scholarly journals Does Functional Bracing of the Unstable Shoulder Improve Return to Play in Scholastic Athletes? Returning the Unstable Shoulder to Play

2020 ◽  
Vol 13 (1) ◽  
pp. 45-48 ◽  
Author(s):  
Adam Kwapisz ◽  
Ellen Shanley ◽  
Amit M. Momaya ◽  
Chris Young ◽  
Michael J. Kissenberth ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Nonoperative Treatment ◽  
Return To Play ◽  
Successful Outcome ◽  
Anterior Shoulder Instability ◽  
Success Rates ◽  
Shoulder Injury ◽  
Adolescent Athletes ◽  
Level Of Evidence ◽  
Current Season

Background: Functional bracing is often used as an adjunct to nonoperative treatment of anterior shoulder instability, but no study has evaluated the effectiveness of in-season bracing. The purpose of this study was to examine successful return to play in a nonoperative cohort of adolescent athletes with in-season shoulder instability and compare those athletes treated with bracing to those who were not. Hypothesis: The use of functional bracing will improve success rates in a cohort of athletes treated nonoperatively for in-season shoulder instability. Study Design: Cohort study. Level of Evidence: Level 3. Methods: A total of 97 athletes with anterior shoulder instability were followed for a minimum of 1 year. The mean age was 15.8 ± 1.4 years (range, 12.0-18.0 years). All athletes were treated with initial nonoperative management. Twenty athletes (21%) were also treated with bracing while 77 (79%) were not. The athlete completing the current season and 1 subsequent season without surgery or time lost from shoulder injury was defined as a successful outcome. Results: There was no statistical difference in nonoperative success rates between the braced and nonbraced athletes ( P = 0.33). Braced athletes (n = 20) returned to play 80% of the time, while nonbraced athletes (n = 77) returned at a rate of 88%. Of the braced athletes, 85% were football players (n = 17). A football-only comparison demonstrated no difference between braced failures (26%) and nonbraced failures (16%) ( P = 0.47). Conclusion: This is the first study to evaluate the utility of functional bracing in returning an athlete to sport and completing a full subsequent season without surgery or time loss due to injury of the shoulder. In adolescent athletes with shoulder instability treated nonoperatively, functional bracing did not result in increased success rates when compared with no bracing. Clinical Relevance: The data from this study indicate that functional bracing may not improve success rates for athletes with shoulder instability.

Clinical Outcomes of Patients With Anterior Shoulder Instability and Glenolabral Articular Disruption Lesions: A Retrospective Comparative Study

2020 ◽  
Vol 48 (14) ◽  
pp. 3472-3477
Author(s):  
Martin S. Davey ◽  
Eoghan T. Hurley ◽  
Christopher A. Colasanti ◽  
John P. Scanlon ◽  
Mohamed Gaafar ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Shoulder Instability ◽  
Return To Sport ◽  
Return To Play ◽  
Anterior Shoulder Instability ◽  
Control Group ◽  
Control Groups ◽  
Level Of Evidence ◽  
Significant Difference ◽  
And Control

Background: Anterior shoulder instability is a common clinical condition that often requires surgical stabilization. Glenoid labral tears are often associated with instability, with glenolabral articular disruption (GLAD) lesions occasionally being identified arthroscopically during repair, particularly in collision athletes. Purpose: To evaluate the clinical outcomes and recurrence rates in patients who had GLAD lesions and underwent arthroscopic Bankart repair (ABR) and compare them with a control group without GLAD lesions. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of patients who underwent ABR with GLAD lesions, by a single surgeon between July 2012 and March 2017, was performed. Additionally, these were pair matched in a 2:1 ratio for age, sex, sport, and level of play with a control group who underwent ABR without GLAD lesions. Return to sport, the level of return, and the timing of return were assessed. The visual analog scale (VAS) for pain score, Rowe score, Shoulder Instability–Return to Sport after Injury (SIRSI) score, and Subjective Shoulder Value (SSV) were evaluated. Results: The study included a total of 66 patients (22 and 44 patients for the GLAD and control groups, respectively), with a mean age of 25.8 years and a mean follow-up of 66 months. Overall, there was no significant difference in any of the clinical outcome scores (VAS, Rowe, SIRSI, and SSV) utilized for the GLAD and control groups ( P > .05 for all). Similarly, there was no significant difference in the total rate of return to play (90.9% vs 88.6%; P > .99) or return at the same/higher level (68.2% vs 72.7%; P = .78). There was no significant difference in timing of return to play (6.3 ± 6.6 months vs 6.4 ± 2.5 months; P = .98). There were 3 cases (13.6%) requiring further surgery (1 revision stabilization, 1 arthroscopic release, and 1 rotator cuff repair) in the GLAD group and 2 cases (4.5%) requiring further surgery (both revision stabilization) in the control group; the difference was not statistically significant ( P = .32). Conclusion: After arthroscopic repair, patients with GLAD lesions had similar midterm outcomes when compared with a control group without GLAD lesions.

