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Introduction: The pre-pubic aponeurotic complex (PPAC) is a fibrous capsule which lines the anterior of the pubic symphysis. The PPAC may be injured during pelvic torsional movements and single-stance maneuvers., Case Report: This case report describes a PPAC lesion in a 23-year-old professional male athlete specializing in decathlon on a national level. The lesion was treated with US-guided infiltration therapy with botulinum toxin (BTX) and platelet-rich plasma therapy (PRPt) to the longus adductor (LA) and rectus abdominis (RA) muscles. The magnetic resonance imaging control performed at 24 weeks after BTX infiltration and PRPt showed a total restitution ad integrum of the lesion area. At a 3-year follow-up, the subject no longer complained of pain and was restored to his pre-injury level of sport., Conclusion: The distention of LA and RA obtained by BTX infiltration coupled with PRPt allowed PPAC to heal. The BTX infiltrative therapy coupled with PRPt may represent a new and promising treatment for PPAC lesions., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Groin pain syndrome (GPS) is often a diagnostic challenge for sport physicians. Despite this diagnostic difficulty, the incidence of GPS in athletes is relatively high, afflicting 10-20% of the total sports population. In the literature, a certain number of studies demonstrate an important gender-based difference in the incidence of GPS in both sexes, with a ratio of female:male athletes clearly in favor of the female gender being relatively less prone to GPS. Indeed, some anatomical differences between the two sexes seem to represent a protective factor against the onset of GPS in women, although the current literature still needs to clarify the validity of these findings. It is the aim of this systematic review to examine all the anatomical differences between men and women that may be responsible for the difference in the onset of GPS in the two sexes.

Introduction: Tendon tissue turnover is a very slow process. However, some tendons show very unique regeneration capabilities. The Achilles tendon regeneration and maturation process occurs uniformly and centripetally along the entire the length of the neo-tendon., Case Report: The present case report describes a complete regeneration of the Achilles tendon in a 54-year-old patient with a reinjury to the Achilles tendon following open tenorrhaphy surgery. The regenerative process had a positive outcome despite the patient suffering, at the time, from an infection caused by Cutibacterium acnes., Conclusion: This case report is a paradigmatic example of how the Achilles tendon is able to maintain its regenerative capacity even in extremely critical biological situations such as after an infection. However, the issue concerning the biological characteristics of the regenerated tendon remains open., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Groin pain syndrome (GPS) is one of the most frequent injuries in competitive sports. Stresses generated in the lower limbs by quick turns and accelerations, such as in soccer, basketball or hockey, can produce localized regions of increased forces, resulting in anatomical lesions. The differential diagnoses are numerous and comprise articular, extra-articular, muscular, tendinous and visceral clinical conditions and a correct diagnosis is crucial if treatment is to be efficient. MRI is the gold standard of diagnostic techniques, especially when an alternative pathology needs to be excluded and/or other imaging techniques such as ultrasound or radiography do not lead to a diagnosis. This paper, based on the current literature, gives a comprehensive review of the anatomy of the pubic region and of the typical MRI findings in those affected by GPS. Many clinical conditions causing GPS can be investigated by MRI within appropriate protocols. However, MRI shows limits in reliability in the investigation of inguinal and femoral hernias and therefore is not the imaging technique of choice for studying these clinical conditions.

Longstanding (chronic) adductor-related groin pain syndrome is a widely common problem for athletes in many sports activities which often drastically reduces player activity and performance. The first choice in therapeutic treatment is conservative therapy. The objective of this study is to provide a systematic review regarding conservative treatment for longstanding adductor-related groin pain syndrome present in literature today. Furthermore, this study aims to give a critical vision of the current state of the art of the considered topic. After screening 234 articles, 19 studies following the inclusion criteria were included and summarized in this current systematic review and seven different types of therapeutic interventions were described. Compression clothing therapy, manual therapy together with strengthening exercise and prolotherapy were the therapeutic interventions which showed both the greatest level of strength of evidence (Moderate) and grade of recommendation (D). The remaining four types of therapeutic interventions i.e.: corticoid injection, platelet rich plasma therapy, intra-tissue percutaneous electrolysis and pulse-dose radiofrequency, showed both lower levels of strength of evidence (Conflicting) and grade of recommendation (C). In conclusion the literature available on the conservative treatment for longstanding adductor-related groin pain syndrome is limited and characterized by a low level of evidence. Therefore, our recommendation is to refer only to the few studies with higher level of evidence and at the same time to encourage further research in this area. The intervention showing the greater level of strength of evidence, and the greater grade of recommendation are compression clothing therapy, manual therapy and strengthening exercise, and prolotherapy. Other therapeutic interventions such as intra-tissue percutaneous electrolysis and pulse-dose radiofrequency seem promising but require further studies to confirm their efficacy., Competing Interests: The authors report no conflicts of interest., (Copyright © 2020 Termedia.)

