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Forlizzi JM, Ward MB, Whalen J, Wuerz TH, Gill TJ. Core Muscle Injury: Evaluation and Treatment in the Athlete. Am J Sports Med 2023; 51:1087-1095. [PMID: 35234538 DOI: 10.1177/03635465211063890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pain in the groin region, where the abdominal musculature attaches to the pubis, is referred to as a "sports hernia,""athletic pubalgia," or "core muscle injury" and has become a topic of increased interest due to its challenging diagnosis. Identifying the cause of chronic groin pain is complicated because significant symptom overlap exists between disorders of the proximal thigh musculature, intra-articular hip pathology, and disorders of the abdominal musculature. PURPOSE To present a comprehensive review of the pathoanatomic features, history and physical examination, and imaging modalities used to make the diagnosis of core muscle injury. STUDY DESIGN Narrative and literature review; Level of evidence, 4. METHODS A comprehensive literature search was performed. Studies involving the diagnosis, treatment, and rehabilitation of athletes with core muscle injury were identified. In addition, the senior author's extensive experience with the care of professional, collegiate, and elite athletes was analyzed and compared with established treatment algorithms. RESULTS The differential diagnosis of groin pain in the athlete should include core muscle injury with or without adductor longus tendinopathy. Current scientific evidence is lacking in this field; however, consensus regarding terms and treatment algorithms was facilitated with the publication of the Doha agreement in 2015. Pain localized proximal to the inguinal ligament, especially in conjunction with tenderness at the rectus abdominis insertion, is highly suggestive of core muscle injury. Concomitant adductor longus tendinopathy is not uncommon in these athletes and should be investigated. The diagnosis of core muscle injury is a clinical one, although dynamic ultrasonography is becoming increasingly used as a diagnostic modality. Magnetic resonance imaging is not always diagnostic and may underestimate the true extent of a core muscle injury. Functional rehabilitation programs can often return athletes to the same level of play. If an athlete has been diagnosed with athletic pubalgia and has persistent symptoms despite 12 weeks of nonoperative treatment, a surgical repair using mesh and a relaxing myotomy of the conjoined tendon should be considered. The most common intraoperative finding is a deficient posterior wall of the inguinal canal with injury to the distal rectus abdominis. Return to play after surgery for an isolated sports hernia is typically allowed at 4 weeks; however, if an adductor release is performed as well, return to play occurs at 12 weeks. CONCLUSION Core muscle injury is a diagnosis that requires a high level of clinical suspicion and should be considered in any athlete with pain in the inguinal region. Concurrent adductor pathology is not uncommon.
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Affiliation(s)
| | - Mark B Ward
- New England Baptist Hospital, Boston, Massachusetts, USA
| | - James Whalen
- New England Patriots, Foxboro, Massachusetts, USA
| | - Thomas H Wuerz
- New England Baptist Hospital, Boston, Massachusetts, USA
| | - Thomas J Gill
- New England Baptist Hospital, Boston, Massachusetts, USA
- St Elizabeth's Medical Center, Brighton, Massachusetts, USA
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Palumbo P, Massimi F, Lucchese S, Grimaldi S, Vernaccini N, Cirocchi R, Sorrenti S, Usai S, Intini SG. Open Surgery for Sportsman’s Hernia a Retrospective Study. Front Surg 2022; 9:893390. [PMID: 35784930 PMCID: PMC9243487 DOI: 10.3389/fsurg.2022.893390] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
Sportsman’s hernia is a painful syndrome in the inguinal area occurring in patients who play sports at an amatorial or professional level. Pain arises during sport, and sometimes persists after activity, representing an obstacle to sport resumption. A laparoscopic/endoscopic approach is proposed by many authors for treatment of the inguinal wall defect. Aim of this study is to assess the open technique in terms of safety and effectiveness, in order to obtain the benefit of an open treatment in an outpatient management. From October 2017 to July 2019, 34 patients underwent surgery for groin pain syndrome. All cases exhibited a bulging of the inguinal posterior wall. 14 patients were treated with Lichtenstein technique with transversalis fascia plication and placement of a polypropylene mesh fixed with fibrin glue. In 20 cases, a polypropylene mesh was placed in the preperitoneal space. The procedure was performed in day surgery facilities. Early or late postoperative complications did not occur in both groups. All patients returned to sport, in 32 cases with complete pain relief, whereas 2 patients experienced mild residual pain. The average value of return to sport was 34.11 ± 8.44 days. The average value of return to play was 53.82 ± 11.69 days. With regard to postoperative pain, no substantial differences between the two techniques were detected, and good results in terms of the resumption of sport were ensured in both groups. Surgical treatment for sportsman’s hernia should be considered only after the failure of conservative treatment. The open technique is safe and allows a rapid postoperative recovery.