Return to Professional Australian Rules Football After Surgery for Traumatic Anterior Shoulder Instability

2021 ◽  
pp. 036354652110290
Author(s):  
Michael Perret ◽  
Sarah Warby ◽  
Godefroy Brais ◽  
Stephanie Hinse ◽  
Sophie Hoy ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Return To Sport ◽  
Field Performance ◽  
Return To Play ◽  
Anterior Shoulder Instability ◽  
Level Of Evidence ◽  
Australian Football League ◽  
Early Return ◽  
Significant Difference ◽  
Australian Football

Background: The treatment of traumatic anterior shoulder instability in professional Australian Football League (AFL) players is challenging, with an emphasis on early return to play and avoidance of instability recurrence. Purpose: To investigate return-to-sport (RTS) outcomes and complications after 2 different procedures for traumatic anterior shoulder instability in professional AFL players. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed our surgical database for professional AFL players who underwent capsulolabral stabilization or open Latarjet procedure by a single surgeon between 2006 and 2017. Outcomes included RTS, on-field performance, and complications. Between-group analyses for RTS and complications were estimated using Kaplan-Meier survival analyses. Within-group analyses for on-field performance data were performed using paired t tests with significance set at .05. Results: A total of 58 capsulolabral stabilization procedures in 54 players and 32 Latarjet procedures in 29 players were included in the analysis; 93.1% of capsulolabral patients and 96.9% of Latarjet patients returned to professional AFL. The median RTS time was 6.8 months for the capsulolabral group and 7.3 months for the Latarjet group. There was no significant difference in RTS rates between the 2 groups ( P = .270). Of those undergoing surgery early in the season, 75% of the capsulolabral and 71% of Latarjet group were able to RTS within the same season, at a mean time of 16.9 weeks and 18.8 weeks, respectively. There was a significant difference in instability recurrence, with 19% for the capsulolabral group and no recurrence in the Latarjet group ( P = .017). There was no significant reduction in player on-field performance in either group ( P < .05). Conclusion: In this study, the median RTS in AFL players was approximately 7 months after capsulolabral and Latarjet surgery with no compromise to on-field performance. Instability-related complications occurred only in the capsulolabral group, and the incidence increased with time.

scholarly journals Athletes With Anterior Shoulder Instability: A Prospective Study on Player Perceptions of Injury and Treatment

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110322
Author(s):  
Leslie A. Fink Barnes ◽  
Charles M. Jobin ◽  
Charles A. Popkin ◽  
Christopher S. Ahmad
Keyword(s):  
Physical Therapy ◽  
Shoulder Instability ◽  
Injury Severity ◽  
Treatment Decision ◽  
Cross Sectional Study ◽  
Nonoperative Treatment ◽  
Anterior Shoulder Instability ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
A Prospective Study

Background: Many in-season athletes choose to delay or avoid surgery in order to continue playing and avoid downtime such as missed games or seasons. Purpose: To learn about the attitudes toward the injury and treatment of in-season shoulder instability in competitive athletes who have suffered a shoulder dislocation. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A study-specific questionnaire about athletes’ perceptions of injury and treatment was administered to injured players. Secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) score and the Western Ontario Shoulder Instability Index (WOSI). Mean scores and standard deviations were calculated, and between-group analyses with t tests were performed to compare the ASES and WOSI scores. The Mann-Whitney U test was used for analyses performed on the following groups: early operative versus nonoperative management; age <18 versus ≥18 years; first-time dislocators versus recurrent dislocators; self-reducing subluxations versus dislocations requiring assistance; and dominant arm affected versus nondominant arm. Results: There were 45 patients included in this study (33 male, 12 female) with a mean age of 18 ± 2.8 years. Several sports were represented, with the most common being football, baseball, soccer, and rugby. In this study of in-season athletes with shoulder instability, 13 (28.9%) chose early surgery, 4 (8.9%) chose surgery at season’s end, while 28 (62.2%) chose physical therapy followed by a wait-and-see approach, with 13 (46.4%) of these patients ultimately requiring surgery. Athletes who chose nonoperative treatment were statistically more likely to believe that their shoulder would heal on its own ( P < .001) or with physical therapy ( P < .025); they were also more likely to agree that they would rather stop sports than undergo surgery ( P < .04). Athletes with worse ASES and WOSI scores at injury were more likely to choose surgery ( P < .03 and P < .05, respectively). Athletes with >1 dislocation were less likely to believe that the shoulder would heal without surgery ( P < .025). Most athletes agreed that seasonal timing and recruitment prospects were an important factor in their decision in favor of surgery ( P < .038), and most agreed that their doctor influenced their ultimate treatment decision ( P < .006). Most athletes also agreed that a repeat dislocation would cause further injury to the shoulder. Conclusion: Treatment decisions were most strongly related to the athletes’ perceptions of injury severity and the influence of the treating surgeon.

