The dissertation presents the original research on an important medical problem of modern sports, specifically the diagnosis of sports hernia in football players and the optimal method of its surgical treatment. In most cases, exercise-related inguinal pain is the main manifestation of sports hernia in football players. Painful sensations are induced by high-intensity explosive rotational movements of the torso and lower extremities, followed by a hard kick. The dissertation highlights diagnostic criteria, optimization of the choice of the most effective surgical techniques and prediction of sports hernia in football players.
The purpose of the study is to increase the effectiveness of surgical treatment of football players with sports hernia by introducing the established diagnostic criteria and optimizing the choice of minimally invasive hernia repair technique.
The scientific substantiation of the stated goal requires the completion of the following tasks:
1. To conduct a retrospective analysis of unfavourable outcomes of surgical treatment of sports hernia in football players.
2. To investigate and specify the main diagnostic MRI and ultrasound criteria for a sports hernia in order to verify its diagnosis in football players.
3. To determine the most optimal way of surgical treatment of sports hernia in football players.
4. To assess the timeline of professional rehabilitation and quality of life after surgical treatment of football players with sports hernia.
5. To identify changes in the biomechanics of specific movements of football players after surgical treatment of sports hernia.
6. To investigate the association between gene polymorphisms COL1A, MCT1, COL12A1 and increased risk for developing chronic inguinal pain and the possibility of its prediction.
The research consisted of five stages.
The first stage included a retrospective analysis of unfavourable outcomes of surgical treatment of 36 professional and amateur football players with sports hernia.
The second stage was designed to carry out clinical, laboratory and instrumental examination of 62 football players. Diagnostic MRI and ultrasound criteria were specified to verify diagnosis of sports hernia in football players. Ultrasound examination of football players with sports hernia on one side of the groin helped to establish ultrasound criteria for predicting its occurrence on the opposite side.
The third stage included the application of laparoscopic surgical procedures in the treatment of 36 football players who, according to the diagnostic findings, met the established set of diagnostic criteria for a sports hernia. Intraperitoneal hernia repair (IPOM) of the inguinal canals was performed in 10 (27.8%) football players. Subsequently, the method, developed in the course of the study, was used in the treatment of 8 (22.2%) football players and included IPOM with subcutaneous suturing of the inner inguinal rings as their width increased. In 18 (50%) football players, bilateral transabdominal preperitoneal (TAPP) repair was chosen as surgical treatment of sports hernia.
The analysis of surgical treatment outcomes for sports hernia was performed in 2 groups of football players. The main group included 36 (50%) football players who underwent laparoscopic hernia repair with the application of different techniques. The comparison group included 36 (50%) football players who underwent open hernia repair with the reconstruction of the anterior or posterior wall of the inguinal canal. Pain intensity, limitations in motor activity, length of stay in the hospital, terms of rehabilitation (full resumption of professional activities) and the impact on the quality of life of football players were analysed. The career achievements of professional football players were also studied. Based on the surgical treatment outcomes, the optimal method for sports hernia repair in football players was chosen.
The fourth stage included a study of the peak force of the muscles of the anterior abdominal wall (rectus abdominis, external oblique abdominal muscles of the both sides) and adductor muscles of both thighs in order to determine changes in the biomechanics of specific movements in football players with sports hernia after surgery. The first group of the study consisted of 15 professional football players with ARS-syndrome, the second group included 36 football players who underwent bilateral laparoscopic hernia repair, and the third group included 54 healthy professional and amateur football players aged 17 to 33 years and 11 U-13 youth players.
In the fifth stage, to predict the risk of chronic inguinal pain, the frequency of allelic variants of COL1A1 rs1800012 (G/T), MCT1 rs1049434 (A/T), COL12A1 rs240736 (A/G) genes was determined in 41 football players, who noted chronic pain in the groin area at the time of inclusion (study group 1), and in 54 healthy players (study group 2).
