Systematic review: laparoscopic treatment of long-standing groin pain in athletes

Paajanen, Hannu; Montgomery, Agneta; Simon, Thomas; Sheen, Aali J.

doi:10.1136/bjsports-2014-094544

Cited by 19 publications

(16 citation statements)

References 40 publications

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“…Most non‐randomized studies have indicated that laparoscopic treatment of sportsman's hernia is effective in 80–90 per cent of patients. Two previous RCTs included surgical treatment, but neither compared different surgical techniques.…”

Section: Discussionmentioning

confidence: 99%

Randomized clinical trial of open suture repairversustotally extraperitoneal repair for treatment of sportsman's hernia

Sheen

Montgomery

Simon

et al. 2019

British Journal of Surgery

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Background: Sportsman's hernia/athletic pubalgia is a recognized cause of chronic groin pain in athletes. Both open and laparoscopic surgical repairs have been described for treatment, but there are no comparative studies. The hypothesis here was that relief of pain would be achieved earlier in patients treated with open minimal suture repair than totally extraperitoneal repair. Methods: A randomized multicentre trial in four European countries was conducted to compare open minimal suture repair with totally extraperitoneal repair. The primary endpoint was complete relief of pain (visual analogue scale (VAS) score 20 or less on a scale from 0 to 100 mm) at 1 month. Secondary endpoints included complications, time to return to sporting activity, and number of patients returning to sport within 1 year. Results: A total of 65 athletes (92 per cent men) with a median age of 29 years were enrolled (31 open repair, 34 totally extraperitoneal repair). By 4 weeks after surgery, median preoperative VAS scores had dropped from 70-80 to 10-20 in both groups (P < 0⋅001). Relief of pain (VAS score 20 or less) during sports activity 4 weeks after surgery was achieved in 14 of 31 patients after open repair and 24 of 34 after totally extraperitoneal repair (P = 0⋅047). Return to full sporting activity was achieved by 16 and 18 patients respectively after 1 month (P = 0⋅992), and by 25 versus 31 after 3 months (P = 0⋅408). Conclusion: Totally extraperitoneal repair was less painful than open repair in the first month, but otherwise both procedures were similarly effective in treating chronic pain due to sportsman's hernia. Registration number: NCT02297711 (http://www.clinical.trials.gov).

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Section: Discussionmentioning

confidence: 99%

Randomized clinical trial of open suture repairversustotally extraperitoneal repair for treatment of sportsman's hernia

Sheen

Montgomery

Simon

et al. 2019

British Journal of Surgery

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“…In Lloyd et al and Mann et al, to confirm inguinal ligament pathology, patients must have had tenderness near the insertion of the inguinal ligament onto the PT or superficial inguinal ring without any evidence of a hernia. Although these stringent criteria may have excluded potential participants from the study due to varying pain presentations, the outcome measures from the studies by Lloyd et al and Mann et al were comparable to high level outcomes in existing literature for surgical interventions managing ID [24]. Pain severity scores improved slightly in the study by Mann et al [19], possibly explained by access to higher quality physiotherapy programmes in the all-athletic population (51% of whom were professional), or by slight improvement in intra-operative technique over time.…”

Section: Discussionmentioning

confidence: 99%

A qualitative literature review exploring the role of the inguinal ligament in the context of inguinal disruption management

Clelland

2018

Surg Radiol Anat

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PurposeGroin injury, sportsman’s groin and inguinal disruption (ID) refer to a diffuse chronic groin pain syndrome that has significant impact on athletes and is often unresponsive to conservative management. The ID aetiology is poorly understood but may involve weakness of the inguinal ligament attachments or the posterior inguinal canal wall or the tendons of adductor longus and rectus abdominis. We discuss the literature in which the inguinal ligament was directly targeted for ID management in athletic populations. Secondarily, we discuss the anatomical reclassification of the inguinal ligament to a tendon based on the above information.MethodsThis was a qualitative review of the published literature, in English, from January 2007 to February 2017.ResultsFive research papers, including 264 patients, were appraised. In patients with ID, tears were identified in the inguinal ligament, and to relieve pain, the surgical treatment of the ligament by tenotomy was shown to be beneficial. Techniques such as radiofrequency denervation involving the inguinal ligament and ilioinguinal nerve were also shown to relieve symptoms in athletes.ConclusionsThis qualitative review has specifically focused on the literature directly targeting the inguinal ligament in ID which is a relatively unexplored management approach. When treated as a tendon, the inguinal ligament appears to be an appropriate ID therapeutic target. Integrated studies and randomised clinical trials will promote a better understanding of the role of the inguinal ligament and its tendinous properties in ID and provide a foundation for evidence-based management of chronic groin pain in athletes.