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Affiliation(s)
- Piergaspare Palumbo
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
- Correspondence: Piergaspare Palumbo
| | - Fanny Massimi
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Sara Lucchese
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Serena Grimaldi
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Roberto Cirocchi
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Salvatore Sorrenti
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Sofia Usai
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
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Castle JP, Kessler A, Abbas MJ, Wager S, Khalil LS, Okoroha KR, Mehran N. High Return to Play Rate and Reduced Career Longevity Following Surgical Management of Athletic Pubalgia in National Basketball Association Players. Arthrosc Sports Med Rehabil 2021; 3:e1359-e1365. [PMID: 34712974 PMCID: PMC8527258 DOI: 10.1016/j.asmr.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 07/05/2021] [Indexed: 11/04/2022] Open
Abstract
Purpose To assess the effects of surgical treatment of athletic pubalgia (AP) on game use and performance metrics in National Basketball Association (NBA) players. Methods A retrospective review of all NBA players who underwent surgical management for AP from 1996 to 2018 was performed. A matched control group was created for comparison. The index period was defined as the entire NBA season in which surgery occurred, including the corresponding offseason. Player demographics, use (games played, games started, and minutes per game) and performance (player efficiency rating) metrics were collected for all players. Statistical analysis was performed to compare data before and after return to play. Results Thirty players with a history of surgical management for AP were included in the final analysis. Following surgery for AP, NBA players were found to have a return to play (RTP) rate of 90.91% (30/33). The average RTP following surgery was 4.73 ± 2.62 months. Compared with control athletes, athletes in the AP group played significantly fewer seasons postinjury (4.17 ± 2.70 vs 5.49 ± 3.04 seasons, respectively; P = .02). During the first year following RTP, NBA players experienced significant reductions in game use and performance, both when compared with the year prior and matched control athletes (P < .05). At 3-year follow-up, players continued to demonstrate significant reductions in game use (minutes per game, P < .05) but not performance. Conclusions Following surgical treatment of AP, NBA players demonstrated a high RTP rate, but shortened career. A short-term reduction in game use and performance metrics was found the year of return following surgery. However, 3-year follow-up performance metrics normalized when compared with healthy controls. Study Design Level III; retrospective case-control study.
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Affiliation(s)
- Joshua P Castle
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Adam Kessler
- University of California Los Angeles, Los Angeles, California, U.S.A
| | - Muhammad J Abbas
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Susan Wager
- Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Lafi S Khalil
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Kelechi R Okoroha
- Department of Orthopedic Surgery, Mayo Clinic, Minneapolis, Minnesota, U.S.A
| | - Nima Mehran
- Department of Orthopaedic Surgery, Kaiser Permanente, Los Angeles, California, U.S.A
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IONIŢE C, AROTĂRIŢEI D, TURNEA M, ILEA M, ROTARIU M. Applications of fitness function in Pubalgia affliction. BALNEO AND PRM RESEARCH JOURNAL 2021. [DOI: 10.12680/balneo.2021.423] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction. The relationships among variables are important in medicine and sport, and the most common approaches use linear correlation for optimization and prediction. Material and method. We propose to o novel usage of a known method (the genetic programming algorithm) to construct a nonlinear model in a practical case for rehabilitation find out the mathematical formula for a relationship among many variables . This study seeks to find a mathematical function to estimate the current state of the patient: healthy, affected by Pubalgia. Results and discussions. In the proposed application, a mathematical relationship is sought for five variables that express a state of health for patients, plantar footprint, plantar footprint – right, plantar pressure, plantar pressure – right and the surface of the body weight center. Conclusions. In this article, genetic programming has been proposed to construct a mathematical function to estimate the patient's condition possibly affected by Pubalgia.