scholarly journals Latarjet procedure enables 73% to return to play within 8 months depending on preoperative SIRSI and Rowe scores

2021 ◽  
Author(s):  
Yoann Bohu ◽  
◽  
Pierre Abadie ◽  
Floris van Rooij ◽  
Luca Nover ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Multivariable Analysis ◽  
Return To Sport ◽  
Patient Characteristics ◽  
Return To Play ◽  
Anterior Shoulder Instability ◽  
Latarjet Procedure ◽  
Level Of Evidence ◽  
Injury Index ◽  
Sport Type

Abstract Purpose Systematic reviews report return to play (RTP) within 5.8 months (range, 3–8) following the Latarjet procedure, but the factors that influence RTP remain unknown. The present study aimed to report the rate and time of return to play (RTP) during the first 8 months following the Latarjet procedure, and to determine the influence of sport type or patient characteristics. Methods The authors retrospectively collected the records of patients that underwent Latarjet procedures for anterior shoulder instability between 2015 and 2017. Patients were excluded if they had any concomitant rotator cuff tendon lesions, or previous ipsilateral shoulder surgery. The authors retrieved patient demographics, time from injury to surgery, type of sport practiced (overhead/non-overhead, contact/non-contact), as well as pre- and postoperative Western Ontario Shoulder Instability index (WOSI), Shoulder Instability-Return to Sport After Injury index (SIRSI), and Rowe score. Results A total of 217 patients (217 shoulders) were eligible for inclusion, comprising 184 males and 33 females, aged 26.8 ± 7.3 years at index surgery. The main sport practiced prior to surgery involved overhead (n = 173, 80%) and/or contact (n = 152, 70%) activities. By 8 month follow-up, 158 patients (73%) resumed their main sport, at a mean of 5.1 ± 1.5 months. Multivariable analysis revealed that RTP was more likely in patients with higher preoperative Rowe score (OR, 1.02; p = 0.024) and SIRSI score (OR, 1.02; p = 0.008). Conclusions By 8 months following the Latarjet procedure, 73% of patients had resumed their main sport. The likelihood of RTP was significantly associated with preoperative Rowe and SIRSI scores, but not with sport type. Level of evidence IV.

Recurrence After Arthroscopic Labral Repair for Traumatic Anterior Instability in Adolescent Rugby and Contact Athletes

2018 ◽  
Vol 46 (12) ◽  
pp. 2969-2974 ◽  
Author(s):  
Emma Torrance ◽  
Ciaran J. Clarke ◽  
Puneet Monga ◽  
Lennard Funk ◽  
Michael J. Walton
Keyword(s):  
Recurrence Rate ◽  
Shoulder Instability ◽  
Case Series ◽  
Labral Repair ◽  
Shoulder Injuries ◽  
Adolescent Athletes ◽  
Recurrence Rates ◽  
Level Of Evidence ◽  
Bony Bankart ◽  
The Mean

