Simultaneous Bilateral Hip Arthroscopy in Adolescent Athletes With Symptomatic Femoroacetabular Impingement.

BACKGROUND: Femoroacetabular impingement represents a common cause of hip pain in adolescents. The purpose of the present study was to evaluate the safety and efficacy of simultaneous bilateral hip arthroscopy for bilateral symptomatic femoroacetabular impingement in adolescent athletes. METHODS: Clinical data were collected in a prospective database on patients who underwent unilateral or simultaneous bilateral hip arthroscopy and included complications, reoperation rate, and return to play time. Differences in International Hip Outcome Tool (iHOT)-12 scores according to hip side and postoperative follow-up time (preoperative, 1.5, 3, 6, 12, and 24 mo) were evaluated using a 2×6 repeated-measures analysis of variance with post hoc repeated-measures 1-way analysis of variance and Bonferroni-corrected paired t tests. RESULTS: In total, 24 patients (36 hips) were studied, of whom 12 underwent simultaneous bilateral hip arthroscopy (24 hips) and a case-matched control group of 12 patients underwent unilateral hip arthroscopy. There were 5 males in each group (41.7%). Average age was 15.7 and 16.5 years in the bilateral and unilateral groups, respectively. No patients were lost to follow-up. In the bilateral group, a significant increase in mean iHOT-12 score was observed between 1.5- and 3-month follow-up (61.8 vs. 82.8, respectively; P=0.003), and 6-, 12-, and 24-month follow-up (91.4, 95.1, and 96.6, respectively, P=0.004). At all follow-up times, there were no significant differences in mean iHOT-12 scores or other outcome measures between bilateral and unilateral cohorts. Time to return to preinjury level of activity was similar between the bilateral and unilateral groups (4.7 vs. 4.9 mo, respectively; P=0.40). One transient lateral femoral cutaneous nerve palsy occurred in each group, though no other complications were documented. No patients required revision surgery by latest follow-up. CONCLUSIONS: Bilateral simultaneous hip arthroscopy is safe and reproducible in adolescent athletes, achieving equivalent outcomes, and similar rehabilitation time when compared with unilateral surgery. LEVEL OF EVIDENCE: Level II-therapeutic study.

The Role of Hip Arthroscopy in Investigating and Managing the Painful Hip Resurfacing Arthroplasty.

PURPOSE: To determine the safety and efficacy of hip arthroscopy performed in the peripheral compartment as a diagnostic and therapeutic treatment option for patients with hip pain after hip resurfacing surgery. METHODS: Indications for hip arthroscopy after hip resurfacing included patients with a symptomatic hip-resurfaced arthroplasties who did not respond to nonoperative treatment. Patients who underwent a hip arthroscopy after a painful hip resurfacing were included with a minimum of 1 year follow-up. Subgroup analysis was performed according to whether an established diagnosis was made before arthroscopic intervention or not. Subjective measures were based on Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores, and results were calculated and analyzed. RESULTS: We included 68 patients (26 male [38%] and 42 female [62%]) who underwent subsequent hip arthroscopy from a population of 978 consecutive hip-resurfaced arthroplasties performed between 1999 and 2010. The average age was 58 (range, 37 to 78 years). The mean follow-up after hip arthroscopy was 3.4 years (range, 12 months to 5.8 years). Patients who had an established diagnosis (n = 41) before hip arthroscopy showed statistical improvement in their WOMAC scores (7 to 2, P < .001). Only 3 (7%) of these 41 patients failed and were converted to a total hip replacement (THR); however, patients who did not have an established diagnosis (n = 27) before undergoing hip arthroscopy showed statistical worsening of the WOMAC (15 to 21, P = .002). Ten (37%) of these 27 patients without a diagnosis failed and needed to be converted to a THR. A significant correlation was found between the collections found on ultrasound (psoas bursa and/or in the hip joint) and the need for synovectomy (P = .01). The overall revision rate to THR after hip resurfacing in our group of patients was 1.3% (n = 13). Female patients were more likely to require postresurfacing hip arthroscopy with 42 (60%) female to only 26 (40%) male patients undergoing this procedure. In our study population, 70% (14/21, P < .05) of patients with hip pain caused by severe metal synovial reaction or metal-on-metal reaction were women. A total of 5 (7%) patients had minor-to-mild complications after hip arthroscopy. CONCLUSIONS: Hip arthroscopy is a safe surgical treatment option for those patients with a painful hip resurfacing arthroplasty. Having an accurate diagnosis before hip arthroscopy improves the likelihood a good outcome. LEVEL OF EVIDENCE: Level IV - therapeutic case series.

