Groin Pain Research Articles

Avascular necrosis of the femoral head in a patient recovering from COVID-19: A case report and literature review

Case report of a 31 year old man affected by Coronavirus Disease 2019 (CoViD-19) requiring orotracheal intubation in prone position for several days, presenting left hip groin pain and limitation of range of motion after one year of recovery of his stay in intensive care unit, without history of previous symptoms or trauma

The Efficacy and Safety of Single-Incision Mini-Slings for Stress Urinary Incontinence: A Network Meta-Analysis.

To evaluate the efficacy and safety of single-incision mini-sling for stress urinary incontinence based on network Meta-analysis. We searched PubMed, Embase, and Cochrane libraries from August 2008 to August 2019. Randomized controlled trials comparing two or more indicators of Miniarc (Single Incision Mini-slings), Ajust (Adjustable Single-Incision Sling), C-NDL (Contasure-Needleless), TFS (Tissue Fixation System), Ophria (Transobturator Vaginal Tap), TVT-O (Transobturator Vaginal Tape), and TOT (Trans-obturatortape) in treating female stress urinary incontinence were collected. Totally, 3,428 patients from 21 studies were included. Ajust had the highest subjective cure rate (Rank=0.52), while Ophira had the worst (Rank=0.67). TFS had the highest objective cure rate, and the worst was found in Ophira. TFS required the shortest operating time (Rank=0.40), while TVT-O required the longest operating time (Rank=0.47). Miniarc had the least bleeding (Rank=0.47), while TVT-O had the most bleeding (Rank=0.37). C-NDL had the shortest postoperative hospital stay (Rank=0.77), while Ajust had the longest postoperative hospital stay (Rank=0.36). For postoperative complications, TFS performed best in groin pain (Rank=0.84), urinary retention (Rank=0.78), and repeat surgery (Rank=0.45). TVT-O performed worst in groin pain (Rank=0.36), and urinary retention (Rank=0.58). Miniarc had the highest repeat surgery rate (Rank=0.35). Ajust had the lowest probability of tap erosion (Rank=0.30), while Ophira had the highest tap erosion level (Rank=0.45). Miniarc showed the greatest advantage in urinary tract infections (Rank=0.84) and de novo urgency (Rank=0.60), while C-NDL had the highest incidence of urethral infections (Rank=0.51). Ophira performed worst in de novo urgency (Rank=0.60). C-NDL performed the best in sexual intercourse pain (Rank=0.79) while Ajust was the worst (Rank=0.49). In view of comprehensive efficacy and safety, we recommend that TFS or Ajust should be selected first for single-incision sling and the application of Ophria should be minimized.

To Determine the Efficacy of Mulligan Mobilisation and Muscle Energy Technique in Sacroiliac Joint Dysfunction: A Single Blinded, Randomized Clinical Trial

The Sacroiliac Joint Dysfunction may lead to hypermobility or hypomobility at the joint, resulting in pain andirritation. Patient complains of dull aching pain on the affected side. The pain increases during the activities whileturning, sitting, bending or acquired standing posture.The pain gets referred to either groin, gluteal region or the posterior aspect of the thigh. With or without associatednumbness, in groin region and pain on one side is more common than bilateral. This Sacroiliac joint dysfunctioncan be managed conservatively using physical agent modalities such as electrotherapy, laser therapy, ultrasound,longwave, rest, exercises, or using manual mobilisation.Purpose Of the Study: To determine the effectiveness of Mulligan Mobilisation and Muscle Energy Technique inSacroiliac Joint Dysfunction.Material And Method Used: 700 subjects were screened to include 72 subjects with diagnosis of sacroiliac jointdysfunction and further were haphazardly divided into two groups viz. Muscle Energy Technique therapy groupand Mobilisation group via block randomization, depending on severity of pain (mild, moderate, severe) usinglottery method.Results: The values of Visual Analogue Scale, Modified Oswestry Disability Questionnaire and Pain Pressurethreshold within the group were analysed using Paired t-test and between the groups were analysed usingIndependent t-test.Conclusion: MET and Mobilisation both techniques are operative in treatment of Sacroiliac Joint Dysfunction.