The lockdown caused by the COVID-19 pandemic represents a great unknown regarding the physiological changes induced in elite football players. Although it will differ from country to country, the return to sport for professional football players will follow a forced lockdown never experienced and longer than the normal annual season break. Moreover, in addition to an obvious decrease in performance, the lockdown will possibly lead to an increase of the injury risk. In fact, preseason is always a period with a specific football injury epidemiology, with an increase in the incidence and prevalence of overuse injuries. Therefore, it seems appropriate to recommend that specific training and injury prevention programmes be developed, with careful load monitoring. Training sessions should include specific aerobic, resistance, speed and flexibility training programmes. The aerobic, resistance and speed training should respect some specific phases based on the progressiveness of the training load and the consequent physiological adaptation response. These different phases, based on the current evidence found in the literature, are described in their practical details. Moreover, injury prevention exercises should be incorporated, especially focusing on overuse injuries such as tendon and muscle lesions. The aim of this paper is to provide practical recommendations for the preparation of training sessions for professional footballers returning to sport after the lockdown., Competing Interests: All authors declare having no conflict of interest., (Copyright © Biology of Sport 2020.)

The aim of the study was to assess the effects of multi-directional plyometric training (MPT) on vertical jump height, change of direction speed (CODS), and dynamic postural control (DPC) of soccer players under 21 year (U-21). Twenty-seven male soccer players were randomly allocated to either an experimental group (EG; n = 14; age: 19.0 ± 0.9 years) or a control group (CG; n = 13; age: 19.0 ± 0.7 years). The EG introduced 6 weeks MPT, 2 days per week into their in-season training, while CG continued training without change. Measurements of vertical jump height, CODS and DPC were completed at the beginning and end of the 6 week MPT. ANOVA demonstrated a significant group × time interaction for SJ ( F = 6.03, p = 0.021), CMJ ( F = 9.10, p = 0.006), and T -Test ( F = 10.46, p = 0.002). The Bonferroni Post Hoc test demonstrated significant increase for the three tests in both group (EG and CG). For SJ (EG: p < 0.001; CG: p < 0.001), CMJ (EG: p < 0.001; CG: p = 0.005) and T -Test (EG: p < 0.001; CG: p = 0.02). For DPC on the dominant leg, there was a significant group × time interaction for four axes [anterior ( F = 5.48, p = 0.028), antero-lateral ( F = 4.82, p = 0.038), postero-lateral ( F = 4.82, p = 0.038), and medial ( F = 6.77, p = 0.015)]. The Bonferroni Post Hoc test demonstrated significant increase in EG ( p < 0.001), but no significant change in CG in four axes (anterior, antero-lateral, postero-lateral and medial). Furthermore DPC on the non-dominant leg, there was a significant group × time interaction for three axes [lateral ( F = 8.09, p = 0.009), postero-lateral ( F = 11.92, p = 0.002), and medial ( F = 5.84, p = 0.023)]. The Bonferroni Post Hoc test demonstrated significant increase in EG ( p < 0.001), but no significant change in CG in three axes (lateral, postero-lateral, and medial). In conclusion, incorporating MPT into the in-season regimen of under 21 soccer players improved performance of various indices related to soccer activity (i.e., CMJ, CODS, and DPC). MPT has the potential to be appealing to coaches, as it requires little time while yielding valuable results in the physical preparation of soccer players., (Copyright © 2020 Jlid, Coquart, Maffulli, Paillard, Bisciotti and Chamari.)

The aim of the study was to assess the effects of multidirectional plyometric training (MPT) on vertical jump height, change of direction performance (CODP), and dynamic postural control (DPC) in young soccer players. Twenty-eight young male soccer players were randomly assigned to an experimental group (EG, n = 14; age: 11.8 ± 0.4 years) and a control group (CG, n = 14; age: 11.6 ± 0.5 years). The EG introduced 8-week MPT, two days per week into their in-season training, while CG continued training without change. Measurements of vertical jump height, CODP, and DPC were completed at the beginning and end of the 8-week MPT. A significant group × time interaction was observed for Squat-Jump ( p < 0.05), for Counter-Movement Jump ( p < 0.05), and for CODP test ( p < 0.05). In addition, a significant group × time interaction was observed for DPC in seven axes for the dominant- (anterior, lateral, postero-lateral, posterior, postero-medial, medial, and antero-medial; p < 0.05 for all) and in seven axes for the non-dominant- (anterior, antero-lateral, lateral, posterior, postero-medial, medial and antero-medial; p < 0.05 for all) legs. The rest of the axes of both legs did not show any significant group × time interaction ( p > 0.05). In conclusion, incorporating MPT into the in-season regimen of young male soccer players improved performance of various indices related to soccer activity (i.e., vertical jump height, CODP, and DPC). MPT has the potential to be appealing to coaches, as it requires little time while yielding valuable results in the physical preparation of young soccer players., (Copyright © 2019 Jlid, Racil, Coquart, Paillard, Bisciotti and Chamari.)