Plasma rich in growth factors (PRGF) as a treatment for high ankle sprain in elite athletes: a randomized control trial.

PURPOSE: Syndesmotic sprains are uncommon injuries that require prolonged recovery. The influence of ultrasound-guided injections of platelet-rich plasma (PRP) into the injured antero-inferior tibio-fibular ligaments (AITFL) in athletes on return to play (RTP) and dynamic stability was studied. METHODS: Sixteen elite athletes with AITFL tears were randomized to a treatment group receiving injections of PRP or to a control group. All patients followed an identical rehabilitation protocol and RTP criteria. Patients were prospectively evaluated for clinical ability to return to full activity and residual pain. Dynamic ultrasound examinations were performed at initial examination and at 6 weeks post-injury to demonstrate re-stabilization of the syndesmosis joint and correlation with subjective outcome. RESULTS: All patients presented with a tear to the AITFL with dynamic syndesmosis instability in dorsiflexion-external rotation, and larger neutral tibia-fibula distance on ultrasound. Early diagnosis and treatment lead to shorter RTP, with 40.8 (±8.9) and 59.6 (±12.0) days for the PRP and control groups, respectively (p = 0.006). Significantly less residual pain upon return to activity was found in the PRP group; five patients (62.5 %) in the control group returned to play with minor discomfort versus one patient in the treatment group (12.5 %). One patient in the control group had continuous pain and disability and subsequently underwent syndesmosis reconstruction. CONCLUSIONS: Athletes suffering from high ankle sprains benefit from ultrasound-guided PRP injections with a shorter RTP, re-stabilization of the syndesmosis joint and less long-term residual pain. LEVEL OF EVIDENCE: II.

Bilateral hip arthroscopy under the same anesthetic for patients with symptomatic bilateral femoroacetabular impingement: 1-year outcomes.

PURPOSE: The purpose of this study was to investigate whether, in patients with bilateral symptomatic femoroacetabular impingement, bilateral surgery under 1 anesthetic is safe and efficacious and allows a rapid return of function compared with staged procedures. METHODS: Three groups were evaluated: in group 1 both hips were treated simultaneously, in group 2 both hips were treated in a staged fashion, and in group 3 a single hip was addressed. The outcome measures were anesthesia and surgical times; time in the hospital; visual analog scale score for pain on postoperative days 1, 3, 7, and 30; analgesic use; and time until the patient could bike, drive, perform office work, perform gym activities, run, and return to play. Midterm evaluation was performed with the Non-Arthritic Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index score at 6 and 12 months postoperatively. RESULTS: We enrolled 76 patients (122 hips) in this study. There were 42 male and 34 female patients. The mean age was 33 years (range, 14 to 50 years), and the mean body mass index was 24 (range, 18 to 35). Group 1 comprised 26 patients (52 hips, 16 male and 10 female patients). Group 2 comprised 20 patients (40 hips, 13 male and 7 female patients), with a mean time between surgeries of 14.56 weeks. Group 3 comprised 33 patients (30 hips, 13 male and 17 female patients). No preoperative differences were found between the groups. The surgical and anesthesia times in group 1 were significantly longer than those in groups 2 and 3. We found no significant differences in postoperative visual analog scale scores, analgesic use, or length of hospital stay. Group 1 required more time before patients were able to ride a stationary bicycle (14.7 days in group 1, 7.8 days in group 2, and 8.5 days in group 3; P < .05). We found no differences between the groups regarding when patients returned to driving, performing office work, or reporting a normal gait. Each group had significant improvements in the Western Ontario and McMaster Universities Osteoarthritis Index and Non-Arthritic Hip Score at 6 and 12 months compared with preoperatively (P < .05). No significant differences in outcome scores were found in the 3 groups before surgery and at 6 or 12 months after surgery. CONCLUSIONS: Simultaneous femoroacetabular impingement surgery does not lead to higher rates of complications, postoperative pain, analgesic use, or side effects. The return to daily activities is similar to a single-hip procedure with the advantage of a single rehabilitation. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Can hip arthroscopy be performed with conventional knee-length instrumentation?

