Adductor tenotomy: its role in the management of sports-related chronic groin pain.

PATIENTS AND METHODS: Chronic adductor-related groin pain in athletes is debilitating and is often challenging to treat. Little is published on the surgical treatment when conservative measures fail. This single center study reviews the outcomes of 48 patients (68 groins) who underwent percutaneous adductor tenotomy for sports-related chronic groin pain. Questionnaire assessments were made preoperatively and at a minimum follow-up of 25 months. RESULTS: Mean pre-injury Tegner activity scores of 8.8 reduced to 6.1 post-injury and these improved to 7.7 following surgery (p < 0.001). Sixty percent of patients regained or bettered their pre-injury Tegner activity scores after the adductor surgery; however, mean post-surgical Tegner scores still remained lower than pre-injury scores (p < 0.001). No patient had been able to engage in their chosen sport at their full ability pre-operatively, and 40% had been unable to participate in any sporting activity. The mean return to sports was at 18.5 weeks postoperatively, with 54% returning to their pre-injury activity levels, and only 8% still unable to perform athletic activities at latest follow-up. Seventy-three percent patients rated the outcome of their surgery as excellent or very satisfactory, and only three patients would not have wished to undergo the procedure again if symptoms recurred or developed on the opposite side. No patients reported their outcome as worse. A 78.1% mean improvement in function and an 86.5% mean improvement in pain were reported, and these two measures showed statistically significant correlation (p = 0.01). Groin disability scores improved from a mean of 11.8 to 3.9, post-operatively (p < 0.001). Bruising was seen in 37% of procedures, 3 patients developed a scrotal hematoma and 1 patient had a superficial wound infection. One patient developed recurrent symptoms following re-injury 26 months post-surgery, and fully recovered following a further adductor tenotomy. CONCLUSIONS: Adductor tenotomy provides good symptomatic and functional improvement in chronic adductor-related groin pain refractory to conservative treatment.

The outside-in subcutaneous arthroscopically assisted lateral retinacular release: a new technique.

Arthroscopic lateral retinacular release in the knee has been used extensively for the treatment of patellar pain and instability. The release can be performed using a number of techniques, but achieving access to the retinaculum can often be difficult, particularly in obese patients. We describe a simple modification of an arthroscopically assisted method, which utilises electrosurgery through a subcutanous channel to perform an outside-in release.

Anterior cruciate ligament graft preparation: a new and quick alternative to the whipstitch.

Anterior cruciate ligament reconstruction is a common procedure in orthopaedic practice. Hamstring autograft is increasingly becoming the graft of choice; however, there is little consensus as to the best method of graft preparation and, in particular, the efficacy of the use of a whipstitch with all tibial fixation systems. We propose a new, quick, and economical method of preparing the hamstring graft that involves securing a double loop of suture material around the tendon. This is achieved by passing a loop of No. 2 braided suture under the tendon; the free suture ends are then subsequently passed through the loop twice and tightened. This "loop-the-loop" traction suture allows the surgeon to apply adequate traction to the graft for tensioning while not compromising graft fixation. This new technique is faster than conventional whipstitching and has cost savings, because no needles are necessary. It is of particular help when using a central 4-quadrant sleeve-and-screw fixation device.