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Rezaie N, Ithurburn MP, Powell MT, Mussell EA, Kidwell-Chandler AL, Emblom BA. Outcomes and Proportions of Subsequent Contralateral Sports Hernia Repair Following Primary Unilateral Repair. Am J Sports Med 2024; 52:653-659. [PMID: 38284216 DOI: 10.1177/03635465231221496] [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: 01/30/2024]
Abstract
BACKGROUND In the event that nonoperative treatment for sports hernia fails, surgical repair may be warranted. Bilateral repair can occur in up to 45% of surgically treated patients. PURPOSE To investigate the clinical outcomes of athletes who underwent unilateral sports hernia repair and determine the proportion of patients who required contralateral sports hernia repair. STUDY DESIGN Case series; Level of evidence, 4. METHODS We identified patients at our institution who underwent primary unilateral sports hernia repair (rectus abdominis-adductor longus aponeurotic plate repair and adductor lengthening) with a single surgeon between 2015 and 2020. We assessed patient-reported outcomes using the Hip Outcome Score-Sport (HOS-Sport), the Numeric Pain Rating Scale, and an internally developed return-to-play questionnaire. We further collected data regarding subsequent sports hernia procedures on the ipsilateral or contralateral side. We calculated summary statistics for outcomes and examined the association between preinjury patient characteristics and the HOS-Sport score at follow-up or successful return to preinjury sport using linear and logistic regression, respectively. RESULTS A total of 104 of 128 (81.3%) eligible patients (mean age at surgery, 23.0 ± 6.2 years; 94.2% male; 51.9% American football athletes) completed follow-up at a mean time of 4.4 ± 1.5 years. Overall, 79.8% of athletes (n = 83) were able to return to their preinjury sport/activity, but 90.2% (83/92) who attempted to return were able to do so. When examining reasons for not returning to preinjury sport, only 9 patients reported not returning to preinjury sport because of limitations or persistent symptoms from their original injury. Only 4 patients underwent subsequent sports hernia procedures (3 contralateral, 1 ipsilateral revision) after their index unilateral sports hernia repair. At follow-up, the mean HOS-Sport score was high (94.0 ± 10.8), and the mean Numeric Pain Rating Scale score was low (0.31 ± 1.26). There were no preinjury patient characteristics associated with either the HOS-Sport score at follow-up or the successful return to preinjury sport. CONCLUSION Patients with unilateral sports hernia symptoms can undergo repair and return to sport at the preinjury level with little concern for injuries to the contralateral groin. In our cohort, patient-reported hip function and pain outcomes at follow-up were excellent.
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Affiliation(s)
- Nima Rezaie
- American Sports Medicine Institute, Birmingham, Alabama, USA
- Atlantic Orthopaedic Specialists, Virginia Beach, Virginia, USA
| | - Matthew P Ithurburn
- American Sports Medicine Institute, Birmingham, Alabama, USA
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Eric A Mussell
- American Sports Medicine Institute, Birmingham, Alabama, USA
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
| | | | - Benton A Emblom
- American Sports Medicine Institute, Birmingham, Alabama, USA
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA
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Kopscik M, Crisman JL, Lomasney L, Smith S, Jadidi S. Sports Hernias: A Comprehensive Review for Clinicians. Cureus 2023; 15:e43283. [PMID: 37692688 PMCID: PMC10492628 DOI: 10.7759/cureus.43283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Sports hernias are a complex cause of chronic groin pain in athletes, posing diagnostic and treatment challenges for clinicians. This review article synthesizes current knowledge on sports hernias, exploring pathogenesis, diagnostic approaches, and management strategies. Despite the growing body of research, sports hernias continue to present a significant challenge, necessitating a multidisciplinary approach and further research to improve clinical outcomes. This comprehensive review aims to equip clinicians with an updated understanding of sports hernias, ensuring optimal patient care and informing future research.
