Abstract
Purpose
There are several reports on the association between pubalgia and intra-articular hip disorders. The purpose of this study was to evaluate the long-term outcome in athletes who underwent tenotomy due to long-standing groin pain. A secondary purpose was evaluating the frequency of femoro-acetabular impingement (FAI) and its impact on the long-term outcome.
Methods
Thirty-two high-level male athletes treated with adductor tenotomy, rectus abdominis tenotomy or both were included. At a median follow-up time of 6 years after the tenotomy, the subjects underwent standardised clinical examination, plain radiographs, completed web-based health-related patient-reported outcomes, including iHOT12, HAGOS (six subscales), EQ-5D (two subscales), HSAS for physical activity level and a VAS for overall hip function. Furthermore, patient satisfaction and return to sports were documented.
Results
Twenty-four of the 32 (75 %) athletes were satisfied with the outcome of the tenotomy, and 22 of the athletes (69 %) were able to return to their pre-injury sport. Before the long-term follow-up, two of these satisfied athletes had undergone repeat surgery (one hip arthroscopy due to FAI and one repeat tenotomy). Of the 24 satisfied athletes, eight (33 %) had a positive hip impingement test at the follow-up. Of the remaining eight athletes not satisfied with the outcome, only one returned to their pre-injury sport and three had undergone hip arthroscopy prior to follow-up. Five had positive hip impingement tests which was significantly more frequently than in the satisfied group (p = 0.008). The group with a positive hip impingement test reported significantly more pain and symptoms, more hip problems during sports and physical activity, as well as lower hip-related quality of life according to the HAGOS scores (p < 0.05), at follow-up.
Conclusion
Tenotomy for pubalgia yielded a satisfactory long-term outcome, with three of four athletes being able to return to their pre-injury sport. The athletes that did not return to their pre-injury sport had higher frequency of positive hip impingement test and inferior functional outcome compared with the athletes that did return to their pre-injury sport. It is therefore recommended that the hip should be carefully evaluated for hip impingement before tenotomy is considered as treatment for athletes with pubalgia.
Level of evidence
Retrospective case series, Level IV.
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References
Akermark C, Johansson C (1992) Tenotomy of the adductor longus tendon in the treatment of chronic groin pain in athletes. Am J Sports Med 20(6):640–643
Barton C, Salineros MJ, Rakhra KS, Beaule PE (2011) Validity of the alpha angle measurement on plain radiographs in the evaluation of cam-type femoroacetabular impingement. Clin Orthop Relat Res 469(2):464–469
Birmingham PM, Kelly BT, Jacobs R, McGrady L, Wang M (2012) The effect of dynamic femoroacetabular impingement on pubic symphysis motion: a cadaveric study. Am J Sports Med 40(5):1113–1118
Boykin RE, Stull JD, Giphart JE, Wijdicks CA, Philippon MJ (2013) Femoroacetabular impingement in a professional soccer player. Knee Surg Sports Traumatol Arthrosc 21(5):1203–1211
Bradshaw CJ, Bundy M, Falvey E (2008) The diagnosis of longstanding groin pain: a prospective clinical cohort study. Br J Sports Med 42(10):851–854
Cowan SM, Schache AG, Brukner P, Bennell KL, Hodges PW, Coburn P, Crossley KM (2004) Delayed onset of transversus abdominus in long-standing groin pain. Med Sci Sports Exerc 36(12):2040–2045
Feeley BT, Powell JW, Muller MS, Barnes RP, Warren RF, Kelly BT (2008) Hip injuries and labral tears in the national football league. Am J Sports Med 36(11):2187–2195