Background: Traumatic glenohumeral dislocation of the shoulder is one of the most common shoulder injuries, especially among adolescent athletes. The treatment of instability for young athletes continues to be controversial owing to high recurrence rates. Purpose: To investigate the recurrence rate of shoulder instability after arthroscopic capsulolabral repair for adolescent contact and collision athletes. Study Design: Case series; Level of evidence, 4. Methods: Sixty-seven patients aged <18 years underwent an arthroscopic labral repair over a 5-year period. The mean ± SD age of the cohort was 16.3 ± 0.9 years (range, 14-17 years) and consisted of 1 female and 66 males. All patients were contact athletes, with 62 of 67 playing rugby. Demographic, clinical, and intraoperative data for all patients with shoulder instability were recorded in our database. Recurrence rates were recorded and relative risks calculated. Results: At a follow-up of 33 ± 20 months, 34 of 67 patients had recurrent instability for an overall recurrence rate of 51% among adolescent contact athletes after arthroscopic labral repair surgery. The mean time to recurrence was 68.1 ± 45.3 weeks. All recurrences occurred as a result of a further sporting injury. Relative risk analysis demonstrated that athletes aged <16 years had 2.2 (95% CI, 1.2-2.1) times the risk of developing a further instability episode as compared with athletes aged ≥16 years at the time of index surgery ( P = .0002). The recurrence rate among adolescent athletes after bony Bankart repairs was 57.9% versus 47.9% for soft tissue labral repairs ( P = .4698). The incidence of Hill-Sachs lesions ( P = .0002) and bony Bankart lesions ( P = .009) among adolescent athletes was significantly higher than among adult controls ( P = .002). The presence of bone loss did not lead to a significant increase in recurrence rate over and above the effect of age. Conclusion: Adolescent contact athletes undergoing arthroscopic labral repair have an overall recurrence rate of 51%. Rugby players who undergo primary arthroscopic shoulder stabilization aged <16 years have 2.2 times the risk of developing a further instability episode when compared with athletes aged ≥16 years at the time of index surgery, with a recurrence rate of 93%.

scholarly journals Treatment type may influence degree of post-dislocation shoulder osteoarthritis: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Lukas P. E. Verweij ◽  
Erik C. Pruijssen ◽  
Gino M. M. J. Kerkhoffs ◽  
Leendert Blankevoort ◽  
Inger N. Sierevelt ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Shoulder Instability ◽  
Operative Procedures ◽  
Lower Degree ◽  
Anterior Shoulder Instability ◽  
Latarjet Procedure ◽  
Eligibility Criteria ◽  
Level Of Evidence ◽  
Treatment Type

Abstract Purpose Age at primary dislocation, recurrence, and glenoid bone loss are associated with development of osteoarthritis (OA). However, an overview of OA following traumatic anterior shoulder instability is lacking and it is unclear to what degree type of surgery is associated with development of OA in comparison to non-operative treatment. The aim of this study was to determine the degree of OA at long-term follow-up after non-operative and operative treatments for patients with anterior shoulder instability. Surgery is indicated when patients experience recurrence and this is associated with OA; therefore, it was hypothesized that shoulders show a higher proportion or degree of OA following operative treatment compared to non-operative treatment. Methods A literature search was performed in the PubMed/Medline, EMBASE, and Cochrane databases. Articles reporting the degree of OA that was assessed with the Samilson–Prieto or Buscayret OA classification method after non-operative and operative treatment for anterior shoulder instability with a minimum of 5 years follow-up were included. Results Thirty-six articles met the eligibility criteria of which 1 reported the degree of OA for non-operative treatment and 35 reported the degree of OA for 9 different operative procedures. A total of 1832 patients (1854 shoulders) were included. OA proportions of non-operative and operative treatments are similar at any point of follow-up. The Latarjet procedure showed a lower degree of OA compared to non-operative treatment and the other operative procedures, except for the Bristow procedure and Rockwood capsular shift. The meta-analyses showed comparable development of OA over time among the treatment options. An increase in OA proportion was observed when comparing the injured to the contralateral shoulder. However, a difference between the operative subgroups was observed in neither analysis. Conclusion Non-operative and operative treatments show similar OA proportions at any point of follow-up. The hypothesis that shoulders showed a higher proportion or degree of OA following operative treatment compared to non-operative treatment is not supported by the data. Operative treatment according to the Latarjet procedure results in a lower degree of OA compared to other treatments, including non-operative treatment. Level of evidence IV.

Preoperative Analysis of the Hill-Sachs Lesion in Anterior Shoulder Instability

2011 ◽  
Vol 39 (11) ◽  
pp. 2389-2395 ◽  
Author(s):  
Seung Hyun Cho ◽  
Nam Su Cho ◽  
Yong Girl Rhee
Keyword(s):  
3D Reconstruction ◽  
Shoulder Instability ◽  
Humeral Head ◽  
Postoperative Recurrence ◽  
Anterior Shoulder Instability ◽  
Level Of Evidence ◽  
Preoperative Prediction ◽  
Mean Width ◽  
The Mean ◽  
The Hill

