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The Role of Femoroacetabular Impingement in the Etiology of Athletic Pubalgia and Sports Hernias

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Sports Hernia and Athletic Pubalgia

Abstract

Groin injuries in athletes are a common problem, especially in athletes participating in sports requiring significant cutting, twisting, and kicking. Two of the most common causes of groin pain in athletes are femoroacetabular impingement (FAI) and athletic pubalgia. FAI is the impingement of the femoral neck on the acetabular rim due to abnormal bone morphology. Athletic pubalgia is a constellation of injuries to the soft tissues surrounding the pelvis caused by repetitive injury. The most commonly injured structures in athletic pubalgia are the insertions of the rectus abdominis and adductor muscles. FAI may be the first step in a cascade of events that lead to athletic pubalgia. FAI leads to biomechanical changes including decreased hip range of motion, and athletes compensate for this loss of motion by increasing movement in the pelvis. This increased motion of the pelvis can lead to imbalance and injury of the muscles surrounding the pubic bones. Tearing of the insertion of the rectus abdominis and other muscles of the pelvis may lead to the pain associated with athletic pubalgia.

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References

  1. Smodlaka V. Groin pain in soccer players. Phys Sports Med. 1980;8:57–61.

    Google Scholar 

  2. Hackney RG. The sports hernia: a cause of chronic groin pain. Br J Sports Med. 1993;27(1):58–62.

    Article  CAS  PubMed  Google Scholar 

  3. Malycha P, Lovell G. Inguinal surgery in athletes with chronic groin pain: the ‘sportsman’s’ hernia. Aust N Z J Surg. 1992;62(2):123–5.

    Article  CAS  PubMed  Google Scholar 

  4. Anderson K, Strickland SM, Warren R. Hip and groin injuries in athletes. Am J Sports Med. 2001; 29(4):521–33.

    CAS  PubMed  Google Scholar 

  5. Ashby EC. Chronic obscure groin pain is commonly caused by enthesopathy: ‘tennis elbow’ of the groin. Br J Surg. 1994;81(11):1632–4.

    Article  CAS  PubMed  Google Scholar 

  6. Biedert RM, Warnke K, Meyer S. Symphysis syndrome in athletes: surgical treatment for chronic lower abdominal, groin, and adductor pain in athletes. Clin J Sport Med. 2003;13(5):278–84.

    Article  PubMed  Google Scholar 

  7. Brannigan AE, Kerin MJ, McEntee GP. Gilmore’s groin repair in athletes. J Orthop Sports Phys Ther. 2000;30(6):329–32.

    Article  CAS  PubMed  Google Scholar 

  8. Gilmore J. Groin pain in the soccer athlete: fact, fiction, and treatment. Clin Sports Med. 1998;17(4):787–93. vii.

    Article  CAS  PubMed  Google Scholar 

  9. Meyers WC, Foley DP, Garrett WE, Lohnes JH, Mandlebaum BR. Management of severe lower abdominal or inguinal pain in high-performance athletes. PAIN (Performing Athletes with Abdominal or Inguinal Neuromuscular Pain Study Group). Am J Sports Med. 2000;28(1):2–8.

    CAS  PubMed  Google Scholar 

  10. Srinivasan A, Schuricht A. Long-term follow-up of laparoscopic preperitoneal hernia repair in professional athletes. J Laparoendosc Adv Surg Tech A. 2002;12(2):101–6.

    Article  PubMed  Google Scholar 

  11. Fon LJ, Spence RA. Sportsman’s hernia. Br J Surg. 2000;87(5):545–52.

    Article  CAS  PubMed  Google Scholar 

  12. Genitsaris M, Goulimaris I, Sikas N. Laparoscopic repair of groin pain in athletes. Am J Sports Med. 2004;32(5):1238–42.

    Article  PubMed  Google Scholar 

  13. Kluin J, den Hoed PT, van Linschoten R, IJzerman JC, van Steensel CJ. Endoscopic evaluation and treatment of groin pain in the athlete. Am J Sports Med. 2004;32(4):944–9.

