Radiofrequency denervation of the inguinal ligament for the treatment of ‘Sportsman's Hernia’: a pilot study

Comin, Jules; Obaid, Haron; Lammers, Gregory John; Moore, Joe; Wotherspoon, Mark; Connell, David

doi:10.1136/bjsports-2012-091129

Cited by 32 publications

(34 citation statements)

References 37 publications

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“…There are several randomised trials in the area of groin injury but they mostly cover conservative treatment or prevention of adductor-related groin pain and are summarised in table 3 34–37…”

Section: Radiological Intervention Techniquesmentioning

confidence: 99%

“…A more recent randomised trial from Australia hypothesised that inflammation and compression around the ilioinguinal nerve was the most likely cause of chronic groin pain in athletes and consequently constructed a study examining the effects of radiofrequency denervation (RFD) of the inguinal ligament compared to local anaesthesia and steroid injections in 36 patients 37. This study showed a significantly improved benefit in terms of pain with the use of RFD (p<0.001) with a subgroup of patients finding further short-term improvement from RFD if surgery had failed 37…”

Section: Radiological Intervention Techniquesmentioning

confidence: 99%

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‘Treatment of the Sportsman's groin’: British Hernia Society's 2014 position statement based on the Manchester Consensus Conference

et al. 2013

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IntroductionThe aim was to produce a multidisciplinary consensus to determine the current position on the nomenclature, definition, diagnosis, imaging modalities and management of Sportsman's groin (SG).MethodsExperts in the diagnosis and management of SG were invited to participate in a consensus conference held by the British Hernia Society in Manchester, UK on 11–12 October 2012. Experts included a physiotherapist, a musculoskeletal radiologist and surgeons with a proven track record of expertise in this field. Presentations detailing scientific as well as outcome data from their own experiences were given. Records were made of the presentations with specific areas debated openly.ResultsThe term ‘inguinal disruption’ (ID) was agreed as the preferred nomenclature with the term ‘Sportsman's hernia’ or ‘groin’ rejected, as no true hernia exists. There was an overwhelming agreement of opinion that there was abnormal tension in the groin, particularly around the inguinal ligament attachment. Other common findings included the possibility of external oblique disruption with consequent small tears noted as well as some oedema of the tissues. A multidisciplinary approach with tailored physiotherapy as the initial treatment was recommended with any surgery involving releasing the tension in the inguinal canal by various techniques and reinforcing it with a mesh or suture repair. A national registry should be developed for all athletes undergoing surgery.ConclusionsID is a common condition where no true hernia exists. It should be managed through a multidisciplinary approach to ensure consistent standards and outcomes are achieved.

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Section: Radiological Intervention Techniquesmentioning

confidence: 99%

Section: Radiological Intervention Techniquesmentioning

confidence: 99%

‘Treatment of the Sportsman's groin’: British Hernia Society's 2014 position statement based on the Manchester Consensus Conference

et al. 2013

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“…A secondary aim was to discuss the anatomical reclassification of the inguinal ligament to a tendon based on the above information and drawing from structural and functional evidence supporting this argument. The hypothesis was that direct inguinal ligament tenotomy [13, 19] or radiofrequency denervation (RFD) [4, 20] would be clinically beneficial in the context of ID management in athletes and that the published literature would support the reclassification of the inguinal ligament to a tendon.…”

Section: Introductionmentioning

confidence: 99%

A qualitative literature review exploring the role of the inguinal ligament in the context of inguinal disruption management

Clelland

2018

Surg Radiol Anat

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PurposeGroin injury, sportsman’s groin and inguinal disruption (ID) refer to a diffuse chronic groin pain syndrome that has significant impact on athletes and is often unresponsive to conservative management. The ID aetiology is poorly understood but may involve weakness of the inguinal ligament attachments or the posterior inguinal canal wall or the tendons of adductor longus and rectus abdominis. We discuss the literature in which the inguinal ligament was directly targeted for ID management in athletic populations. Secondarily, we discuss the anatomical reclassification of the inguinal ligament to a tendon based on the above information.MethodsThis was a qualitative review of the published literature, in English, from January 2007 to February 2017.ResultsFive research papers, including 264 patients, were appraised. In patients with ID, tears were identified in the inguinal ligament, and to relieve pain, the surgical treatment of the ligament by tenotomy was shown to be beneficial. Techniques such as radiofrequency denervation involving the inguinal ligament and ilioinguinal nerve were also shown to relieve symptoms in athletes.ConclusionsThis qualitative review has specifically focused on the literature directly targeting the inguinal ligament in ID which is a relatively unexplored management approach. When treated as a tendon, the inguinal ligament appears to be an appropriate ID therapeutic target. Integrated studies and randomised clinical trials will promote a better understanding of the role of the inguinal ligament and its tendinous properties in ID and provide a foundation for evidence-based management of chronic groin pain in athletes.

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“…3,18,32,35 Radiofrequency denervation of the inguinal nerve and inguinal ligament as both a primary treatment and for refractory pain after prior AP surgery has recently been described in athletes, with encouraging results up to 6 months postprocedure. 8 …”

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confidence: 99%

Performance and Return to Sport After Sports Hernia Surgery in NFL Players

Jack

Evans

Echo

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Recognition, diagnosis, and treatment of athletic pubalgia (AP), also known as sports hernia, once underrecognized and undertreated in professional football, are becoming more common. Surgery as the final treatment for sports hernia when nonsurgical treatment fails remains controversial. Given the money involved and popularity of the National Football League (NFL), it is important to understand surgical outcomes in this patient population.Hypothesis:After AP surgery, players would: (1) return to sport (RTS) at a greater than 90% rate, (2) play fewer games for fewer years than matched controls, (3) have no difference in performance compared with before AP surgery, and (4) have no difference in performance versus matched controls.Study Design:Cohort study; Level of evidence, 3.Methods:Internet-based injury reports identified players who underwent AP surgery from January 1996 to August 2015. Demographic and performance data were collected for each player. A 1:1 matched control group and an index year analog were identified. Control and case performance scores were calculated using a standardized scoring system. Groups were compared using paired Student t tests.Results:Fifty-six NFL players (57 AP surgeries) were analyzed (mean age, 28.2 ± 3.1 years; mean years in NFL at surgery, 5.4 ± 3.2). Fifty-three players were able to RTS. Controls were in the NFL longer (P < .05) than players who underwent AP surgery (3.8 ± 2.4 vs 3.2 ± 2.1 years). Controls played more games per season (P < .05) than post-AP players (14.0 ± 2.3 vs 12.0 ± 3.4 games per season). There was no significant (P > .05) difference in pre- versus post-AP surgery performance scores and no significant (P > .05) difference in postoperative performance scores versus controls post-index.Conclusion:There was a high RTS rate after AP surgery without a significant difference in postoperative performance, though career length and games per season after AP surgery were significantly less than that of matched controls.

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Radiofrequency denervation of the inguinal ligament for the treatment of ‘Sportsman's Hernia’: a pilot study

Abstract: This novel technique could help athletes suffering from chronic groin pain return to play more quickly, both facilitating and allowing deferral of remedial physiotherapy treatments, and potentially avoiding the need for surgery.

Cited by 32 publications

References 37 publications

‘Treatment of the Sportsman's groin’: British Hernia Society's 2014 position statement based on the Manchester Consensus Conference

‘Treatment of the Sportsman's groin’: British Hernia Society's 2014 position statement based on the Manchester Consensus Conference

A qualitative literature review exploring the role of the inguinal ligament in the context of inguinal disruption management

Performance and Return to Sport After Sports Hernia Surgery in NFL Players

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