Return to sport after surgical treatment for pubalgia among professional soccer players

Abstract

Objectiveto evaluate the return to sport after surgical treatment for pubalgia among 30 professional soccer players and describe the surgical technique used.Methodthis case series was evaluated by means of a questionnaire and physical examination on 30 male professional soccer players of mean age 24.4 years (range: 18–30). The mean duration of the symptoms was 18.6 months (range: 13–28). The diagnosis was made through clinical investigation, special maneuvers and complementary examinations, by the same examiner. All the patients underwent surgical treatment after conservative treatment failed; all procedures were performed by the same surgeon using the same technique. Nonparametric comparisons were made to investigate the time taken to recover after the surgery, for the patients to return to their sport.Resultsfive patients evolved with hematoma, with the need to remove the stitches three weeks after the operation because of a small dehiscence at the site of the operative wound. The wound healed completely in all these cases by five weeks after the surgery. Four patients presented dysuria in the first week, but improved in the second postoperative week. The mean time taken to return to training was around eight weeks (range: seven–nine). All the players returned to competitive soccer practice within 16 weeks. When asked about their degree of satisfaction after the operation (satisfied or dissatisfied), taking into consideration their return to the sport, there was 100% satisfaction, and they returned to professional practice at the same competitive level as before the injury. This degree of satisfaction continued to the last assessment, which was made after 36 months of postoperative follow-up.Conclusionthe surgical technique presented in this case series, with trapezoidal resection of the pubic symphysis in association with bilateral partial tenotomy of the long adductor, was a fast and effective procedure with a low rate of postoperative complications. It was shown to be an excellent treatment option for refractory cases, with a return to sports activity among professional soccer players.

Ultrasound-Guided Cutting Wire Release of the Proximal Adductor Longus Tendon: A Feasibility Study

“…Return to sport following a standard isolated AL release is reportedly between 11 and 18.5 weeks or 4 to 16 weeks when combined with a hernia repair. 2,3,16 –18,20 Complications associated with standard AL releases include adductor weakness, hematoma formation, infection, numbness, painful scarring, contracture, dysuria, and painful intercourse. 3,16,17,19,20 One disadvantage of a USG AL tendon release is the inability to perform electrocautery hemostasis, as can be performed during an open surgical procedure.…”

“…Given the amount of tissue disruption during the surgical procedure, the athlete is frequently not allowed to return to full unrestricted activity until 4 to 18.5 weeks after the procedure. 2,3,16 –18,20 Furthermore, surgical AL releases may result in complications, including adductor weakness, hematoma formation, infection, numbness, painful scarring, contracture, dysuria, and painful intercourse. 2,3,5,16,19,23 Thus, identifying the least invasive means by which to release the tendon to minimize risk and facilitate rapid return to sport is desirable.…”

Surgical Outcomes of Inguinal-, Pubic-, and Adductor-Related Chronic Pain in Athletes: A Systematic Review Based on Surgical Technique

“…One article with 30 patients reported the results of pubic symphysis resection in association with bilateral adductor release and partial tenotomy of the rectus abdominis. 14 At a mean follow-up of 36 months, the authors noted 100% return to play, 100% satisfaction from the patients, and a mean time of 8 months to return to sport.…”

“…Additional criteria in the case of comparative studies: (9) an adequate control group, (10) contemporary groups, (11) baseline equivalence of groups, (12) adequate statistical analyses. 52 5 b 0 Gill (2020) 24 Koutserimpas (2020) 37 0 1 Gerhardt (2020) 23 4 4 2 Van Meirhaeghe (2019) 79 3 3 Piozzi (2019) 57 1.5 Zoland (2018) 85 Emblom (2018) 19 1 2 2 1 9 c 0 Kajetanek (2018) 32 Roos (2018) 63 Matikainen (2017) 45 Pokorny (2017) 58 7 0 Kopelman (2016) 36 0 Santilli (2016) 67 Rossidis (2015) 65 2 Boukhris (2014) 6 5 de Queiroz (2014) 14 17 13 d Schilders (2013) 68 7 Messaoudi (2012) 46 3 Dojčinović (2012) 16 Maffulli (2012) 40 0 0 5 2 3 e Dellon (2011) 13 0 0 0 0 0 Robertson (2011) 62 1.8 0 1.8 Atkinson (2010) 2 1.5 1.5 1.5 34 Radic (2008) 60 26 Ziprin (2008) 83 Paajanen (2008) 53 12. 17 2 Kumar (2002) 38 11 Srinivasan (2002) 73 0 Irshad (2001) 30 4.5 9 4.5 Williams (2000) 82 14 f Meyers (2000) 47 1.2 0.6 Brannigan (2000) 7 Ziprin (1999) 84 Hackney (1993) 26 Malycha (1992) 41 Akermark (1992) 1 Polglase (1991) 59 1.5…”

High Return to Play Rate and Reduced Career Longevity Following Surgical Management of Athletic Pubalgia in National Basketball Association Players

“…Previous reports of time to RTP following surgical treatment of AP show considerable variation among multiple sports, ranging from as low as 4.23 weeks to beyond 23 weeks. 16,[29][30][31][32][33] This significant variability may be attributed to the inherent ambiguity of the term "sports hernia" or "athletic pubalgia," 34 which encompasses multiple sites of pathology such as the rectus abdominis, inguinal wall, adductor longus tendon, and pubis symphysis. 5,10,35 In a systematic review and meta-analysis of inguinal groin pain in athletes of various skill levels from 1980 to 2013 stratified by anatomic sites, King et al 36 reported the lowest RTP rates for adductor tendon related pain (81%) and highest RTP rates for abdominal pain (96%).…”