    Article  PubMed  Google Scholar 

  14. Meyers WC, McKechnie A, Philippon MJ, Horner MA, Zoga AC, Devon ON. Experience with “sports hernia” spanning two decades. Ann Surg. 2008; 248(4):656–65.

    PubMed  Google Scholar 

  15. Myers W. Understanding sports hernias: the anatomical and pathophysiological basis for abdominal and groin pain in athletes. Oper Tech Sports Med. 2007; 15:165–77.

    Article  Google Scholar 

  16. Robinson P, Salehi F, Grainger A, Clemence M, Schilders E, O’Connor P, et al. Cadaveric and MRI study of the musculotendinous contributions to the capsule of the symphysis pubis. AJR Am J Roentgenol. 2007;188(5):W440–5.

    Article  PubMed  Google Scholar 

  17. Anda S, Svenningsen S, Grontvedt T, Benum P. Pelvic inclination and spatial orientation of the acetabulum. A radiographic, computed tomographic and clinical investigation. Acta Radiol. 1990;31(4):389–94.

    CAS  PubMed  Google Scholar 

  18. DiGioia AM, Jaramaz B, Blackwell M, Simon DA, Morgan F, Moody JE, et al. The Otto Aufranc Award. Image guided navigation system to measure intraoperatively acetabular implant alignment. Clin Orthop Relat Res. 1998;355:8–22.

    Article  PubMed  Google Scholar 

  19. Lembeck B, Mueller O, Reize P, Wuelker N. Pelvic tilt makes acetabular cup navigation inaccurate. Acta Orthop. 2005;76(4):517–23.

    Article  PubMed  Google Scholar 

  20. Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg Br. 1993; 75(2):228–32.

    CAS  PubMed  Google Scholar 

  21. Fricker PA, Taunton JE, Ammann W. Osteitis pubis in athletes. Infection, inflammation or injury? Sports Med. 1991;12(4):266–79.

    Article  CAS  PubMed  Google Scholar 

  22. O’Connell MJ, Powell T, McCaffrey NM, O’Connell D, Eustace SJ. Symphyseal cleft injection in the diagnosis and treatment of osteitis pubis in athletes. AJR Am J Roentgenol. 2002;179(4):955–9.

    Article  PubMed  Google Scholar 

  23. Williams PR, Thomas DP, Downes EM. Osteitis pubis and instability of the pubic symphysis. When nonoperative measures fail. Am J Sports Med. 2000; 28(3):350–5.

    CAS  PubMed  Google Scholar 

  24. Muschaweck U, Berger LM. Sportsmen’s groin-diagnostic approach and treatment with the minimal repair technique: a single-center uncontrolled clinical review. Sports Health. 2010;2(3):216–21.

    Article  PubMed Central  PubMed  Google Scholar 

  25. 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;27(6):768–75.

    Article  PubMed  Google Scholar 

  26. Gerhardt MB, Romero AA, Silvers HJ, Harris DJ, Watanabe D, Mandelbaum BR. The prevalence of radiographic hip abnormalities in elite soccer players. Am J Sports Med. 2012;40(3):584–8.

    Article  PubMed  Google Scholar 

  27. Singh PJ, O’Donnell JM. The outcome of hip arthroscopy in Australian football league players: a review of 27 hips. Arthroscopy. 2010;26(6):743–9.

    Article  PubMed  Google Scholar 

  28. Yen YM, Kocher MS. Chondral lesions of the hip: microfracture and chondroplasty. Sports Med Arthrosc. 2010;18(2):83–9.

    Article  PubMed  Google Scholar 

  29. Byrd JW, Jones KS. Arthroscopic management of femoroacetabular impingement: minimum 2-year follow-up. Arthroscopy. 2011;27(10):1379–88.

