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Arthroskopisch assistierte minimal-invasive Symphysioplastik zur Behandlung des schambeinbezogenen Leistenschmerzes

Arthroscopically assisted minimally invasive symphysioplasty for the treatment of pubic related groin pain

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Zusammenfassung

Operationsziel

Therapie des schambeinbedingten Leistenschmerzes über eine minimal-invasive Symphysioplastik.

Indikationen

Therapierefraktärer schambeinbedingter Leistenschmerz auf Basis einer Osteitis pubis.

Kontraindikationen

Leistenschmerz anderer Genese.

Operationstechnik

Nach minimal-invasivem Zugang erfolgt die Eröffnung der anterioren Kapsel unter Schonung der dorsalen Kapselanteile und des Ligamentum arcuatum pubis. Die Symphysenendplatten werden mittels Kugelfräse arthroskopisch assistiert remodelliert. Die neu geschaffene Schambeinfuge wird mit autogenem Fibrin gefüllt, um die Bildung eines Neodiskus zu unterstützen. Abschließend erfolgt der schichtweise Wundverschluss.

Weiterbehandlung

Teilbelastung mit 20 kg an Unterarmgehstützen für 4 Wochen, danach langsames Aufbelasten. In den ersten 4 Wochen sollte die Flexion auf 60° und die Innenrotation auf 10° eingeschränkt werden.

Ergebnisse

Seit 2010 bis 2018 wurden 10 Sportler (7 männlich, 3 weiblich; Durchschnittsalter 34,1 ± 7,8 [23–47] Jahre) mittels arthroskopisch assistierter, minimal-invasiver Symphysioplastik und operativer Therapie des femoroazetabulären Impingementsyndroms behandelt. Die durchschnittliche Nachuntersuchungszeit betrug 5,1 (2–9) Jahre. Alle Patienten konnten zu ihrem Sportniveau zurückkehren. Der Non-Arthritic Hip Score (NAHS) zeigt zum Follow–up-Zeitpunkt einen signifikanten Anstieg von 64,4 ± 15,1 (32,1–86,5) auf 91,4 ± 9,8 (62,4–98,75) Punkte (p < 0,0001). Die durchschnittliche Patientenzufriedenheit (Skala 0 bis 10; 10 höchste Zufriedenheit) lag bei 9,8 ± 0,4 (9–10).

Abstract

Objective

Therapy of pubic related groin pain via minimally invasive symphysioplasty.

Indications

Therapy of refractory pubic related groin pain based on osteitis pubis.

Contraindications

Groin pain from causes other than pubic related groin pain.

Surgical technique

After a minimally invasive approach, an incision in the anterior capsule is made while protecting the dorsal capsule parts and the arcuate pubic ligament. The symphysis end plates are remodeled arthroscopically assisted using a surgical burr. The newly created pubic symphysis joint is filled with autogenous fibrin to support the formation of a new discus interpubicus.

Postoperative management

Partial weight-bearing for 4 weeks with 20 kg using crutches is recommended. During the first 4 weeks the range of motion should be restricted.

Results

Since 2010, 10 athletes (7 men, 3 women; average age 34.1 ± 7.8 (23–47) years) have undergone arthroscopically assisted minimally invasive symphysioplasty and treatment of femoroacetabular impingement syndrome. The average follow-up time was 5.1 (2–9) years. All patients returned to their sport level. The mean preoperative Nonarthritic Hip Score (NAHS) of 64.4 ± 15.1 (32.1–86.5) points improved to a mean postoperative NAHS of 91.4 ± 9.8 (62.4–98.75) points (p < 0.0001). The average patient satisfaction (scale 0 to 10; 10 highest satisfaction) was 9.8 ± 0.4 (9–10).

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Literatur

  1. Angoules AG (2015) Osteitis pubis in elite athletes. Diagnostic and therapeutic approach. World J Orthop 6(9):672–679

    Article  Google Scholar 

  2. Birmingham PM, Kelly BT, Jacobs R, McGrady L, Wang M (2012) The effect of dynamic femoroacetabular impingement on pubic symphysis motion. A cadaveric study. Am J Sports Med 40(5):1113–1118

    Article  Google Scholar 

  3. Choi H, McCartney M, Best TM (2011) Treatment of osteitis pubis and osteomyelitis of the pubic symphysis in athletes. A systematic review. Br J Sports Med 45(1):57–64