Hip Arthroscopy with Acetabular Osteoplasty and Labral Repair

Hip arthroscopy with femoral neck or acetabular osteoplasty with or without labral repair can be used for treatment of femoroacetabular impingement. Patients may present with insidious onset of hip pain and mechanical symptoms and pain worse with activity and sitting. On physical exam hip flexion and internal rotation may be reduced and anterior impingement testing will produce groin pain in the majority of patients with femoroacetabular impingement. Imaging may demonstrate lesions responsible for Cam-type or Pincer-type impingement and MRI may demonstrate labral tear or cartilaginous lesions. Arthroscopic surgical treatment is indicated for patients who have failed conservative treatment.

A Prospective Comparative Study of Laparoscopic Totally Extraperitoneal (TEP) and Laparoscopic Transabdominal Preperitoneal (TAPP) Inguinal Hernial Repair.

Introduction Inguinal hernia is a common surgical problem throughout the world. Currently, the management options available are open mesh hernioplasty and laparoscopic mesh repair. Laparoscopic mesh repair can be performed by either transabdominal preperitoneal (TAPP) repair or totally extraperitoneal (TEP) repair. Many studies comparing the two procedures have been unable to establish the superiority of one procedure over the other and have yielded conflicting results. Thus, we performed this study to compare TAPP and TEP. Aim The aim of this study is to compare the clinical outcomesand safety of laparoscopic TEP and laparoscopic TAPP for inguinal hernia repair. Materials and methods Patients were randomly divided into two groups on the basis of surgical procedures. The first group of patients underwent laparoscopic TAPP mesh repair, and the second group of patients underwent laparoscopic TEP mesh repair. Their intraoperative and postoperative findings were noted. Patients were followed up at regular intervals for up to six months. Results The mean age and mean weight distribution between the two groups were not significant. The duration of surgeryneeded (in minutes) for TAPP was found to be significantly less compared to TEP. In the TEP group, conversion to open occurred for three subjects (6.7%) while there was no conversion in the TAPP group. Postoperative pain at 24 hrs was found to be higher in TAPP subjects compared to that in TEP subjects, but the difference was statistically insignificant. Tolerance to a liquid diet started few hours after surgery was found to be the same in both groups. Association of the duration of hospital stays with the type of surgery was not significant. Six subjects (13.2%) showed hematoma in the TEP group while five subjects (11%) in the TAPP group showed hematoma after one week of surgery. Eight subjects (17.6%) showed seroma in the TEP group while three subjects (15.4%) in the TAPP group showed seroma after one week of surgery. Two subjects (4.4%) showed superficial wound infection in both the TEP group and TAPP group after one week of surgery. Four subjects each (8.9%) showed scrotal edema in the TEP group as well as the TAPP group after one week of surgery. No subject showed port site hernia withoutclosureofthesheathat one-week, one-month,and six-monthfollow-upvisits. Two subjects (4.4%) each showed groin pain in the TEP group as well as the TAPP group after one week of surgery. There were no instances of bowel obstruction or mesh infection. Conclusion TEP is a more skill-demanding procedure as compared to TAPP and thus takes more time to perform. However, it is superior on account of not breaching the peritoneum. TAPP is favorable for larger hernias. The choice of procedure should be individualized according to the patient's characteristics and surgeon's preference.

The effectiveness of non-surgical interventions in athletes with groin pain: a systematic review and meta-analysis