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Affiliation(s)
- Michael Kopscik
- Family & Community Medicine, AnMed Health Medical Center, Anderson, USA
| | - Joseph L Crisman
- Family & Community Medicine, Loyola University Medical Center, Chicago, USA
| | - Laurie Lomasney
- Musculoskeletal Imaging, Interventional Radiology, Diagnostic Radiology, Loyola University Medical Center, Chicago, USA
| | - Sean Smith
- Musculoskeletal Radiology, Superior Sports Radiology, Greenville, USA
| | - Shaheen Jadidi
- Sports Medicine, Edward-Elmhurst Health/NorthShore University HealthSystem, Chicago, USA
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3
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Holmes RD, Yan YY, Mallinson PI, Andrews GT, Munk PL, Ouellette HA. Imaging Review of Hockey-related Lower Extremity Injuries. Semin Musculoskelet Radiol 2022; 26:13-27. [PMID: 35139556 DOI: 10.1055/s-0041-1731795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hockey is a fast-paced contact sport with a high incidence of injuries. Although injuries are more frequent among elite players, recreational hockey injuries are a common issue faced by primary care and emergency physicians. Lower extremity injuries in hockey are particularly important because they account for approximately a third of all injuries and > 60% of all overuse injuries. This pictorial review provides the general and specialty trained radiologist with a knowledge of the patterns of lower extremity injury that occur in ice hockey.
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Affiliation(s)
- R Davis Holmes
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Yet Yen Yan
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada.,Department of Radiology, Changi General Hospital, Singapore
| | - Paul I Mallinson
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Gordon T Andrews
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Peter L Munk
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Hugue A Ouellette
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
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4
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Hassanmirzaei B, Fahimipour F, Khosravi A, Barghi TS. Full duodenal rupture after direct abdominal trauma in soccer: a case report of an elite soccer player with follow up and return to play protocol. SCI MED FOOTBALL 2022; 5:254-260. [PMID: 35077290 DOI: 10.1080/24733938.2020.1853804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Severe traumatic abdominal injuries and duodenal ruptures are relatively rare in soccer and can be easily missed and turn into a life-threatening condition. All team physicians need to be familiar with the warning sign in these situations. This report aims to report a case, discuss the diagnostic and treatment process and the return to play protocol.During a professional female soccer team training session, the injury occurred while the player's epigastrium was hit hardly by the opponent's knee. In the first evaluation, there was only mild epigastrium pain without any other sign. Eventually, pain exacerbated, nausea and vomiting were added. All the initial evaluation (Physical examination, abdominal X-ray, ultrasonography, blood tests) were normal. Eventually, she developed abdominal guarding and underwent abdominopelvic computed tomography with intravenous contrast where Duodenal rupture becomes evident. She underwent laparotomy and full duodenal repair and discharged from the hospital in good health.For the return to play determination in such injuries, the abdomen should not be imposed on any trauma for about 6 months, so while the player can start a self-training session firstly without a ball and then with a ball, she is not allowed to play or train with others for 6 months.
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Affiliation(s)
- Bahar Hassanmirzaei
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.,Iran Football Medical Assessment and Rehabilitation Center - IFMARC, Tehran, Iran
| | - Farinaz Fahimipour
- Department of Sports Medicine, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Afifeh Khosravi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.,School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Tohid Seif Barghi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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5
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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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6