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“… 10 , 14 , 25 Without a clear clinical and pathological diagnosis, subsequent management is difficult. Open and laparoscopic repairs produce good results; the latter may allow earlier return to full sport, 17 but comparative studies between open and laparoscopic procedures in athletic pubalgia do not exist. Video-assisted repair of chronic pubalgia (total extraperitoneal), particularly in athletes, has many theoretic advantages.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the preperitoneal technique is less invasive than open anterior techniques. 8 , 17 Postoperative pain and wound complications are less frequent after laparoscopic surgery than in open surgery. The combination of complex anatomy in the groin area, variability of presentation, and the nonspecific nature of the signs and symptoms make the diagnostic process somewhat problematic.…”

Section: Discussionmentioning

confidence: 99%

“… 14 , 15 Surgical approaches for athletic pubalgia include open repair or laparoscopic or totally extraperitoneal techniques, with or without polypropylene mesh. 14 , 17 One randomized trial confirmed the efficacy of video-assisted, preperitoneal insertion of polypropylene mesh in the treatment of athletic pubalgia. 15 In male athletes with pubalgia, the presence of pubic BME had no remarkable effect on recovery from endoscopic treatment.…”

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confidence: 97%

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Athletic Pubalgia in Females: Predictive Value of MRI in Outcomes of Endoscopic Surgery

Matikainen

Hermunen

Paajanen

2017

Orthopaedic Journal of Sports Medicine

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Background:Athletic pubalgia is typically associated with male athletes participating in contact sports and less frequently with females. Endoscopic surgery may fully treat the patient with athletic pubalgia.Purpose:To perform an outcomes analysis of magnetic resonance imaging (MRI) and endoscopic surgery in female patients with athletic pubalgia.Study Design:Cohort study; Level of evidence, 3.Methods:Fifteen physically active female patients (mean age, 37 years) with athletic pubalgia were treated surgically via placement of total extraperitoneal endoscopic polypropylene mesh behind the injured groin area. The presence of preoperative bone marrow edema (BME) at the pubic symphysis seen on MRI was graded from 0 to 3 and correlated with pain scores after surgery. The outcome measures were pre- and postoperative pain scores and recovery to daily activity between 1 and 12 months after surgery. Results were compared with previously published scores from male athletes (n = 30).Results:With the exception of lower body mass index, the females with (n = 8) and without (n = 7) pubic BME had similar patient characteristics to the corresponding males. Mean inguinal pain scores (0-10) before surgical treatment were greater in females than males (during exercise, 7.8 ± 1.1 vs 6.9 ± 1.1; P = .0131). One month after surgery, mean pain scores for females were still greater compared with males (2.9 ± 1.7 vs 1.3 ± 1.6; P = .0034). Compared with female athletes with normal MRI, pubic BME was related to increased mean preoperative pain scores (8.13 ± 0.99 vs 6.43 ± 1.2; P = .0122). After 1 year, surgical outcomes were excellent or good in 47% of women.Conclusion:Endoscopic surgery was helpful in half of the females with athletic pubalgia in this study. The presence of pubic BME may predict slightly prolonged recovery from surgery.

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Systematic review: laparoscopic treatment of long-standing groin pain in athletes

Abstract: Laparoscopic surgery for elite athlete groin pain is increasingly becoming more common with almost 1000 patients reported since 1997. No particular laparoscopic technique appears to offer any advantage over the other.

Cited by 19 publications

References 40 publications

Randomized clinical trial of open suture repairversustotally extraperitoneal repair for treatment of sportsman's hernia

Randomized clinical trial of open suture repairversustotally extraperitoneal repair for treatment of sportsman's hernia

A qualitative literature review exploring the role of the inguinal ligament in the context of inguinal disruption management

Athletic Pubalgia in Females: Predictive Value of MRI in Outcomes of Endoscopic Surgery

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