Nonsurgical Management of Adductor-related groin pain with Ultrasound-Guided Platelet-Rich Plasma Injection and Physical Therapy in a Competitive Soccer Player: A Case Report.

Introduction: Adductor-related groin pain involves an injury to the common aponeurosis connecting the rectus abdominus and adductor longus to the pubis. It commonly occurs in sports that require cutting and pivoting and can result in significant loss of playing time. Platelet-Rich Plasma (PRP) is often indicated for treatment of musculoskeletal disorders and may represent an alternative treatment for patients with adductor-related groin pain. The purpose of this case report is to describe the non-surgical management of adductor-related groin pain in a competitive soccer player with a with an ultrasound (US)-guided PRP injection and physical therapy management. Case Description: A 17-year-old male competitive soccer player with right-sided adductor-related groin pain was treated with an US-guided PRP and a multi-phased physical therapy regimen based on tissue healing and individual patient/criteria progression. The patient completed 12 physical therapy sessions over six weeks post PRP injection. Outcomes: At the end of treatment, clinically meaningful improvements were observed in pain intensity, passive range of motion, strength (handheld dynamometry, Biodex), functional tests, psychosocial (OSPRO-YF) and patient-reported outcomes (HAGOS, LEFS). The subject returned to sport at six weeks post injection without limitation and at three months follow up, the subject reported that he had returned to 95% of his previous level of play. Discussion: This case report may offer support for PRP as an alternative treatment in the management of adductor-related groin pain. Incorporation of PRP as an adjunct to physical therapy led to improvements on all outcomes that surpassed the clinical significance change criteria. Level of evidence: 5.

Groin pain aggravated in short term contracted by COVID-19 in THA patients: a case-crossover study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) rapidly spreads worldwide and causes more suffering. The relation about the aggravation of inguinal pain and COVID-19 was unclear in patients with total hip arthroplasty (THA). This study aimed to evaluate the risk of groin pain aggravation in short-term THA patients after COVID-19. METHODS: Between 2020 and 2022, 129 patients with THA who were affected COVID-19 were enrolled. A short-standardized questionnaire was administered during follow-up to inquire about the aggravation of groin ache before and after SARS-COV-2 affection. Furthermore, we evaluated the potential association between the presence of increased pain and various factors, including age, gender, body mass index, diagnosis, and length of hospital stay. RESULTS: The case-crossover study revealed an increased risk of inguinal soreness aggravation when comparing 8 weeks after COVID-19 with 12 weeks before COVID-19 (Relative risk [RR], 9.5; 95% Confidence intervals [CI], 2.259-39.954). For COVID-19 positive patients, multivariate analysis showed length of stay was an independent factor significantly associated with increased risk of aggravation of groin pain (Odds ratio [OR], 1.26; 95%CI, 1.03-1.55, p = 0.027). CONCLUSION: This study confirms the association between COVID-19 and the exacerbation of soreness in the groin region in THA patients and extended length of stay is a possible contributing factor. This study expands the current literature by investigating the risk of aggravation of inguinal pain in patients with THA after COVID-19, providing valuable insights into postoperative outcomes in this specific population. Trial registration This retrospective study was approved by the Institutional Review Board of Shanghai general hospital (No.2023-264).

Intra-obturator bupivacaine injection and post-operative pain following the trans-obturator tension-free vaginal tape procedure: randomized study.

PURPOSE: To assess the effectiveness of a long-acting anesthetic injection into the obturator membrane for pain relief in women undergoing trans-obturator tension-free vaginal tape. METHODS: A total of 22 women were randomized for the intra-operative injection of bupivacaine into one of their obturator membranes: the left or right side. All the participants were asked to define their groin pain on a visual analog scale (scored 0-10 cm) at 1, 6, 12, and 24 h post-operative. For each woman, pain scores were compared between the local anesthetic-injected side and the opposite side. RESULTS: Statistically significant differences were not observed in groin pain scores between the bupivacaine injection side and the no injection side at 1 h (p = 0.76), 6 h (p = 1), 12 h (p = 0.95), and 24 h (p = 0.82) post-operative. CONCLUSION: In women who undergo trans-obturator tension-free vaginal tape procedures, intra-operative intra-obturator injection of local anesthetics is not effective in alleviating the characteristic post-operative groin pain. TRIAL REGISTRATION: This study is registered on ClinicalTrials.gov (NCT03479996).