Keywords: e-health, rehabilitation, genetic algorithm,fitness function,
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Affiliation(s)
- Cătălin IONIŢE
- Faculty of Medical Bioengineering, “University of Medicine and Pharmacy Grigore T Popa”, Iassy, Romania
| | - Dragoş AROTĂRIŢEI
- Faculty of Medical Bioengineering, “University of Medicine and Pharmacy Grigore T Popa”, Iassy, Romania
| | - Marius TURNEA
- Faculty of Medical Bioengineering, “University of Medicine and Pharmacy Grigore T Popa”, Iassy, Romania
| | - Mihai ILEA
- Faculty of Medical Bioengineering, “University of Medicine and Pharmacy Grigore T Popa”, Iassy, Romania
| | - Mariana ROTARIU
- Faculty of Medical Bioengineering, “University of Medicine and Pharmacy Grigore T Popa”, Iassy, Romania
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Abstract
Core muscle injury is a common but difficult problem to treat. Although it can affect all individuals, it is most commonly seen in male athletes in cutting, twisting, pivoting, and explosive sports. Owing to the high association of femoroacetabular impingement, we believe these individuals are best treated with a multidisciplinary approach involving both orthopedic and general surgeons. Conservative treatment should be the first step in management. When conservative means are unsuccessful, operative intervention to correct all the pathologic issues around the pubis can have extremely high success rates.
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Affiliation(s)
- Timothy J Mulry
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medicine School, Worcester, MA, USA
| | - Paul E Rodenhouse
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medicine School, Worcester, MA, USA. https://twitter.com/PaulRodenhouse
| | - Brian D Busconi
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medicine School, Worcester, MA, USA.
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HIP AND PELVIC STABILITY AND GAIT RETRAINING IN THE MANAGEMENT OF ATHLETIC PUBALGIA AND HIP LABRAL PATHOLOGY IN A FEMALE RUNNER: A CASE REPORT. Int J Sports Phys Ther 2020; 15:1174-1183. [PMID: 33344033 DOI: 10.26603/ijspt20201174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Athletic pubalgia is a prevalent injury in athletes who kick, pivot, and cut, however it is poorly described in the literature. Many athletes with this diagnosis fail conservative management secondary to continued pain with activity and require surgical intervention for return to sport. Purpose The purpose of this case report is to describe an intervention strategy focusing on gait retraining and hip and lumbopelvic stability for a female runner diagnosed with athletic pubalgia and a labral tear of the hip. Case Description This case report involved a 45-year-old female runner who was seen for 14 visits, from examination to return to sport, with a follow up at 12 months post discharge. Interventions included hip, pelvic, and lumbar stability exercises, and gait retraining. Outcomes measurements included: pain on the numeric pain rating scale, the Lower Extremity Functional Scale (LEFS), gait mechanics, strength, and participation in sport. Outcomes At discharge the subject demonstrated improved strength of all muscle groups and changes in lower extremity running biomechanics. Changes in running mechanics included increased cadence, decreased pelvic drop, diminished over striding, and improved knee control with less valgus movement during the stance phase of gait. The subject reported no pain with running or recreational activities at discharge and follow up at 12 months post discharge. Discussion/Conclusion Most of the literature on conservative rehabilitation for athletic pubalgia focuses on athletes whose sports require pivoting and kicking. The literature provides little information on gait analysis and retraining for runners with a diagnosis of athletic pubalgia and/or hip labrum tears. The program used in this case report including gait retraining and hip, pelvic, and lumbar stability training allowed for full return to running in a 45-year-old female with a diagnosis of hip labrum tear and athletic pubalgia. Further research is needed to discern best conservative treatment for runners with athletic pubalgia and/or hip labral tears. Level of evidence 4.
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ROTARIU M, RATA G, TURNEA M, IONITE C. EFFECTS OF KINETIC MEANS IN RECOVERING PUBALGIC SYNDROME TO FOOTBALL PLAYERS. BALNEO RESEARCH JOURNAL 2020. [DOI: 10.12680/balneo.2020.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pubalgic syndrome is a growing disease with an incidence of 10% -13% of all injuries suffered during a competitive year in 2011. Once installed, it has negative repercussions on the spatial-temporal parameters, eliminating them from the competitive activity and implicitly having a negative effect on the socio-economic situation of the athlete, but also on the capital of the club where he operates. The study was conducted on a batch of football players affected by the pubalgic syndrome (pubis osteitis). All study participants were evaluated both initially and finally. Between the two evaluations, they benefited from a kinetic treatment protocol. At the end of the initial evaluation, the data obtained were compared and processed using statistical programs. Both in comparison of the results and their processing with the help of the statistical programs showed that the treatment protocol had positive effects on the symptomatology generated by the pubalgic syndrome, but also to the socio-economic situation of the athlete.