BackgroundGroin pain is a common pathology among athletes, presenting pain and a reduced range of motion (ROM) as clinical characteristics. Passive physical therapy (PPT) and exercise therapy (ET) interventions are chosen firstly before surgery. The aim of this systematic review and meta-analysis was: (i) to qualitative review the effects of each non-surgical intervention; (ii) to quantitative compare the effects of PPTs plus ET intervention to ET in isolation in pain intensity, and hip ROM in athletes with groin pain.MethodsA systematic review and meta-analysis was conducted. Pubmed, PEDro, Web of science, Scopus and Cochrane library were searched. Randomized controlled trials comparing PPT plus ET to ET interventions were included. The methodological quality and risk of bias of the included studies, were assessed with the PEDro scale and the Cochrane risk-of-bias tool. To assess the certainty of evidence the GRADEpro GDT was used. Meta-analyses were conducted using RevMan 5.4 using mean difference analysis to assess the variables pain intensity and hip ROM.ResultsA total of 175 studies was identified from the consulted databases. Five studies were included for systematic- review, from which three studies were meta-analyzed. The methodological quality of the included studies ranged from poor to high. ET compared to PPT plus ET provided statistically significant improvements in pain intensity in the short-term (MD = 2.45; 95% CI 1.11, 3.79; I2 :65%). No statistically significant differences between interventions were obtained for hip ROM in the short-term.ConclusionsThe qualitative review showed that PPTs plus ET and ET seem to have positive effects on pain intensity and hip ROM. The quantitative analysis found very low certainty of evidence proposing a positive effect in pain intensity for ET interventions based on hip muscles stretching, compared to PPT combined with ET, in the short-term.

Adductor longus and brevis lesion in an amateur soccer player: platelet rich plasma and multifractioned hyaluronic acid injections to enhance clinical recovery.

Groin pain is a common issue in athletes, with a particularly high incidence in male soccer players. Adductor muscles are the most involved site of the groin, accounting for up to one-fourth of muscle injuries of that region. Physical therapy and rehabilitation programs for adductor-related groin pain using active exercises are effective in getting athletes back to sport. However, the return-to-play time varies according to the injury severity. Minor lesions can recover in 1-2 weeks, while severer injuries require 8-12 weeks. To enhance tendon healing and shorten the return to play time, intrandentinous injections of Platelet Rich Plasma (PRP) have been proposed. An increasing body of evidence in literature have shown efficacy of platelet rich plasma in aiding the healing process in tendinopathies. Similarly, more recent evidences have proven hyaluronic (HA) acid to have anti-inflammatory, proliferative, repairing, and analgesic effects. This case report presents the clinical application of combined PRP and a multifractioned (a mixture of different molecular weights) HA in a 24-year-old athlete suffering from a hip adductor rupture.

Visceral symptoms in patients with anterior cutaneous nerve entrapment syndrome (ACNES): expression of viscerosomatic reflexes?

PurposeAnterior cutaneous nerve entrapment (ACNES) is characterized by neuropathic pain in a predictable, circumscript abdominal area. The diagnostic delay is long, with half of ACNES-affected individuals reporting nausea, bloating, or loss of appetite mimicking visceral disease. The aim of this study was to describe these phenomena and to determine whether treatment could successfully reverse the visceral symptoms.MethodsThis prospective observational study was conducted between July 2017 and December 2020 at SolviMáx, Center of Excellence for Chronic Abdominal Wall and Groin Pain, Máxima Medical Center, Eindhoven. Adult patients who fulfilled published criteria for ACNES and reported at least one visceral symptom at intake were eligible for the study. A self-developed Visceral Complaints ACNES Score (VICAS) questionnaire that scores several visceral symptoms (minimum 1 point, maximum 9 points) was completed before and after therapy. The success of treatment was defined as at least 50% reduction in pain.ResultsData from 100 selected patients (86 females) aged 39 ± 5 years were available for analysis. Frequently reported symptoms were abdominal bloating (78%), nausea (66%) and altered defecation (50%). Successful treatment significantly reduced the number of visceral symptoms, with a VICAS before of 3 (range 1–8) and after of 1 (range 0–6) (p < 0.001). A low baseline VICAS was associated with successful treatment outcome (OR 0.738, 95% CI 0.546–0.999).ConclusionPatients with ACNES may report a variety of visceral symptoms. Successful treatment substantially reduces these visceral symptoms in selected patients.

Posterior Wall Acetabular Fracture After Low-Energy Trauma Masquerading as Infection: A Case Report.

A 12-year-old adolescent boy presented after a low-energy fall with groin pain, inability to bear weight, painful passive range of motion, fever, elevated inflammatory markers, and upper respiratory symptoms. Initial radiographs did not demonstrate any abnormality, and magnetic resonance imaging suggested infection. Posterior wall acetabular fracture was not diagnosed until a computed tomography-guided biopsy was performed. Pediatric acetabular fractures are exceedingly rare. They can be difficult to diagnose after low-energy trauma as symptoms mimic infectious hip pathologies. Children presenting with infectious hip symptomology and a history of trauma may benefit from more extensive trauma imaging before costly and invasive infectious diagnostic procedures.

