Disclosures: Alexander Lloyd, MD: Nothing to disclose

Case Description: A 21-year-old collegiate soccer player presented with gradual onset right groin pain of one year’s duration. The pain started towards the end of the previous season during practice without inciting trauma or event. He was evaluated by an orthopaedic surgeon and diagnosed with a rectus abdominis-adductor aponeurosis tear and underwent adductor longus tenotomy, inguinal neurectomy, and reinforcement and lateralization of the rectus abdominis tendon. His symptoms persisted in spite of surgery and he received a steroid injection with transient relief. He subsequently presented to our clinic for consideration of prolotherapy per his team physician’s recommendation. He underwent ultrasound-guided prolotherapy to the proximal adductor tendon.

Setting: Outpatient sports clinic

Patient: 21-year-old male Division 1 soccer player

Assessment/Results: The initial injection yielded partial relief so the athlete underwent two additional injections at one and three months after initial presentation with additive improvement.

Discussion: Proximal adductor/distal rectus abdominis tendinosis in the athlete is common amongst kicking athletes, but injectable treatment is often palliative. Steroid injection is common, but its long-term benefit for athletes has not been studied. Additionally, steroid tenotoxicity is a concern, especially post-surgically. Many high-level athletes proceed with surgical options early in their diagnosis because some procedures offer success rates of up to 90% with rapid return to play. Few options remain when these surgeries fail beyond further surgery. Evidence exists for prolotherapy as a conservative, pre-surgical intervention for recalcitrant, non-specific groin pain in the athletes. Our case demonstrates that ultrasound-guided prolotherapy may also be a viable option for treatment of persistent symptoms after surgery. It also demonstrates that repeated injections may have additional benefit in those who initially experience only partial relief.

Conclusion: Prolotherapy can be considered for surgical salvage of proximal adductor tendinosis/distal rectus abdominis tendinosis in kicking athletes.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/prolotherapy-salvage-for-chronic-groin-pain-persisting-after-surgery-a-case-report/