PURPOSE: The purpose of this study was to determine whether hip arthroscopy can be performed using conventional knee-length arthroscopy instrumentation. METHODS: We included 116 consecutive hip arthroscopies (104 patients) in this study. Age, side of surgery, height (in inches), weight (in pounds), body mass index (BMI), and a subjective assessment of body type (1, muscular; 2, somewhat overweight; 3, overweight; 4, thin; and 5, normal weight) were recorded. The depth from the skin at 2 portal sites to 3 commonly accessed positions (12 o'clock, 3 o'clock, and acetabular fossa) was assessed using a guide with marked notches (in millimeters). Subgroup analysis was performed according to BMI and subjective biotype for each patient. RESULTS: We included 104 patients with a mean age of 35 years (range, 14 to 55 years). As categorized by BMI, 60% of patients were normal weight, 22% were overweight, 16% were obese, and 2% were underweight. All but 8 procedures were performed with conventional knee-length arthroscopic shavers and burrs. The 8 procedures that needed additional hip instrumentation were performed in patients who required ligamentum teres debridement or those with iliopsoas tenotomy. Overall, the distance from skin to socket was less than 11 cm at the 12-o'clock and 3-o'clock positions from both the anterolateral and anterior portals. Obese and overweight patients had statistically longer distances from skin to socket at all 3 measurement points compared with underweight and normal-weight patients. Considering biotype, the distances from skin to socket in underweight, normal-weight, and muscular patients were all equal to or less than 10 cm. CONCLUSIONS: The distance from skin to socket at the 12- and 3-o'clock positions is less than 11 cm, suggesting that hip arthroscopy can be performed with conventional knee-length instrumentation devices. In obese and overweight patients and patients requiring ligamentum teres debridement or iliopsoas tendon release, specific hip arthroscopic tools should be available. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Not all patient-reported outcome measures are equivalent at two years compared to one year after anterior cruciate ligament reconstruction based on a retrospective analysis.

OBJECTIVE: This article aims to assess for clinically important differences in patient-reported outcome measures (PROMs) at one and two years post anterior cruciate ligament reconstruction (ACLR). METHODS: A retrospective comparison of prospectively collected PROMs for a single cohort who underwent a primary ACLR with or without associated meniscal surgery from 2016 to 2020 was assessed. Six externally validated PROMs were collected preoperatively and at standardized times postoperatively. Descriptive statistics and paired equivalence testing of PROMs at one and two years after surgery was completed using previously published or calculated minimal clinically important differences as upper and lower equivalence limits. A repeated measures analysis of PROMs that were not clinically equivalent at one and two years after surgery was completed to assess for a clinically significant difference. Subgroup analyses based on sex, age and associated meniscal injury were completed. RESULTS: One-hundred and forty-five participants with a mean age of 28.7 years (standard deviation: 9.9 years) were included in the final analysis. All PROMs were clinically equivalent at two years compared to one year after ACLR except the quality of life and sport and recreation domains of the Knee Injury and Osteoarthritis Outcome Score (KOOS). The quality of life (mean difference (MD):12.3, P â€‹< â€‹0.01, effect size (η2): 0.65) and sport and recreation (MD: 8.78, P â€‹< â€‹0.01, η2: 0.50) domains of the KOOS were clinically different at two years compared to one year postoperatively. No major differences were found in the subgroup analyses compared to the entire included sample. CONCLUSION: While most PROMs were equivalent at two years compared to one year after ACLR, the quality of life and sport and recreation domains of the KOOS, which reflect knee performance during higher demand activities, exhibited a clinically significant difference. LEVEL OF EVIDENCE: IV.

The anterior approach for a non-image-guided intra-articular hip injection.

PURPOSE: The purpose of this study was to investigate and validate the accuracy and safety of a technique using an anterior approach for non-image-guided intra-articular injection of the hip by use of anatomic landmarks. METHODS: We enrolled 55 patients. Injections were performed before supine hip arthroscopy after landmarking and before application of traction. After the needle insertion, success was confirmed with an air arthrogram and by direct visualization after arthroscope insertion. Accuracy and difficulty achieving correct needle placement were correlated with age, weight, height, body mass index, body type, gender, and surgical indication, as well as femoral and pelvic morphology. Forty-five patients who underwent injection in the office were followed up separately to document injection side effects. Needle placement accuracy was correlated to patients' demographics. All statistical tests with P values were 2 sided, with the level of significance set at P < .05. RESULTS: There were 51 correct needle placements and 4 misses, yielding a 93% success rate. The most common location for needle placement was the upper medial head-neck junction. Female gender was correlated with a more difficult needle placement and misses in relation to group size (P = .06). The reasons for misplacements of the needle were a high-riding trochanter, increased femoral version, thick adipose tissue over the landmarks, and variant of ilium morphology. Of 45 patients in the side effect study arm, 3 reported sensory changes of the lateral femoral cutaneous nerve that resolved within 24 hours. CONCLUSIONS: Hip injections by use of the direct anterior approach, from the intersection of the lines drawn from the anterior superior iliac spine and 1 cm distal to the tip of the greater trochanter, are safe and reproducible. Patient characteristics, such as increased subcutaneous adipose tissue or osseous anatomic variants, can lead to difficulty in placing the needle successfully. These characteristics can be predicted with the aid of physical examination and careful study of the pelvic radiographs. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Catastrophic failure of hip arthroscopy due to iatrogenic instability: can partial division of the ligamentum teres and iliofemoral ligament cause subluxation?