Background: It has been reported that engagement of the Hill-Sachs lesion affects postoperative recurrence of anterior shoulder instability. However, no method has been recognized as an effective preoperative means to predict engagement of the Hill-Sachs lesion. Purpose: This study was undertaken to assess the diagnostic validity of computed tomography (CT) with 3-dimensional (3D) reconstruction to judge engagement of the Hill-Sachs lesion preoperatively. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: One hundred four consecutive patients (107 shoulders) who underwent arthroscopic Bankart repair for traumatic anterior shoulder instability were enrolled for this study. Preoperatively, CT with 3D reconstruction was performed on all patients to evaluate the size (width and depth measured on axial and coronal images), orientation (Hill-Sachs angle), and location (bicipital and vertical angles) of the Hill-Sachs lesion. Dynamic arthroscopic examination was made to confirm engagement of the Hill-Sachs lesion. Then the correlation between the results and measurements on CT images was statistically analyzed. Results: In cases of engaging lesions, the mean width was 52% (range, 27%-66%) and the mean depth was 14% (range, 8%-20%) of the humeral head diameter on axial images. The corresponding measurements on coronal images were 42% (range, 16%-67%) and 13% (range, 5%-24%), respectively. In cases of nonengaging lesions, the corresponding measurements were 40% (range, 0%-71%) and 10% (range, 0%-21%) on axial images and 31% (range, 0%-62%) and 11% (range, 0%-46%) on coronal images. The size of engaging Hill-Sachs lesions was significantly larger than that of nonengaging lesions on both axial and coronal images ( P = .001, < .001, .012, .007). The Hill-Sachs angle was 25.6° ± 7.4° in engaging lesions, which was significantly larger than 13.8° ± 6.2° in nonengaging lesions ( P < .001). The bicipital and vertical angles did not demonstrate significant correlation with engagement of the Hill-Sachs lesion ( P = .850, .584). Conclusion: On CT with 3D reconstruction images, the engaging Hill-Sachs lesions were larger in size and more horizontally oriented to the humeral shaft than nonengaging lesions. The authors concluded that preoperative prediction of the engagement of the Hill-Sachs lesion, based on these findings, would be useful in planning additional procedures to treat a significant bone defect on the humeral head.

scholarly journals Return to Play in Adolescent Athletes With Symptomatic Spondylolysis Without Listhesis: A Meta-Analysis

2017 ◽  
Vol 8 (2) ◽  
pp. 190-197 ◽  
Author(s):  
Samuel C. Overley ◽  
Steven J. McAnany ◽  
Steve Andelman ◽  
Jun Kim ◽  
Robert K. Merrill ◽  
...  
Keyword(s):  
Event Rate ◽  
Meta Analysis ◽  
Relevant Literature ◽  
Nonoperative Treatment ◽  
Return To Play ◽  
Q Value ◽  
Adolescent Athletes ◽  
Cochrane Reviews ◽  
Pars Interarticularis ◽  
Q Statistic

Study Design: Meta-analysis. Objectives: To assess return to play (RTP) rates in adolescent athletes with lumbar spondylolysis without spondylolisthesis treated conservatively or operatively. Methods: A review of Medline, EMBASE, and Cochrane Reviews was performed. The pooled results were performed by calculating the effect size based on the logit event rate. Studies were weighted by the inverse of the variance. Confidence intervals were reported at 95%. Heterogeneity was assessed using the Q statistic and I2 value. Results: The initial literature search resulted in 724 articles, of which 29 were deemed relevant on abstract review. Overall, 11 studies provided data for 376 patients with a pars interarticularis defect. Return to athletic competition, based on logit event rate, was found to be statistically favored after both nonoperative and operative treatment (92.2% vs 90.3%). There was no heterogeneity noted among the studies reporting nonoperative treatment ( Q value of 4.99 and I2 value of 0). There was mild heterogeneity within the operative studies ( Q value of 3.54 and I2 value of 15.18). Conclusions: Adolescent athletes RTP 92.2% of the time with nonoperative management, compared with 90.3% when treated operatively, though both treatment groups strongly favor RTP. As this is the first study to pool results of all relevant literature, it provides strong evidence to guide decision making and help manage expectations in this unique patient population.

