Athletic Pubalgia Secondary to Rectus Abdominis–Adductor Longus Aponeurotic Plate Injury: Diagnosis, Management, and Operative Treatment of 100 Competitive Athletes

Emblom, Benton A.; Mathis, Taylor P; Aune, Kyle T.

doi:10.1177/2325967118798333

Cited by 27 publications

(50 citation statements)

References 25 publications

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“…16,18 Adductor tendinopathy is a common cause of pain and has been associated with lower abdominal and inguinal pain in the high-performance athlete. 6,15 As stated in our inclusion/exclusion criteria, players with any objective evidence of intra-articular hip pathology, such as femoral acetabular impingement, labral tear, or degenerative changes, were specifically excluded from this cohort to minimize bias of the results. In a study by Brophy et al, 2 NFL kickers were more likely to have injuries in the pelvis and hip than any other anatomic location, and muscle-tendon injuries were the most common type.…”

Section: Discussionmentioning

confidence: 99%

Surgical Release of the Adductor Longus With or Without Sports Hernia Repair Is a Useful Treatment for Recalcitrant Groin Strains in the Elite Athlete

Gill

Wall

Gwathmey

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Chronic strain and/or tendinopathy of the adductor longus tendon can be a cause of long-standing groin pain in the elite athlete, resulting in significant time lost from competition. Accurate diagnosis and treatment can expedite return to play. Purpose/Hypothesis: To evaluate return to sport and performance in National Collegiate Athletic Association (NCAA) Division I football players and National Football League (NFL) players following adductor longus release with or without sports hernia repair. We hypothesized that adductor release will be an effective method of treatment for recalcitrant groin/adductor pain in these athletes. Study Design: Case series; Level of evidence, 4. Methods: A cohort study was performed of all NFL players and NCAA Division I college athletes who had undergone an adductor longus tendon release with or without sports hernia repair by 1 of 2 fellowship-trained orthopaedic surgeons between May 1999 and January 2013. All patients reported groin pain below the inguinal ligament and localized to their adductor longus. Symptoms lasted longer than 10 weeks and limited their ability to effectively perform during sport, as assessed by their coach and self-assessment. Questionnaires were given to all 26 patients to assess long-term surgical outcomes. A subgroup analysis was performed for NFL players, in which “performance scores” were calculated according to individual player statistics while playing. Scores obtained before the diagnosis of chronic adductor longus tendinopathy or strain were compared with those after surgery. Patients with prior abdominal or pelvic surgery, radiographic evidence of degenerative joint disease of the hip, labral tears or femoral acetabular impingement, prostatic or urinary tract disease, or nerve entrapment of the ilioinguinal, genitofemoral, or lateral femoral cutaneous nerves were excluded from the study. Results: A total of 32 athletes underwent an adductor longus tenotomy during the study period. Of these patients, 28 were college- or professional-level athletes who underwent an adductor longus tenotomy, with a mean ± SD follow-up time of 6.2 ± 4.2 years (range, 12-178 months). Of the 32 patients, 20 had a concomitant sports hernia repair in addition to an adductor longus tenotomy. Thirty-one patients (97%) were able to return to their previous sport, and 30 (94%) were able to return at their previous level of play. Thirty patients (94%) reported that they were satisfied with their decision to have surgery. No player complained of weakness or a decrease in running speed or power. Mean return to play was 12 weeks from date of surgery. In the subgroup analysis of 16 NFL players, there were no statistically significant differences for the pre- versus postoperative comparisons of the athlete performance scores ( P = .74) and the percentage of the games started versus played ( P = .46). After separation of players who had a concomitant hernia repair from players who did not, there was no statistically significant difference in performance scores or percentages of games started. Conclusion: In this study of elite athletes, adductor longus tenotomy with or without a concomitant sports hernia repair provided overall acceptable and excellent results. Athletes were able to return to their previous level of athletic competition and performance with consistent relief of groin pain. Return to play in an NFL game averaged 12 weeks following surgery.

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Section: Discussionmentioning

confidence: 99%

Surgical Release of the Adductor Longus With or Without Sports Hernia Repair Is a Useful Treatment for Recalcitrant Groin Strains in the Elite Athlete

Gill

Wall

Gwathmey

et al. 2020

Orthopaedic Journal of Sports Medicine

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“… 16 , 20 Often called a “sports hernia” or athletic pubalgia, these injuries often respond to nonoperative treatment, with CMI repair reserved for patients who do not respond to conservative management. 3 , 21 …”