Hip arthroscopy is an evolving surgical tool, and with any new procedure, it is important to learn from the complications encountered. A patient with mild hip dysplasia and a symptomatic labral tear underwent uneventful hip arthroscopy and labral repair including partial debridement of a hypertrophied ligamentum teres. Despite preservation of the labrum, no pincer resection, and a modest capsulotomy, 3 months, subluxation and joint space narrowing were noted. One year, end-stage arthritis was present, requiring total hip replacement. Instability after hip arthroscopy is due to a number of factors, including excessive rim trimming, capsulotomy, overzealous labral resection, or inadequate labral repair. This report emphasizes the importance of the ligamentum teres and small disruptions of the capsule in patients with mild dysplasia.

Graft Options in Hip Labral Reconstruction.

PURPOSE OF REVIEW: The last decade has seen a boom in hip arthroscopy with refined indications. Improved understanding of pathoanatomy and disease progression has allowed for the development of advanced techniques. Labral reconstruction has been developed to substitute a non-functional or absent labrum. It has become an important technique in the armamentarium of high-volume arthroscopic hip surgeons. RECENT FINDINGS: Basic science studies have improved understanding of hip biomechanics in the presence and absence of a labrum with a labral reconstruction allowing for reconstitution of normalcy. Current techniques have shown success with autograft and allograft tissue options. While autograft tissue allows for easy access intra-operatively and maintains patient biology, donor site morbidity is possible. Allografts negate donor site morbidity and allow for an abundance of tissue but can be resource-intensive and face availability concerns. Recent studies support outcomes of labral reconstructions using both autograft and allograft. Promising results have also allowed for performing labral reconstruction in a primary setting. Labral reconstruction can be successfully performed using both autograft and allograft. Patient biology should be respected, and native hip biomechanics restored. The literature is plentiful for appropriate surgical decision-making allowing the surgeon with multiple graft choices depending on training, experience, and resources.

Graft tensioning in anterior cruciate ligament reconstruction: a systematic review of randomized controlled trials.

PURPOSE: The purposes of this study were to (1) perform a systematic review of randomized controlled trials evaluating graft tensioning in anterior cruciate ligament (ACL) reconstruction, and (2) determine the scientific quality of published randomized controlled trials evaluating graft tensioning in ACL reconstruction. METHODS: The search strategy included a computerized literature search, a citation search, and a manual search of key journals and conference proceedings. Eligible studies were randomized controlled trials evaluating the effect of graft tensioning on the outcomes of ACL reconstruction. Two reviewers independently performed the literature searches. The validity of the trials was scored using the Detsky quality scale. Consensus was achieved by a study committee of 3 investigators. RESULTS: Five randomized controlled trials met the inclusion criteria. The mean standardized Detsky score was 61.3 +/- 15.2%. Only 2 of the studies scored >or=75%. All trials consisted of autogenous graft sources, with 3 involving a bone-patellar tendon-bone graft, 1 involving a 5-strand semitendinosus-polyester (5STP) graft, and 1 involving a semitendinosus-gracilis-polyester (STGP) graft. CONCLUSIONS: Based on the evidence in this systematic review, there is a trend that suggests that 80 N of tension is the most effective amount of tension to apply during ACL reconstruction using hamstring-polyester graft sources. For ACL reconstruction using semitendinosus-gracilis or patellar tendon graft sources, there is no clear trend in terms of statistically significant or clinically relevant differences in terms of the amount of applied tension to apply to the graft during graft fixation. We are unable to provide recommendations as to the amount of tension to apply to 4-strand semitendinosus-gracilis autografts without polyester augmentation because there has been no randomized clinical trial conducted to determine the most effective amount of tension to apply when using this graft source.

Quantification of pronator quadratus contribution to isometric pronation torque of the forearm.