A Novel Treatment of Fascial Pain With Glucopuncture: Three Clinical Cases.

The fascial system (FS) represents a sophisticated and intricate network within the human body, comprising both superficial and deep fascial layers. Disruptions or dysfunctions within this system have been implicated in a variety of musculoskeletal (MSK) disorders and pain syndromes. Specifically, fascial tightness has been associated with diminished range of motion and localized pain. Glucopuncture, a novel therapeutic approach, involves the administration of 5% dextrose injections directly into the fascial layers, such as the superficial fascia, to address these issues. This article presents a case series involving three patients who underwent palpation/ landmark-guided glucopuncture for the treatment of superficial fascial dysfunction. The first case involves a 45-year-old male with a nine-month history of left groin pain, who experienced significant pain relief following glucopuncture below the inguinal ligament, with complete resolution of symptoms within four weeks. The second case describes a 36-year-old female suffering from left arm and neck pain for two years, who reported gradual pain alleviation over six weeks after receiving multiple injections in the fasciae of the neck, scapula, and lateral aspect of the triceps muscle. The final case involves a 67-year-old female with a six-month history of low back and buttock pain, who showed improvement after four weeks following multiple injections in the fasciae of the low back, lumbar region, and buttocks. These cases highlight the potential of palpation-guided glucopuncture as a simple, cost-effective method for modulating regional pain caused by superficial fascial dysfunction. However, further research is necessary to fully ascertain the efficacy and safety of glucopuncture for treating fascial dysfunction.

The association of permanent versus absorbable fixation on developing chronic post-herniorrhaphy groin pain in patients undergoing laparoscopic inguinal hernia repair.

INTRODUCTION: Fixation of mesh during minimally invasive inguinal hernia repair is thought to contribute to chronic post-herniorrhaphy groin pain (CGP). In contrast to permanent tacks, absorbable tacks are hypothesized to minimize the likelihood of CGP. This study aimed to compare the rates of CGP after laparoscopic inguinal hernia repair between absorbable versus permanent fixation at maximum follow-up. METHODS: This is a post hoc analysis of a randomized controlled trial in patients undergoing laparoscopic inguinal hernia repair (NCT03835351). All patients were contacted at maximum follow-up after surgery to administer EuraHS quality of life (QoL) surveys. The pain and restriction of activity subdomains of the survey were utilized. The primary outcome was rate of CGP, as defined by a EuraHS QoL pain domain score ≥ 4 measured at ≥ 1 year postoperatively. The secondary outcomes were pain and restriction of activity domain scores and hernia recurrence at maximum follow-up. RESULTS: A total of 338 patients were contacted at a mean follow-up of 28 ± 11 months. 181 patients received permanent tacks and 157 patients received absorbable tacks during their repair. At maximum follow-up, the rates of CGP (27 [15%] vs 28 [18%], P = 0.47), average pain scores (1.78 ± 4.38 vs 2.32 ± 5.40, P = 0.22), restriction of activity scores (1.39 ± 4.32 vs 2.48 ± 7.45, P = 0.18), and the number of patients who reported an inguinal bulge (18 [9.9%] vs 15 [9.5%], P = 0.9) were similar between patients with permanent versus absorbable tacks. On multivariable analysis, there was no significant difference in the odds of CGP between the two groups (OR 1.23, 95% CI [0.60, 2.50]). CONCLUSION: Mesh fixation with permanent tacks does not appear to increase the risk of CGP after laparoscopic inguinal hernia repair when compared to fixation with absorbable tacks. Prospective trials are needed to further evaluate this relationship.

Dynamic Magnetic Resonance Imaging (MRI) in Inguinal-Related Chronic Groin Pain (CGP): Comparison With Systematic Surgical Assessment.