Current Clinical Concepts: Exercise and Load Management of Adductor Strains, Adductor Ruptures, and Long-Standing Adductor-Related Groin Pain.

Adductor-related groin pain is a common problem in sports. Evidence-based management of athletes with adductor strains, adductor ruptures, and long-standing adductor-related groin pain can be approached in a simple yet effective and individualized manner. In most cases, managing adductor-related pain in athletes should be based on specific exercises and loading strategies. In this article, I provide an overview of the different types of adductor injuries, from acute to overuse, including their underlying pathology, functional anatomy, diagnosis, prognosis, mechanisms, and risk factors. This information leads to optimal assessment and management of acute to long-standing adductor-related problems and includes primary, secondary, and tertiary prevention strategies that focus on exercise and load-based strategies. In addition, information on different options and contexts for exercise selection and execution for athletes, athletic trainers, and sports physical therapists in adductor injury rehabilitation is provided.

A Comparative study of suture fixed versus nonfixed mesh techniques in laparoscopic trans-abdominal preperitoneal repair of noncomplicated adult inguinal hernia

Aim This study aimed at comparing the effect of sutured mesh fixation and non-fixation in cases of laparoscopic trans-abdominal preperitoneal (TAPP) in terms of operative time, hospital stay, and complications particularly recurrence and chronic groin pain (CGP). Patients and methods This prospective randomized comparative study included 40 patients diagnosed with noncomplicated inguinal hernias admitted to the Department of Surgery at Fayoum University Hospital, Egypt from March 2019 to July 2021. Cases were divided into two groups by draw of lots; group A as mesh fixation (n=20) and group B as nonfixation (n=20). Results The results were calculated with χ 2test (P value). Results were found to be not significant in demographic features, in-hospital stay, hernia characteristics, and complications i.e. (intraoperative, postoperative, and long term) and were significant as regards operative time and early postoperative pain in favor of nonfixation group and results were highly significant (P &lt; 0.001). Conclusion TAPP repair without mesh fixation shows advantages over mesh fixation, which include significantly less early postoperative inguinal pain and operative time, with comparable intraoperative, postoperative, and long-term complications (with no increase in hernia recurrence), hospital stay, and mean operative time. Hence, our study favors TAPP without mesh fixation a valuable alternative option.

Athletes treated for inguinal-related groin pain by endoscopic totally extraperitoneal (TEP) repair: long-term benefits of a prospective cohort

PurposeInguinal-related groin pain (IRGP) in athletes is a multifactorial condition, posing a therapeutic challenge. If conservative treatment fails, totally extraperitoneal (TEP) repair is effective in pain relief. Because there are only few long-term follow-up results available, this study was designed to evaluate effectiveness of TEP repair in IRGP-patients years after the initial procedure.MethodsPatients enrolled in the original, prospective cohort study (TEP-ID-study) were subjected to two telephone questionnaires. The TEP-ID-study demonstrated favorable outcomes after TEP repair for IRGP-patients after a median follow-up of 19 months. The questionnaires in the current study assessed different aspects, including, but not limited to pain, recurrence, new groin-related symptoms and physical functioning measured by the Copenhagen Hip and Groin Outcome Score (HAGOS). The primary outcome was pain during exercise on the numeric rating scale (NRS) at very long-term follow-up.ResultsOut of 32 male participants in the TEP-ID-study, 28 patients (88%) were available with a median follow-up of 83 months (range: 69–95). Seventy-five percent of athletes were pain free during exercise (p < 0.001). At 83 months follow-up, a median NRS of 0 was observed during exercise (IQR 0–2), which was significantly lower compared to earlier scores (p <0.01). Ten patients (36%) mentioned subjective recurrence of complaints, however, physical functioning improved on all HAGOS subscales (p <0.05).ConclusionThis study demonstrates the safety and effectivity of TEP repair in a prospective cohort of IRGP-athletes, for whom conservative treatment had failed, with a follow-up period of over 80 months.

