Mini-open Incision Sports Hernia Repair: A Surgical Technique for Core Muscle Injury

Scillia, Anthony J.; Pierce, Todd P.; Simone, Erica S.; Novak, Richard C.; Emblom, Benton A.

doi:10.1016/j.eats.2017.05.006

Cited by 11 publications

(17 citation statements)

References 10 publications

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“…For all patients, surgical treatment consisted of CMI repair via a mini-open approach as previously described, in which an adductor tenotomy with suture repair of the rectus abdominis to the periosteum of the pubis was performed with cosurgeons trained in orthopaedic sports medicine and general surgery. 21 Correction of both anatomic structures has shown favorable outcomes among patients with rectus abdominis and adductor longus injuries. 14 , 15 Patients with a history and physical examination findings of CMI but MRI consistent with osteitis pubis underwent CMI repair to relieve overload of the pubis.…”

Section: Methodsmentioning

confidence: 99%

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Use of Preoperative Magnetic Resonance Imaging to Predict Clinical Outcomes After Core Muscle Injury Repair

Kraeutler

Kurowicki

Castrodad

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Core muscle injury (CMI), often referred to as a sports hernia or athletic pubalgia, is a common cause of groin pain in athletes. Imaging modalities used to assist in the diagnosis of CMI include ultrasound (US) and magnetic resonance imaging (MRI). Purpose: To determine if preoperative MRI findings predict clinical outcomes after surgery for CMI. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort study was performed on a consecutive series of patients who were operatively treated for CMI by a single surgeon. CMI was diagnosed based on history, physical examination, and a positive US. In addition, all patients underwent a preoperative MRI. Patients were divided into 2 groups based on whether the MRI was interpreted as positive or negative for CMI. All patients underwent mini-open CMI repair. Patient-reported outcomes (PROs) were collected both pre- and postoperatively and included a visual analog scale (VAS) for pain, the University of California, Los Angeles (UCLA) activity score, and the modified Harris Hip Score. Results: A total of 39 hips were included in this study, of which 17 had a positive MRI interpretation for CMI (44%) and 22 had a negative MRI interpretation (56%). Mean age at the time of surgery was 35 years (range, 17-56 years), and mean follow-up was 21 months (range, 12-35 months). No significant difference was found between groups in mean age or time to follow-up. Patients in both groups demonstrated significant improvement from preoperative to most recent follow-up in terms of the UCLA activity score ( P < .05). VAS scores significantly improved for patients with a positive MRI interpretation ( P = .001) but not for those with a negative MRI interpretation ( P = .094). No significant difference on any PROs was found between groups at the most recent follow-up. Conclusion: Successful clinical outcomes can be expected in patients undergoing surgery for CMI diagnosed based on history, physical examination, and US. Patients with a preoperative MRI consistent with CMI may experience greater improvement in pain postoperatively, although MRI does not predict postoperative activity level in these patients.

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Section: Methodsmentioning

confidence: 99%

“… 16 , 20 Often called a “sports hernia” or athletic pubalgia, these injuries often respond to nonoperative treatment, with CMI repair reserved for patients who do not respond to conservative management. 3 , 21 …”

mentioning

confidence: 99%

Use of Preoperative Magnetic Resonance Imaging to Predict Clinical Outcomes After Core Muscle Injury Repair

Kraeutler

Kurowicki

Castrodad

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…For all patients, surgical treatment consisted of CMI repair via a mini-open approach, which has been previously described. 15 Given that the mechanism of injury for CMI typically occurs during resisted hip flexion and adduction, this surgical correction involved lengthening of the adductor longus tendon, because of its relationship with the conjoined tendon, and direct repair of the rectus abdominis to the pubis. 15 Correction of both anatomic structures has shown favorable outcomes among patients with rectus abdominis and adductor longus injuries.…”

Section: -In-5mentioning

confidence: 99%

“…First-line treatment for CMI is always nonoperative management, with elective sports hernia repair reserved for refractory cases. 3,15…”

mentioning

confidence: 99%

“…First-line treatment for CMI is always nonoperative management, with elective sports hernia repair reserved for refractory cases. 3,15 Despite treatment success, the clinical diagnosis of CMI is challenging. This is because of the complex anatomy of the abdominopelvic structures and the many root causes of groin pain, which can include infectious, inflammatory, neoplastic, and traumatic causes.…”

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confidence: 99%

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Diagnostic Accuracy of Physical Examination Tests in Core Muscle Injury

et al. 2020

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Background: Core muscle injury (CMI), often referred to as a sports hernia, is a common cause of groin pain in athletes characterized by concomitant injury to the insertion of the adductor longus and the rectus abdominis muscles. Currently, the literature on CMI is sparse with no standardized physical examination tests used in the diagnosis of this type of injury. Purpose: To determine the diagnostic accuracy of various physical examination tests in the diagnosis of CMI. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: A consecutive series of patients evaluated by the senior author with symptoms consistent with CMI were included. Four physical examination tests were routinely performed in these patients by the senior author and were noted in each patient’s chart as positive or negative: (1) pain with resisted cross-body sit-up in figure-of-4 position, (2) pain with straight-leg sit-up, (3) pain with resisted hip flexion in external rotation (external rotation Stinchfield test), and (4) the presence of an adductor contracture. CMI was independently diagnosed by a reference standard (magnetic resonance imaging [MRI]). All MRI scans were read by a musculoskeletal fellowship-trained radiologist. The sensitivity and specificity of each physical examination test alone and in combination were calculated based on this reference standard. Results: A total of 81 patients were included in this study. MRI was positive for a CMI in 39 patients (48%) overall. Both the cross-body sit-up test and the presence of an adductor contracture were found to have a sensitivity of 100% (specificity, 3% for both). The external rotation Stinchfield test was found to have the highest specificity of 60% (sensitivity, 15%). The sensitivity of all 4 physical examination tests in combination was found to be 100% (specificity, 0%). Conclusion: Certain physical examination maneuvers can be used to assist in the diagnosis of a CMI. The cross-body sit-up test and the presence of an adductor contracture are highly sensitive but nonspecific tests for CMI and therefore should be used in conjunction with diagnostic imaging before deciding on an appropriate treatment course.

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