Van Neck-Odelberg Disease: A Systematic Review of Literature and Case Presentation.

Van Neck-Odelberg disease (VND) is a term used to describe ischiopubic osteochondritis, which typically presents with atraumatic unilateral groin pain. We performed a systematic review of the existing literature on reported cases of VND to collate what is already known. We also present a new case of VND to add to the relatively small body of literature on the topic. A systematic literature review was performed in July 2024 of PubMed, Medline, and Cochrane databases using the MeSH terms "van Neck Odelberg" to identify published articles. Inclusion criterion was defined as articles that provide individual details on cases of VND. Literature reviews without individual case details were excluded. Two authors independently screened titles and abstracts according to relevance and content. A total of 16 case reports and four case series were included in the final review, excluding our own case presentation. This review included 43 cases of VND (28 males and 15 females). There was no significant difference in average age of presentation between males and females. Majority of VND cases presented with unilateral pain (n=37), mainly in the groin (n=25) and typically non-radiating (n=18). Pain associated with VND most commonly occurred on the side of the non-dominant lower limb (n=8). Review findings demonstrated a common pattern of features associated with the presentation of VND, which included unilateral non-radiating groin pain occurring on the side of the non-dominant lower limb. Our case of a nine-year-old, left-foot dominant, boy who presented with atraumatic right-sided groin pain was in keeping with others reported from our review. MRI confirmed the diagnosis of VND in our case; repeat MRI after a period of activity modification and use of non-steroidal analgesics showed improvement in radiological appearance, and the patient showed improvement in function.

The Use of Botulinum Toxin in Pre-Pubic Aponeurotic Complex Injuries: A Case Report.

Introduction: The pre-pubic aponeurotic complex (PPAC) is a fibrous capsule which lines the anterior of the pubic symphysis. The PPAC may be injured during pelvic torsional movements and single-stance maneuvers. Case Report: This case report describes a PPAC lesion in a 23-year-old professional male athlete specializing in decathlon on a national level. The lesion was treated with US-guided infiltration therapy with botulinum toxin (BTX) and platelet-rich plasma therapy (PRPt) to the longus adductor (LA) and rectus abdominis (RA) muscles. The magnetic resonance imaging control performed at 24 weeks after BTX infiltration and PRPt showed a total restitution ad integrum of the lesion area. At a 3-year follow-up, the subject no longer complained of pain and was restored to his pre-injury level of sport. Conclusion: The distention of LA and RA obtained by BTX infiltration coupled with PRPt allowed PPAC to heal. The BTX infiltrative therapy coupled with PRPt may represent a new and promising treatment for PPAC lesions.

Athletes With Adductor-Related Groin Pain: A Narrative Review.

Adductor-related groin pain is extremely common among athletes, and despite its high prevalence and impact, there is no consensus regarding taxonomy, anatomy, physiopathology, or treatment. We performed a comprehensive literature review and tried to demystify this pathology and its treatment. The Doha agreement classification and its impact are scrutinized as well as the complexity of the proximal adductor longus (AL) insertion and its relationship with the pyramidalis-anterior pubic ligament-AL complex. The stress-shielding and compression theories for the origin of AL tendon pathology are exploited along with how this knowledge translates into injury prevention protocols and surgical techniques. The importance of active rehabilitation protocols and intersegmental control-focused programs is highlighted. The role of an enthesis injection in the treatment algorithm is discussed along with when to perform a tenotomy. The differences between selective and complete tenotomy are highlighted.

Strength effects of the Copenhagen adduction exercise vs an adductor squeeze exercise in male football players - A randomized controlled trial.

To examine the effect of assigning male football players to an 8-week Copenhagen Adduction (CA) and Adductor Squeeze (SQ) Pragmatic randomized controlled trial, 57 participants (16.7 ± 0.9 years, 175.9 ± 7.3 height and 66 ± 8.4 weight) were individually randomized to an 8-week progressive dynamic training protocol with the CA or an isometric training protocol with the SQ twice per week. Maximal eccentric (EHAD) and isometric (IHAD) hip adductor torque was tested with a handheld dynamometer. Perceived exertion and delayed onset muscle soreness (DOMS) were recorded throughout the intervention period. In the intention-to-treat analysis, no significant between-group difference was observed for EHAD (p = 0.478-0.833) nor IHAD (p = 0.084-0.118). There was a significant difference in DOMS between groups in the third to sixteenth exercise session, with the CA group reporting higher values (median varying between 0-3 vs 0-1, p = 0.000-0.009). Perceived exertion was greater for the CA group only in the fifteenth exercise session of the protocol (median of 4 vs 3, p = 0.031). No other significant differences between the groups were observed for DOMS nor perceived exertion. An 8-week adductor training program with either the Copenhagen Adduction or Adductor Squeeze exercise performed with two sets twice a week and adjusted for total volume did not result in significant differences in eccentric nor isometric adduction torque between the groups.

