San Diego—February 19, 2011
“If individuals have symptoms of athletic pubalgia otherwise known as sports hernia, doctors should carefully assess their hip joint to make sure there is not an underlying mechanical problem in the hip that may be the bigger problem in the overall function of the athlete,” said Bryan Kelly, M.D., co-director of the Center for Hip Preservation at Hospital for Special Surgery who led the study. “If patients present with both sports hernia and femoro-acetabular impingement symptoms, you have to consider what the order of treatment should be or whether you should just treat one.” He said the research suggests that treating the joint mechanics first is optimal and if problems persist, doctors can then try surgery for the sports hernia.
In recent years, a hip condition known as femoro-acetabular impingement (FAI) or hip impingement has become widely recognized in the medical community. The hip is a ball-and-socket joint where the upper end of the thigh bone fits into the cup-shaped socket of the pelvis. In a healthy hip joint, the ball rotates freely in the cup, but in some people a bony bump on the upper thigh bone produces a situation where there is inadequate space for the hip bone to move freely in the socket. The result is damage to the socket rim and the cartilage that lines the bones, which can lead to hip arthritis. In the past few years, doctors have thought that this condition may also cause sports hernias. A sports hernia is a tearing of the tissue that forms the inner part of the abdominal wall and inserts into the pubic bone.
To investigate how often FAI is associated with sports hernia, researchers examined the records of all professional athletes who underwent arthroscopic surgery at HSS for symptomatic FAI between April 2005 and April 2010. Patients were included if their FAI limited their ability to return to competitive play. The group, 38 in total, included nine baseball players, 13 football players, eight hockey players, five soccer players, two basketball players, and one skater. Retrospective data regarding prior athletic sports hernia surgery, ability to return to play, and duration until return to play was collected from all patients.
The investigators found that while 32 percent of the athletes had previously undergone surgery for their hernia, none of them had been able to return to their previous level of competition with the hernia surgery alone. One patient underwent hernia surgery at the same time as the FAI surgery. Thirty-nine percent of patients had hernia symptoms that resolved with FAI surgery alone and 36 of 38 patients were able to return to their previous level of play. All 12 patients that had both hernia and FAI surgery were able to return to professional competition. On average, athletes were able to return to their sport 5.9 months after arthroscopic surgery.
This is the first paper that has looked at the coincidence of FAI and sports hernia, and has practical implications for practice. “Groin pulls and lower abdominal muscle strains are frequently associated with hip joint mechanical problems, and patients should make sure that doctors are looking at both those locations as potential sources of the pain,” said Dr. Kelly, who is also in the Sports Medicine and Shoulder Service at HSS. “Before this study we knew that both impingement in the hip joint and athletic pubalgia were the cause of decreased function and pain in athletes. Now we recognize that there is a close relationship between those two, and oftentimes the problems coexist and need to be looked at when treatment options are being discussed.”
Other Hospital for Special Surgery investigators involved in the study include Asheesh Bedi, M.D., former resident who is now at the University of Michigan Medical Center; Sommer Hammoud, M.D.; Erin Magennis, B.A.; William Meyers, M.D., Drexel University College of Medicine; and Bryan Kelly, M.D.
A High Incidence of Athletic Pubalgia in Professional Athletes with Symptomatic FAI. AOSSM Specialty Day
Saturday, Feb. 19, 8:30 a.m. – 8:37 a.m. San Diego Convention Center, Ballroom 20A.
About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the ninth consecutive year) and No. 3 in rheumatology by U.S.News & World Report (2018-2019). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.