    Article  Google Scholar 

  4. Economopoulos KJ, Milewski MD, Hanks JB, Hart JM, Diduch DR (2014) Radiographic evidence of femoroacetabular impingement in athletes with athletic pubalgia. Sports Health 6(2):171–177

    Article  Google Scholar 

  5. Ekstrand J, Hilding J (1999) The incidence and differential diagnosis of acute groin injuries in male soccer players. Scand J Med Sci Sports 9(2):98–103

    Article  CAS  Google Scholar 

  6. Elattar O, Choi H‑R, Dills VD, Busconi B (2016) Groin injuries (athletic pubalgia) and return to play. Sports Health 8(4):313–323

    Article  Google Scholar 

  7. Fricker PA, Taunton JE, Ammann W (1991) Osteitis pubis in athletes. Infection, inflammation or injury? Sports Med 12(4):266–279

    Article  CAS  Google Scholar 

  8. Frizziero A, Vittadini F, Pignataro A et al (2016) Conservative management of tendinopathies around hip. Muscles Ligaments Tendons J 6(3):281–292

    Article  Google Scholar 

  9. Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA (2003) Femoroacetabular impingement. A cause for osteoarthritis of the hip. Clin Orthop Relat Res 417:112–120

    Google Scholar 

  10. Hechtman KS, Zvijac JE, Popkin CA, Zych GA, Botto-van Bemden A (2010) A minimally disruptive surgical technique for the treatment of osteitis pubis in athletes. Sports Health 2(3):211–215

    Article  Google Scholar 

  11. Holt MA, Keene JS, Graf BK, Helwig DC (1995) Treatment of osteitis pubis in athletes. Results of corticosteroid injections. Am J Sports Med 23(5):601–606

    Article  CAS  Google Scholar 

  12. Hopp S, Tumin M, Wilhelm P, Pohlemann T, Kelm J (2014) Arthroscopic pubic symphysis debridement and adductor enthesis repair in athletes with athletic pubalgia. Technical note and video illustration. Arch Orthop Trauma Surg 134(11):1595–1599

    Article  Google Scholar 

  13. Hopp SJ, Culemann U, Kelm J, Pohlemann T, Pizanis A (2013) Osteitis pubis and adductor tendinopathy in athletes. A novel arthroscopic pubic symphysis curettage and adductor reattachment. Arch Orthop Trauma Surg 133(7):1003–1009

    Article  Google Scholar 

  14. Kelm J, Ludwig O, André J, Maas S, Hopp S (2018) Was wissen wir über die Osteitis pubis bei Sporttreibenden? Sportverletz Sportschaden. https://doi.org/10.1055/s-0043-122763

    Article  PubMed  Google Scholar 

  15. Krüger J (2012) Das Knochenödem im Os pubis – Vorschlag einer Stadieneinteilung unter Anwendung der MRT. Sportorthop Sporttraumatol 28(3):182–188

    Google Scholar 

  16. Larson CM (2014) Sports hernia/athletic pubalgia. Evaluation and management. Sports Health 6(2):139–144

    Article  Google Scholar 

  17. Larson CM, Pierce BR, Giveans MR (2011) Treatment of athletes with symptomatic intra-articular hip pathology and athletic pubalgia/sports hernia. A case series. Arthroscopy 27(6):768–775

    Article  Google Scholar 

  18. Larson CM, Sikka RS, Sardelli MC et al (2013) Increasing alpha angle is predictive of athletic-related „hip“ and „groin“ pain in collegiate National Football League prospects. Arthroscopy 29(3):405–410

    Article  Google Scholar 

  19. Maffulli N, Loppini M, Longo UG, Denaro V (2012) Bilateral mini-invasive adductor tenotomy for the management of chronic unilateral adductor longus tendinopathy in athletes. Am J Sports Med 40(8):1880–1886

    Article  Google Scholar 

  20. Matsuda DK (2010) Endoscopic pubic symphysectomy for reclacitrant osteitis pubis associated with bilateral femoroacetabular impingement. Orthopedics. https://doi.org/10.3928/01477447-20100129-31

    Article  PubMed  Google Scholar 

  21. Matsuda DK, Ribas M, Matsuda NA, Domb BG (2015) Multicenter outcomes of endoscopic pubic symphysectomy for osteitis pubis associated with femoroacetabular impingement. Arthroscopy 31(7):1255–1260

    Article  Google Scholar 

  22. Mehin R, Meek R, O’Brien P, Blachut P (2006) Surgery for osteitis pubis. Canadian journal of surgery. Can J Surg 49(3):170–176