Hand and wrist complete degloving: A case report and litterature review.

INTRODUCTION: Complete hand degloving injuries are traumatic avulsion injuries causing the skin to pull away from the underlying tissues and are most often caused by industrial machinery. We present the case of a degloving trauma of the whole fingers, hand, and wrist resulting in a "watch hand" by analogy with the "ring finger" and discuss alternatives and recommendations from the rare cases described of similar traumas. CASE PRESENTATION: A 33-year-old manual worker, a non-smoker with no significant medical or surgical comorbidities, was admitted for a complete skin avulsion of the left hand and wrist following a work-related accident with a trommel-type industrial roller. Our approach covered the five fingers and the dorsal aspect of the hand and wrist with an artificial dermal matrix, while the palmar side of the hand and wrist was covered with a pedicled groin flap in emergency. At 15months, the patient's sensitivity was classified as S1 on the sensory evaluation scale, joint mobility was less than 30°, and the residual hand retained what we might call "basic" functions, i.e., a counterweight when carrying loads and the ability to pick up and hold a light object in the thumb-index grasp. CONCLUSION: Complete soft tissue hand defects are exceptional and require urgent treatment. If re-implantation is not possible, combining a dermal matrix with a pedicled flap is a simple salvage solution. The risks of vascular, infectious, and stiffening complications in these traumas are high and must be prevented. Patients must be warned of the severity of the trauma, the need for secondary surgeries to restore a policy-digital grip, and the poor functional results expected.

Monitoring hip adductor strength in professional women's football players over a season: A prospective study.

OBJECTIVES: To describe the changes in hip adductor strength of professional women's football players over a season. DESIGN: One-season prospective study. SETTING: Facilities of a national first division club. PARTICIPANTS: Professional women's football players. MAIN OUTCOME MEASURES: Maximum hip adductor isometric strength in the long-lever and short-lever positions at four timepoints: early preseason, early season, mid-season, and end-season. RESULTS: Twenty-two players completed the study. Hip adductor strength values in early preseason (134 ± 29 N in the long-lever position and 317 ± 68 N in the short-lever position) were significantly lower than in the early season (171 ± 29 N and 363 ± 54 N) and mid-season (163 ± 23 N and 369 ± 53 N). By the end of the season (150 ± 19 N and 345 ± 39 N), strength values had significantly declined from both early and mid-season levels. Visual inspection of individual athletes' strength evolution over time reveals heterogeneous responses, with some players showing trajectories opposite to the group at specific time points. CONCLUSIONS: Hip adductor strength increased from the preseason to the start of the women's football national league, remained stable during the first half of the league, but slightly declined in the second half. The heterogeneous responses among athletes underscore the importance of individualized monitoring throughout the season.

Understanding patient experiences to improve care for females groin hernia.

BACKGROUND: Thousands of females undergo inguinal hernia repair annually, yet females have been excluded from prior clinical trials evaluating inguinal hernia repairs. Research shows females face worse outcomes after hernia repair compared to males, including higher recurrence rates, increased chronic pain, and limited data to guide treatment. Prospective studies focused on optimizing outcomes for females are critically needed. Prior to conducting such trials, it is essential to obtain preliminary data from female participants to ensure that the studies are designed appropriately to address their priorities and improve sex disparities in outcomes. METHODS: Semi-structured qualitative interviews were conducted between July 7 and December 31, 2023, with 34 females evaluated for groin hernia. Interviews were conducted via Zoom at an academic medical center. The discussions aimed to explore the challenges in diagnosing hernias, the considerations for selecting treatment options, and the priorities for future research. The transcripts were analyzed using descriptive content analysis, facilitated by MAXQDA software. RESULTS: Diagnostic challenges included delayed recognition due to underappreciation of female hernias. Participants desired greater familiarity with hernias and treatment options from providers. For surgical decisions, fear of complications drove some towards surgery, while others prioritized avoiding recovery time for asymptomatic hernias. Participants called for research on female-specific risk factors, pain experiences, recovery impacts, and non-operative approaches. The majority of participants agreed or considered participating and serving as an advisor in a future study. CONCLUSION: Females with hernia face sex-based disparities in diagnosis and treatment. Improving provider awareness and developing guidelines are needed. This qualitative study identifies key areas for future research to optimize person-centered hernia care for females based directly on personal perspectives and priorities, laying the groundwork for prospective trials aimed at improving outcomes.