Sunt meşele necesare în tratamentul incontinenţei urinare de efort la femei?

Introduction. Stress urinary incontinence (SUI) impacts over 20% of women, and its prevalence is increasing with the aging of population. This review assesses mesh surgery for SUI treatment by analyzing midurethral slings, retropubic urethropexy, bulking agents and artificial sphincters. Methodology. We searched the PubMed database from 1995 to 2023 inclusive, and 31 studies met our inclusion criteria, focusing on women aged 20-70 years old with SUI, excluding nervous system diseases affecting the function of the bladder. Results. Minimally invasive midurethral slings – particularly transvaginal tension-free tape (TVT) and transobturator tension-free vaginal tape (TOT) – have become the standard of care, endorsed by the Food and Drug Administration (FDA) in 2011. TVT offers reduced hospital stays and shorter operating times, with risks including bladder perforation and infections. TOT, while minimizing bladder perforation risks, may increase groin pain. Mini-slings and autologous fascial slings show varying success; the latter has higher success but more complications than Burch colposuspension. Retropubic urethropexy is effective on the long term, but with longer recovery and more complications. Conclusions. Mesh-based midurethral slings (MUS) are pivotal in SUI treatment, providing high short-term success and enhanced quality of life. Effective SUI management requires individualized treatment, with a fine balance between benefits and risks. With emerging regenerative medicine, the future of SUI treatment is promising. Until then, MUS remains a key modality, necessitating careful patient selection and ongoing research to refine the surgical outcomes and improve the quality of life for SUI patients.

An Amyand’s Hernia with Recurrence: Clinical and Therapeutic Particularities with Literature Review

Fortuitous discovery of an Amyand hernia during surgery in a patient admitted to the emergency room for groin pain likely related to a strangulated inguinal hernia. The aim of this study is to contribute to the understanding of this disease, particularly in terms of diagnosis and optimization of surgical management. Although serious complications have been described, Amyand hernia generally has a good prognosis. However, practitioners must master the clinical and surgical peculiarities of Amyand hernia in order to ensure optimal and adequate treatment of the hernia while avoiding recurrence. Questions remain regarding its pathophysiology, clinical peculiarity, and treatment. More research and evidence are needed, which will be difficult to achieve due to the rarity of Amyand hernia.

Principles of Treating the Sequelae of Perthes Disease

Background: Perthes disease is a form of juvenile idiopathic osteonecrosis characterized by temporary bone mortality due to inadequate blood supply to the femoral head. Objectives: This cross-sectional study aimed to evaluate the treatment outcomes and sequelae of Perthes Disease and to identify the most effective treatment modalities for managing its sequelae. Methods: The research enrolled 59 Perthes Disease patients who had completed treatment at our institution between 2021 and 2022. The information pertaining to demographic characteristics, clinical presentations, radiological findings, specific treatments administered, and follow-up records were collected. Pain levels and hip functionality were secondary outcome measures. The Harris Hip Score (HHS) was used to assess the primary outcome of quality of life. Practical Implication: The practical implications for treating the sequelae of Perthes disease include early detection, a multidisciplinary approach, conservative management, surgical interventions when necessary, rehabilitation and physical therapy, long-term monitoring, and patient and family education. Timely diagnosis, collaboration among healthcare professionals, tailored treatment plans, and regular follow-up are important for optimizing outcomes and managing the condition effectively. Results: The average age of the study population was 4.76+1.10 years, with a higher proportion of males. Left-sided (59.32%) participation was more prevalent than right-sided (37.28%) participation (p&lt;0.05). The disease's duration differed between patients. The majority of participants exhibited clinical symptoms such as hip or groin pain, limping, restricted hip movement, and deformities. The most prevalent treatment modality (p&lt;0.05) was physical therapy (52.54%), followed by orthotic devices (30.50%) and surgical interventions (16.94%). Surgical procedures employed both extra-articular (70%) and intra-articular techniques (10%) (p&lt;0.05). Conclusion: Multimodal, patient-specific approach is essential for managing Perthes disease sequelae. Physical therapy was the primary modality of care, while surgical interventions were employed selectively. Significant improvements were observed in pain reduction, functional outcomes, deformity correction, and ROM as a result of the treatment. These findings provided important insights into the management of Perthes disease and highlighted the need for individualized treatment strategies to achieve optimal patient outcomes. Keywords: Harris Hip Score; Perthes Disease; Orthopedic deformities; Orthotic devices; Radiological examination.