PURPOSE: The contribution of the pronator quadratus (PQ) muscle in generation of pronation torque has not been determined. The purpose of this study was to investigate pronation torque in healthy volunteers before and after temporary paralysis of the PQ with lidocaine, under electromyographic guidance. METHODS: A custom apparatus was designed to allow isometric testing of pronation torque at 5 positions of rotation: 90 degrees of supination, 45 degrees of supination, neutral, 45 degrees of pronation, and 80 degrees of pronation. After validation of the apparatus, 17 (9 male, 8 female) right-hand-dominant volunteers were recruited. They were tested at all 5 positions in random order and then had their PQ muscles paralyzed with lidocaine. Repeat testing was performed in the same random order 30 minutes after injection. Three unblinded subjects underwent testing after injection of saline instead of lidocaine to determine effect of fluid volume alone on PQ function. RESULTS: The validation trial demonstrated reproducibility of the testing apparatus. After paralysis of PQ with lidocaine, pronation torque decreased by an average 21% (range, 16.7% to 23.2%) at all positions compared with preinjection testing. All were statistically significant except at 80 degrees of pronation. The subjects who underwent injection of saline showed no evidence of decrease in pronation torque. CONCLUSIONS: This study demonstrated a significant decrease in pronation torque with controlled elimination of PQ function. Open reduction and internal fixation of distal radius fractures damages the PQ and may result in a pronation torque deficit. Pronation torque measurement may help in postoperative outcome analysis of surgical procedures using the volar approach to the distal radius.

Case reports: ipsilateral shoulder and elbow arthroplasty using custom interlocking prostheses.

Ipsilateral shoulder and elbow arthritis is not an uncommon problem seen in patients of upper extremity surgeons. If arthroplasty is required in both joints, there is a significant risk of periprosthetic fracture resulting from the stress riser occurring between the implants. We report the placement of custom interlocking shoulder and elbow prostheses in a patient with rheumatoid arthritis. The elbow prosthesis with an uncemented humeral component was placed followed 18 months later by a custom-designed shoulder prosthesis. An internal strut between the two prostheses was created. Seven years postoperatively, the patient was asymptomatic with no radiographic signs of impending failure.

Arthroscopic Hip Labral Reconstruction and Augmentation Using Knotless Anchors.

Biomechanical stability is the primary function of the acetabular labrum. It provides a hip suction seal and optimal joint function. Labral tears are a common reason for hip arthroscopy, to improve patient function and to prevent long-term degenerative arthropathy. Arthroscopic labral repair has shown significantly better outcomes in return to premorbid activity levels when compared with labral debridement. Injury to the acetabular labrum is a challenge and can lead to long-term complications. In this scenario, arthroscopic labral reconstruction has shown good results regarding patient subjective and objective outcomes. We describe a technique for complete arthroscopic labral reconstruction using tensor fascia lata allograft.

Endoscopic Sciatic Neurolysis.

Despite remaining a controversial diagnosis, piriformis syndrome continues to affect patients' quality of life with pain, sitting discomfort, and exercise intolerance. Open sciatic neurolysis has been noted by the senior author to often only bring temporary relief of the symptoms, with the recurrence presumably due to postoperative scar tissue. Minimally invasive techniques used to decompress the nerve have met with mixed results. This article describes a step-by-step surgical technique designed to maximize patient safety, as well as surgeon orientation, and achieve a thorough neurolysis. Preoperative findings suggestive of piriformis syndrome are described and include retro-trochanteric pain, sciatica-like leg pain, and paresthesias, as well as a positive response to computed tomography-guided injection of dilute ropivacaine hydrochloride and 40 mg of triamcinolone. The operation is performed with the patient in the lateral decubitus position through 2 portals 6 to 8 cm apart, allowing for good triangulation. Dissection is undertaken with a combination of radiofrequency and a laparoscopic peanut, with the assistance of a vascular sling to control the sciatic nerve. Encouraging results have been achieved, and with increasing interest in this procedure, a step-by-step technical description with an accompanying video may prove useful for other experienced hip arthroscopists. Pearls and pitfalls are discussed.

Revision anterior cruciate ligament reconstruction with bone-patellar tendon-bone allograft and extra-articular iliotibial band tenodesis.