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Hatem M, Martin RL, Bharam S. Surgical Outcomes of Inguinal-, Pubic-, and Adductor-Related Chronic Pain in Athletes: A Systematic Review Based on Surgical Technique. Orthop J Sports Med 2021; 9:23259671211023116. [PMID: 34541009 PMCID: PMC8442511 DOI: 10.1177/23259671211023116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Controversies remain regarding the surgical treatment of inguinal-, pubic-, and adductor-related chronic groin pain (CGP) in athletes. Purpose: To investigate the outcomes of surgery for CGP in athletes based on surgical technique and anatomic area addressed. Study Design: Systematic review; Level of evidence, 4. Methods: The PubMed and Embase databases were searched for articles reporting surgical treatment of inguinal-, pubic-, or adductor-related CGP in athletes. Inclusion criteria were level 1 to 4 evidence, mean patient age >15 years, and results presented as return-to-sport, pain, or functional outcomes. Quality assessment was performed with the CONSORT (Consolidated Standards of Reporting Trials) statement or MINORS (Methodological Index for Non-randomized Studies) criteria. Techniques were grouped as inguinal, adductor origin, pubic symphysis, combined inguinal and adductor, combined pubic symphysis and adductor, or mixed. Results: Overall, 47 studies published between 1991 and 2020 were included. There were 2737 patients (94% male) with a mean age at surgery of 27.8 years (range, 12-65 years). The mean duration of symptoms was 13.1 months (range, 0.3-144 months). The most frequent sport involved was soccer (71%), followed by rugby (7%), Australian football (5%), and ice hockey (4%). Of the 47 articles reviewed, 44 were classified as level 4 evidence, 1 study was classified as level 3, and 2 randomized controlled trials were classified as level 1b. The quality of the observational studies improved modestly with time, with a mean MINORS score of 6 for articles published between 1991 and 2000, 6.53 for articles published from 2001 to 2010, and 6.9 for articles published from 2011 to 2020. Return to play at preinjury or higher level was observed in 92% (95% CI, 88%-95%) of the athletes after surgery to the inguinal area, 75% (95% CI, 57%-89%) after surgery to the adductor origin, 84% (95% CI, 47%-100%) after surgery to the pubic symphysis, and 89% (95% CI, 70%-99%) after combined surgery in the inguinal and adductor origin. Conclusion: Return to play at preinjury or higher level was more likely after surgery for inguinal-related CGP (92%) versus adductor-related CGP (75%). However, the majority of studies reviewed were methodologically of low quality owing to the lack of comparison groups.
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Affiliation(s)
- Munif Hatem
- Hip Preservation Center-Baylor Scott and White Research Institute, Dallas, Texas, USA
| | | | - Srino Bharam
- New York Hip Preservation and Groin Center at Lenox Hill Hospital of Northwell Health, New York, New York, USA
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Kraeutler MJ, Mei-Dan O, Belk JW, Larson CM, Talishinskiy T, Scillia AJ. A Systematic Review Shows High Variation in Terminology, Surgical Techniques, Preoperative Diagnostic Measures, and Geographic Differences in the Treatment of Athletic Pubalgia/Sports Hernia/Core Muscle Injury/Inguinal Disruption. Arthroscopy 2021; 37:2377-2390.e2. [PMID: 33845134 DOI: 10.1016/j.arthro.2021.03.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To perform a systematic review of reported terminologies, surgical techniques, preoperative diagnostic measures, and geographic differences in the treatment of core muscle injury (CMI)/athletic pubalgia/inguinal disruption. METHODS A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify clinical studies or articles that described a surgical technique to treat CMI refractory to nonoperative treatment. The search phrase used was "core muscle injury" OR "sports hernia" OR "athletic pubalgia" OR "inguinal disruption." The diagnostic terminology, country of publication, preoperative diagnostic measures, surgical technique, and subspecialty of the operating surgeons described in each article were extracted and reported. RESULTS Thirty-one studies met the inclusion and exclusion criteria, including 3 surgical technique articles and 28 clinical articles (2 Level I evidence, 1 Level II, 4 Level III, and 21 Level IV). A total of 1,571 patients were included. The most common terminology used to describe the diagnosis was "athletic pubalgia," followed by "sports hernia." Plain radiographs and magnetic resonance imaging of the pelvis were the most common imaging modalities used in the preoperative evaluation of CMI/athletic pubalgia/inguinal disruption. Tenderness-to-palpation testing was the most common technique performed during physical examination, although the specific locations assessed with this technique varied substantially. The operating surgeons were general surgeons (16 articles), a combination of orthopaedic and general surgeons (7 articles), or orthopaedic surgeons (5 articles). The most common procedures performed were open or laparoscopic mesh repair, adductor tenotomy, primary tissue (hernia) repair, and rectus abdominis repair. The procedures performed differed on the basis of surgeon subspecialty, geographic location, and year of publication. CONCLUSIONS A variety of diagnostic methods and surgical procedures have been used in the treatment of a CMI/athletic pubalgia/sports hernia/inguinal disruption. These procedures are performed by orthopaedic and/or general surgeons, with the procedures performed differing on the basis of surgeon subspecialty and geographic location. LEVEL OF EVIDENCE Level V, systematic review of Level I to V studies.