Comparison of Laparoscopic Percutaneous Extraperitoneal Internal Ring Closure by Two-Hook Hernia Needle and Open Repair for Pediatric Inguinal Hernia.

Purpose: In children, pediatric inguinal hernia (PIH) is a prevalent condition. PIH is currently more frequently managed by laparoscopic closure of the hernia sac. We improved this minimally invasive technique; that is, laparoscopic two-hook hernia needle percutaneous extraperitoneal internal ring closure. Safety and effectiveness were evaluated by comparing the differences between laparoscopic repair (LR) and open repair (OR) in terms of operation time, surgical complications, contralateral metachronous hernia incidence, and recurrence rate. Methods: A retrospective clinical data analysis was performed on pediatric patients who had hernia surgery utilizing the LR or OR method between June 2019 and June 2021. Medical records of all of the children were gathered, and clinical traits, information about the procedure, and follow-up were all analyzed. Results: A total of 370 patients' inguinal hernias were repaired. For 136 patients undergoing OR and 234 patients undergoing LR, all procedures were completed satisfactorily. There were 98 cases of bilateral hernias and 272 cases of unilateral hernias (180 on the right side and 92 on the left). In the LR group, 58 patients who had been initially diagnosed with unilateral hernias developed contralateral occult hernias intraoperatively. Inguinal hernia operations took an average of 13.82 (LR) and 32.07 (OR) minutes for unilateral cases, and 21.00 (LR) and 54.85 (OR) minutes for bilateral cases. For LR and OR, the average follow-up time was 22.41 months and 23.10 months, respectively. The perioperative complications included peritoneal rupture in 3 patients, scrotal edema or hematoma in 5, hydrocele in 3, and groin pain in 6. In the LR group, 1 patient experienced the postoperative recurrence, whereas 8 individuals in the OR group did. Conclusions: Our initial research showed that laparoscopic two-hook hernia needle percutaneous extraperitoneal internal ring closure inguinal hernia repair is a safe and effective procedure. The LR method has the benefits of concealing the incision, a quicker procedure, having a lower risk of complications, and finding contralateral patent processus vaginalis. Therefore, promoting and using this surgical technique in clinical practice are merited. Clinical Trial Registration number: Medical Association of Xiangtan (2022-xtyx-28).

An international survey of 1014 hernia surgeons: outcome of GLACIER (global practice of inguinal hernia repair) study.

The practice of inguinal hernia repair varies internationally. The global practice of inguinal hernia repair study (GLACIER) aimed to capture these variations in open, laparoscopic, and robotic inguinal hernia repair. A questionnaire-based survey was created on a web-based platform, and the link was shared on various social media platforms, personal e-mail network of authors, and e-mails to members of the endorsed organisations, which include British Hernia Society (BHS), The Upper Gastrointestinal Surgical Society (TUGSS), and Abdominal Core Health Quality Collaborative (ACHQC). A total of 1014 surgeons from 81 countries completed the survey. Open and laparoscopic approaches were preferred by 43% and 47% of participants, respectively. Transabdominal pre-peritoneal repair (TAPP) was the favoured minimally invasive approach. Bilateral and recurrent hernia following previous open repair were the most common indications for a minimally invasive procedure. Ninety-eight percent of the surgeons preferred repair with a mesh, and synthetic monofilament lightweight mesh with large pores was the most common choice. Lichtenstein repair was the most favoured open mesh repair technique (90%), while Shouldice repair was the favoured non-mesh repair technique. The risk of chronic groin pain was quoted as 5% after open repair and 1% after minimally invasive repair. Only 10% of surgeons preferred to perform an open repair using local anaesthesia. This survey identified similarities and variations in practice internationally and some discrepancies in inguinal hernia repair compared to best practice guidelines, such as low rates of repair using local anaesthesia and the use of lightweight mesh for minimally invasive repair. It also identifies several key areas for future research, such as incidence, risk factors, and management of chronic groin pain after hernia surgery and the clinical and cost-effectiveness of robotic hernia surgery.