Revision anterior cruciate ligament (ACL) reconstruction is a technically demanding procedure with outcomes that generally fail to reach those seen with primary ACL reconstruction. With most index procedures using autograft tissue, it is not uncommon for allograft tissue to be required for revision ACL reconstruction. Compared with autografts, allografts take longer to incorporate and lead to more episodes of instability. In this article, we describe ipsilateral iliotibial band tenodesis performed to augment use of bone-patellar tendon-bone allograft in revision ACL reconstruction. This technique adds rotational stability to protect the allograft tissue while it incorporates.

A novel technique for ligamentum teres reconstruction with "all-suture" anchors in the medial acetabular wall.

The function of the ligamentum teres remains poorly understood, but tears have been recognized as a source of hip pain. In some patients with complete ligamentum teres tears, symptoms of instability are described. Microinstability and excess motion are hypothesized to be a source of pain and mechanical symptoms. Efforts in recent years to improve symptoms have led to the development of techniques used to reconstruct the ligamentum teres, with some early evidence that reconstruction can improve symptoms in appropriately selected patients. We describe our technique for ligamentum teres allograft reconstruction using anchors made only of suture seated in the acetabular floor.

Inside out: a novel labral repair and advancement technique.

Labral tears are a significant cause of hip pain and are currently the most common indication for hip arthroscopy. Compared with labral debridement, labral repair has significantly better outcomes in terms of both daily activities and athletic pursuits in the setting of femoral acetabular impingement. The techniques described in the literature all use anchor placement on the capsular aspect of the acetabular rim, which can be difficult especially anteriorly, where the rim is very thin, and has the potential for significant complications. Anchor breakage, anchor slippage into the surrounding (capsular side) soft tissue, and penetration of the cartilage surface are among the most common complications. We describe an intra-articular anchor placement technique for labral repair from inside out. This technique, because of the location of the anchor and direction of suture pull, can assist in labral advancement in cases in which the native labrum fails to create a seal because of its location away from the femoral head.

Percutaneous femoral derotational osteotomy for excessive femoral torsion.

Femoral derotational osteotomy is an acceptable treatment for excessive femoral torsion. The described procedure is a minimally invasive single-incision technique based on an intramedullary saw that enables an inside-out osteotomy, preserving the periosteum and biological activity in the local bone and soft tissue. After the osteotomy is complete and correction is achieved, an expandable intramedullary nail is used to achieve immediate stability, without the need for locking screws. Indications, tips, and pitfalls related to this novel osteotomy technique are discussed.

Improved limb positioning and hip access during hip arthroscopy with articulated traction device.

Surgeons use hip arthroscopy to address intra-articular pathology of the hip. To access the central compartment, traction must be applied to the leg. Various types of equipment and techniques have been used, but many have limitations. Improved ability to assess the offending pathology is achieved with improved ability to move the hip joint in space during surgery. Dynamic assessment of femoroacetabular impingement allows the surgeon to gauge the adequacy of resection. We describe the use of an articulated traction device that allows complete surgeon control over the leg position, as well as the freedom to place the leg in virtually any position with ease, unencumbered by the mechanics of a standard traction table. This device provides the surgeon with an improved ability to dynamically assess the hip and removes some of the responsibility of the operating room staff for intraoperative leg positioning.

Adductor tenotomy as a treatment for groin pain in professional soccer players.

Chronic, exercise-related groin pain is a debilitating condition. Nonoperative treatment has limited efficacy, but surgical intervention on the adductor-abdomino complex may be used to alleviate symptoms and allow return to play (RTP). The purpose of this study was to report the outcome of adductor tenotomy and hernioplasty for professional soccer players with groin pain. Between 2000 and 2006, a total of 155 professional and recreational soccer players with recalcitrant groin pain (with or without lower abdominal pain) and resistance to conservative treatment were included in this retrospective analysis. Ninety-six patients were treated with adductor tenotomy and 59 patients were treated with combined adductor tenotomy and hernioplasty. No difference in pre- or postoperative parameters was detected between groups, apart from abdominal wall muscle defects revealed during ultrasound for patients in the combined group. The RTP time and subjective and objective outcome measures were compared. A combined score was developed to evaluate outcomes that consisted of overall satisfaction (50%), RTP time (15%), and Tegner scores (35%). Mean RTP was 11 weeks (range, 4-36 weeks). Postoperative Tegner score remained 8.2 (same as the preinjury Tegner score). Subjective outcome was rated 4.3 of 5. The combined score indicated 80% of good or excellent results for both groups. Surgical intervention allows RTP at the same level in professional soccer players following failure of nonoperative treatments. Athletes with adductor syndrome and accompanying sportsman's hernia may benefit from adductor tenotomy alone.