Ouch! Treating Groin Pain in Soccer Players

Chronic exercise-related groin pain occurs in between 0.5% and 6.2% of all athletes but is especially common among soccer players where recent research has pegged the incidence rate at 10 to 18 injuries per 100 soccer players.

Nonoperative treatments often have limited efficacy and some studies have shown that only 38% of injuries resolve with nonoperative treatment alone. Surgical procedures on the adductor-abdomino complex can be more effective for alleviating symptoms. A recent study titled, “Adductor Tenotomy as a Treatment for Groin Pain in Professional Soccer Players” tackled this touchy issue.

Drs. Omer Mei-Dan, Vicente Lopez, Michael R. Carmont, Mark O. McConkey, Gilbert Steinbacher, Pedro D. Alvarez, and Ramon B. Cugat examined 155 professional and recreational soccer players between 2000 to 2006.

All subjects in this study were players with recalcitrant groin pain, both with and without lower abdominal pain. The players also exhibited a resistance to nonoperative treatment. Ninety-six of the study patients were treated with adductor tenotomy and 59 patients were treated with combined adductor tenotomy and hernioplasty.

The authors documented return to play (RTP) time, and subjective and objective outcome measures. To quantify surgical success, the doctors used a subjective evaluation by the patient (50% of the score), the Tegner score (35%), and time before RTP (15%). In the subjective evaluation, 5 or excellent merited 50 points; 4 or good, 35 points; 3 or satisfactory, 20 points. Any score below a 3 was given 0 points.

The last documented Tegner score was compared to the level of play before the onset of symptoms. If the athlete resumed the same level of activity or higher, 35 points were awarded. For a Tegner score of 1 grade lower, 15 points were awarded and no points were given for more than a 1 level decrease.

For RTP time, less than 2 months merited the maximum 15 points; 2-4 months, 10 points; more than 4 months, 5 points. Total scores of 90-100 were deemed excellent; 80-89, good; 70-79, fair; below 70, poor. These scores were also compared between the tenotomy only group and the combined tenotomy and hernioplasty group.

Of the 155 patients, 15 were lost over the 66-month period, resulting in 140 patients with sufficient data. Combining the groups, the mean subjective outcome was 4.4±0.9 out of 5 (range, 1-5). Of all the soccer players, the average preinjury Tegner score was 8.3±0.6 (range, 8-10). The average postoperative Tegner score was the same as the preoperative score, with only 2.8% or 4 patients having a reduced follow-up score. The mean RTP time was 11.6±5.4weeks (range, 4-36 weeks).

The combined score showed excellent results in 65% (92) patients, good results in 15% (21) patients, fair in 2.5 (3), and poor in 17% (24). No differences were found between the tenotomy only and the tenotomy and hernioplasty groups for the 3 main outcome measures and combined score.