title: Radiofrequency denervation of the inguinal ligament for the treatment of 'Sportsman's Hernia': a pilot study.
abstract: BACKGROUND
  Chronic groin pain is a common and debilitating condition in highly active athletes. Symptoms are often ascribed to the so-called Sportsman's Hernia, and these patients frequently undergo prolonged and often painful remedial physiotherapy, or, if the condition is refractory, surgery to repair the posterior inguinal wall.
  
  
  OBJECTIVE
  We hypothesised that radiofrequency denervation (RFD) of both the ilioinguinal nerve and inguinal ligament could be used to desensitise the groin region and enable the athlete to become pain-free.
  
  
  METHODS
  A prospective randomised controlled trial of three groups of patients with chronic groin pain.
  
  
  METHODS
  Thirty-six patients with chronic groin pain of greater than 6 months duration, with no identifiable structural cause and which was refractory to conservative treatment, were randomised into two groups. Group 1 was treated with RFD (n=18), while group 2 was treated with local anaesthetic (Bupivicaine) and steroid (Trimacinolone) injection (n=18). A further 10 patients with previous failed surgery for the same condition were treated with RFD without randomisation. All patients then underwent a standardised physiotherapy regimen. The Visual Analogue Scale at rest (VASr) and with activity (VASa) was used to assess pain, and London Adductor and Abdominal Groin Score was used to assess function, at baseline and at 1 week, 3 months and 6 months post-treatment.
  
  
  RESULTS
  RFD treatment resulted in a significant improvement above baseline in all measures and at each time intervals up to 6 months, in both the randomised Group 1 and in the postsurgery group (p values ranging from <0.001 to 0.001). Injection of local anaesthetic and steroid resulted in a significant improvement above baseline in all measures, but only at 1 week (p values ranging from 0.001 to 0.021), and not at any of the later intervals. Improvements in all measures was significantly greater in Group 1 than in Group 2 at all follow-up intervals (p values ranging from <0.001 to 0.003). No persistent adverse events were recorded.
  
  
  CONCLUSIONS
  The use of RFD in the treatment of refractory Sportsman's Hernia is safe and efficacious at least in the short term, and is superior to anaesthetic/steroid injection. The results suggest that symptoms are related to tendon inflammation and ilioinguinal nerve compression, and can be abolished with pharmacological or radiofrequency treatment, without the need for surgery.
  
  
  CONCLUSIONS
  This novel technique could help athletes suffering from chronic groin pain return to play more quickly, both facilitating and allowing deferral of remedial physiotherapy treatments, and potentially avoiding the need for surgery.
authors.affiliation: Imaging @ Olympic Park, Melbourne, Victoria, Australia. julescomin@gmail.com
authors.forename: Jules
authors.initials: J
authors.lastname: Comin
authors.forename: Haron
authors.initials: H
authors.lastname: Obaid
authors.forename: Greg
authors.initials: G
authors.lastname: Lammers
authors.forename: James
authors.initials: J
authors.lastname: Moore
authors.forename: Mark
authors.initials: M
authors.lastname: Wotherspoon
authors.forename: David
authors.initials: D
authors.lastname: Connell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000379:methods*; D059350:Chronic Pain / Q000517:prevention & control; D006119:Groin; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007264:Inguinal Canal / Q000294:innervation; D008875:Middle Aged; D009121:Muscle Denervation / Q000379:methods*; D010865:Pilot Projects; D011446:Prospective Studies; D055815:Young Adult