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Affiliation(s)
- Mariana ROTARIU
- 1 University of Medicine and Pharmacy “Grigore T. Popa, 16 University Street, Iasi, Romania
| | - Gloria RATA
- 2 National University of Physical Education and Sports,140 Constantin Noica Street, Bucharest, Romania
| | - Marius TURNEA
- 1 University of Medicine and Pharmacy “Grigore T. Popa, 16 University Street, Iasi, Romania
| | - Catalin IONITE
- 1 University of Medicine and Pharmacy “Grigore T. Popa, 16 University Street, Iasi, Romania
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Paajanen H, Hermunen H, Ristolainen L, Branci S. Long-standing groin pain in contact sports: a prospective case-control and MRI study. BMJ Open Sport Exerc Med 2019; 5:e000507. [PMID: 31191965 PMCID: PMC6539155 DOI: 10.1136/bmjsem-2018-000507] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2019] [Indexed: 12/24/2022] Open
Abstract
Objectives We aimed to prospectively evaluate the prevalence of long-standing groin pain and related MRI findings in contact sports. Methods This case–control study followed three male elite-level soccer, ice-hockey and bandy teams (102 players) for 2 years. All athletes with long-standing groin pain lasting >30 days and age-matched controls (1:3) from the same teams were examined clinically, using pelvic MRI and Hip and Groin Outcome Scores (HAGOS). Primary outcome measures were annual prevalence of groin pain and underlying MRI findings. Results The annual prevalence of chronic groin pain was 7.5%. Training characteristics and pain scores of athletes were similar in all teams. On MRI, there was no significant difference in the percentage of pubic bone marrow oedema (p = 0.80) between symptomatic players (8/15; 53%) versus controls (20/43; 47%), but adductor tendinopathy and degenerative changes at the pubic symphysis were twice more common among players with pain. Rectus muscle or iliopsoas pathology were seldom observed. Lower HAGOS subscales (p < 0.01) were recorded in players who experienced groin pain compared with the controls. Conclusion Long-standing groin pain was observed annually in 1 of 14 athletes in contact sports. Abnormalities in the pubic symphysis were common MRI findings in both symptomatic and asymptomatic players. Trial registration number NCT02560480
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Affiliation(s)
- Hannu Paajanen
- Department of Surgery, University of Eastern Finland, Kuopio, Finland
| | - Heikki Hermunen
- Department of Radiology, Mikkeli Central Hospital, Mikkeli, Finland
| | - Leena Ristolainen
- Department of Orthopaedics, Orton Orthopaedic Hospital, Helsinki, Finland
| | - Sonia Branci
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark.,Arthroscopic Center Amager, Hvidovre Hospital, Copenhagen, Denmark
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Otten R, Vuckovic Z, Weir A, Serner A. Rehabilitation and Return to Play Following Surgery for Inguinal-Related Groin Pain. OPER TECHN SPORT MED 2017. [DOI: 10.1053/j.otsm.2017.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Matikainen M, Hermunen H, Paajanen H. Athletic Pubalgia in Females: Predictive Value of MRI in Outcomes of Endoscopic Surgery. Orthop J Sports Med 2017; 5:2325967117720171. [PMID: 28840145 PMCID: PMC5546653 DOI: 10.1177/2325967117720171] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Athletic pubalgia is typically associated with male athletes participating in contact sports and less frequently with females. Endoscopic surgery may fully treat the patient with athletic pubalgia. Purpose: To perform an outcomes analysis of magnetic resonance imaging (MRI) and endoscopic surgery in female patients with athletic pubalgia. Study Design: Cohort study; Level of evidence, 3. Methods: Fifteen physically active female patients (mean age, 37 years) with athletic pubalgia were treated surgically via placement of total extraperitoneal endoscopic polypropylene mesh behind the injured groin area. The presence of preoperative bone marrow edema (BME) at the pubic symphysis seen on MRI was graded from 0 to 3 and correlated with pain scores after surgery. The outcome measures were pre- and postoperative pain scores and recovery to daily activity between 1 and 12 months after surgery. Results were compared with previously published scores from male athletes (n = 30). Results: With the exception of lower body mass index, the females with (n = 8) and without (n = 7) pubic BME had similar patient characteristics to the corresponding males. Mean inguinal pain scores (0-10) before surgical treatment were greater in females than males (during exercise, 7.8 ± 1.1 vs 6.9 ± 1.1; P = .0131). One month after surgery, mean pain scores for females were still greater compared with males (2.9 ± 1.7 vs 1.3 ± 1.6; P = .0034). Compared with female athletes with normal MRI, pubic BME was related to increased mean preoperative pain scores (8.13 ± 0.99 vs 6.43 ± 1.2; P = .0122). After 1 year, surgical outcomes were excellent or good in 47% of women. Conclusion: Endoscopic surgery was helpful in half of the females with athletic pubalgia in this study. The presence of pubic BME may predict slightly prolonged recovery from surgery.