Development and Validation of a 30-Day Point-Scoring Risk Calculator for Open Groin Vascular Surgery: The George Washington Groin Score.

BACKGROUND: Open groin vascular surgeries are important in managing peripheral arterial diseases. Given its inherent risks and the diverse patient profiles, there is a need for risk assessment tools. This study aimed to develop a 30-d point-scoring risk calculator for patients undergoing open groin vascular surgeries. METHODS: Patients underwent open groin vascular surgery, including aortobifemoral, axillofemoral, femorofemoral, iliofemoral, femoral-popliteal, and femoral-tibial bypass as well as thromboendarterectomy, were identified in American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2021. Patients were randomly sampled into experimental (2/3) and validation (1/3) groups. The George Washington (GW) groin score, a weighted point-scoring system, was developed for 30-d mortality from multivariable regression on preoperative risk variables by Sullivan's method. GW groin score was subjected to internal and external validation. Furthermore, the effectiveness of GW groin score was evaluated in 30-d major surgical complications. RESULTS: A total of 129,424 patients were analyzed, with 86,715 allocated to experimental group and 42,709 to validation group. GW groin score is derived as follows: aortobifemoral bypass (2 points), axillofemoral bypass (1 point), age (>75 y, 2 points; 65-75 y, 1 point), disseminated cancer (2 points), emergent presentation (1 point), American Society of Anesthesiology score 4 or 5 (1 point), dialysis (1 point), and preoperative sepsis (1 point).GW groin score exhibited robust discrimination (c-statistic = 0.794, 95% CI = 0.786-0.803) and calibration (Brier score = 0.029). The transition from individual preoperative variables (c-statistic = 0.809, 95% CI = 0.801-0.818) to the point-scoring system was successful and external validation of the score was confirmed (c-statistic = 0.789, 95% CI = 0.777-0.801, Brier score = 0.030). Furthermore, GW groin score can effectively discriminate major surgical complications. CONCLUSIONS: This study developed GW groin score, a concise and comprehensive 10-point risk calculator. This well-validated score demonstrates robust discriminative and predictive abilities for 30-d mortality and major surgical complications following open groin vascular surgeries. GW groin score can anticipate potential perioperative complications and guide treatment decisions.

A Multicenter Analysis of 3 Decades of Hip Arthroscopy: Evolving Techniques and Growing Patient Volumes From 1988 to 2022.

Background: The number of hip arthroscopies performed in the United States has grown significantly over the past several decades, with evolving indications and emerging techniques. Purposes: To (1) examine the evolution of hip arthroscopy at 3 tertiary referral centers between 1988 and 2022 and (2) quantify trends in patient demographics and procedures performed. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis was performed of all patients undergoing hip arthroscopy at 3 academic centers between 1988 and 2022. Demographic data were collected using standardized forms and operative notes, and intraoperative images were manually reviewed for each patient to determine the specific procedures performed at the time of the hip arthroscopy. Surgical procedures were plotted over time to evaluate trends. Patients were divided into 3 time periods for comparison: early hip arthroscopy from 1988 to 2008, 2009 (the time of the first labral repair in our cohort) to 2015, and 2016 to 2022. Results: A total of 3000 patients (age, 35.7 ± 13.8 years; age range, 10-89 years; female sex, 2109 (70.3%); body mass index, 27.4 ± 6.3 kg/m2) underwent arthroscopic hip procedures between 1988 and 2022. The mean number of cases increased from a mean of 3.2 per year in 1988-2008 to 285.9 per year in 2016-2022 (P < .001). Labral treatment at the time of primary hip arthroscopy evolved from 100% debridement and 0% repair in 1988-2008 to 5.0% debridement, 94.0% repair, and 1.0% labral reconstruction in 2016-2022 (P < .001). Cam resection increased from 4.1% in 1988-2008 to 86.9% in 2016-2022 (P < .001). By 2022, 45 out of 325 cases (13.8%) were revisions. The rate of capsular repair at the time of primary hip arthroscopy increased from 0.0% in 1988-2008 up to 81.0% in 2016-2022. Conclusion: There has been a significant growth of hip arthroscopy volumes as well as a significant transition from use as a tool for diagnosis and labral debridement to procedures restoring native anatomy including labral repair, cam resection, capsular repair, periacetabular osteotomy, and gluteal repair.