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Affiliation(s)
- Matthew J Kraeutler
- Department of Orthopaedic Surgery, St Joseph's University Medical Center, Paterson, New Jersey, U.S.A..
| | - Omer Mei-Dan
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - John W Belk
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | | | - Toghrul Talishinskiy
- Department of Surgery, St Joseph's University Medical Center, Paterson, New Jersey, U.S.A
| | - Anthony J Scillia
- Department of Orthopaedic Surgery, St Joseph's University Medical Center, Paterson, New Jersey, U.S.A.; New Jersey Orthopaedic Institute, Wayne, New Jersey, U.S.A
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8
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Moran MW, Rogowski KR. 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 PMCID: PMC7727419 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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Affiliation(s)
- Megan W Moran
- Department of Physical Therapy, Marymount University, Arlington, Virginia, USA
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9
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Koutserimpas C, Vlasis K, Makris MC, Ioannidis A, Konstantinidis MK, Antonakopoulos F, Athanasopoulos P, Mazarakis A, Papagelopoulos PJ, Konstantinidis KM. Operative treatment of athletic pubalgia in competitive athletes: a retrospective study. J Sports Med Phys Fitness 2020; 60:758-763. [PMID: 32438790 DOI: 10.23736/s0022-4707.20.10389-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Athletic pubalgia is an obscure sport injury, presenting mainly with groin pain during twisting movements. The present 15 year study reports outcomes, intraoperative findings and complications of the endoscopic surgical treatment in competitive athletes. METHODS All competitive athletes, from 2004 to 2018, suffering from athletic pubalgia, treated with laparoscopic Total Extra-Peritoneal technique, at the Department of General, Laparoscopic, Oncologic and Robotic Surgery of the Athens Medical Center were included in this retrospective cohort. Postoperative pain, complications, return to previous training routine and patients' satisfaction were evaluated. RESULTS A total of 130 patients (115; 88.5% males and 15; 11.5% females) with a mean age of 26.7±7.5 years were evaluated. Preoperatively, mean numeric scale pain was found to be 7.7±1.7. Three days postoperatively, the mean numeric pain scale was 3.4±1.5, showing 55.8% decrease. The mean time for return to sports activity was found to be 6.27±3.02 weeks. Regarding complications, six patients (4.6%) had slight numbness at the groin area during the first 6 postoperative months and one patient (0.8%) suffered from a postoperative hematoma. No recurrence was observed. At the final follow-up (mean 76.58±46.5 months), a total of 97 (74.7%) patients were very satisfied, 31 (23.8%) satisfied and two (1.5%) not satisfied with the outcome. CONCLUSIONS Laparoscopic operative treatment in competitive athletes suffering from athletic pubalgia seems to offer rapid recovery, rapid return to sports, as well as very low complications rate and no recurrence.
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Affiliation(s)
- Christos Koutserimpas
- Department of Orthopedics and Traumatology - .,Hellenic Air Force General Hospital, Athens, Greece -
| | | | - Marinos C Makris
- Department of Anatomy, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Argyrios Ioannidis
- Department of Anatomy, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael K Konstantinidis
- Department of Anatomy, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Fotios Antonakopoulos
- Department of Anatomy, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Athanasopoulos
- Department of Anatomy, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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10
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Gerhardt M, Christiansen J, Sherman B, Miranda A, Hutchinson W, Chahla J. Outcomes following surgical management of inguinal-related groin pain in athletes: a case series. J Hip Preserv Surg 2020; 7:103-108. [PMID: 32382436 PMCID: PMC7195923 DOI: 10.1093/jhps/hnz068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 12/19/2019] [Accepted: 12/24/2019] [Indexed: 12/18/2022] Open
Abstract
To determine the outcomes of a limited surgical intervention, consisting of neurolysis, inguinal wall repair and/or adductor debridement of adhesions based on intraoperative findings. Retrospective case series. Outpatient orthopedic/general surgery clinic. Fifty-one athletes treated surgically for inguinal-related groin pain from 2009 to 2015. Limited surgical intervention, consisting of neurolysis, inguinal wall repair and/or adductor debridement based on intra-operative findings. Ability to return to sport at the same level, time to return to play. Fifty-one athletes were included in the study with an average follow-up of 4.42 years (range 2.02–7.01). The average age was 24.2 years (range 16–49) and consisted of 94.0% males and 6.0% females. Nerve entrapment was demonstrated in 96.2% of cases with involvement of the ilioinguinal in 92.5%, the iliohypogastric in 30.8% and the genitofemoral in 13.2%. Attenuation of the posterior inguinal wall was present and repaired in 79.3% of cases. Scar tissue was present around the adductor origin and required debridement in 56.7% of cases. Forty-nine (96.1%) athletes returned to sport at the same level of play at an average of 5.9 weeks. Two athletes required a revision surgery. High rates of return to sport were achieved after surgery for inguinal-related groin pain that addresses the varying pathology and associated nerve entrapment.