Gosvig KK, Jacobsen S, Sonne-Holm S, Palm H, Troelsen A (2010) Prevalence of malformations of the hip joint and their relationship to sex, groin pain, and risk of osteoarthritis: a population-based survey. J Bone Joint Surg Am 92(5):1162–1169
Griffin DR, Parsons N, Mohtadi NG, Safran MR (2012) A short version of the International Hip Outcome Tool (iHOT-12) for use in routine clinical practice. Arthroscopy 28(5):611–616; quiz 616-618
Hack K, Di Primio G, Rakhra K, Beaule PE (2010) Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers. J Bone Joint Surg Am 92(14):2436–2444
Holmich P, Nyvold P, Larsen K (2011) Continued significant effect of physical training as treatment for overuse injury: 8- to 12-year outcome of a randomized clinical trial. Am J Sports Med 39(11):2447–2451
Ibrahim A, Murrell GA, Knapman P (2007) Adductor strain and hip range of movement in male professional soccer players. J Orthop Surg (Hong Kong) 15(1):46–49
Jónasson P, Thomeé R, Karlsson J, Sansone M, Ahldén M, Baranto A (2013) A standardized outcome measure for pain, symptoms and physical function in young patients with hip and groin disability (Submitted)
Larson CM, Pierce BR, Giveans MR (2011) Treatment of athletes with symptomatic intra-articular hip pathology and athletic pubalgia/sports hernia: a case series. Arthroscopy 27(6):768–775
Maffulli N, Loppini M, Longo UG, Denaro V (2012) Bilateral mini-invasive adductor tenotomy for the management of chronic unilateral adductor longus tendinopathy in athletes. Am J Sports Med 40(8):1880–1886
Maslowski E, Sullivan W, Forster Harwood J, Gonzalez P, Kaufman M, Vidal A, Akuthota V (2010) The diagnostic validity of hip provocation maneuvers to detect intra-articular hip pathology. Pm R 2(3):174–181
Naal FD, Miozzari HH, Wyss TF, Notzli HP (2011) Surgical hip dislocation for the treatment of femoroacetabular impingement in high-level athletes. Am J Sports Med 39(3):544–550
Notzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J (2002) The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br 84(4):556–560
Pollard TC, Villar RN, Norton MR, Fern ED, Williams MR, Simpson DJ, Murray DW, Carr AJ (2010) Femoroacetabular impingement and classification of the cam deformity: the reference interval in normal hips. Acta Orthop 81(1):134–141
Rabin R, de Charro F (2001) EQ-5D: a measure of health status from the EuroQol Group. Ann Med 33(5):337–343
Sansone M, Ahlden M, Jonasson P, Sward L, Eriksson T, Karlsson J (2013) Total dislocation of the hip joint after arthroscopy and ileopsoas tenotomy. Knee Surg Sports Traumatol Arthrosc 21(2):420–423
Thomeé R, Jónasson P, Karlsson J, Sansone M, Ahldén M, Baranto A (2013) Cross-cultural adaptation and validation according to the COSMIN checklist of the Copenhagen Hip and Groin Outcome Score(HAGOS) for pain, symptoms and Physical function in young patients with hip and groin disability.(Submitted)
Thorborg K, Holmich P, Christensen R, Petersen J, Roos EM (2011) The Copenhagen Hip and Groin Outcome Score (HAGOS): development and validation according to the COSMIN checklist. Br J Sports Med 45(6):478–491
Verrall GM, Slavotinek JP, Barnes PG, Esterman A, Oakeshott RD, Spriggins AJ (2007) Hip joint range of motion restriction precedes athletic chronic groin injury. J Sci Med Sport 10(6):463–466
Weir A, de Vos RJ, Moen M, Holmich P, Tol JL (2011) Prevalence of radiological signs of femoroacetabular impingement in patients presenting with long-standing adductor-related groin pain. Br J Sports Med 45(1):6–9
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Sansone, M., Ahldén, M., Jonasson, P. et al. Can hip impingement be mistaken for tendon pain in the groin? A long-term follow-up of tenotomy for groin pain in athletes. Knee Surg Sports Traumatol Arthrosc 22, 786–792 (2014). https://doi.org/10.1007/s00167-013-2738-y
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DOI: https://doi.org/10.1007/s00167-013-2738-y