Assessing the Safety of Mesh Repair in Strangulated Groin Hernias: A Systematic Review and Meta-Analysis.

The use of mesh in emergency repair of complicated groin hernias has been a subject of discussion for decades. While it is now generally accepted that mesh could safely be used in incarcerated (irreducible) and obstructed hernias (without strangulation), with wound infection rates comparable to suture repairs, the use of mesh in strangulated hernias involving bowel resection is still controversial. The aim of this study, therefore, was to analyse the safety of mesh use in strangulated hernias with ischaemic bowel at the time of surgery. A literature search was carried out using relevant keywords. The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 framework anddata analysis was done using the Review Manager version 5.4 (The Cochrane Collaboration, Oxford, UK) meta-analysis software. Seven studies comprising 1,159 patients who had emergency surgery for strangulated groin hernias were analysed. A pooled random effect meta-analysis did not show any significant difference in the surgical site infection rate (odds ratio (OR) = 0.88, 95% confidence interval (CI) = 0.39-1.96, p = 0.75), seroma formation (OR = 3.39; 95% CI = 0.70-16.43; p = 0.13), and hernia recurrence (OR = 0.33; CI = 0.05-2.22; p = 0.26) between the two groups. The long-held concern that mesh could not be safely used in strangulated groin hernias has not been validated by the results obtained from this systematic review and meta-analysis. However, more randomised controlled trials in this clinical area would need to be carried out to further validate the results of this study.

Conservative Management of Vulvar Cancer-Where Should We Draw the Line?

Vulvar cancer is a rare disease, and cure rates were low until the mid-20th century. The introduction of an en bloc radical vulvectomy and bilateral groin and pelvic lymph node dissection saw them rise from 15-20% to 60-70%. However, this very radical surgery was associated with high physical and psychological morbidity. Wounds were usually left open to granulate, and the average post-operative hospital stay was about 90 days. Many attempts have been made to decrease morbidity without compromising survival. Modifications that have proven to be successful are as follows: (i) the elimination of routine pelvic node dissection, (ii) the use of separate incisions for groin dissection, (iii) the use of unilateral groin dissection for lateral, unifocal lesions, (iv) and radical local excision with 1 cm surgical margins for unifocal lesions. Sentinel node biopsy with ultrasonic groin surveillance for patients with node-negative disease has been the most recent modification and is advocated for patients whose primary cancer is <4 cm in diameter. Controversy currently exists around the need for 1 cm surgical margins around all primary lesions and on the appropriate ultrasonic surveillance for patients with negative sentinel nodes.

The Translation, Cross-Cultural Adaptation and Validation of the Italian Version of the Hip and Groin Outcome Score Questionnaire for a Young and Active Population.

The HAGOS (Hip and Groin Outcome Score) questionnaire is a valid and reliable measure of the self-assessment of symptoms, activity limitation, participation restriction, and quality of life (Qol) of subjects with hip and/or groin pain. The aims of this study are to translate and transculturally adapt the HAGOS into Italian (HAGOS-I) and to assess its internal consistency, validity, and reliability in physically active, young, and middle-aged subjects. The translation and transcultural adaptation of (HAGOS-I) was carried out according to international guidelines. Eight-one subjects (mean age 28.19) were included in this study. All the participants completed the HAGOS-I, the Lower Extremity Functional Scale (LEFS-I), the Oxford Hip Score (OHS-I), and the Short Form 36 Health Surveys (SF-36-I). The Cronbach's α for the six HAGOS subscales ranged from 0.63 to 0.87. Statistically significant correlations were obtained between the six HAGOS-I subscales and the LEFS-I (rs = 0.44-0.68; p < 0.01). Only one HAGOS-I subscale (Participation in Physical Activities) did not reach statistical significance with the OHS-I, while the remaining five had a moderate correlation (rs = 0.40-0.60; p < 0.01). The test-retest reliability (Intraclass Correlation Coefficient) ranged from 0.57 to 0.86 for the six HAGOS-I subscales. The HAGOS-I is a valid and reliable instrument that can be used in clinical settings with young and middle-aged subjects with hip and/or groin pathologies.

