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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

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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Correspondence to Alexander Zimmerer.

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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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Schlüsselwörter

  • Behandlung der Osteitis pubis
  • Schambeinbedingter Leistenschmerz
  • Hüftschmerz
  • Sportler
  • Sportlerleiste

Keywords

  • Osteitis pubis
  • Pubic related groin pain
  • Hip pain
  • Athletes
  • Sports hernia