Schilders Ernest, Bismil Quamar, Robinson Philip, O'Connor Philip J, Gibbon Wayne William, Talbot J Charles
Department of Orthopaedics, Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ, England.
J Bone Joint Surg Am. 2007 Oct;89(10):2173-8. doi: 10.2106/JBJS.F.00567.
Adductor dysfunction is a condition that can cause groin pain in competitive athletes, but the source of the pain has not been established and no specific interventions have been evaluated. We previously defined a magnetic resonance imaging protocol to visualize adductor enthesopathy. The aim of this study was to elucidate, in the context of adductor-related groin pain in the competitive athlete, the role of the adductor enthesis (origin), the relevance of adductor enthesopathy diagnosed with magnetic resonance imaging, and the efficacy of entheseal pubic cleft injections of local anesthetic and steroids.
We reviewed the findings in a consecutive series of twenty-four competitive athletes who had presented to our sports medicine clinic with groin pain secondary to adductor longus dysfunction. Magnetic resonance imaging was performed to assess the adductor longus origin for the presence or absence of enthesopathy. Seven patients (Group 1) had no evidence of enthesopathy on magnetic resonance imaging, and seventeen patients (Group 2) had enthesopathy confirmed on magnetic resonance imaging. All patients were treated with a single pubic cleft injection of local anesthetic and steroid into the adductor enthesis. At one year after this treatment, the patients were assessed for recurrence of symptoms.
On clinical reassessment five minutes after the injection, all twenty-four athletes reported resolution of the groin pain. At one year, none of the seven patients in Group 1 had experienced a recurrence. Sixteen of the seventeen patients in Group 2 had a recurrence of the symptoms (p < 0.001) at a mean of five weeks (range, one to sixteen weeks) after the injection.
A single entheseal pubic cleft injection can be expected to afford at least one year of relief of adductor-related groin pain in a competitive athlete with normal findings on a magnetic resonance imaging scan; however, it should be employed only as a diagnostic test or short-term treatment for a competitive athlete with evidence of enthesopathy on magnetic resonance imaging.
内收肌功能障碍是一种可导致竞技运动员腹股沟疼痛的病症，但疼痛来源尚未明确，也未对特定干预措施进行评估。我们之前定义了一种磁共振成像方案来观察内收肌起止点病变。本研究的目的是在竞技运动员内收肌相关腹股沟疼痛的背景下，阐明内收肌起止点（起点）的作用、磁共振成像诊断的内收肌起止点病变的相关性，以及耻骨联合间隙注射局部麻醉剂和类固醇的疗效。
我们回顾了连续24例因长收肌功能障碍导致腹股沟疼痛而到我们运动医学诊所就诊的竞技运动员的检查结果。进行磁共振成像以评估长收肌起点是否存在起止点病变。7例患者（第1组）磁共振成像未显示起止点病变证据，17例患者（第2组）磁共振成像证实存在起止点病变。所有患者均接受了一次耻骨联合间隙注射局部麻醉剂和类固醇到内收肌起止点。在该治疗后一年，评估患者症状复发情况。
注射后5分钟临床复查时所有24例运动员均报告腹股沟疼痛缓解。一年时，第1组的7例患者均未复发。第2组的17例患者中有16例在注射后平均5周（范围1至16周）出现症状复发（p<0.001）。
对于磁共振成像扫描结果正常的竞技运动员，单次耻骨联合间隙起止点注射有望缓解内收肌相关腹股沟疼痛至少一年；然而，对于磁共振成像有起止点病变证据的竞技运动员，该方法仅应用作诊断试验或短期治疗。
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