Objective This study aimed to assess the performance of dynamic MRI in Chronic Groin Pain (CGP) related to the inguinal region, comparing it with surgery as the gold standard. Materials and methods A cohort of 25 consecutive patients exhibiting persistent clinical inguinal-related CGP underwent a pre-surgical pelvis MRI. Imaging encompassed strictly axial Fast Spin Echo (FSE) T1 sequences, both without (static sequence) and with Valsalva Maneuver (VM, dynamic sequence), alongside axial-oblique Proton Density weighted with Fat Saturation (PDFS). Evaluation of these sequences focused on identifying Abdominal Wall (AW) injuries. A consistent surgical approach was employed by the same surgeon across all patients (34 AW injuries in 25 patients). Specificity (Sp), Sensitivity (Se), Negative Predictive Value (NPV), Positive Predictive Value (PPV), and overall accuracy of MRI sequences and their combinations for detecting AW injuries were computed by comparing them to surgical findings. Results Ninety sequences were obtained, revealing that the axial PDFS oblique sequence emerged as the most singularly reliable (Accuracy: 58.82%). The optimal sequence combination was found to be axial T1 combined with axial T1 VM, exhibiting an accuracy of 75.00% (Se: 85.71%, Sp: 70.59%, PPV: 54.55%, NPV: 92.31%, with an average duration of 4 minutes and 31 seconds). Conclusion Based on our findings, we advocate for the adoption of the axial FSE T1 combined with Valsalva Maneuver as a dependable protocol for inguinal-related CGP, characterized by a highly reasonable examination duration.

The Role of MRI in Groin Pain Syndrome in Athletes.

Groin pain syndrome (GPS) is one of the most frequent injuries in competitive sports. Stresses generated in the lower limbs by quick turns and accelerations, such as in soccer, basketball or hockey, can produce localized regions of increased forces, resulting in anatomical lesions. The differential diagnoses are numerous and comprise articular, extra-articular, muscular, tendinous and visceral clinical conditions and a correct diagnosis is crucial if treatment is to be efficient. MRI is the gold standard of diagnostic techniques, especially when an alternative pathology needs to be excluded and/or other imaging techniques such as ultrasound or radiography do not lead to a diagnosis. This paper, based on the current literature, gives a comprehensive review of the anatomy of the pubic region and of the typical MRI findings in those affected by GPS. Many clinical conditions causing GPS can be investigated by MRI within appropriate protocols. However, MRI shows limits in reliability in the investigation of inguinal and femoral hernias and therefore is not the imaging technique of choice for studying these clinical conditions.

Dorsal Root Ganglion Stimulation Relieves Chronic Neuropathic Pain Along With a Decrease in Cortical γ Power.

BACKGROUND: Stimulation of dorsal root ganglion (DRG) is an ideal neuromodulative intervention, providing pain relief in localized chronic pain conditions because γ-band oscillations reflect the intensity of ongoing chronic pain in patients affected. OBJECTIVE: We aimed to observe the role of cortical γ-band power associated with the relief of chronic neuropathic pain through DRG stimulation (DRGS). MATERIALS AND METHODS: We examined nine patients (two women, mean age 56.8 years; range, 36-77 years) diagnosed with chronic neuropathic pain who underwent DRGS therapy. We used the numeric rating scale (NRS) on the painful limb and simultaneously recorded the electroencephalography to assess the broadband γ power. Assessments were conducted on the first day and on the seventh day after implantation of the DRGS system and then compared and correlated with the results of the NRS. RESULTS: The NRS scores showed a significant decrease from the first day to the seventh day (p = 0.007). The resting-state γ power revealed a significant decrease (p = 0.021) between 30 and 45 Hz, recorded through the central electrode contralateral to the painful limb from the first day (mean [M] = 0.46, SD = 0.25) to the seventh day (M = 0.31, SD = 0.12) after DRGS. There was no significant change in the resting-state γ-band power recorded through the central electrode ipsilateral to the painful limb. However, we found a positive correlation in the γ-band power (rs = 0.628, p = 0.005) with the NRS rating. CONCLUSIONS: A lateralized decrease in broadband γ power may be considered further evidence supporting a reduction in the hyperexcitability of the nociceptive system in response to DRGS therapy. In the future, γ-band power could serve as a biomarker for assessing the efficacy of DRGS during the seven-day test phase preceding the implantation of the DRGS system.

Patient-reported outcomes in inguinal hernia surgery-Results from the GENESIS study: A multinational multicenter study.