Inflammatory and Immunologic Contributions in Femoroacetabular Impingement Syndrome.

Femoroacetabular impingement (FAI) is one of the most common causes of labral and early cartilage damage in the nondysplastic hip. FAI is increasingly recognized as a cause for hip and groin pain in the young, active patient, and the surgical treatment of FAI with hip arthroscopy has risen exponentially. Although our understanding of FAI and the progression to degenerative osteoarthritis of the hip has historically been considered a mechanical "wear-and-tear" disease of an imperfectly shaped, aspherical, femoral head within a deep or overcovering acetabulum leading to cartilage injury, our understanding of the intrinsic pathophysiologic mechanisms underlying the development of FAI and joint degeneration of the hip remains poor. For example, many patients with FAI morphology may never develop hip pain or osteoarthritis; there remains more to discover regarding the pathophysiology of arthritis in the setting of FAI. Recent work has begun to identify a strong inflammatory and immunologic component to the FAI disease process that affects the hip synovium, labrum, and cartilage and may be detectable from peripheral clinical samples (blood and urine). This review highlights our current understanding of the inflammatory and immunologic contributions to FAI and potential therapeutic strategies to supplement and augment the surgical management of FAI.

Anatomy and terminology of groin pain: Current concepts

Groin pain is a common symptom in athletes. The complex anatomy of the area and the various terms used to describe the etiology behind groin pain have led to a confusing nomenclature. To solve this problem, three consensus statements have been already published in the literature: the Manchester Position Statement in 2014, the Doha agreement in 2015, and the Italian Consensus in 2016. However, when revisiting recent literature, it is evident that the use of non-anatomic terms remains common, and the diagnoses sports hernia, sportsman's hernia, sportsman's groin, Gilmore's groin, athletic pubalgia, and core muscle injury are still used by many authors. Why are they still in use although rejected? Are they considered synonyms, or they are used to describe different pathology? This current concepts review article aims to clarify the confusing terminology by examining to which anatomical structures authors refer when using each term, revisit the complex anatomy of the area, including the adductors, the flat and vertical abdominal muscles, the inguinal canal, and the adjacent nerve branches, and propose an anatomical approach, which will provide the basis for improved communication between healthcare professionals and evidence-based treatment decisions.

Nonsurgical Interventions for the Management of Long-Standing Groin Pain in Athletes: A Systematic Review of Randomized Controlled Trials.

Groin pain is a common problem in athletes, leading to significant distress and long periods of absence from sports. Nonsurgical interventions are usually the first line of treatment. However, the most effective intervention for groin pain is unknown and recommendations are scarce. The primary objective of this systematic review was to assess the effectiveness of nonsurgical interventions in the treatment of long-standing groin pain in athletes and to provide some guidance for clinical practice and further research. A search strategy was performed in March 2020 in Pubmed, Google Scholar, PEDro, and Cochrane Central Register of Controlled Trials databases, without any time restrictions. Only randomized controlled trials (RCT) were included for full-text analysis. Data on the patient's characteristics, duration of pain, study groups, outcome measures results, follow-up time, and return to play time were extracted. The risk of bias in each study was assessed using the Cochrane risk-of-bias assessment tool. Data for analysis could not be pooled for meta-analysis and, as such, a narrative summary of the outcomes was instead performed. The certainty of the evidence was assessed using a variation of the GRADE approach for when a meta-analysis is not possible to perform. Seven RCTs were included for analysis. Most studies were classified as uncertain risk of bias. All studies provided evidence that nonsurgical interventions have significant positive effects and may lead to good outcomes concerning pain, function, and return to sports at previous levels. The certainty of the evidence was assessed to be low using the modified GRADE approach. Despite the low quality of the available evidence, nonsurgical treatments demonstrated efficacy in the management of groin pain and should probably be the initial approach to treatment. More RCTs of high quality are necessary to provide clear recommendations on the most efficient nonsurgical treatment strategy for groin pain.