    Article  PubMed  Google Scholar 

  30. Kapron AL, Anderson AE, Aoki SK, Phillips LG, Petron DJ, Toth R, et al. Radiographic prevalence of femoroacetabular impingement in collegiate football players: AAOS exhibit selection. J Bone Joint Surg Am. 2011;93(19):e111(1–10)

    Google Scholar 

  31. Silvis ML, Mosher TJ, Smetana BS, Chinchilli VM, Flemming DJ, Walker EA, et al. High prevalence of pelvic and hip magnetic resonance imaging findings in asymptomatic collegiate and professional hockey players. Am J Sports Med. 2011;39(4):715–21.

    Article  PubMed  Google Scholar 

  32. Verrall GM, Hamilton IA, Slavotinek JP, Oakeshott RD, Spriggins AJ, Barnes PG, et al. Hip joint range of motion reduction in sports-related chronic groin injury diagnosed as pubic bone stress injury. J Sci Med Sport. 2005;8(1):77–84.

    Article  CAS  PubMed  Google Scholar 

  33. Verrall GM, Slavotinek JP, Barnes PG, Esterman A, Oakeshott RD, Spriggins AJ. Hip joint range of motion restriction precedes athletic chronic groin injury. J Sci Med Sport. 2007;10(6):463–6.

    Article  PubMed  Google Scholar 

  34. Weir A, de Vos RJ, Moen M, Holmich P, Tol JL. Prevalence of radiological signs of femoroacetabular impingement in patients presenting with long-standing adductor-related groin pain. Br J Sports Med. 2011;45(1):6–9.

    Article  CAS  PubMed  Google Scholar 

  35. Feeley BT, Powell JW, Muller MS, Barnes RP, Warren RF, Kelly BT. Hip injuries and labral tears in the national football league. Am J Sports Med. 2008; 36(11):2187–95.

    Article  PubMed  Google Scholar 

  36. Hammoud S, Bedi A, Magennis E, Meyers WC, Kelly BT. High incidence of athletic pubalgia symptoms in professional athletes with symptomatic femoroacetabular impingement. Arthroscopy. 2012;28(10): 1388–95.

    Article  PubMed  Google Scholar 

  37. Kubiak-Langer M, Tannast M, Murphy SB, Siebenrock KA, Langlotz F. Range of motion in anterior femoroacetabular impingement. Clin Orthop Relat Res. 2007;458:117–24.

    CAS  PubMed  Google Scholar 

  38. Lamontagne M, Kennedy MJ, Beaule PE. The effect of cam FAI on hip and pelvic motion during maximum squat. Clin Orthop Relat Res. 2009;467(3): 645–50.

    Article  PubMed  Google Scholar 

  39. Tannast M, Kubiak-Langer M, Langlotz F, Puls M, Murphy SB, Siebenrock KA. Noninvasive three-dimensional assessment of femoroacetabular impingement. J Orthop Res. 2007;25(1):122–31.

    Article  PubMed  Google Scholar 

  40. Kennedy MJ, Lamontagne M, Beaule PE. Femoroacetabular impingement alters hip and pelvic biomechanics during gait Walking biomechanics of FAI. Gait Posture. 2009;30(1):41–4.

    Article  PubMed  Google Scholar 

  41. Weidner J, Buchler L, Beck M. Hip capsule dimensions in patients with femoroacetabular impingement: a pilot study. Clin Orthop Relat Res. 2012;470(12):3306–12.

    Article  PubMed  Google Scholar 

  42. Roach KE, Miles TP. Normal hip and knee active range of motion: the relationship to age. Phys Ther. 1991;71(9):656–65.

    CAS  PubMed  Google Scholar 

  43. Bedi A, Dolan M, Leunig M, Kelly BT. Static and dynamic mechanical causes of hip pain. Arthroscopy. 2011;27(2):235–51.

    Article  PubMed  Google Scholar 

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Correspondence to Kostas J. Economopoulos .

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Economopoulos, K.J. (2014). The Role of Femoroacetabular Impingement in the Etiology of Athletic Pubalgia and Sports Hernias. In: Diduch, D., Brunt, L. (eds) Sports Hernia and Athletic Pubalgia. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-7421-1_5

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  • DOI: https://doi.org/10.1007/978-1-4899-7421-1_5

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