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Affiliation(s)
- Michael Gerhardt
- Cedars-Sinai Kerlan-Jobe Institute, 2020 Santa Monica Blvd. Suite 400, Santa Monica, CA 90404, USA
| | - Josh Christiansen
- Cedars-Sinai Kerlan-Jobe Institute, 2020 Santa Monica Blvd. Suite 400, Santa Monica, CA 90404, USA
| | - Benjamin Sherman
- Riverside University Health System, Department of Orthopedic Surgery, 26520 Cactus Ave. Suite B2042, Moreno Valley, CA 92555, USA
| | - Alejandro Miranda
- Cedars-Sinai Kerlan-Jobe Institute, 2020 Santa Monica Blvd. Suite 400, Santa Monica, CA 90404, USA
| | - William Hutchinson
- Pacific Coast Hernia Center, 2001 Santa Monica Blvd. Suite 890, Santa Monica, CA 90404, USA
| | - Jorge Chahla
- Rush University Medical Center, Midwest Orthopaedics, 1611 W. Harrison Ave. Suite 300, Chicago, IL 60612, USA
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11
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Bastia P, Ghirarduzzi P, Schiavi P, Donelli D, Pedrazzini A, Leigheb M, Ceccarelli F, Pogliacomi F. Surgical or conservative treatment in ARGP syndrome? A systematic review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:14-24. [PMID: 31821279 PMCID: PMC7233710 DOI: 10.23750/abm.v90i12-s.8962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/21/2019] [Indexed: 12/04/2022]
Abstract
Background and aim of the work: The rectus-adductor syndrome is a common cause of groin pain. In literature the adductor longus is reported as the most frequent site of injury so that the syndrome can be fitted into the adductor related groin pain (ARGP) group. The aim of this study was to define what is the best treatment between surgical and conservative in athletes affected by ARGP in terms of healing and return to play (RTP) time. Methods: A systematic review was performed searching for articles describing studies on RTP time for surgical or conservative interventions for ARGP. A qualitative synthesis was performed. Only 10 out 7607 articles were included in this systematic review. An exploratory meta-analysis was carried out. Due to high heterogeneity of the included studies, raw means of surgery and conservative treatment groups were pooled separately. A random effects model was used. Results: The results showed quicker RTP time for surgery when pooled raw means were compared to conservative treatments: 11,23 weeks (CI 95%, 8.18,14.28, p<0.0001, I^2=99%) vs 14,9 weeks (CI 95%, 13.05,16.76, p<0.0001, I^2 = 77%). The pooled results showed high statistical heterogeneity (I^2), especially in the surgical group. Conclusions: Surgical interventions are associated with quicker RTP time in athletes affected by ARGP, but due to the high heterogeneity of the available studies and the lack of dedicated RCTs this topic needs to be investigated with dedicated high quality RCT studies. (www.actabiomedica.it)
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Affiliation(s)
- Paolo Bastia
- Orthopaedics and Traumatologic Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy .
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12
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De Maeseneer M, Forsyth R, Provyn S, Milants A, Lenchik L, De Smet A, Marcelis S, Shahabpour M. MR imaging-anatomical-histological evaluation of the abdominal muscles, aponeurosis, and adductor tendon insertions on the pubic symphysis: a cadaver study. Eur J Radiol 2019; 118:107-113. [DOI: 10.1016/j.ejrad.2019.06.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/26/2019] [Accepted: 06/30/2019] [Indexed: 11/29/2022]
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13
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Sheen AJ, Montgomery A, Simon T, Ilves I, Paajanen H. Randomized clinical trial of open suture repair versus totally extraperitoneal repair for treatment of sportsman's hernia. Br J Surg 2019; 106:837-844. [DOI: 10.1002/bjs.11226] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 02/22/2019] [Accepted: 04/04/2019] [Indexed: 12/31/2022]
Abstract
Abstract
Background
Sportsman's hernia/athletic pubalgia is a recognized cause of chronic groin pain in athletes. Both open and laparoscopic surgical repairs have been described for treatment, but there are no comparative studies. The hypothesis here was that relief of pain would be achieved earlier in patients treated with open minimal suture repair than totally extraperitoneal repair.
