Successful Treatment of Athletic Pubalgia in a Lacrosse Player with Ultrasound‐Guided Needle Tenotomy and Platelet‐Rich Plasma Injection: A Case Report

Abstract

Athletic pubalgia is a syndrome of persistent groin pain due to chronic repetitive trauma or stress involving the pelvic joints and many musculotendinous structures that cross the anterior pelvis. As a result, the differential diagnosis can be complex, but insertional tendinopathies are the most common. This case report describes a novel approach to the treatment of distal rectus abdominis tendinopathies with ultrasound-guided needle tenotomy and platelet-rich plasma (PRP) injection. After injection, the patient returned to pain-free play at his previous level of intensity. This suggests that PRP may be a useful treatment for this diagnosis.

Ultrasound-guided Musculoskeletal Interventions for the Most Common Hip and Pelvis Conditions: A Step-by-Step Approach

“…44,45 US-guided dry needling and PRP injection into the rectus abdominis muscle and prolotherapy with dextrose and lidocaine injection into the thigh adductor origins were also described as providing significant relief. 46,47 Choi et al reviewed a different case series including in total 30 athletes with osteitis pubis who were treated with corticosteroid injections with or without local analgesic. 48 The analysis was performed without any direct comparison of the treatment techniques and showed that most of the treated athletes were able to return to sport; however, a significant nonresponder rate (20.7%) was present.…”

Therapeutic Intervention in Musculoskeletal Radiology: Current Practice and Future Directions

“…225 There is a report of ultrasound-guided needle tenotomy with PRP injection of benefit in this patient cohort; however, further study is required in this area. 226 Labral and cartilaginous injury, which may or may not be related to femoroacetabular impingement, are also common causes of hip pain in athletes. Intra-articular hip injections can offer both diagnostic and therapeutic benefit in this situation.…”

Ultrasound Diagnostic and Therapeutic Injections of the Hip and Groin

“…Schilders, et al [4647] reported one year of pain relief was achieved following a single entheseal pubic cleft injection for adductor-related groin pain in 68% of 28 recreational athletes and in all of the seven competitive athletes with normal findings on MRI but 94% of 17 competitive athletes with enthesopathy confirmed on MRI had experienced a recurrence. Ultrasound-guided needle tenotomy, PRP injection and prolotherapy with dextrose and lidocaine injection have also been described with symptom improvement following treatment but these were only in a case report and small pilot study [4849]. A systemic review in treatment of osteitis pubis in athletes identified only level four evidence with 24 case series in a total of 195 athletes without any direct comparison of treatment modalities [50].…”