Is It Possible to Improve Performance in Competition After an Adductor Longus Injury in Professional Football Players?

CONTEXT: Adductor longus muscle strains are one of the most common injuries occurring in intermittent sports such as soccer. OBJECTIVE: The purpose of this study was to know the effect of a specific rehabilitation and reconditioning program, which was previously validated, after adductor longus injury in professional soccer players. METHODS: A specific rehabilitation and reconditioning program was applied to 11 injured male professional soccer players. PARTICIPANTS: Eleven male professional soccer players (age = 29.18 [4.45] y; height = 179.64 [4.97] cm; mass = 75.33 [3.84] kg). INTERVENTIONS: In the first place, the days taken to return to full team training and to return to competition (RTP) was analyzed; second, the most important performance parameters were analyzed and compared in the preinjury match (PRE) and after the return to competition at 2 different points in time (RTP1-RTP2). RESULTS: The return to full team training recorded was 11.91 (1.92) days and the RTP was 15.36 (3.04) days. Match performance parameters showed significant improvements after injury. Significant improvements were observed during RTP2, in the variables of high-speed running (P = .002), very high-speed running (P = .006), acceleration (>3 m/s2; P = .048), and high metabolic load distance (P = .009). CONCLUSION: The results allow us to conclude that this program was very effective, as it allowed the players to obtain similar and/or higher performance values in a reduced period of time after the injury.

Hidden hernias hurt: a plea for early diagnosis and treatment of occult inguinal hernias.

INTRODUCTION: Hidden or occult inguinal hernias are symptomatic hernias that do not present with a bulge. For some surgeons, if a bulge is not present, then no hernia repair is contemplated. We report preoperative findings of patients with occult inguinal hernias and outcomes after repair to assist in early detection and treatment of this special population. METHODS: All patients who underwent inguinal hernia repairs, 2008-2019, were reviewed. Patients were classified as having occult inguinal hernias if they (a) complained of groin pain, (b) did not have bulging on exam, (c) had supportive imaging showing an inguinal hernia, and (d) were confirmed to have inguinal hernias that were repaired intraoperatively. Presentation and outcomes were compared with the non-occult group treated during the same time period. RESULTS: Of 485 patients who underwent elective inguinal hernia repairs over 10 years, 212 (44%) had occult inguinal hernias. Patients in the occult group were significantly more likely to be female, younger, and with higher BMI compared to the non-occult group. They also had more preoperative pain for a significantly longer time. This was associated with higher incidence of pain medications usage, including opioids, in the occult group. On physical examination, those with occult hernias were twice as likely to have tenderness over the inguinal canal. Most hernia repairs (66%) were laparoscopic and 94% used mesh. Postoperatively, the occult group had 83% resolution of symptoms after hernia repair. CONCLUSION: Some surgeons hesitate recommending hernia repair to patients with occult inguinal hernias, as these patients do not fit the traditional definition of a hernia, i.e., a bulge. Our study challenges this perception by showing that discounting groin pain due to occult hernia prolongs patient's suffering and may risk increased opioid use, especially in females, although 83% cure can be achieved with hernia repair.

Leg Pain-An Unexpected Twist.

BACKGROUND: Obturator hernia is a rare condition, often presenting with non-specific symptoms, such as thigh pain, groin pain, nausea, or vomiting. Obturator hernias are most common in thin, elderly women. Oftentimes, they are diagnosed late in the disease course resulting in complications and high morbidity and mortality. CASE REPORT: We present the case of a 75-year-old female who presented with right thigh pain with no other symptoms. After computed tomography (CT) of the abdomen/pelvis, the patient was found to have an incarcerated obturator hernia complicated by a small bowel obstruction, ultimately requiring urgent surgical intervention. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Given the very general symptoms associated with the condition, the diagnosis of obturator hernia can easily be missed, leading to a delayed diagnosis, more complications, and a higher morbidity and mortality rate. Due to the risk associated with a delayed diagnosis, it is important for emergency physicians to maintain a high clinical suspicion for the diagnosis.

Association between Hip/Groin Pain and Hip ROM and Strength in Elite Female Soccer Players.

