Sports hernia and femoroacetabular impingement in athletes
In this article, David N. Woznica, MD discusses sports hernia and femoroacetabular impingement in athletes.
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The idea that sports related chronic groin pain represents a major diagnostic and therapeutic challenge in sports medicine has been discussed at length in the medical research. Ohio State University researchers writing in the medical journal Frontiers in Surgery. write the “complexity of the anatomy and biomechanics of the groin makes these injuries more difficult to identify and manage. Patients may find themselves evaluated by multiple physicians and receive numerous diagnostic studies over a period of months.1
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Italian researchers reporting in the World journal of clinical cases say Femoroacetabular impingement has been reported in as few as 12% to as high as 94% of patients with sports hernias, athletic pubalgia or adductor-related groin pain.
Cam-type impingement is proposed to lead to increased symphyseal motion (resulting in cartilage deterioration) with overload on the surrounding extra-articular structures and muscle, which can result in the development of sports hernia and athletic pubalgia. In simpler terms, hip/pelvic instability.
In this paper the researchers are suggesting that for patients with FAI and sports hernia, the surgical management of both problems is more effective than sports pubalgia surgery or hip arthroscopy alone (89% vs 33% of cases).
As sports hernias and FAI are typically treated by general and orthopedic surgeons, respectively, a multidisciplinary approach for diagnosis and treatment is recommended for optimal treatment of patients with these injuries.2
This idea that to successfully treat sports hernia you would need to surgically repair numerous areas is not new. In 2011 doctors at the Minnesota Orthopedic Sports Medicine Institute wrote: When surgery only addressed either the athletic pubalgia or intra-articular hip pathology in this patient population, outcomes were suboptimal. Surgical management of both disorders concurrently or in a staged manner led to improved postoperative outcomes scoring and an unrestricted return to sporting activity in 89% of hips.3
For some athletes this is good news, for others multi-stage surgeries present time off challenges. Here are the results of that study:
- 37 hips (mean patient age, 25 years) were diagnosed with both symptomatic athletic pubalgia and symptomatic intra-articular hip joint pathology.
- There were 8 professional athletes, 15 collegiate athletes, 5 elite high school athletes, and 9 competitive club athletes.
- Outcomes included an evaluation regarding return to sports and various scoring systems to determine successful treatment.
- Thirty-one hips underwent thirty-five athletic pubalgia surgeries.
- Hip arthroscopy was performed in 32 hips (30 cases of femoroacetabular impingement treatment, 1 traumatic labral tear, and 1 borderline dysplasia).
- Of 16 hips that had athletic pubalgia surgery as the index procedure, 4 (25%) returned to sports without limitations, and 11 (69%) subsequently had hip arthroscopy at a mean of 20 months after pubalgia surgery.
- Of 8 hips managed initially with hip arthroscopy alone, 4 (50%) returned to sports without limitations, and 3 (43%) had subsequent pubalgia surgery at a mean of 6 months after hip arthroscopy.
- Thirteen hips had athletic pubalgia surgery and hip arthroscopy at one setting. Concurrent or eventual surgical treatment of both disorders led to improved postoperative outcomes scores sporting activity in 89% of hips (24 of 27).
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1. Strosberg DS, Ellis TJ, Renton DB. The Role of Femoroacetabular Impingement in Core Muscle Injury/Athletic Pubalgia: Diagnosis and Management. Frontiers in Surgery. 2016;3:6. [Pubmed]
2 Munegato D, Bigoni M, Gridavilla G, Olmi S, Cesana G, Zatti G. Sports hernia and femoroacetabular impingement in athletes: A systematic review. World Journal of Clinical Cases : WJCC. 2015;3(9):823-830. [Pubmed]
3. Larson CM, Pierce BR, Giveans MR. Treatment of athletes with symptomatic intra-articular hip pathology and athletic pubalgia/sports hernia: a case series. Arthroscopy. 2011 Jun;27(6):768-75. [Pubmed]