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confidence: 99%

“…16,20 Often called a "sports hernia" or athletic pubalgia, these injuries often respond to nonoperative treatment, with CMI repair reserved for patients who do not respond to conservative management. 3,21 The clinical diagnosis of CMI is challenging because of the many potential causes of groin pain in athletes, including CMI, intra-articular hip-related groin pain, and other causes of groin pain. 5,11,20,22,23 History and physical examination, including tests such as the cross-body sit-up test and the presence of an adductor contracture, are important in establishing a diagnosis of CMI.…”

mentioning

confidence: 99%

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

Kraeutler

Kurowicki

Castrodad

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Core muscle injury (CMI), often referred to as a sports hernia or athletic pubalgia, is a common cause of groin pain in athletes. Imaging modalities used to assist in the diagnosis of CMI include ultrasound (US) and magnetic resonance imaging (MRI). Purpose: To determine if preoperative MRI findings predict clinical outcomes after surgery for CMI. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort study was performed on a consecutive series of patients who were operatively treated for CMI by a single surgeon. CMI was diagnosed based on history, physical examination, and a positive US. In addition, all patients underwent a preoperative MRI. Patients were divided into 2 groups based on whether the MRI was interpreted as positive or negative for CMI. All patients underwent mini-open CMI repair. Patient-reported outcomes (PROs) were collected both pre- and postoperatively and included a visual analog scale (VAS) for pain, the University of California, Los Angeles (UCLA) activity score, and the modified Harris Hip Score. Results: A total of 39 hips were included in this study, of which 17 had a positive MRI interpretation for CMI (44%) and 22 had a negative MRI interpretation (56%). Mean age at the time of surgery was 35 years (range, 17-56 years), and mean follow-up was 21 months (range, 12-35 months). No significant difference was found between groups in mean age or time to follow-up. Patients in both groups demonstrated significant improvement from preoperative to most recent follow-up in terms of the UCLA activity score ( P < .05). VAS scores significantly improved for patients with a positive MRI interpretation ( P = .001) but not for those with a negative MRI interpretation ( P = .094). No significant difference on any PROs was found between groups at the most recent follow-up. Conclusion: Successful clinical outcomes can be expected in patients undergoing surgery for CMI diagnosed based on history, physical examination, and US. Patients with a preoperative MRI consistent with CMI may experience greater improvement in pain postoperatively, although MRI does not predict postoperative activity level in these patients.

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“…First-line treatment for CMI is always nonoperative management, with elective sports hernia repair reserved for refractory cases. 3,15…”

mentioning

confidence: 99%

“…First-line treatment for CMI is always nonoperative management, with elective sports hernia repair reserved for refractory cases. 3,15 Despite treatment success, the clinical diagnosis of CMI is challenging. This is because of the complex anatomy of the abdominopelvic structures and the many root causes of groin pain, which can include infectious, inflammatory, neoplastic, and traumatic causes.…”

mentioning

confidence: 99%

Diagnostic Accuracy of Physical Examination Tests in Core Muscle Injury

et al. 2020

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Background: Core muscle injury (CMI), often referred to as a sports hernia, is a common cause of groin pain in athletes characterized by concomitant injury to the insertion of the adductor longus and the rectus abdominis muscles. Currently, the literature on CMI is sparse with no standardized physical examination tests used in the diagnosis of this type of injury. Purpose: To determine the diagnostic accuracy of various physical examination tests in the diagnosis of CMI. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: A consecutive series of patients evaluated by the senior author with symptoms consistent with CMI were included. Four physical examination tests were routinely performed in these patients by the senior author and were noted in each patient’s chart as positive or negative: (1) pain with resisted cross-body sit-up in figure-of-4 position, (2) pain with straight-leg sit-up, (3) pain with resisted hip flexion in external rotation (external rotation Stinchfield test), and (4) the presence of an adductor contracture. CMI was independently diagnosed by a reference standard (magnetic resonance imaging [MRI]). All MRI scans were read by a musculoskeletal fellowship-trained radiologist. The sensitivity and specificity of each physical examination test alone and in combination were calculated based on this reference standard. Results: A total of 81 patients were included in this study. MRI was positive for a CMI in 39 patients (48%) overall. Both the cross-body sit-up test and the presence of an adductor contracture were found to have a sensitivity of 100% (specificity, 3% for both). The external rotation Stinchfield test was found to have the highest specificity of 60% (sensitivity, 15%). The sensitivity of all 4 physical examination tests in combination was found to be 100% (specificity, 0%). Conclusion: Certain physical examination maneuvers can be used to assist in the diagnosis of a CMI. The cross-body sit-up test and the presence of an adductor contracture are highly sensitive but nonspecific tests for CMI and therefore should be used in conjunction with diagnostic imaging before deciding on an appropriate treatment course.

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Athletic Pubalgia Secondary to Rectus Abdominis–Adductor Longus Aponeurotic Plate Injury: Diagnosis, Management, and Operative Treatment of 100 Competitive Athletes

Cited by 27 publications

References 25 publications

Surgical Release of the Adductor Longus With or Without Sports Hernia Repair Is a Useful Treatment for Recalcitrant Groin Strains in the Elite Athlete

Surgical Release of the Adductor Longus With or Without Sports Hernia Repair Is a Useful Treatment for Recalcitrant Groin Strains in the Elite Athlete

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

Diagnostic Accuracy of Physical Examination Tests in Core Muscle Injury

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