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Affiliation(s)
- Markku Matikainen
- Department of Surgery, North Karelia Central Hospital, Joensuu, Finland
| | - Heikki Hermunen
- Department of Radiology, Mikkeli Central Hospital, Mikkeli, Finland
| | - Hannu Paajanen
- Department of Surgery, Kuopio University Hospital, Kuopio, Finland
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Osteitis pubis in professional football players: MRI findings and correlation with clinical outcome. Eur J Radiol 2017; 94:46-52. [PMID: 28941759 DOI: 10.1016/j.ejrad.2017.07.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/13/2017] [Accepted: 07/17/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Osteitis pubis (OP), a common pathology in elite athletes, is an aseptic inflammatory process of the pubic symphysis bone, and may involve surrounding soft tissues, tendons and muscles. OP is typically characterized by (often recurring) groin pain and is an important cause of time-off from sports activity in athletes. Aim of this retrospective study was to analyze magnetic resonance imaging (MRI) findings in professional football players with clinical diagnosis of OP and to correlate MRI findings with clinical outcome. MATERIAL AND METHODS All professional football players (23 males, 1 female; mean age: 21±3.7years; range: 16-30 years) with groin pain and clinical diagnosis of OP, who underwent pelvic MRI in our institution were retrospectively analyzed. The MR images were analyzed regarding the presence of bone marrow edema and its extension, whether fluid in the symphysis pubis or periarticular soft tissue edema with a rim-like periosteal distribution or edema in the muscles located around the symphyseal joint were present, whether degenerative changes of the symphysis pubis and of signs of symphyseal instability were encountered. A quantitative measurement of the signal intensity in bone marrow edema on 3T STIR sequences was performed, normalizing these values to the mean signal intensity values in the ipsilateral iliopsoas muscle. All patients were classified according to a 3-point grading scale. For each patient, both the symptoms 18 months after the initial MRI examination, the duration of time off from playing football and the kind of treatment applied were evaluated. RESULTS Among all professional athletes, in 20/24 (83.3%) MRI showed signs of OP with bone marrow edema at the pubic bone. 12 of these patients showed complete clinical recovery without any symptoms after 18 months, while in 8 patients partial recovery with persistence of groin pain during higher sports activity was observed. Patients with edema in periarticular soft tissues or in the muscles around the symphyseal joint on MRI at the beginning of symptoms presented significantly more often with a partial recovery after returning to high sports activity (p=0.042 and p=0.036, respectively). A partial recovery was also significantly associated with higher normalized mean signal intensity values in bone marrow edema on STIR sequences at the beginning of symptoms (mean=4.77±1.63 in the group with partial recovery vs. mean=2.86±0.45 in the group with complete recovery; p=0.0019). No significant association was noticed between MRI findings and time of abstinence from high sports activity, as well as between the 3-point grading scale and the time off from high sport activity and recovery at 18 months. CONCLUSIONS Edema in periarticular soft tissues, edema with extension to the muscles located around the symphyseal joint, as well as higher normalized signal intensity values in bone marrow edema on STIR sequences in the pubic bones at the beginning of groin pain are the most reliable MRI findings of a poor clinical long-term outcome of OP in professional football players and should be regarded as negative prognostic factors.
