2015 ISAKOS Biennial Congress ePoster #817
Clinical Outcomes After Surgical Treatment of Athletic Pubalgia Through Adductor Longus and Rectus Abdominis Lengthening
Leandro Ejnisman, MD, PhD, São Paulo, SP BRAZIL
Andre Pedrinelli, Prof., São Paulo, SP BRAZIL
Arnaldo J. Hernandez, MD, PhD, São Paulo, SP BRAZIL
Ricardo De Serro Azul Nobre, São Paulo, SP BRAZIL
Henrique Melo De Campos Gurgel, São Paulo, SP BRAZIL
Helder De Souza Miyahara, MD, São Paulo, São Paulo BRAZIL
Jose Ricard Negreiros Vicente, SP BRAZIL
Alberto Tesconi Croci, MD, Sao Paulo, Sao Paulo BRAZIL
University of São Paulo, São Paulo, São Paulo, BRAZIL
FDA Status Cleared
Summary: This paper reports the clinical outcomes of 45 athletes who underwent surgical intervention for athletic pubalgia after a failed trial of conservative treatment. Surgery consisted of bilateral Adductor Longus and Rectus Abdominis tendon lengthening through a Pfannenstiel approach. All patients had full return to athletic activity.
Athletic pubalgia is a common cause of hip pain in athletes. Initially, conservative treatment is indicated, which includes rest, anti-inflammatory drugs and physical therapy. Although most patients get better with clinical management, often athletes will not be able to return to sports activity because of persistent pain. Many surgical techniques have been described to address athletic pubalgia. This study has 3 goals: (1) describe a surgical technique to treat athletic pubalgia; (2) describe a cadaveric investigation to evaluate the safeness of this procedure; (3) describe clinical outcomes in a case series of athletes.
Matherials and Methods: (1) Twenty fresh frozen cadavers were operated with this technique. The patient lies supine in the operating table. A Pfannesntiel approach is done in the lower abdomen. After careful dissection, the Rectus Abdominis and both Adductor Longus are identified. The anterior part of the Rectus Abdominis tendon is released as well as both Adductor Longus tendons. After tendon release, meticulous investigation of possible iatrogenic damage to regional structures was performed. (2) Forty five athletes (100% males, 35 professional soccer players) were submitted to this procedure. Mean age was 21.3 years old (range, 18-25). Patients had in average 14 months (range, 5-28) of pain before surgery. Five have been submitted to local corticosteroid infiltration prior to surgery. Patients were followed to access return to sports and possible complications.
(1) No major structures were damaged during the procedure in cadavers. A continuity of the Rectus Abdominis and Adductor Longus tendons were observed in all specimens. (2) All patients returned to sports activity following surgical treatment after a mean of 14 weeks (range, 7-24). Four complications (8.9%) occurred: 2 hematomas needed surgical evacuation, 1 patient developed a superficial infection which subsided with oral antibiotics, and one patient was submitted to a new tenotomy.
Correct diagnosis is of paramount importance in the treatment of athletic pubalgia. It is essential to exclude intra-articular hip pathology, specially femoroacetabular impingement, in athletes with hip/pelvic pain.
We believe the continuity of the Rectus Abdominis and Adductor Longus tendons is involved in the pathomechanics of athletic pubalgia. Inbalance in this muscle unit can lead to local pain. Most of the times, conservative treatment, with special focus on reestablishing balance between these muscles, is successful. When clinical treatment fails, surgery is indicated. Because our belief that this disease is caused by soft tissue imbalance, in the author’s opinion there is no need to address the pubic bone as described by others. The technique described in this study, has been shown to be safe in cadavers, and demonstrated good clinical results in this series of patients. Proper care after surgical intervention is needed to avoid recurrence, as well as prompt return to sport.
Surgical treatment of athletic pubalgia through adductor longus and rectus abdominis lengthening is a safe and effective procedure.