Background/Objectives: Hip strength and range of motion have been compared in soccer players with and without hip and groin pain but only in male footballers or gender-combined samples. In female soccer players, the biomechanics contributing to this injury remain poorly understood compared to other sporting injuries. The aim of the present study is to investigate whether differences exist in adductor and abductor isometric test values and hip joint range of motion between elite female soccer players with longstanding groin pain and injury-free controls. Methods: Ten female elite soccer players with current longstanding hip and groin pain and twenty-five injury-free controls from the same teams were included in the study. Hip adductor and abductor isometric strength were evaluated with a hand-held dynamometer. A bent knee fall-out test was also utilized to examine the hip joint range of motion. Results: A significant difference in abductor isometric test values was observed between the control group (2.29 ± 0.53 N/Kg) and the hip and groin pain group (2.77 ± 0.48 N/Kg; p = 0.018). Furthermore, the injured group showed a decreased adductor/abductor ratio compared to the control group (1.00 ± 0.33 vs. 1.27 ± 0.26; p = 0.013). No differences were observed in the bent knee fall-out test (p = 0.285). Conclusions: Female elite soccer players with current longstanding hip and groin pain exhibited higher abductor isometric strength and lower adductor/abductor ratio compared to non-injured women players. There were no differences in the BKFO test between groups.

Shouldice versus Lichtenstein inguinal hernia repair: A meta-analysis of randomized controlled trials.

BACKGROUND: The Lichtenstein technique is the standard treatment for adult open inguinal hernia repair. Among the non-mesh repair techniques, Shouldice has shown the best results and is comparable to mesh repairs in selected cases. Due to the risk of chronic groin pain associated with the Lichtenstein technique, Shouldice has increased in popularity, and some surgeons have adopted it as a viable first-line option. METHODS: MEDLINE, Cochrane, Central Register of Clinical Trials, and EMBASE for randomized controlled trials (RCT) published until February 2024. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using the Cochran Q test and I2 statistics with p-values <0.10 and I2 > 25% considered significant. Statistical analysis was performed using R Software, version 4.1.2. RESULTS: Fourteen RCTs comprising 2784 patients were included, of whom 1379 (47.5%) were submitted to the Shouldice hernia repair and 1513 (52.5%) to the Lichtenstein technique. Shouldice was associated with a significant increase in the recurrence rate (4.2% vs. 0.9%; RR 3.68; 95% CI 2.05-6.60; p < 0.001; I2 = 0%) compared with Lichtenstein. The number needed to treat (NNT) to prevent one Shouldice recurrence was 30.3. There were no significant differences between groups in chronic pain, urinary retention, bladder injury, testicular atrophy, wound infection, hematoma-seroma, or hypesthesia. CONCLUSION: The Lichtenstein technique was associated with reduced recurrence rates compared with Shouldice in patients undergoing inguinal hernia repair. However, the overall recurrence rate with the Shouldice technique was still low (4.2%), suggesting that it may be a viable option in selected patients.

Some minutes matter more: Groin-to-recanalization is the main time-related predictor of outcome in acute ischemic stroke.

INTRODUCTION: Endovascular thrombectomy (EVT) is the standard of care for selected patients with acute ischemic stroke (AIS) and large vessel occlusion (LVO), associated with intravenous thrombolysis, when indicated. While many studies focused on pre-hospital and in-hospital pathways, only few analyzed the relationship between groin-to-recanalization (GTR) time and functional outcome. AIM: To explore whether GTR time is an independent predictor of outcome in patients undergoing EVT. METHODS: All patients with anterior circulation stroke treated with EVT at a high-volume center from January 2021 to December 2023 were included. The cohort was divided into two groups according to GTR time shorter or longer than 30 min. Regression analysis assessed the association between GTR time and 3-month good outcome, defined as modified Rankin Scale 0-2. RESULTS: The study included 419 patients. The groups had similar baseline characteristics and similar onset to recanalization (OTR) time. Regression analysis showed shorter GTR time is an independent predictor of favorable outcome (OR 2.49 [95% CI 1.26-4.94]). Age, baseline NIHSS, ASPECT score and bridging IVT were also found to be independently associated with outcome. DISCUSSION AND CONCLUSIONS: Our study showed GTR time is an independent predictor of good outcome in patients undergoing EVT with similar OTR time, emphasizing procedural time as a key prognostic factor, even greater than other well-known pre-hospital and in-hospital time-dependent variables. These findings may raise the issue of developing alternative approaches or early "rescue" strategies for complicated procedures.