BACKGROUND: Chronic groin pain following inguinal hernia repair can be troublesome. The current literature is limited, especially from Asia and Africa. We aimed to evaluate patient-reported outcomes using the Carolinas Comfort Scale (CCS) following inguinal hernia repair at an international level, especially to include patients from Asia and Africa. METHODS: An international cohort of surgeons was invited to collaborate and collect data of consecutive adult patients who underwent inguinal hernia repair. The data were collected to allow at least 2 years of follow-up. A total score for CCS was calculated and compared for the following groups-patient age <30 years versus (vs.) > 30 years; open versus laparoscopic repair, emergency versus elective surgery, and unilateral versus bilateral hernia repair. The CCS scores between Asia, Africa, and Europe were also compared. RESULTS: The mean total CCS score of patients operated in Asia (n = 891), Europe (n = 853), and Africa (n = 157) were 7.32, 14.6, and 19.79, respectively. The total CCS score was significantly higher following open repair, emergency repair, and unilateral repair, with surgical site infections (SSI) and recurrence. In the subgroup analysis, the patients who underwent elective open repair in Europe had higher CCS scores than those in Asia. CONCLUSION: About 15% of patients had a CCS score of more than 25 after a minimum follow-up of 2 years. The factors that influence CCS scores are indication, approach, complications, and geographic location.

Differential diagnoses of inguinal swellings: a case series of atypical diagnoses.

This case series highlights the importance of a thorough differential diagnosis in patients with groin swelling, often mistaken for inguinal hernias. It presents three patients with groin swelling initially suspected of having inguinal hernias but diagnosed differently upon further investigation. Patient 1 had a recurrence of endometrial adenocarcinoma in the right groin, Patient 2 had penile carcinoma with left inguinal metastasis, and Patient 3 had a metastasis of prostate carcinoma in the left groin. These cases underline the need to consider various pathologies beyond the common diagnosis of inguinal hernia. Accurate diagnosis requires a careful clinical examination and appropriate diagnostic tools, ensuring correct treatment.

The effect of match congestion on hip adductor squeeze strength in youth rink hockey players

Introduction Groin injuries are common among rink hockey players. Monitoring the main risk factors can reduce the likelihood of suffering such injury. The objective of this study was to evaluate the effect of a competitive congestion period on the squeeze strength of the hip adductor muscles in a group of adolescent rink hockey players, and whether the strength reduction exceeded the injury risk threshold (>15%) for sustaining a groin injury. Materials and Methods Twenty U-16 athletes (9 females) participated in the study. Eighty-three adductor strength measurements were recorded after 10 games (2109 min of play). Function was assessed using the Sport subscale of the Hip and Groin Outcome Score (HAGOS) questionnaire. A simple linear regression model was used to analyze the accumulated time-strength relationship, and the pre-tournament and post-tournament HAGOS results were compared. Results The accumulation of games resulted in a significant strength reduction in male players' (R2= 0.27), but not in females. Eighty-five percent of the sample had their strength reduced to values at risk compared to baseline strength, but none of them stopped their activity due to discomfort in the groin region. HAGOS results were not affected by the competitive congestion (p = 0.07–0.48). Conclusion Match congestion can negatively impact adductor strength. However, there may not be a relationship between strength loss above 15% and the appearance of a groin injury. (AU)

Epidemiology of injuries in elite female rink hockey players: A two season observational study.

OBJECTIVES: To record the time-loss injuries of female rink hockey players and describe the affected region, tissue, and onset of injury. DESIGN: Cross-sectional survey study. SETTING: First (Ok Liga) and Second (Plata) division clubs. PARTICIPANTS: 280 player-seasons. MAIN OUTCOME MEASURES: Incidence of overall, training, and match injuries (number of injuries per 1000 h) from two seasons. RESULTS: A total of 229 injuries occurred in 56,438 h of exposure. The overall incidence was 4 injuries per 1000 h (4/1000 h), with a significantly higher rate of injuries during matches (15.2/1000 h) compared to training sessions (2.6/1000 h) (p < 0.001). Injuries affecting the lower limb were the most common (2.3/1000 h), followed by upper limb (1.2/1000 h), and head/trunk (0.6/1000 h). The tissue with the highest incidence of injury was the muscle/tendon (1.3/1000 h), followed by the ligament (0.8/1000 h). Around one in every three injuries (31%) affected either the thigh or hip/groin (73 injuries). CONCLUSIONS: The injury incidence in elite female rink hockey is moderate and occurs mainly during match sessions. Preventative measurements should be implemented in rink hockey with a special concern for injuries affecting the thigh, and hip/groin.

