A proposed algorithm for the treatment of core muscle injuries

ABSTRACT In recent years, there has been increased awareness and treatment of groin injuries in athletes. These injuries have been associated with various terminologies including sports hernia, core muscle injury (CMI), athletic pubalgia and inguinal disruption, among others. Treatment of these injuries has been performed by both orthopaedic and general surgeons and may include a variety of procedures such as rectus abdominis repair, adductor lengthening, abdominal wall repair with or without mesh, and hip arthroscopy for the treatment of concomitant femoroacetabular impingement. Despite our increased knowledge of these injuries, there is still no universal terminology, diagnostic methodology or treatment for a CMI. The purpose of this review is to present a detailed treatment algorithm for physicians treating patients with signs and symptoms of a CMI. In doing so, we aim to clarify the various pathologies involved in CMI, eliminate vague terminology, and present a clear, stepwise approach for both diagnosis and treatment of these injuries.

THE FEATURES OF THE BIOMECHANICS IN FOOTBALL PLAYERS ON THE ANATOMICAL STRUCTURES OF THE GROIN

Pain in the lower abdomen and groin can occur in athletes who perform sharp lower extremity movement during training or sports, make sharp turns and change direction of the trunk movement as well as lower extremity acceleration/deceleration. An excessive load during the sports game can disturb the biomechanics of the player's movements. A precise localization of damaged tissues can improve for the diagnosis, determining treatment and forecasting the time of return to sports. The aim was to estimate the importance of the football biomechanics movement for the anatomy of the groin and to determine the anatomical features of the groin in football players with sports hernia. We analysed the thickness and length measurements on MRI of the rectus abdominis muscle in 51 football players of professional and amateur clubs aged 17 to 33 years with groin pain who were treated at the Kyiv Clinical City Hospital №3 for the period 2014-2020. In the second stage of the study, we investigated the peak force of the abdominal muscles (rectus abdominis, external oblique abdominal muscles) and the adductor muscles of both lower extremities using the microFET2 dynamometer for 4 groups of football players. The first group of the study includes 15 football players of professional clubs with sports hernia who had received conservative treatment, the partipants of the second group are 36 football players after laparoscopic hernioplasty, the third group consisted of 54 healthy young football players and 11 teenage footballers. In the third stage of the study, a formula was substantiated, according to which we calculated the acceleration of the lower extremity when kicking the ball. The results of the study demostrate that the disruption of the lower extremity biomechanics during kicking the ball cause the appearance of sports hernia in football players. An axial MRI scan of groin areas of football players with sports hernia represented changes in the lateral edge of the rectus abdominis. The groin pain syndrome of football players with sports hernia includes three pathogenetic mechanisms of development: disruption of the biomechanics, muscle imbalance and microtrauma and inflammation.

Assoсiation analysis of gene polymorphisms col1a, mct1, col12a1 with sports hernia in football players

Sports hernias are diagnosed in over 80% of athletes presenting with chronic groin pain. The genotype distributions of the examined polymorphisms were studied in 95 football players, all males, using the Copenhagen Hip and Groin Outcome Score (HAGOS) questionnaire. DNA extracted from buccal epithelium. Statistical calculations were performed in the R statistical environment (r-project.org) and Odds ratios (OR) were used to estimate genotype associations. Multifactor dimensionality reduction was used to identify multiple sports hernia susceptibility loci.Two single nucleotide polymorphisms MCT1 rs1049434 and COL1A1 rs1800012 are associated with sports hernias (63% testing accuracy shown by random forest). According to the HAGOS questionnaire outcomes, exercise-related pain, reduced mobility, and range of motion in the groin and thigh are typically associated with sports hernia diagnosis (75% testing accuracy shown by random forest).The combination of genetic research and HAGOS questionnaire helped obtain a sensitivity of 93% for the detection of sports hernia. Active engagement in sport is the most important risk factor for sports hernia, so the identification genes SNP in footballers may contribute to taking timely preventive actions. This study is the first demonstration of an association between sports hernia and COL1A1 rs1800012 genotype. The study discovered a synergistic interaction between the indicated polymorphism and the gene polymorphism MCT1 rs1049434. Further investigations are required to study the association between COL12A1 rs240736 gene SNP and sports hernia.