Original Article
High Incidence of Athletic Pubalgia Symptoms in Professional Athletes With Symptomatic Femoroacetabular Impingement

https://doi.org/10.1016/j.arthro.2012.02.024Get rights and content

Purpose

The purpose of this study was to identify the incidence of symptoms consistent with athletic pubalgia (AP) in athletes requiring surgical treatment for femoroacetabular impingement (FAI) and the frequency of surgical treatment of both AP and FAI in this group of patients.

Methods

Thirty-eight consecutive professional athletes, with a mean age of 31 years, underwent arthroscopic surgery for symptomatic FAI that limited their ability to play competitively. In all cases a cam and/or focal rim osteoplasty with labral refixation or debridement was performed. In 1 case concomitant intramuscular lengthening of the psoas was performed. Retrospective data regarding prior AP surgery and return to play were collected.

Results

Thirty-two percent of patients had previously undergone AP surgery, and 1 patient underwent AP surgery concomitantly with surgical treatment of FAI. No patient returned to his previous level of competition after isolated AP surgery. Thirty-nine percent had AP symptoms that resolved with FAI surgery alone. Of the 38 patients, 36 returned to their previous level of play; all 12 patients with combined AP and FAI surgery returned to professional competition. The mean duration before return to play was 5.9 months (range, 3 to 9 months) after arthroscopic surgery.

Conclusions

There is a high incidence of symptoms of AP in professional athletes with FAI of the hip. This study draws attention to the overlap of these 2 diagnoses and highlights the importance of exercising caution in diagnosing AP in a patient with FAI.

Level of Evidence

Level IV, therapeutic, retrospective case series.

Section snippets

Methods

This study was approved by our institutional review board. From April 2005 to April 2010, 38 consecutive professional athletes underwent arthroscopic surgery for the treatment of symptomatic FAI that limited their ability to return to competitive play. The group included 9 baseball players, 13 football players, 8 hockey players, 5 soccer players, 2 basketball players, and 1 skater (Table 1). All patients were men, with a mean age of 31 years (range, 19 to 35 years).

Throughout our article, we

Results

The mean age of the professional athletes at the time of surgery was 31 years (range, 19 to 35 years). Of the patients, 32% (12 of 38) had previously undergone AP surgery by an outside referring general surgeon, and 1 of these underwent AP surgery concomitantly with surgical treatment of FAI. Three patients underwent AP and FAI surgery within 1 month's time. Most other patients underwent a trial period of returning to play after AP surgery to assess the absolute need for surgical intervention

Discussion

The purpose of our study was to highlight the frequent overlap of AP and FAI diagnoses and to show the frequency of concomitant AP and FAI symptoms. We hypothesized that some elite athletes may manifest AP symptoms due to compensatory stresses from FAI and that these symptoms may resolve with surgical correction of FAI. In a consecutive series of 38 professional athletes treated for symptomatic FAI, we identified 12 (32%) who had undergone previous AP surgery. Interestingly, these 12 patients

Conclusions

There is a high incidence of symptoms of AP in professional athletes with FAI of the hip. This study draws attention to the overlap of these two diagnoses and highlights the importance of exercising caution in diagnosing AP in a patient with FAI.

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    The authors report that they have no conflicts of interest in the authorship and publication of this article.

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