OBJECTIVES
To investigate the efficacy of bilateral adductor tenotomy with or without hernioplasty in treating groin pain in professional football players.
Methods
Forty-two male football players affected by exercise-limiting groin pain lasting more than 6 months were enrolled in this retrospective study. The participants had a mean age of 25 (range: 20-32 years), a mean height of 174 (range: 162-188 cm), a mean weight of 70 (range: 60-88 kg) and a mean body mass index of 23 (range: 20.5-24.9 kg/m2).
Based on clinical examination by a specialized general surgeon and associated Magnetic Resonance Imaging (MRI) findings, groin pain was attributed to osteitis pubis in 26 patients (62%), while the remaining 16 (38%) were diagnosed with osteitis pubis combined with sports hernia. All patients subsequently underwent bilateral adductor tenotomy. Unilateral open hernioplasty with synthetic mesh was also performed in patients with sports hernia.
The Return To Training (RTT) time, the pre and postoperative (1 year after surgery) Visual Analogue Scale (VAS) score and the pre-injury and postoperative (1 year after surgery) Tegner scores were recorded. The maximum distance between the superior pubic ramus and the retracted proximal end of the dissected adductor longus tendon (MDPA) was measured sonographically one year postoperatively.
Results
The mean±SD RTT time was 10±2.8 weeks (range: 6-16 weeks). The mean VAS score was significantly better (P<0.0001) postoperatively (1.6±0.7) than preoperatively (8.3±0.6) and there was no statistically significant difference (P=0.64) between the mean pre-injury (7.8±0.4) and postoperative (7.7±0.5) Tegner scores. The mean MDPA was 13±2 mm.
No tendon retraction (MPDA = 0) was found in 8 tendons, in otherwise normally rehabilitated and asymptomatic patients. The mean MDPA of the remaining tendons was 14.5±2 mm.
Conclusions
An "A la carte" surgical treatment is mandatory in professional football players with groin pain who failed in conservative treatment.
Exercise-limiting groin pain due to osteitis pubis in football players can be successfully treated with bilateral adductor tenotomy alone, while patients with osteitis pubis combined with sports hernia should be treated with bilateral adductor tenotomy and unilateral hernioplasty.
A few tendons may not exhibit any retraction postoperatively, but that doesn't necessarily correlate with the clinical symptomatology of the football players.