Thursday, 18 September 2008

Regenerative Injection of Elite Athletes with Career-Altering Chronic Groin Pain

Am J Phys Med Rehabil. 2008 Aug 6.
A Consecutive Case Series.
Topol GA, Reeves KD.

From the Physical Medicine and Rehabilitation Service, Jaime Slullitel Rosario Orthopedic and Trauma Institute, Argentina (GAT); Servicio de Medicina Física y Rehabilitación del Hospital Provincial de Rosario, Argentina (GAT); Team Physiatrist, Rosario Rugby Union, Argentina (GAT); Meadowbrook Rehabilitation Hospital, Gardner, Kansas (KDR); and Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas, Kansas (KDR).

Topol GA, Reeves KD: Regenerative injection of elite athletes with career-altering chronic groin pain who fail conservative treatment: a consecutive case series. Am J Phys Med Rehabil 2008. OBJECTIVE:: To obtain multisport and long-term outcome data from use of regenerative injection therapy on career-threatened athletes. DESIGN:: Consecutive enrollment of elite performance-limited athletes with chronic groin/abdominal pain who failed a conservative treatment trial. The treatment consisted of monthly injection of 12.5 dextrose in 0.5% lidocaine in abdominal and adductor attachments on the pubis. Injection of the nociceptive source was confirmed by repetition of resistive testing 5 min after injection. RESULTS:: Seventy-five athletes were enrolled. Seventy-two athletes (39 rugby, 29 soccer, and 4 other) completed the minimum two treatment protocol. Their data revealed a mean groin pain duration of 11 (3-60) mos. Average number of treatments received was 3 (1-6). Individual paired t tests for VAS of pain with sport (VAS Pain) and Nirschl pain phase scale measured at 0 and an average of 26 (6-73) mos indicated VAS Pain improvement of 82% (P < 10), and Nirschl pain phase scale improvement of 78% (P < 10). Six athletes did not improve following regenerative injection therapy treatment and the remaining 66 returned to unrestricted sport. Return to unrestricted sport occurred in an average of 3 (1-5) mos. CONCLUSIONS:: Athletes returned to full elite-level performance in a timely and sustainable manner after regenerative injection therapy using dextrose.

Laparoscopic inguinal ligament tenotomy and mesh reinforcement of the anterior abdominal wall: a new approach for the management of chronic groin pain

Surg Laparosc Endosc Percutan Tech. 2008 Aug;18(4):363-8.

Lloyd DM, Sutton CD, Altafa A, Fareed K, Bloxham L, Spencer L, Garcea G.

Department of Laparoscopic and Upper Gastrointestinal Surgery, The Leicester Royal Infirmary, Leicester.

BACKGROUND: Chronic groin pain has an incidence of up to 6.2% and is common in people undertaking regular sports activity. A variety of surgical options exist for unresolving pain, which consist, for the most part, of a repair of the posterior abdominal wall, with or without mesh placement. We describe a new technique, which combines laparoscopic inguinal ligament tenotomy in conjunction with a mesh repair. METHODS: A retrospective analysis of the notes of 48 patients was undertaken in conjunction with a mailed questionnaire. Success of surgery was judged on return to preinjury sporting activity, severity of pain scores, frequency of pain scores, and functional limitation scores. RESULTS: There were no major complications associated with the procedure. Severity of pain, frequency of pain, and functional limitation scores were all significantly improved after surgery (P=0.0012, <0.0001, and <0.0001, respectively). Ninety-two percent of patients polled returned to normal sports activity after their surgery (n=24). The median return to strenuous sports activity was 28 days (range of 14 to 40 d). CONCLUSIONS: The success rates of laparoscopic tenotomy and mesh repair are comparable with the published literature and a lower median time interval before returning to preinjury sporting activity.

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