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Oliveira ALD, Andreoli CV, Ejnisman B, Queiroz RD, Pires OGN, Falótico GG. Perfil epidemiológico dos pacientes com diagnóstico de pubalgia do atleta. Rev Bras Ortop 2016. [DOI: 10.1016/j.rbo.2016.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Oliveira ALD, Andreoli CV, Ejnisman B, Queiroz RD, Pires OGN, Falótico GG. Epidemiological profile of patients diagnosed with athletic pubalgia. Rev Bras Ortop 2016; 51:692-696. [PMID: 28050542 PMCID: PMC5198137 DOI: 10.1016/j.rboe.2016.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/07/2016] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To evaluate the clinical and epidemiological characteristics of pubalgia in patients from a Sports Medicine Center. METHODS Data analysis from medical records of patients with athletic pubalgia attended to from January 2007 to January 2015. The diagnosis was made by an experienced hip surgeon, complemented with pelvic X-ray, abdominal wall ultrasound, and magnetic resonance imaging of the pelvis. RESULTS Among 43 patients, 42 were men, with mean age of 33 years. As for sports, 25 (58.1%) athletes were soccer players and 13 (30.2%) were runners; 37.2% were professional athletes. Inguinal hernia was diagnosed in 20.9% of patients, showing the importance of its routine search in these patients. Treatment duration ranged from 1 to 12 months and 95.2% of the patients returned to sport. CONCLUSION This study presented the epidemiological characteristics of patients diagnosed with athletic pubalgia attended to in a reference medical center and demonstrated the prevalence of this lesion in male patients, soccer players and runners. It also disclosed a high success rate of the nonoperative treatment, and high rate of return to sport after treatment.
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Affiliation(s)
- Anderson Luiz de Oliveira
- Universidade Federal de São Paulo, Departamento de Ortopedia e Traumatologia, Centro de Traumatologia do Esporte, São Paulo, SP, Brazil
| | - Carlos Vicente Andreoli
- Universidade Federal de São Paulo, Departamento de Ortopedia e Traumatologia, Centro de Traumatologia do Esporte, São Paulo, SP, Brazil
| | - Benno Ejnisman
- Universidade Federal de São Paulo, Departamento de Ortopedia e Traumatologia, Centro de Traumatologia do Esporte, São Paulo, SP, Brazil
| | - Roberto Dantas Queiroz
- Universidade Federal de São Paulo, Departamento de Ortopedia e Traumatologia, Centro de Traumatologia do Esporte, São Paulo, SP, Brazil
| | - Osvaldo Guilherme Nunes Pires
- Universidade Federal de São Paulo, Departamento de Ortopedia e Traumatologia, Centro de Traumatologia do Esporte, São Paulo, SP, Brazil
| | - Guilherme Guadagnini Falótico
- Universidade Federal de São Paulo, Departamento de Ortopedia e Traumatologia, Centro de Traumatologia do Esporte, São Paulo, SP, Brazil
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Choi HR, Elattar O, Dills VD, Busconi B. Return to Play After Sports Hernia Surgery. Clin Sports Med 2016; 35:621-36. [DOI: 10.1016/j.csm.2016.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Core Muscle Injury/Sports Hernia/Athletic Pubalgia, and Femoroacetabular Impingement. Sports Med Arthrosc Rev 2016; 23:213-20. [PMID: 26524557 DOI: 10.1097/jsa.0000000000000083] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Core muscle injury/sports hernia/athletic pubalgia is an increasingly recognized source of pain, disability, and time lost from athletics. Groin pain among athletes, however, may be secondary to various etiologies. A thorough history and comprehensive physical examination, coupled with appropriate diagnostic imaging, may improve the diagnostic accuracy for patients who present with core muscular injuries. Outcomes of nonoperative management have not been well delineated, and multiple operative procedures have been discussed with varying return-to-athletic activity rates. In this review, we outline the clinical entity and treatment of core muscle injury and athletic pubalgia. In addition, we describe the relationship between athletic pubalgia and femoroacetabular impingement along with recent studies that have investigated the treatment of these related disorders.
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Abstract
Context: Groin pain is a common entity in athletes involved in sports that require acute cutting, pivoting, or kicking such as soccer and ice hockey. Athletic pubalgia is increasingly recognized as a common cause of chronic groin and adductor pain in athletes. It is considered an overuse injury predisposing to disruption of the rectus tendon insertion to the pubis and weakness of the posterior inguinal wall without a clinically detectable hernia. These patients often require surgical therapy after failure of nonoperative measures. A variety of surgical options have been used, and most patients improve and return to high-level competition. Evidence Acquisition: PubMed databases were searched to identify relevant scientific and review articles from January 1920 to January 2015 using the search terms groin pain, sports hernia, athletic pubalgia, adductor strain, osteitis pubis, stress fractures, femoroacetabular impingement, and labral tears. Study Design: Clinical review. Level of Evidence: Level 4. Results and Conclusion: Athletic pubalgia is an overuse injury involving a weakness in the rectus abdominis insertion or posterior inguinal wall of the lower abdomen caused by acute or repetitive injury of the structure. A variety of surgical options have been reported with successful outcomes, with high rates of return to the sport in the majority of cases.