Comparing stapler and sutured mesh fixation techniques for laparoscopic TAPP repair: a study on chronic groin pain on 3-year follow-up.

Trans-abdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) repairs are the available surgeries for inguinal hernias, with both methods of laparoscopic repairs requiring mesh applications. This study analyzes the correlation between sutured versus stapler mesh fixation in a laparoscopic TAPP for unilateral groin hernia regarding chronic pain during 3-year follow-up. A total of 130 patients with laparoscopic hernia undergoing TAPP repair were randomized into 2 groups based on their fixation technique-one with sutures and the other with stapler. Postoperative complications and chronic groin pain were noted for each technique. Equal number of participants was present in the stapler and suture groups, with the majority having an ASA score of one. The mean age was 42.50 ± 13.86 years, and the body mass index (BMI) was 27.47 ± 5.88. The stapler group presented a shorter mean operative time than the suture group. However, the stapler group had a significantly higher mean VAS score than the suture group. Most participants in the suture group (89.2%) had LOS for 1 day, while a 2-day LOS was significantly higher in the stapler group (12.3%) than in the suture group (9.2%). No patient reported mesh erosion, conversion, recurrence, testicular atrophy, and mesh infection. Early postoperative pain was more in stapler group along with long hospital stay, but both were non-significant. Chronic postoperative pain results and recurrence incidences over 3-year follow-up were also similar. Re-admission rates were minimal, no significant complications occurred.

MRI findings in athletic groin pain: correlation of imaging with history and examination in symptomatic and asymptomatic athletes.

OBJECTIVE: To determine differences in prevalence and diagnostic accuracy of MRI findings between asymptomatic athletes and athletes with longstanding groin pain. MATERIALS AND METHODS: One hundred twenty-three adult male athletes were approached with 85 consecutive athletes recruited. Group 1 (symptomatic, n = 34) athletes referred for longstanding groin pain (insidious onset, > 3 weeks duration). Group 2 (control, n = 51) athletes referred for injuries remote from the pelvis and no groin pain in the last 12 weeks. All referrers completed a clinical examination proforma documenting absence or presence of pelvis and hip abnormality. All patients completed the Copenhagen Hip and Groin Outcome Score (HAGOS) questionnaire and underwent a 3T MRI groin and hip protocol. MRIs were scored independently by two musculoskeletal radiologists blinded to clinical details. Statistical analysis was performed to evaluate associations between MRI findings, inter-reader reliability, clinical examination and HAGOS scores. RESULTS: Pubic body subchondral bone oedema, capsule/aponeurosis junction tear and soft tissue oedema were more prevalent in the symptomatic group (p = 0.0003, 0.0273 and 0.0005, respectively) and in athletes with clinical abnormality at symphysis pubis, adductor insertion, rectus abdominis, psoas and inguinal canal (p = 0.0002, 0.0459 and 0.00002, respectively). Pubic body and subchondral oedema and capsule/aponeurosis tear and oedema significantly correlated with lower (worse) HAGOS scores (p = 0.004, 0.00009, 0.0004 and 0.002, respectively). Inter-reader reliability was excellent, 0.87 (range 0.58-1). Symphyseal bone spurring, disc protrusion and labral tears were highly prevalent in both groups. CONCLUSION: Clinical assessment and MRI findings of pubic subchondral bone oedema and capsule/aponeurosis abnormality appear to be the strongest correlators with longstanding groin pain.

Outcomes and Proportions of Subsequent Contralateral Sports Hernia Repair Following Primary Unilateral Repair.