Return to play (RTP) decisions in football are currently based on expert opinion. No consensus guideline has been published to demonstrate an evidence-based decision-making process in football (soccer). Our aim was to provide a framework for evidence-based decision-making in RTP following lower limb muscle injuries sustained in football. A 1-day consensus meeting was held in Milan, on 31 August 2018, involving 66 national and international experts from various academic backgrounds. A narrative review of the current evidence for RTP decision-making in football was provided to delegates. Assembled experts came to a consensus on the best practice for managing RTP following lower limb muscle injuries via the Delphi process. Consensus was reached on (1) the definitions of 'return to training' and 'return to play' in football. We agreed on 'return to training' and RTP in football, the appropriate use of clinical and imaging assessments, and laboratory and field tests for return to training following lower limb muscle injury, and identified objective criteria for RTP based on global positioning system technology. Level of evidence IV, grade of recommendation D., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Provide the state of the art concerning (1) biology and aetiology, (2) classification, (3) clinical assessment and (4) conservative treatment of lower limb muscle injuries (MI) in athletes. Seventy international experts with different medical backgrounds participated in the consensus conference. They discussed and approved a consensus composed of four sections which are presented in these documents. This paper represents a synthesis of the consensus conference, the following four sections are discussed: (i) The biology and aetiology of MIs. A definition of MI was formulated and some key points concerning physiology and pathogenesis of MIs were discussed. (ii) The MI classification. A classification of MIs was proposed. (iii) The MI clinical assessment, in which were discussed anamnesis, inspection and clinical examination and are provided the relative guidelines. (iv) The MI conservative treatment, in which are provided the guidelines for conservative treatment based on the severity of the lesion. Furthermore, instrumental therapy and pharmacological treatment were discussed. Knowledge of the aetiology and biology of MIs is an essential prerequisite in order to plan and conduct a rehabilitation plan. Another important aspect is the use of a rational MI classification on prognostic values. We propose a classification based on radiological investigations performed by ultrasonography and MRI strongly linked to prognostic factors. Furthermore, the consensus conference results will able to provide fundamental guidelines for diagnostic and rehabilitation practice, also considering instrumental therapy and pharmacological treatment of MI. Expert opinion, level IV., Competing Interests: Competing interests: None declared.

Background: To analyse the prevalences of the cam and pincer morphologies in a cohort of patients with groin pain syndrome caused by inguinal pathologies., Materials and Methods: Forty-four patients (40 men and 4 women) who suffered from groin pain syndrome were enrolled in the study. All the patients were radiographically and clinically evaluated following a standardised protocol established by the First Groin Pain Syndrome Italian Consensus Conference on Terminology, Clinical Evaluation and Imaging Assessment in Groin Pain in Athlete. Subsequently, all of the subjects underwent a laparoscopic repair of the posterior inguinal wall., Results: The study demonstrated an association between the cam morphology and inguinal pathologies in 88.6% of the cases (39 subjects). This relationship may be explained by noting that the cam morphology leads to biomechanical stress at the posterior inguinal wall level., Conclusions: Athletic subjects who present the cam morphology may be considered a population at risk of developing inguinal pathologies., Level of Evidence: Level IV, Observational cross-sectional study.

The nomenclature and the lack of consensus of clinical evaluation and imaging assessment in groin pain generate significant confusion in this field. The Groin Pain Syndrome Italian Consensus Conference has been organised in order to prepare a consensus document regarding taxonomy, clinical evaluation and imaging assessment for groin pain. A 1-day Consensus Conference was organised on 5 February 2016, in Milan (Italy). 41 Italian experts with different backgrounds participated in the discussion. A consensus document previously drafted was discussed, eventually modified, and finally approved by all members of the Consensus Conference. Unanimous consensus was reached concerning: (1) taxonomy (2) clinical evaluation and (3) imaging assessment. The synthesis of these 3 points is included in this paper. The Groin Pain Syndrome Italian Consensus Conference reached a consensus on three main points concerning the groin pain syndrome assessment, in an attempt to clarify this challenging medical problem., Competing Interests: Competing interests: None declared.

Background: The ACL lesion represents one of the most dramatic injuries in a sportsman's career. There are many injury risk factors related to intrinsic, or non-modifiable, and extrinsic, or modifiable, factors. In literature at today current evidence suggests that ACL injury risk is multifactorial and involves biomechanical, anatomical, hormonal and neuromuscular factors., Purpose: To perform a systematic review of the literature concerning the ACL injury risk factors in soccer., Conclusion: The injury risk factors show a low level of evidence, further studies in the field are needed., Study Design: Systematic review., Competing Interests: Conflicts of interest The Authors declare no conflicts of interest concerning this article.

Background: groin pain affects all types of athletes, especially soccer players. Many diseases with different etiologies may cause groin pain., Purpose: offer a mini review of groin pain in soccer accompanied by the presentation of a case report highlighting the possible association of more clinical frameworks into the onset of groin pain syndrome, in order to recommend that clinical evaluations take into account possible associations between bone, muscle and tendon such as inguinal canal disease., Conclusion: the multifactorial etiology of groin pain syndrome needs to be examined with a comprehensive approach, with standardized clinical evaluation based on an imaging protocol in order to evaluate all possible diseases., Study Design: Mini review- Case report (Level V).