The Management of Inguinal Disruption (Gilmoreā€™s Groin) in the presence of underlying Femoro-Acetabular Impingement in Competitive Sportsmen.

Altuna F, Dunphy O, Carton P
The Hip and Groin Clinic, Whitfield Clinic Medical Centre, Butlerstown North, Cork Road, Waterford.

Introduction: The diagnosis and management of chronic groin pain in competitive sportsmen can be challenging yet rewarding; Inguinal Disruption (ID) and Femoro-acetabular Impingement (FAI) are well recognised as a major cause of groin pain in athletes. The relationship between ID and underlying FAI remains unclear. A cohort of young competitive sportsmen with dual pathology had their clinical outcome evaluated following surgery.

Method: Over a 4.5-year period (Jan 2010 to June 2014) all male competitive athletes under 40 years old were assessed for the presence of ID and FAI. All patients with dual pathology who underwent arthroscopic management of FAI were assessed preoperatively, and at 3-months and minimum 1-year postoperatively using internationally validated outcomes scores. Non-parametric data analysis was utilised with a p value <0.05 considered significant.

Results: 121 cases (96 patients) mean age 26 (18-39) underwent arthroscopic surgery and had clinical signs of ID. 86 cases have completed 3mth and 68 minimum 1-year (mean19 months) follow-up. The HHS increased from a median pre-operative score of 83 (IQR: 73-93) to 96 (86-98) at 3mth, and to 100 (92-100) at min 1-year; UCLA activity increased from 7 (5-9.75) to 9 (6-9) at 3 mth and 10 (7-10) at min 1-year; WOMAC reduced from 18 (29-8) to 5 (16-1) at 3 mth and 3 (7-0) at min 1-year; and the SF-36 increased from 68 (60-83) to 83 (71-92) at 3 mth, and 91 (82-95) at min 1-year. In 8 cases hip surgery failed to resolve the groin pain and a groin repair was performed. Improvement in outcome was statistically significant for all measures.

Conclusion: Excellent results can be expected by managing the FAI component alone. Groin repair surgery should be reserved for sportsmen in whom FAI has been excluded or those who have failed to improve following arthroscopic treatment of underlying FAI.