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Affiliation(s)
- Osama Elattar
- Orthopaedic Sports Medicine, University of Massachusetts, Worcester, Massachusetts
| | - Ho-Rim Choi
- Orthopaedic Sports Medicine, University of Massachusetts, Worcester, Massachusetts
| | - Vickie D Dills
- Director of Clinical Services, Physical Therapy Innovations, Auburn, Massachusetts
| | - Brian Busconi
- Orthopaedic Sports Medicine, University of Massachusetts, Worcester, Massachusetts
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17
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Paajanen H, Montgomery A, Simon T, Sheen AJ. Systematic review: laparoscopic treatment of long-standing groin pain in athletes. Br J Sports Med 2016; 49:814-8. [PMID: 26031647 DOI: 10.1136/bjsports-2014-094544] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES No single aetiological factor has been proven to cause long-standing groin pain in athletes and no sole operative technique (either open or laparoscopic) has been shown to be the preferred method of repair. The aim of this systematic review was to determine whether there are any differences in the return to full sporting activity following laparoscopic repair of groin pain in athletes. DATA SOURCES The minimal access approaches include laparoscopic transabdominal pre-peritoneal (TAPP) or endoscopic total extraperitoneal (TEP) techniques. A systematic literature search was performed in PubMed, SCOPUS, UpToDate and the Cochrane Library databases. Series reporting laparoscopic repair (TAPP/TEP) of groin pain in adult (>18 years) athletes were included. The primary outcome was return to full sporting activity and secondary outcomes included percentage success rates and complications of operations. RESULTS Only 18 studies fulfilled the search criteria with both laparoscopic and sports hernia repairs. The studies were mainly observational with some reporting comparative data, but no large randomised controlled trials were detected. The median return to sporting activity of 4 weeks (28 days) was the same for the TAPP as well as TEP techniques. No real difference in secondary outcome measures was shown. More reported cases to date in the literature used the TAPP technique compared with TEP repair (n=605 vs n=266). CONCLUSIONS Laparoscopic surgery for elite athlete groin pain is increasingly becoming more common with almost 1000 patients reported since 1997. No particular laparoscopic technique appears to offer any advantage over the other.
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Affiliation(s)
- Hannu Paajanen
- Department of Surgery, Kuopio University Hospital, Kuopio, Finland
| | | | - Thomas Simon
- GRN-Klinik Sinsheim, Heidelberg University Hospital, Heidelberg, Germany
| | - Aali J Sheen
- Department of Surgery, Central Manchester Foundation Trust, Manchester Royal Infirmary and University of Manchester, Manchester, UK
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18
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Paksoy M, Sekmen Ü. Sportsman hernia; the review of current diagnosis and treatment modalities. ULUSAL CERRAHI DERGISI 2015; 32:122-9. [PMID: 27436937 DOI: 10.5152/ucd.2015.3132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 04/12/2015] [Indexed: 11/22/2022]
Abstract
Groin pain is an important clinical entity that may affect a sportsman's active sports life. Sportsman's hernia is a chronic low abdominal and groin pain syndrome. Open and laparoscopic surgical treatment may be chosen in case of conservative treatment failure. Studies on sportsman's hernia, which is a challenging situation in both diagnosis and treatment, are ongoing in many centers. We reviewed the treatment results of 37 patients diagnosed and treated as sportsman's hernia at our hospital between 2011-2014, in light of current literature.
