Athletic Pubalgia in Females: Predictive Value of MRI in Outcomes of Endoscopic Surgery

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.

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

“…59 Four articles reported bilateral repair of the posterior inguinal wall in all operated cases, independently if 1 side was asymptomatic. 45,55,57,75 Matikainen et al 45 and Paajan et al 55 justified the bilateral placement of a mesh on the posterior inguinal wall because scarring of the preperitoneal space would most likely prevent a later operation of the nonaffected side. Piozzi et al 57 and Van Meirhaeghe et al 79 argued that performing a TAPP procedure unilaterally could not fully balance and stabilize the anatomic region.…”

“…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…”

“…2 57 2 1 2 0 0 0 0 0 0 0 0 0 5 Zoland (2018) 85 1 2 19 1 2 63 1 45 2 58 1 0 36 1 16 1 0 62 1 83 47 1…”

Use of Preoperative Magnetic Resonance Imaging to Predict Clinical Outcomes After Core Muscle Injury Repair

“…At 3 months postoperatively, patients with BME had significantly higher pain scores ( P = .03), although scores normalized at 1 and 2 years after surgery. In a follow-up study, Matikainen et al 13 performed a similar evaluation in a series of 15 female patients undergoing athletic pubalgia surgery. The authors found that female patients with BME demonstrated significantly higher preoperative pain scores than patients without BME.…”

Abdominal Wall Endometrioma Mimicking Pubalgia: A Case Report

“…The treatment is initially conservative, with physiotherapy, rest, and anti-inflammatory drugs. On the rare occasions when the painful condition persists even after conservative treatment, surgical treatment, indicated on a case-by-case basis, may be required, including debridement of the pubic symphysis, partial pubectomy, adductor, and rectus abdominis tenotomy, or arthrodesis with use bone graft [5]. There is a multitude of differential diagnoses for pubalgia.…”