Methods
A randomized multicentre trial in four European countries was conducted to compare open minimal suture repair with totally extraperitoneal repair. The primary endpoint was complete relief of pain (visual analogue scale (VAS) score 20 or less on a scale from 0 to 100 mm) at 1 month. Secondary endpoints included complications, time to return to sporting activity, and number of patients returning to sport within 1 year.
Results
A total of 65 athletes (92 per cent men) with a median age of 29 years were enrolled (31 open repair, 34 totally extraperitoneal repair). By 4 weeks after surgery, median preoperative VAS scores had dropped from 70–80 to 10–20 in both groups (P < 0·001). Relief of pain (VAS score 20 or less) during sports activity 4 weeks after surgery was achieved in 14 of 31 patients after open repair and 24 of 34 after totally extraperitoneal repair (P = 0·047). Return to full sporting activity was achieved by 16 and 18 patients respectively after 1 month (P = 0·992), and by 25 versus 31 after 3 months (P = 0·408).
Conclusion
Totally extraperitoneal repair was less painful than open repair in the first month, but otherwise both procedures were similarly effective in treating chronic pain due to sportsman's hernia. Registration number: NCT02297711 ( http://www.clinical.trials.gov).
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Affiliation(s)
- A J Sheen
- Department of Surgery, Manchester University Foundation Trust, Manchester, UK
- Centre of Biomedicine Manchester Metropolitan University, Manchester, UK
- Fortius Clinic, London, UK
| | - A Montgomery
- Department of Surgery, Institution for Clinical Science, Lund University, Skåne University Hospital, Malmö, Sweden
| | - T Simon
- Department of General Surgery, GRN-Klinik Sinsheim, Heidelberg University Hospital, Heidelberg, Germany
| | - I Ilves
- Department of Surgery, Mikkeli Central Hospital, Mikkeli, Finland
| | - H Paajanen
- Department of Gastrointestinal Surgery, Kuopio University Hospital, Kuopio, Finland
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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14
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Via AG, Frizziero A, Finotti P, Oliva F, Randelli F, Maffulli N. Management of osteitis pubis in athletes: rehabilitation and return to training - a review of the most recent literature. Open Access J Sports Med 2019; 10:1-10. [PMID: 30613167 PMCID: PMC6307487 DOI: 10.2147/oajsm.s155077] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Osteitis pubis is a common cause of chronic groin pain, especially in athletes. Although a precise etiology is not defined, it seems to be related to muscular imbalance and pelvic instability. Diagnosis is based on detailed history, clinical evaluation, and imaging, which are crucial for a correct diagnosis and proper management. Many different therapeutic approaches have been proposed for osteitis pubis; conservative treatment represents the first-line approach and provides good results in most patients, especially if based on an individualized multimodal rehabilitative management. Different surgical options have been also described, but they should be reserved to recalcitrant cases. In this review, a critical analysis of the literature about athletic osteitis pubis is performed, especially focusing on its diagnostic and therapeutic management.
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Affiliation(s)
- Alessio Giai Via
- Department of Orthopaedic Surgery and Traumatology, Hip Surgery Center, IRCCS Policlinico San Donato, Milano, Italy
| | - Antonio Frizziero
- Department of Physical and Rehabilitation Medicine, University of Padova, Padova, Italy
| | - Paolo Finotti
- Department of Physical and Rehabilitation Medicine, University of Padova, Padova, Italy
| | - Francesco Oliva
- Department of Orthopaedics and Traumatology, Tor Vergata Hospital, University of Rome "Tor Vergata", Rome, Italy,
| | - Filippo Randelli
- Department of Orthopaedic Surgery and Traumatology, Hip Surgery Center, IRCCS Policlinico San Donato, Milano, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Salerno, Italy.,Centre for Sport and Exercise Medicine, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, England
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