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Affiliation(s)
- Melih Paksoy
- Department of General Surgery, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Ümit Sekmen
- Clinic of General Surgery, Acıbadem Fulya Hospital, İstanbul, Turkey
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19
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Wikiel KJ, Eid GM. Groin defects seen at extra-peritoneal laparoscopic dissection during surgical treatment of athletic pubalgia. Surg Endosc 2014; 29:1695-9. [DOI: 10.1007/s00464-014-3866-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 08/16/2014] [Indexed: 11/29/2022]
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20
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Tranovich MJ, Salzler MJ, Enseki KR, Wright VJ. A review of femoroacetabular impingement and hip arthroscopy in the athlete. PHYSICIAN SPORTSMED 2014; 42:75-87. [PMID: 24565824 DOI: 10.3810/psm.2014.02.2050] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Femoroacetabular impingement (FAI) is increasingly recognized as a pathological condition of the hip in athletes. Although it is not always symptomatic, the bone structure leading to FAI and its associated pathology can result in significant pain and performance decline in athletes. Recognition of athletes with symptomatic FAI is of the utmost importance, as prompt treatment is necessary in order to maintain desired sports activity levels and preserve joint function. This review explores the recent evidence on the evaluation, recognition, and treatment of femoroacetabular impingement, and discusses conservative management, postoperative rehabilitation, and treatment in the pediatric and master athlete populations.
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Affiliation(s)
- Michael J Tranovich
- Research Fellow, Department of Orthopaedic Surgery; University of Pittsburgh, Pittsburgh, PA
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21
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Kuikka L, Hermunen H, Paajanen H. Effect of pubic bone marrow edema on recovery from endoscopic surgery for athletic pubalgia. Scand J Med Sci Sports 2013; 25:98-103. [PMID: 24350624 DOI: 10.1111/sms.12158] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2013] [Indexed: 11/27/2022]
Abstract
Athletic pubalgia (sportsman's hernia) is often repaired by surgery. The presence of pubic bone marrow edema (BME) in magnetic resonance imaging (MRI) may effect on the outcome of surgery. Surgical treatment of 30 patients with athletic pubalgia was performed by placement of totally extraperitoneal endoscopic mesh behind the painful groin area. The presence of pre-operative BME was graded from 0 to 3 using MRI and correlated to post-operative pain scores and recovery to sports activity 2 years after operation. The operated athletes participated in our previous prospective randomized study. The athletes with (n = 21) or without (n = 9) pubic BME had similar patients' characteristics and pain scores before surgery. Periostic and intraosseous edema at symphysis pubis was related to increase of post-operative pain scores only at 3 months after surgery (P = 0.03) but not to long-term recovery. Two years after surgery, three athletes in the BME group and three in the normal MRI group needed occasionally pain medication for chronic groin pain, and 87% were playing at the same level as before surgery. This study indicates that the presence of pubic BME had no remarkable long-term effect on recovery from endoscopic surgical treatment of athletic pubalgia.
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Affiliation(s)
- L Kuikka
- Department of Surgery, Kuopio University Hospital, Kuopio, Finland
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22
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Mei-Dan O, Lopez V, Carmont MR, McConkey MO, Steinbacher G, Alvarez PD, Cugat RB. Adductor tenotomy as a treatment for groin pain in professional soccer players. Orthopedics 2013; 36:e1189-97. [PMID: 24025012 DOI: 10.3928/01477447-20130821-23] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Chronic, exercise-related groin pain is a debilitating condition. Nonoperative treatment has limited efficacy, but surgical intervention on the adductor-abdomino complex may be used to alleviate symptoms and allow return to play (RTP). The purpose of this study was to report the outcome of adductor tenotomy and hernioplasty for professional soccer players with groin pain. Between 2000 and 2006, a total of 155 professional and recreational soccer players with recalcitrant groin pain (with or without lower abdominal pain) and resistance to conservative treatment were included in this retrospective analysis. Ninety-six patients were treated with adductor tenotomy and 59 patients were treated with combined adductor tenotomy and hernioplasty. No difference in pre- or postoperative parameters was detected between groups, apart from abdominal wall muscle defects revealed during ultrasound for patients in the combined group. The RTP time and subjective and objective outcome measures were compared. A combined score was developed to evaluate outcomes that consisted of overall satisfaction (50%), RTP time (15%), and Tegner scores (35%). Mean RTP was 11 weeks (range, 4-36 weeks). Postoperative Tegner score remained 8.2 (same as the preinjury Tegner score). Subjective outcome was rated 4.3 of 5. The combined score indicated 80% of good or excellent results for both groups. Surgical intervention allows RTP at the same level in professional soccer players following failure of nonoperative treatments. Athletes with adductor syndrome and accompanying sportsman's hernia may benefit from adductor tenotomy alone.
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24
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Knesek MJ, Skendzel JG, Kelly BT, Bedi A. Approach to the Patient Evaluation Using Static and Dynamic Hip Pathomechanics. OPER TECHN SPORT MED 2012. [DOI: 10.1053/j.otsm.2012.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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