    PubMed  PubMed Central  Google Scholar 

  23. Moore RS, Stover MD, Matta JM (1998) Late posterior instability of the pelvis after resection of the symphysis pubis for the treatment of osteitis pubis. A report of two cases. J Bone Joint Surg Am 80(7):1043–1048

    Article  Google Scholar 

  24. Omar IM, Zoga AC, Kavanagh EC et al (2008) Athletic pubalgia and „sports hernia“. Optimal MR imaging technique and findings. Radiographics 28(5):1415–1438

    Article  Google Scholar 

  25. Radic R, Annear P (2008) Use of pubic symphysis curettage for treatment-resistant osteitis pubis in athletes. Am J Sports Med 36(1):122–128

    Article  Google Scholar 

  26. Rambani R, Hackney R (2015) Loss of range of motion of the hip joint. A hypothesis for etiology of sports hernia. Muscles Ligaments Tendons J 5(1):29–32

    Article  Google Scholar 

  27. Ribas M, Ginebreda I, Candioti L, Villarubias JM (2005) Surgical treatment of the anterior femoroacetabular impingement syndrome of the hip. Orthop Proc 87-B

  28. Rodriguez C, Miguel A, Lima H, Heinrichs K (2001) Osteitis pubis syndrome in the professional soccer athlete. A case report. J Athl Train 36(4):437–440

    PubMed  PubMed Central  Google Scholar 

  29. Ross JR, Stone RM, Larson CM (2015) Core muscle injury/sports hernia/athletic pubalgia, and femoroacetabular impingement. Sports Med Arthrosc 23(4):213–220

    Article  Google Scholar 

  30. Schöberl M, Prantl L, Loose O et al (2017) Non-surgical treatment of pubic overload and groin pain in amateur football players. A prospective double-blinded randomised controlled study. Knee Surg Sports Traumatol Arthrosc 25(6):1958–1966

    Article  Google Scholar 

  31. Strosberg DS, Ellis TJ, Renton DB (2016) The role of femoroacetabular impingement in core muscle injury/athletic pubalgia. Diagnosis and management. Front Surg 3:6

    Article  Google Scholar 

  32. Valent A, Frizziero A, Bressan S, Zanella E, Giannotti E, Masiero S (2012) Insertional tendinopathy of the adductors and rectus abdominis in athletes. A review. Muscles Ligaments Tendons J 2(2):142–148

    PubMed  PubMed Central  Google Scholar 

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

    Article  CAS  Google Scholar 

  34. Vitanzo PC, McShane JM (2001) Osteitis pubis. Solving a perplexing problem. Phy Sportsmed 29(7):33–48

    Article  Google Scholar 

  35. Volpi P (Hrsg) (2015) Football traumatology. New trends, 2. Aufl. Springer, Cham

    Google Scholar 

  36. Weir A, Brukner P, Delahunt E et al (2015) Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med 49(12):768–774

    Article  Google Scholar 

  37. Williams JG (1978) Limitation of hip joint movement as a factor in traumatic osteitis pubis. Br J Sports Med 12(3):129–133

    Article  CAS  Google Scholar 

  38. Williams PR, Thomas DP, Downes EM (2000) Osteitis pubis and instability of the pubic symphysis. When nonoperative measures fail. Am J Sports Med 28(3):350–355

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. ARCUS Kliniken, Pforzheim, Rastatter Str. 17–19, 75179, Pforzheim, Deutschland

    Alexander Zimmerer

  2. Grupo Quirónsalud, Einheit für Hüft und Becken Chirurgie, Universitätsklinikum Dexeus, Barcelona, Spanien

    Luis Ramirez,  Emanuele Astarita,  Vittorio Bellotti,  Carlomagno Cárdenas &  Manuel Ribas

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  1. Alexander Zimmerer
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  2. Luis Ramirez
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  3. Emanuele Astarita
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  5. Carlomagno Cárdenas
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  6. Manuel Ribas
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Correspondence to Alexander Zimmerer.

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Interessenkonflikt

A. Zimmerer, L. Ramirez, E. Astarita, V. Bellotti, C. Cárdenas und M. Ribas geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Zimmerer, A., Ramirez, L., Astarita, E. et al. Arthroskopisch assistierte minimal-invasive Symphysioplastik zur Behandlung des schambeinbezogenen Leistenschmerzes. Oper Orthop Traumatol 34, 109–116 (2022). https://doi.org/10.1007/s00064-021-00753-4

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  • DOI: https://doi.org/10.1007/s00064-021-00753-4

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