Article

Surgery for athletic pubalgia usually consists in abdominal wall
repair combined with routine bilateral adductor tenotomy. We currently confine
the surgical procedure to the injured structure(s) (abdominal wall only, adductor
tendon only, or both) to limit morbidity and expedite recovery. Outcomes of this
a la carte approach are unclear. The objectives of this retrospective study were
to determine the return to play (RTP) time, evaluate the potential influence of
injury location, and assess the frequency of recurrence or contralateral
involvement. HYPOTHESIS: A la carte surgery for athletic pubalgia is associated
with similar RTP times as the conventional procedure and is not followed by
recurrence. MATERIAL AND METHODS: Consecutive adults younger than 40 years of age
who underwent surgery for athletic pubalgia with injury to the abdominal wall
and/or adductor attachment sites between 2009 and 2015 were included. Patients
with intra-articular hip disorders, isolated pubic symphysis involvement, or
herniation were not eligible. The diagnosis was established clinically then
confirmed by at least one imaging technique (ultrasonography plus either a
radiograph of the pelvis or magnetic resonance imaging of the pelvis). The
criterion for performing surgery was failure of appropriate conservative therapy
followed for at least 3 months. RESULTS: Of the 27 included patients, eight had
abdominal wall involvement only, seven adductor tendon involvement only, and 12
both. Overall, 25 (92.6%) patients returned to play at their previous level,
after a mean of 112+/-38 days (range, 53-223 days), and experienced no recurrence
during the 1-year follow-up. Mean RTP time was significantly shorter in the group
with abdominal wall injury only (91.1+/-21.0 days) compared to the groups with
adductor tendon injury only (101.7+/-42.0 days) or combined injuries
(132.5+/-39.0) (p=0.02). DISCUSSION: In patients with athletic pubalgia, a la
carte surgery confined to the injured structure(s) produces excellent RTP
outcomes. RTP time is shortest in patients with isolated lower abdominal wall
injuries. LEVEL OF EVIDENCE: IV, retrospective study with no control group.
CI - Copyright (c) 2018 Elsevier Masson SAS. All rights reserved.

Langue : ANGLAIS