BACKGROUND: In the event that nonoperative treatment for sports hernia fails, surgical repair may be warranted. Bilateral repair can occur in up to 45% of surgically treated patients. PURPOSE: To investigate the clinical outcomes of athletes who underwent unilateral sports hernia repair and determine the proportion of patients who required contralateral sports hernia repair. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: We identified patients at our institution who underwent primary unilateral sports hernia repair (rectus abdominis-adductor longus aponeurotic plate repair and adductor lengthening) with a single surgeon between 2015 and 2020. We assessed patient-reported outcomes using the Hip Outcome Score-Sport (HOS-Sport), the Numeric Pain Rating Scale, and an internally developed return-to-play questionnaire. We further collected data regarding subsequent sports hernia procedures on the ipsilateral or contralateral side. We calculated summary statistics for outcomes and examined the association between preinjury patient characteristics and the HOS-Sport score at follow-up or successful return to preinjury sport using linear and logistic regression, respectively. RESULTS: A total of 104 of 128 (81.3%) eligible patients (mean age at surgery, 23.0 ± 6.2 years; 94.2% male; 51.9% American football athletes) completed follow-up at a mean time of 4.4 ± 1.5 years. Overall, 79.8% of athletes (n = 83) were able to return to their preinjury sport/activity, but 90.2% (83/92) who attempted to return were able to do so. When examining reasons for not returning to preinjury sport, only 9 patients reported not returning to preinjury sport because of limitations or persistent symptoms from their original injury. Only 4 patients underwent subsequent sports hernia procedures (3 contralateral, 1 ipsilateral revision) after their index unilateral sports hernia repair. At follow-up, the mean HOS-Sport score was high (94.0 ± 10.8), and the mean Numeric Pain Rating Scale score was low (0.31 ± 1.26). There were no preinjury patient characteristics associated with either the HOS-Sport score at follow-up or the successful return to preinjury sport. CONCLUSION: Patients with unilateral sports hernia symptoms can undergo repair and return to sport at the preinjury level with little concern for injuries to the contralateral groin. In our cohort, patient-reported hip function and pain outcomes at follow-up were excellent.

Clinical examination tests for adductor- and pubic-related groin pain in athletes with longstanding groin pain: Inter-examiner reliability and prevalence of positive tests.

OBJECTIVES: Evaluate the inter-examiner reliability of pain provocation tests for hip adductors (palpation, stretch and resistance) and for pubic symphysis (palpation) in athletes with longstanding groin pain, and to determine the prevalence of positive tests. DESIGN: Inter-examiner reliability. SETTING: Orthopaedic and sports medicine hospital. PARTICIPANTS: Male athletes with longstanding groin pain. MAIN OUTCOME MEASURES: Inter-examiner reliability, absolute/positive/negative agreement, and the mean prevalence of positive tests for athletes classified with adductor- and pubic-related groin pain were calculated. RESULTS: We included 44 male athletes with longstanding groin pain (61 symptomatic sides). The mean age was 29 years (±6) and 70% were soccer players. Inter-examiner reliability was slight to moderate for adductor palpation (Cohen's Kappa statistic(κ)) = 0.02-0.54) and pubic palpation (κ = 0.37-0.45); moderate for the adductor stretch test (κ = 0.50), and fair to substantial for adductor resistance tests (κ = 0.22-0.74). Palpation pain was most prevalent at the adductor longus origin (94%) in athletes classified with adductor-related groin pain. CONCLUSION: The inter-examiner reliability of palpation tests varied from slight to moderate. The adductor stretch test had a moderate reliability, and adductor resistance tests a fair to substantial reliability. Adductor longus origin is the main site for palpation pain. Adductor palpation tests not related to the adductor longus have limited inter-examiner reliability. The adductor stretch test did not assist in classifying adductor-related groin pain.

Less groin pain with dual-mobility bearings versus fixed bearings in total hip arthroplasty.