A Clinical Comparison of Linear- and Surface Area–Based Methods of Measuring Glenoid Bone Loss

2018 ◽  
Vol 46 (10) ◽  
pp. 2472-2477 ◽  
Author(s):  
Neil K. Bakshi ◽  
George A. Cibulas ◽  
Jon K. Sekiya ◽  
Asheesh Bedi
Keyword(s):  
Bone Loss ◽  
Surface Area ◽  
Shoulder Instability ◽  
Linear Measurement ◽  
Glenoid Bone Loss ◽  
Area Measurement ◽  
Anterior Shoulder Instability ◽  
3D Ct ◽  
Ct Reconstruction ◽  
Level Of Evidence

Background: The purpose of this study was to determine whether linear-based measurement significantly overestimates glenoid bone loss in comparison with surface area–based measurement in patients with recurrent anterior shoulder instability and glenoid bone loss. Hypothesis: Linear-based measurement will significantly overestimate glenoid bone loss in comparison with surface area–based measurement in patients with anterior shoulder instability and glenoid bone loss. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Thirty patients with anterior shoulder instability underwent preoperative bilateral shoulder computed tomography (CT) scans. Three-dimensional CT (3D-CT) reconstruction with humeral head subtraction was performed to obtain an en face view of the 3D-CT glenoid. Glenoid bone loss was measured with the surface area and linear methods of measurement. Statistical analysis was performed with a paired 2-tailed t test. Results: Twenty-eight patients (5 female and 23 male; mean age, 25.1 years; age range, 15-58 years) were included in the study; 17 patients underwent a glenoid augmentation procedure, and 11 underwent arthroscopic Bankart repair. The mean percentage glenoid bone loss calculated with the surface area and linear methods was 12.8% ± 8.0% and 17.5% ± 9.7% ( P < .0001), respectively. For the 17 patients who underwent glenoid augmentation, mean percentage bone loss with the surface area and linear methods was 16.6% ± 7.9% and 23.0% ± 8.0% ( P < .0001), respectively. Conclusion: Linear measurement of glenoid bone loss significantly overestimates bone loss compared with surface area measurement in patients with anterior glenoid bony defects. These results indicate that these different methods cannot be used interchangeably and cannot be used with the same critical thresholds for glenoid bone loss.

scholarly journals Hip Muscle Strength Explains Only 11% of the Improvement in HAGOS With an Intersegmental Approach to Successful Rehabilitation of Athletic Groin Pain

2021 ◽  
pp. 036354652110289
Author(s):  
Samuel R. Baida ◽  
Enda King ◽  
Chris Richter ◽  
Shane Gore ◽  
Andrew Franklyn-Miller ◽  
...  
Keyword(s):  
Lower Limb ◽  
Groin Pain ◽  
External Rotation ◽  
Rehabilitation Program ◽  
Return To Play ◽  
Success Rates ◽  
Level Of Evidence ◽  
Hip Strength ◽  
Hip Muscle ◽  
Flexion Extension

Background: Exercise-based rehabilitation targeting intersegmental control has high success rates and fast recovery times in the management of athletic groin pain (AGP). The influence of this approach on hip strength and lower limb reactive strength and how these measures compare with uninjured athletes (CON) remain unknown. Additionally, the efficacy of this program after return to play (RTP) has not been examined. Purpose: First, to examine differences in isometric hip strength, reactive strength, and the Hip and Groin Outcome Score (HAGOS) between the AGP and CON cohorts and after rehabilitation; second, to examine the relationship between the change in HAGOS and the change in strength variables after rehabilitation; last, to track HAGOS for 6 months after RTP. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 42 athletes diagnosed with AGP and 36 matched controls completed baseline testing: isometric hip strength, lower limb reactive strength, and HAGOS. After rehabilitation, athletes with AGP were retested, and HAGOS was collected at 3 and 6 months after RTP. Results: In total, 36 athletes with AGP completed the program with an RTP time of 9.8 ± 3.0 weeks (mean ± SD). At baseline, these athletes had significantly lower isometric hip strength (abduction, adduction, flexion, extension, external rotation: d = –0.67 to −1.20), single-leg reactive strength ( d = −0.73), and HAGOS ( r = −0.74 to −0.89) as compared with the CON cohort. Hip strength ( d = −0.83 to −1.15) and reactive strength ( d = −0.30) improved with rehabilitation and were no longer significantly different between groups at RTP. HAGOS improvements were maintained or improved in athletes with AGP up to 6 months after RTP, although some subscales remained significantly lower than the CON group ( r = −0.35 to −0.51). Two linear regression features (hip abduction and external rotation) explained 11% of the variance in the HAGOS Sports and Recreation subscale. Conclusion: Athletes with AGP demonstrated isometric hip strength and reactive strength deficits that resolved after an intersegmental control rehabilitation program; however, improved hip strength explained only 11% of improvement in the Sports and Recreation subscale. HAGOS improvements after pain-free RTP were maintained at 6 months.

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