anca, in massima flessione o abduzione, o contro resistenza: grandi campioni dello sport dell\u2019hockey su ghiaccio, del calcio, e del tennis in particolare, ne hanno accusata l\u2019insorgenza.<\/p>\n\n\n\n

Nel 1935, Smith-Petersen1<\/sup> per primo, riconobbe e descrisse una rarissima anomalia dei rapporti del collo femorale con l\u2019acetabolo che determinava un impatto del collo femorale sul margine anteriore dell\u2019acetabolo. <\/p>\n\n\n\n

Quella anomalia, oggi la si pu\u00f2 individuare nel conflitto femoroacetabolare (femoral acetabolar impingement \u2013 FAI): il risultato di un\u2019incongruenza tra l\u2019acetabolo e la giunzione testa-collo del femore, che determina una collisione secondaria e una lesione delle superfici articolari dell\u2019articolazione coxofemorale.<\/p>\n\n\n\n

<\/p>\n\n\n\n

Patogenesi e aspetti clinici<\/h2>\n\n\n\n

Nella patogenesi del conflitto possono essere distinte tre deformit\u00e0 predisponenti: una dell\u2019acetabolo (la deformit\u00e0 tipo \u201ctenaglia\u201d – pincer-type), l\u2019altra dell\u2019estremit\u00e0 prossimale del femore (la deformit\u00e0 \u201ca camma\u201d o a impugnatura di pistola – cam-type) e una forma mista nella quale si identificano i caratteri delle altre due deformit\u00e02<\/sup>. La lesione si pu\u00f2 aggravare progressivamente, in seguito ai continui microtraumi provocati dallo stesso movimento dei capi articolari, in particolare quando i movimenti sono eseguiti ai massimi gradi di flessione o intrarotazione.<\/p>\n\n\n\n

Pregresse lesioni o micro lesioni, anche asintomatiche del cercine acetabolare, e ripetitive sollecitazioni muscoloscheletriche impatto simili, subite dagli atleti durante l\u2019et\u00e0 dell\u2019accrescimento, sono fattori chiamati in causa nella patogenesi del conflitto femoroacetabolare 3,4<\/sup>.<\/p>\n\n\n\n

La diagnosi \u00e8 difficoltosa in quanto anomalie simili alle deformit\u00e0 menzionate possono essere riscontrate con l\u2019esame radiografico in soggetti completamente asintomatici5,6<\/sup>: il consulto di un medico specialista con esperienza nel campo delle malattie sportive dell\u2019apparato muscoloscheletrico \u00e8 pertanto indispensabile.<\/p>\n\n\n\n

Controproducente risulta esasperare lo stretching e gli esercizi di mobilit\u00e0 articolare a dispetto del dolore, nel vano tentativo di recuperare la mobilit\u00e0 articolare dell\u2019anca: l\u2019insulto meccanico che ne deriva aumenta quindi la reazione infiammatoria dei tessuti molli ed aggrava il danno articolare. <\/p>\n\n\n\n

Sono possibili terapie conservative con protocolli fisioterapici personalizzati7<\/sup> e terapie chirurgiche: a breve termine la terapia chirurgica in artroscopia risulterebbe quindi pi\u00f9 efficace bench\u00e9 i suoi vantaggi a lungo termine siano ben lungi dall\u2019essere appurati8<\/sup>.<\/p>\n\n\n\n

Giovanni Monteleone
Docente Universit\u00e0 di Roma Tor Vergata
Medico specialista in Ortopedia e Traumatologia<\/em><\/p>\n\n\n\n

\"\"<\/figure><\/div>\n\n\n\n

Per approfondimenti<\/h3>\n\n\n\n
  1. Smith-Petersen MN, The classic: Treatment of malumcoxae senilis, old slipped upper femoral epiphysis, intrapelvic protrusion of the acetabulum, and coxa plana by means of acetabuloplasty. 1936.. Clin Orthop Relat Res. 2009 Mar; 467(3): 608-15..<\/li>
  2. Di Pietto F, Articular and peri-articular hip lesions in soccer players. The importance of imaging in deciding which lesions will need surgery and which can be treated conservatively? Eur J Radiol. 2018 Aug; 105:227-238.<\/li>
  3. Domb BG, Hartigan DE, Perets I. Decision Making for Labral Treatment in the Hip: Repair Versus D\u00e9bridement Versus Reconstruction. J Am Acad Orthop Surg. 2017 Mar; 25(3):e53-e62.<\/li>
  4. Zadpoor AA, Etiology of Femoroacetabular Impingement in Athletes: A Review of Recent Findings. Sports Med. 2015 Aug; 45(8): 1097-106.<\/li>
  5. Gerhardt MB, Romero AA, Silvers HJ, Harris DJ, Watanabe D, Mandelbaum BR. The prevalence of radiographic hip abnormalities in elite soccer players. Am Sports Med. 2012 Mar; 40(3): 584-8.<\/li>
  6. Reiman MP, Thorborg K, Goode AP, Cook CE, Weir A, H\u00f6lmich P, Diagnostic Accuracy of Imaging Modalities and Injection Techniques for the Diagnosis of Fenoroacetabular Impingement\/ Labral Tear: A Systematic Review With Meta-analysis. Am J Sports Med. 2017 Sep; 45(11):2665-2677<\/li>
  7. Narveson JR, Haberl MD, Nathan Vannatta C, Rhon DI. Conservative treatment continuum for managing femoroacetabular impingement syndrome and acetabular labral tears in surgical candidates: a case series. Int J Sports Phys Ther. 2018 Dec;13(6):1032-1048. Free PMC article <\/a><\/li>
  8. Griffin DR, Dickenson EJ, Wall PDH, Achana F, Donovan JL, Griffin J, Hobson R, Hutchinson CE, Jepson M, Parsons NR, Petrou S, Realpe A, Smith J, Foster NE; FASHIoN Study Group. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. Lancet. 2018 Jun 2;391(10136):2225-2235. doi: 10.1016\/S0140-6736(18)31202-9. Epub 2018 Jun 1. Free PMC article<\/a><\/li><\/ol>\n\n\n\n

    Materiale didattico SIPAL<\/a><\/p>\n\n\n\n

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    Esasperare lo stretching aggrava l’insulto meccanico. 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