INTRODUCTION: The relationship between implant type, dual mobility (DM) or fixed bearing (FB), and postoperative groin pain remains unexplored. We examined the incidence of groin pain in DM implants and compare this to a cohort of FB THA patients. METHODS: From 2006 to 2018, a single surgeon performed 875 DM THA and 856 FB THA procedures with 2.8-year and 3.1-year follow-up, respectively. Each patient received a questionnaire postoperatively and was asked if they had any groin pain (yes/no). Secondary measurements were implant characteristics such as head size, head offset, cup size, and cup-to-head ratio. Additional PROMs that were collected included: Veterans RAND 12 (VR-12), University of California Los Angeles (UCLA) activity score, Pain visual analogue scale (Pain VAS), and range of motion (ROM). RESULTS: The incidence of groin pain was 2.3% in the DM THA cohort and 6.3% in the FB THA group (p < 0.001). Also, low head offset (⩽0 mm) had a significant odds ratio (1.61) for groin pain in both cohorts. There was no significant difference in terms of revision rate between the cohorts (2.5% vs. 3.3%, p = 0.39) at the latest follow up. CONCLUSIONS: This study demonstrated a lower incidence of groin pain (2.3%) in patients with a DM bearing compared to a FB (6.3%) and a greater risk of groin pain with low head offset (<0 mm). As such, surgeons should try to recreate offset of the hip compared to the contralateral side to avoid groin pain.

Significant relationship between musculoaponeurotic attachment of the abdominal and thigh adductor muscles to the pubis: implications for the diagnosis of groin pain.

Groin pain is prevalent in orthopedic and sports medicine, causing reduced mobility and limiting sports activity. To effectively manage groin pain, understanding the detailed anatomy of supporting muscles is crucial. This study aimed to investigate the musculoaponeurotic attachments on the pubis and the relationship among intramuscular aponeuroses of abdominal and thigh adductor musculatures. Macroscopic analyses were performed in 10 pelvic halves. The bone morphology of the pubis was assessed in two pelvic halves using microcomputed tomography. Histological investigations were conducted in two pelvic halves. The external oblique aponeurosis extended to the adductor longus aponeurosis, forming conjoined aponeurosis, which attached to a small impression distal to the pubic crest. The gracilis aponeurosis merges with the adductor brevis aponeurosis and is attached to the proximal part of the inferior pubic ramus. The rectus abdominis and pyramidalis aponeuroses were attached to the pubic crest and intermingled with the gracilis-adductor brevis aponeurosis, forming bilateral conjoined aponeurosis, which attached to a broad area covering the anteroinferior surface of the pubis. Histologically, these two areas of conjoined aponeuroses were attached to the pubis via the fibrocartilage enthesis. Microcomputed tomography revealed two distinctive bone morphologies, a small impression and an elongated osseous prominence on pubis, corresponded to the two areas of conjoined aponeuroses. This study demonstrated close relationships between the aponeurotic attachment of the external oblique and adductor longus, and between the rectus abdominis, pyramidalis, gracilis, and adductor brevis. The findings of aponeurotic complexes would aid in diagnostic and surgical approaches for athletic groin pain.

Improvement of Groin Pain in a Football Player with Femoroacetabular Impingement via a Correction of the Pelvic Position-A Case Report.

Background: Femoroacetabular impingement is one possible cause for groin pain and can lead to long periods of absence for football players. In cam impingement, the end-grade position of the leg at kicking makes the hip particularly prone to faulty contact between the acetabulum and the femoral head. Studies suggest that the resting position of the pelvis in the sagittal plane may have an important role in the biomechanics of movement in the presence of cam impingement. Methods: A 19-year-old male competitive footballer complained of sudden groin pain during a period of low athletic load. Biomechanical tests (3D posture and isometric strength analyses) showed that unbalanced individual strength training had resulted in an increased forward tilt of the pelvis. At the same time, cam impingement was confirmed radiologically, which obviously contributed to the sudden onset of the symptoms. The kicking technique of the athlete showed increased hip and trunk flexion, which also indicated a muscular imbalance. Targeted strength and stretching exercises three times a week improved the pelvic position in terms of reduced anteversion. At the same time, the patient performed strength exercises to improve his kicking technique. Results: After 8 weeks, improvements in his pelvic position and global posture and increased muscle strength could be verified. At the same time, the athlete was free of complaints again. Conclusions: When groin pain occurs in football players with cam impingement, special attention should be paid to the resting position of the pelvis in the sagittal plane. Correcting increased pelvic anteversion can prevent unfavourable end-grade collisions of the acetabulum and femoral head during kicking with strong hip flexion and adduction. Possible changes in the pelvic position due to adverse individual strength training performed by young athletes should always be kept in mind.