Je li kronični sindrom bolne prepone bermudski trokut sportske medicine?

Chronic groin pain is one the most complex conditions encountered in the field of sports medicine. Conservative treatment is long lasting and the result of treatment is often uncertain and symptom recurrences are common, which can be very frustrating for both the patient and the physician. The complex etiology and uncertainties during treatment of chronic groin pain is the reason why some authors call it the Bermuda Triangle of sports medicine. In our prospective, 7-year study, 114 athletes with chronic groin pain resistant to conservative therapy were treated surgically. In 109 athletes with sports hernia, we performed nerve neurolysis along with resection of the genital branch of the genitofemoral nerve and we also reinforced the posterior wall of inguinal canal using a modified Shouldice technique. In 26 athletes that had concomitant adductor tendinosis and in 5 athletes with isolated tendinosis we performed tenotomy. Eighty-one of 83 patients with isolated sports hernia returned to sports within a mean of 4.4 (range, 3-16) weeks. Thirty-one athletes with adductor tenotomy returned to sports activity within a mean of 11.8 (range, 10-15) weeks. If carefully diagnosed using detailed history taking, physical examination and correct imaging techniques, chronic groin pain can be treated very successfully and quickly, so it need not be a Bermuda Triangle of sports medicine.Kronični sindrom bolne prepone je jedno od najsloženijih stanja u sportskoj medicini. Konzervativno liječenje je dugotrajno, ishod liječenja neizvjestan uz brojne recidive, a sve to djeluje frustrirajuće na sportaša i na liječnika koji ga liječi. Zbog brojnih nejasnoća oko etiologije i liječenja kronični sindrom bolne prepone neki nazivaju i bermudskim trokutom sportske medicine. U prospektivoj studiji kroz 7 godina 114 sportaša s kroničnim sindromom bolne prepone otpornim na konzervativnu terapiju liječeno je operativno. Kod 109 sportaša sa sportskom hernijom učinjena je neuroliza ilioingvinalnog živca, resekcija genitalne grane genitofemoralnog živca i pojačanje stražnje stijenke ingvinalnog kanala duplikaturom transverzalne fascije modificiranom tehnikom po Shouldiceu. Kod 26 sportaša koji su uz sportsku herniju imali i tendinozu aduktora te kod 5 sportaša s izoliranom tendinozom aduktora učinjena je tenotomija aduktora. Od 83 sportaša s izoliranom sportskom hernijom 81 se vratio sportu nakon 4,4 tjedna (raspon 3-16 tjedana). Sportaši s tenotomijom aduktora (n=31) vratili su se sportskim aktivnostima nakon 11,8 (raspon 10-15) tjedana. Ako se pažljivo razmotre smetnje sportaša, učini detaljan pregled i utvrdi pravi uzrok bolova, liječenje može biti kratkotrajno i uspješno, a sindrom bolne prepone ne mora predstavljati bermudski trokut sportske medicine