title: Can hip impingement be mistaken for tendon pain in the groin? A long-term follow-up of tenotomy for groin pain in athletes.
abstract: OBJECTIVE
  There are several reports on the association between pubalgia and intra-articular hip disorders. The purpose of this study was to evaluate the long-term outcome in athletes who underwent tenotomy due to long-standing groin pain. A secondary purpose was evaluating the frequency of femoro-acetabular impingement (FAI) and its impact on the long-term outcome.
  
  
  METHODS
  Thirty-two high-level male athletes treated with adductor tenotomy, rectus abdominis tenotomy or both were included. At a median follow-up time of 6 years after the tenotomy, the subjects underwent standardised clinical examination, plain radiographs, completed web-based health-related patient-reported outcomes, including iHOT12, HAGOS (six subscales), EQ-5D (two subscales), HSAS for physical activity level and a VAS for overall hip function. Furthermore, patient satisfaction and return to sports were documented.
  
  
  RESULTS
  Twenty-four of the 32 (75 %) athletes were satisfied with the outcome of the tenotomy, and 22 of the athletes (69 %) were able to return to their pre-injury sport. Before the long-term follow-up, two of these satisfied athletes had undergone repeat surgery (one hip arthroscopy due to FAI and one repeat tenotomy). Of the 24 satisfied athletes, eight (33 %) had a positive hip impingement test at the follow-up. Of the remaining eight athletes not satisfied with the outcome, only one returned to their pre-injury sport and three had undergone hip arthroscopy prior to follow-up. Five had positive hip impingement tests which was significantly more frequently than in the satisfied group (p = 0.008). The group with a positive hip impingement test reported significantly more pain and symptoms, more hip problems during sports and physical activity, as well as lower hip-related quality of life according to the HAGOS scores (p < 0.05), at follow-up.
  
  
  CONCLUSIONS
  Tenotomy for pubalgia yielded a satisfactory long-term outcome, with three of four athletes being able to return to their pre-injury sport. The athletes that did not return to their pre-injury sport had higher frequency of positive hip impingement test and inferior functional outcome compared with the athletes that did return to their pre-injury sport. It is therefore recommended that the hip should be carefully evaluated for hip impingement before tenotomy is considered as treatment for athletes with pubalgia.
authors.affiliation: Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital/Mölndal, Mölndal, Sweden, mikael.sansone@gmail.com.
authors.forename: Mikael
authors.initials: M
authors.lastname: Sansone
authors.forename: Mattias
authors.initials: M
authors.lastname: Ahldén
authors.forename: Pall
authors.initials: P
authors.lastname: Jonasson
authors.forename: Roland
authors.initials: R
authors.lastname: Thomeé
authors.forename: Anders
authors.initials: A
authors.lastname: Falk
authors.forename: Leif
authors.initials: L
authors.lastname: Swärd
authors.forename: Jón
authors.initials: J
authors.lastname: Karlsson
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy; D001265:Athletic Injuries / Q000175:diagnosis / Q000601:surgery*; D059350:Chronic Pain / Q000601:surgery; D003937:Diagnosis, Differential; D057925:Femoracetabular Impingement / Q000175:diagnosis / Q000601:surgery*; D005500:Follow-Up Studies; D006119:Groin / Q000293:injuries / Q000601:surgery; D006615:Hip / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013710:Tendons / Q000601:surgery; D058971:Tenotomy; D055815:Young Adult