Operative treatment of athletic pubalgia in competitive athletes: a retrospective study

Koutserimpas, Christos; Vlasis, Konstantinos; Makris, Marinos C.; Ioannidis, Argyrios; Konstantinidis, Michael; Antonakopoulos, Fotios; Athanasopoulos, Panagiotis; Mazarakis, Antonios; Papagelopoulos, Panagiotis; Konstantinidis, Konstantinos

doi:10.23736/s0022-4707.20.10389-x

Cited by 4 publications

(3 citation statements)

References 25 publications

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“…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%).…”

Section: Discussionmentioning

confidence: 99%

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

Castle

Kessler

Abbas

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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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 AE 2.62 months. Compared with control athletes, athletes in the AP group played significantly fewer seasons postinjury (4.17 AE 2.70 vs 5.49 AE 3.04 seasons, respectively; P ¼ .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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Section: Discussionmentioning

confidence: 99%

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

Castle

Kessler

Abbas

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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“…The mean return to sports in this cohort was at 6 weeks. 28 With respect to open repair, patients who had undergone the Gilmore (open) repair technique were reported to have a return-to-sports rate of 96% at 15 weeks. 9 A technique of open pelvic floor repair and reattachment of the rectus abdominis resulted in a 95% rate of return to sports at 3 months postoperatively.…”

Section: Outcomes Of Operative Treatment Isolated Athletic Pubalgiamentioning

confidence: 99%

Core Muscle Injury: Evaluation and Treatment in the Athlete

Forlizzi

Ward

Whalen³

et al. 2022

Am J Sports Med

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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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“…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…”

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confidence: 99%

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

Hatem

Martin

Bharam

2021

Orthopaedic Journal of Sports Medicine

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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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Operative treatment of athletic pubalgia in competitive athletes: a retrospective study

Cited by 4 publications

References 25 publications

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

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

Core Muscle Injury: Evaluation and Treatment in the Athlete

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

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